Tracking COVID-19 Policies.

Many Americans have been sheltering in place for days or weeks, working or studying from home or newly unemployed. Some states have closed schools, gyms, and nonessential business. Some have reduced arrests and banned visits to nursing homes, and many have called in the National Guard for assistance—while other states have taken few steps so far to curb the COVID-19 pandemic.

As states (and other countries) weigh taking different steps, they need to know how different policies are working, says Julia Raifman, assistant professor of health law, policy & management.

That’s why she and a group of students at the School of Public Health have created a COVID-19 US state policy database.

“As someone who uses observational data to study how policies drive population health and health disparities, I know it’s really important to have information on the dates when policy changes occurred,” Raifman says.

“Researchers will be able to use this information to study the dynamics of the coronavirus, as well as things like mental health outcomes, unemployment, and morbidity and mortality related to the disease but not directly due to it—how people are doing if they have a heart attack or chronic disease in the period when these policies are in place,” she says.

For help gathering detailed and up-to-the-moment data on when and how policies have been implemented, Raifman and research fellow Kristen Nocka put out a call to MPH students in the Health Policy and Law certificate program. They almost immediately heard back from a dozen students—Rachel Scheckman, Elizabeth Long, Emily Baroni, Sarah Brewer, Karen Contador, Claire Corkish, Elizabeth Ferrara, Felicia Heykoop, Carolyn Hoffman, Suchitra Kulkarni, Manish Patel, and Morgan Simko—and the team got right to work.

“Public health is what I came here to do,” says Scheckman. She was a medical lab scientist before coming to SPH, and says this project is a great opportunity to help out in the fight against COVID-19 while learning about how policy shapes the health of the public.

Long agrees. “This problem is so big, and can feel so out of control,” she says. “We may not be creating protective gear for health care workers or getting out there on the front lines, but policies protect us, and having the ability to clarify some of these points and have a uniform database where we can see where everyone is at across the country is beneficial—and comforting.”

In the broad field of public health, Raifman says, there are many ways to help right now. “I wanted to do whatever I could to address the epidemic,” she says. “I’m not an infectious disease epidemiologist, but I am someone who studies policies, so I thought that this was something that I could contribute.

“People around the world will be making a lot of decisions about which policies to implement, how long to have these policies, and when to lift them, and having this policy database will be helpful for informing those decisions.”

Although it may be too early to glean strong conclusions about policies quite yet, Raifman is particularly interested in bans on visitors at nursing homes. “It’s a really hard thing to do, and has a lot of implications for the mental health of a lot of residents, but given how many outbreaks we’re seeing in nursing homes, I was really surprised to see that only 23 states have implemented visitor bans as a formal policy.” On the other hand, she says she’s happy to see that some of the states with these bans have also supported efforts to help nursing home residents use video calls, to reduce isolation.

Scheckman has been particularly interested in stay-at-home orders—or rather the lack thereof, with some governors even putting out statements that they won’t give such orders. She has also been tracking quarantine requirements and recommendations for people coming from outside of a state, holds on abortion services, and religious exemptions for large gatherings.

“These are policies—or lack of policies—where we could see major impacts,” Scheckman says, “and if we don’t track them now, we may lose sight of one of the causes for greater outbreaks in those places.”

More will become clear in the weeks and months ahead Raifman says, “but we already see how critically important it is” for states to take action to reduce the spread of the coronavirus.

“We see our health care providers on the front lines starting to get sick, and some of them dying,” she says. “We need to learn from these policies about how we can best mitigate the spread, and provide an environment for people who are sick and for our health care workers to be as safe as possible.”

Other faculty contributing to the project include: Jacob Bor, assistant professor of global health and epidemiology; David Jones, associate professor of health law, policy & management; Sarah Lipson, assistant professor of health law, policy & management; Jonathan Jay, assistant professor of community health sciences; and Philip Chan of Brown Medical School.

COVID-19 US state policy database is free to access here.

—Michelle Samuels

SPH will host the free, online seminar Politics, Health, and Coronavirus as part of the Coronavirus Seminar Series on Thursday, April 2. Sign up here.