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Researchers say the reopenings last spring led to an increase in COVID-19 hospitalizations. Nina Westervelt/Bloomberg via Getty Images
  • Researchers say the reopening of businesses and public places last spring did eventually cause COVID-19 hospitalizations to increase.
  • COVID-19 deaths also rose, but not by as much. Experts say that may be because better treatments were being introduced by then.
  • The researchers said they hope their study will help healthcare professionals and state leaders plan better when the next pandemic hits.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub and follow our live updates page for the most recent information on the COVID-19 pandemic.

The reopening of businesses and public facilities in some states during the initial height of the pandemic between April and July 2020 caused an increase in COVID-19-related hospitalizations and deaths.

That’s according to research published in JAMA Health Forum that examined the impact state reopening policies had on pandemic outcomes.

“Earlier research showed that during the closure period (before reopening), reduced mobility was associated with reductions in hospitalizations and deaths,” the study authors wrote.

“Our findings that hospitalization and mortality trends were positive after reopenings supports the findings from studies showing reopenings were substantially associated with higher mobility, emphasizing the health outcomes associated with reopenings,” they added.

In undertaking their study, the researchers analyzed 3,686 days of state-day observations across 47 states between April 16 and July 31, 2020.

“We examined two COVID-19–specific outcome variables: current hospitalizations per capita and new COVID-19–related deaths per capita for each state-day. We sought to evaluate how trends in these outcomes varied before and after state reopenings,” the authors wrote.

The researchers said they found that reopenings across the United States were associated with 5,319 additional people hospitalized every day due to COVID-19.

Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Tennessee, said the study’s findings are important.

“Having an academic unit look at it very critically, soberly, and put careful numbers to it, I think gives these results a special weight and meaning,” he told Healthline. “It’s important to have this academically quantified. Here we have a very sober, objective, quantified sense of how much of a public health price we paid for reopening. I think that’s very, very important.”

For the states that reopened in spring 2020, such as Alabama, Florida, and Arkansas, the researchers found that on the day of reopening, the mean number of hospitalizations for every 100,000 people was 17.69.

The daily number of hospitalizations had been stable in these states before reopening, but then began to increase after restrictions were relaxed.

Schaffner argues this suggests the United States reopened too early and with a lack of consideration.

“The way we reopened, the speed and I would say the carelessness with which we reopened, clearly had an adverse impact. We should have opened up more slowly and with an insistence on masks and social distancing,” he said.

The study found that the mean daily death rate for every 100,000 people was not statistically significant in the early days after reopening.

The daily death rate began increasing after reopening, with the new rate becoming statistically significant 35 days after reopening, when it rose from 0.395 deaths per 100,000 people the day of reopening to 0.96 deaths per 100,000 people.

Schaffner said this trend is in keeping with patterns seen in other infectious diseases.

“It wasn’t statistically significant until you got about a month later, and that… reinforces the notion that deaths are a lagging indicator,” he said.

“First come cases, followed by hospitalizations, and then it takes a longer period of time because people may linger in the hospital receiving intensive care, sometimes for weeks, and deaths then begin to rise anywhere from 2 to 4 weeks after cases and hospitalizations start to rise,” Schaffner said.

“I thought that pattern was entirely consistent with what we’ve known for, for example, influenza cases, hospitalizations, and deaths,” he added.

While the number of hospitalizations increased significantly due to reopening, the rate of deaths didn’t have as high an increase.

Schaffner argues this is likely due to improvement in care during the period in which data for the study was collected.

“By that time already in 2020, colleagues across the country, particularly those who were working in intensive care units, had gotten much better at treating COVID. So, it was much more likely that by the time we got to April, June, July last year, if you were admitted to an intensive care unit, your chance of leaving the intensive care unit alive had increased substantially over the early months of late winter and early spring,” he said.

“Practice is part of it, and part of that practice is the very rapid appreciation of all the diverse organ systems that the COVID virus can infect,” Schaffner explained.

“Also by that time, remdesivir had become available and was being used as well as dexamethasone, the steroid, and people were getting much more adroit at when to give those medications, and that plus everything we had learned about supportive care really improved survival rates,” he said.

The study authors note that exceeding the capacity of hospitals and healthcare infrastructure is a major risk during the COVID-19 pandemic.

Given this, they say having a better understanding of the data will help better prepare for future pandemics.

Schaffner agrees.

“There will be future pandemics, or major outbreaks of infectious diseases, and we have much to learn with what we did appropriately and many more things inappropriately in response to the current one. I think this is information that will guide us in the future,” he said.

“Right now, these lessons do apply. Here we have this highly transmissible variant and there are still many communities made up of largely vaccine resisters who are trying to behave as though the virus didn’t exist. These events will repeat themselves in those communities. There will be members of those communities who find themselves in the hospital,” he added.