But is there a cost to lifting restrictions and trying to get back to pre-pandemic normality?
The study also found that delaying the lifting of restrictions would not prevent sudden increases in deaths in those states, and concluded that there is no “magic time” to lift restrictions.
The study, published Friday in the Journal of the American Medical Association Health Forum, projected Covid-19 deaths in each of the 50 states, the District of Columbia and Puerto Rico between March 1 and December 31, 2022. The researchers simulated the lifting of restrictions at different times of the year and predicted the number of deaths that would follow using current estimates of infection and vaccination rates, taking into account differences in risk between age groups.
“There may not be an additional amount of waiting time in any state after which to withdraw [Covid-19 restrictions] will not lead to increased morbidity and mortality,” the study says.
In almost every state, it says, lifting restrictions any time in 2022 would lead to a spike in the peak Covid-19 deaths seen during the Omicron surge due to the high transmissibility of the circulating variant.
However, when the researchers repeated the analysis using the transmissibility of the less contagious Alpha and Delta variants, they did not see a similar increase in deaths.
“If we didn’t have Omicron, we wouldn’t have this problem,” said Dr. Benjamin Linas, co-senior author of the study and a professor of medicine at Boston University School of Medicine.
Delaying elevators had a different effect on Covid-19 deaths depending on the state.
In California, Montana, North Carolina and Oregon, extending restrictions for just one month helped flatten the curve of deaths, although at no time could a rise in death rates be prevented. However, delaying the lifting of restrictions could help alleviate a significant hospital burden in these states, the authors wrote.
The study found that prolonging Covid-19 restrictions caused a higher number of incident deaths when restrictions were lifted in Massachusetts, New Jersey, New York and Ohio. Linas said this is likely due to decreased immunity in states with lower levels of natural immunity, which is the kind you get after an infection.
Meanwhile, in Florida, Illinois, Michigan, Tennessee and Washington, the predicted spike in deaths remained relatively similar despite delays in lifting restrictions. In these states, prolonging the restrictions would not change the burden of disease in the community.
For those states, “what needs to be changed is the history of vaccination and immunity, and that is the way out,” Linas said.
Therefore, deciding when to remove the mandates requires a cost-benefit analysis, he said. Some states will have to weigh postponing a surge in deaths on the one hand and a return to normalcy on the other.
“I would like for policymakers to take the study and try to lead the honest discussion that we need now, which is, what is the point of our mitigation policies?” Lines said.
The study uses a simulation model in which several assumptions had to be made, and cannot predict the transmissibility and severity of any future variant of Covid-19. The model also does not account for interstate travel and the role it can play in transmitting infections.
Additionally, it is possible that people will continue to wear masks and maintain social distance even once state restrictions are lifted, which could ease the spike in deaths.