Changes in social environment due to the state of emergency and Go To campaign during the COVID-19 pandemic in Japan: An ecological study

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic in Japan, the state of emergency, as a public health measure to control the spread of COVID-19, and the Go To campaign, which included the Go To Travel and Go To Eat campaigns and was purposed to stimulate economic activities, were implemented. This study investigated the impact of these government policies on COVID-19 spread. METHODS: This ecological study included all 47 prefectures in Japan as samples between February 3 and December 27, 2020. We used COVID-19 cases and mobility as variables. Additionally, places where social contacts could accrue, defined as restaurants, companies, transportation, and tourist spots; mean temperature and humidity; the number of inhabitants in their twenties to fifties; and the number of COVID-19 cases in the previous period, which were factors or covariates in the graphical modeling analysis, were divided into five periods according to the timing of the implementation of the state of emergency and Go To campaign. RESULTS: Graphical changes occurred throughout all five periods of COVID-19. During the state of emergency (period 2), a correlation between COVID-19 cases and those before the state of emergency (period 1) was observed, although this correlation was not significant in the period after the state of emergency was lifted (period 3). During the implementation of Go To Travel and the Go To Eat campaigns (period 5), the number of places where social contacts could accrue was correlated with COVID-19 cases, with complex associations and mobility. CONCLUSIONS: This study confirms that the state of emergency affected the control of COVID-19 spread and that the Go To campaign led to increased COVID-19 cases due to increased mobility by changing behavior in the social environment where social contacts potentially accrue.