Following the Science? Examining the Issuance of Stay-At-Home Orders Related to COVID-19 by U.S. Governors

Informed by the public health policymaking literature, this study's objective is to identify scientific, political, social, economic, and external factors related to U.S. governors' decisions to issue stay-at-home orders (SAHOs) in response to the first wave of the COVID-19 pandemic. Public health experts advocate for social distancing to slow the spread of infectious diseases, but government mandates to social distance can impose substantial social and economic costs. This study uses event history analysis to investigate the issuance of COVID-19-related gubernatorial SAHOs during a 41-day period in the 50 U.S. states. The findings indicate that scientific, political, and economic factors were associated with the issuance of SAHOs, but that external considerations played the largest role, particularly those related to the timing of other governors' decisions. This study offers evidence about how some U.S. political leaders balance public health concerns against other considerations and, more broadly, how state governments address crisis-level issues.

Governors' Use of Executive Orders and Proclamations in Hurricane Response, 2006-2018

Hurricanes can destroy or overwhelm communities and cause or exacerbate health conditions. Legal mechanisms and practices may aid or impede hurricane response. In the United States, where states have primary public health responsibility, state governors possess legal powers to address hurricanes. They often exercise these powers using executive orders and proclamations-legal mechanisms that direct public and private parties. Although executive orders and proclamations are critical for hurricane preparedness and response, how governors use them to respond to hurricanes is not fully understood. Using legal epidemiology, we systematically identified and analyzed hurricane-related executive orders and proclamations issued in the United States from January 1, 2006, through December 31, 2018. We found 468 relevant executive orders and proclamations, 14% of which were issued, at least in part, to benefit a jurisdiction other than the issuer's state. We observed variations in when and where such orders and proclamations were issued. Executive orders and proclamations were most commonly used to direct government response or recovery (32%), handle and administer government resources (31%), and suspend legal requirements perceived to inhibit response (27%). Fewer orders and proclamations regulated private parties (10%). Understanding how governors use executive orders and proclamations to respond to hurricanes can bolster future preparedness and response efforts.

Long-Term Care, Residential Facilities, and COVID-19: An Overview of Federal and State Policy Responses

The COVID-19 pandemic has disproportionately affected residents and staff at long-term care (LTC) and other residential facilities in the United States. The high morbidity and mortality at these facilities has been attributed to a combination of a particularly vulnerable population and a lack of resources to mitigate the risk. During the first wave of the pandemic, the federal and state governments received urgent calls for help from LTC and residential care facilities; between March and early June of 2020, policymakers responded with dozens of regulatory and policy changes. In this article, we provide an overview of these responses by first summarizing federal regulatory changes and then reviewing state-level executive orders. The policy and regulatory changes implemented at the federal and state levels can be categorized into the following 4 classes: (1) preventing virus transmission, which includes policies relating to visitation restrictions, personal protective equipment guidance, and testing requirements; (2) expanding facilities' capacities, which includes both the expansion of physical space for isolation purposes and the expansion of workforce to combat COVID-19; (3) relaxing administrative requirements, which includes measures enacted to shift the attention of caretakers and administrators from administrative requirements to residents' care; and (4) reporting COVID-19 data, which includes the reporting of cases and deaths to residents, families, and administrative bodies (such as state health departments). These policies represent a snapshot of the initial efforts to mitigate damage inflicted by the pandemic. Looking ahead, empirical evaluation of the consequences of these policies-including potential unintended effects-is urgently needed. The recent availability of publicly reported COVID-19 LTC data can be used to inform the development of evidence-based regulations, though there are concerns of reporting inaccuracies. Importantly, these data should also be used to systematically identify hot spots and help direct resources to struggling facilities.