Epidemiology of Reopening in the COVID-19 Pandemic in the United States, Europe and Asia

Since the discovery of the novel coronavirus (SARS-CoV-2), COVID-19 has become a global healthcare and economic crisis. The United States (US) and Europe exhibited wide impacts from the virus with more than six million cases by the time of our analysis. To inhibit spread, stay-at-home orders and other non-pharmaceutical interventions (NPIs) were instituted. Beginning late April 2020, some US states, European, and Asian countries lifted restrictions and started the reopening phases. In this study, the changes of confirmed cases, hospitalizations, and deaths were analyzed after reopening for 11 countries and 40 US states using an interrupted time series analysis. Additionally, the distribution of these categories was further analyzed by age due to the known increased risk in elderly patients. Reopening had varied effects on COVID-19 cases depending on the region. Recent increases in cases did not fully translate into increased deaths. Eight countries had increased cases after reopening while only two countries showed the same trend in deaths. In the US, 30 states had observed increases in cases while only seven observed increased deaths. In addition, we found that states with later reopening dates were more likely to have significant decreases in cases, hospitalizations, and deaths. Furthermore, age distributions through time were analyzed in relation to COVID-19 in the US. Younger age groups typically had an increased share of cases after reopening.