Mandatory public health measures for COVID-19 are associated with improved mortality, equity and economic outcomes

We review approaches to the COVID-19 pandemic in a systematic way by comparing countries/states representative of the mandatory vs. voluntary approach to non-pharmaceutical interventions in Europe and the US. We use a comparative tabular format to examine differences in mortality, economic impact and equity between regions with mandatory versus voluntary policies. Mandatory shelter-in-place policies were associated with 3 to 4 fold lower population adjusted mortality in the US model and 11 fold lower in the European one. We conclude that voluntary policies are less effective, based on historical precedent and the current analysis. Moreover, effects on health equity mirrored the increased mortality outcomes of voluntary policies and there was no apparent economic benefit associated with voluntary measures.