On the effectiveness of COVID-19 restrictions and lockdowns: Pan metron ariston

BACKGROUND: Early evaluations of the effectiveness of non-pharmaceutical intervention (NPI) mandates were constrained by the lack of empirical data, thereby also limiting model sophistication (e.g., models did not take into account the endogeneity of key variables). METHODS: Observational analysis using a behavioral four-equation structural model that accounts for the endogeneity of many variables and correlated unobservable country characteristics. The dataset includes information from 132 countries from February 15, 2020, to April 14, 2021, with data on confirmed cases and deaths, mobility, vaccination and testing rates, and NPI stringency. The main outcomes of interest are the growth rates of confirmed cases and deaths. RESULTS: There were strongly decreasing returns to more stringent NPI mandates. No additional impact was found for NPI mandates beyond a Stringency Index range of 51–60 for cases and 41–50 for deaths. A nonrestrictive policy of extensive and open testing constituted 51% [27% to 76%] of the impact on pandemic dynamics of the optimal NPIs. Reductions in mobility were found to increase, not decrease, both case [Formula: see text] and death growth rates [Formula: see text]. More stringent restrictions on gatherings and international movement were found to be effective. Governments conditioned policy choices on recent pandemic dynamics, and were found to be more hesitant in de-escalating NPIs than they were in imposing them. CONCLUSION: At least 90% of the maximum effectiveness of NPI mandates is attainable with interventions associated with a Stringency Index in the range of 31–40, which impose minimal negative social externalities. This was significantly less than the average stringency level of implemented policies around the world during the same time period. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-14177-7.