Sheltering in place and the likelihood of non-natural death

Catalano, R.; Glymour, M.; Chen, Y.-H.; Bibbins-Domingo, K.

Increasing hospitalizations for COVID-19 in the United States (US) and elsewhere have ignited debate over whether to reinstate shelter-in-place policies adopted early in the pandemic to slow the spread of infection. The debate includes claims that sheltering in place influences deaths unrelated to infection or other natural causes. Testing this claim should improve the benefit/cost accounting that presumably informs the decision of whether to reimpose sheltering in place. To distinguish effects of shelter-in-place policies from other events in the pandemic, we compare experiences in two large US states with markedly different policies. We use time-series methods to compare temporal variation in non-natural deaths in California to that in Florida. California was the first state to begin and among the last to end sheltering in place while sheltering began later and ended earlier in Florida. We find that during weeks when California had shelter-in-place orders in effect, but Florida did not, the odds that a non-natural death occurred in California rather than Florida fell 14.8% below values expected from history. These results suggest that sheltering-in-place policies reduce mortality from mechanisms unrelated to infection or other natural causes of death.