by Gregory S. Schober, PhD; Silvia M. Chavez-Baray, PhD; and Eva M. Moya, PhD, LMSW

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The COVID-19 pandemic has overwhelmed many local public health and health care systems and killed over 280,000 people across the world. Because there is not an available vaccine, many governments used community mitigation measures to slow the spread of infection, reduce the strain on health care systems, and buy additional time for the development of a vaccine. In the United States, governors instituted social distancing measures—efforts to “reduce virus transmission from infected persons to susceptible individuals by increasing physical distance between people or reducing frequency of congregation in socially dense community settings” (also see here and here).   

Many US households face severe challenges to comply with social distancing measures for COVID-19, and these challenges create immense threats to public health. In their official responses to the COVID-19 pandemic, do US state governors allow what we call “social assistancing”—direct, inter-household service actions to support vulnerable populations with compliance to social distancing measures? If so, how do state governors acknowledge challenges related to complying with social distancing orders, and in what ways do they allow or encourage social assistancing efforts? 

Assessing Stay-at-Home Orders

We used a modified text analysis approach (see here and here) to assess if governors’ stay-at-home orders acknowledged severe challenges to order compliance and allowed for social assistancing. We obtained the gubernatorial executive orders or directives through a news article and the corresponding websites of the governors’ offices. These sources revealed that governors issued statewide stay-at-home orders in 42 states in March and early April of 2020. In a small number of states—Arkansas, Iowa, Nebraska, North Dakota, Oklahoma, South Dakota, Utah, and Wyoming—there were no statewide stay-at-home orders in response to the pandemic, so these states were excluded from the sample. 

To evaluate each stay-at-home order, we used standardized search terms generated through a deductive and inductive process by means of preliminary examinations, team discussions, and subsequent refinement. The first examination employed descriptive search terms inclusive of reasons for why people could not comply with a stay-at-home order (ie, vulnerable, disadvantage, homeless, domestic violence, safe, care, food) as well as potential ways that a state would allow social assistancing to help another household (ie, food, medication, supplies necess, assist, care, and shelter). A second examination considered a small number of stay-at-home orders to assess what is allowed in practice, and it revealed that additional search terms (caring and medical) were needed to capture all social assistancing allowances. These two examinations produced standardized search terms used for the analysis.

One researcher screened all the identified executive orders to confirm that they were statewide stay-at-home orders in response to COVID-19, and then coded the orders using the standardized search terms to identify (a) any acknowledgements of severe challenges to order compliance and (b) any allowances for social assistancing. Two additional researchers  abstracted and coded all the stay-at-home orders. The three researchers agreed on 86% of the coding decisions. Disagreements were resolved through a team review. Triangulation from three different researchers enhanced the reliability of our measures and analysis. No study protocol was needed for the research because no human participants were involved.

Evaluation Summary

As a part of their social distancing measures, governors issued statewide executive orders for individuals to stay at home—at their primary residence—unless they are engaging in essential activities. Of course, not all individuals are able to comply with these orders. For example, homeless populations do not have a stable primary residence, so it is not possible for them to stay at home. Furthermore, some people live in an unsafe home environment during the pandemic, due to domestic violence, intimate partner violence, or abuse, and it would be dangerous for them to remain at home.

Table 1 displays the summary results of the analysis. Our evaluation of 42 gubernatorial stay-at-home orders reveals that many directives do not recognize key challenges with compliance. Only 17 gubernatorial orders (40%) acknowledged that homeless individuals would not be able to comply with the directives, and included a specific exemption in the order for homeless populations.  Even fewer gubernatorial orders (16, or 38%) contained an exemption for people experiencing unsafe home conditions. If we consider whether the gubernatorial stay-at-home orders acknowledged either homelessness or unsafe home conditions, then still only half of the orders (21, or 50%) recognized at least one of these severe challenges to order compliance. This finding indicates that, in half of the states with these directives, individuals experiencing homelessness and those living in unsafe home conditions are subject to the full penalty for violating the order.

Regarding social assistancing, only 16 gubernatorial orders (38%) allowed individuals from one household to leave home in order to provide necessary supplies like food or medications for another household. Interestingly, a larger number of gubernatorial orders (28, or 67%) allowed individuals to provide direct care to members of another household. Because all gubernatorial orders that allowed the direct, inter-household delivery of necessary supplies also allowed the direct provision of inter-household care, the same number of states (28, or 67%) allowed social assistancing for either necessary supplies or care. This finding reveals that providing direct assistance to another household is a clear violation of the orders in 14 states (33%).

Key Takeaways

• There is room for improvement in acknowledging severe challenges with compliance to stay-at-home orders in many US states.
• Some US states do not clearly specify whether direct inter-household assistance is allowed under stay-at-home orders, thus discouraging efforts to assist vulnerable populations.
• Executive orders that do not allow social assistancing create threats to public health, because vulnerable households have fewer (legal) options to receive necessary supplies and care through their social networks.
• In future statewide social distancing measures, governors may wish to acknowledge severe challenges with compliance to stay-at-home orders, clarify whether social assistancing is allowed in each state, and provide clear guidelines on how to safely engage in social assistancing efforts.

For Further Discussion

The stay-at-home orders greatly impacted the lives and livelihoods of millions of people in the US, and it is informative to examine what the orders included (and what they left out). Our findings indicate that gubernatorial stay-at-home orders in 25 states (60%) did not give an exemption to homeless individuals, even though it is impossible for them to comply with these orders. Moreover, in 26 states (62%), the orders did not allow individuals to leave home due to unsafe conditions. In 14 states (33%), the orders did not permit individuals to leave home in order to help someone in another household, whether it be with providing necessary supplies or care.

Social assistancing is a new concept that encompasses direct, inter-household service actions to help vulnerable populations with compliance to social distancing measures. Our comparative state policy evaluation, and the resulting descriptive statistics, operationalizes this concept in the context of the US. Because some individuals face severe challenges with compliance to stay-at-home orders, and direct inter-household assistance can help vulnerable, high-risk populations to stay home, social assistancing has the potential to improve public health. Indeed, previous research strongly suggests that executive orders matter for public health (see here and here). Thus, the new social assistancing measure emerges as a promising variable to explain compliance behavior, the spread of COVID-19, and public health outcomes across US states.

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Gregory S. Schober, PhD, is a behavioral scientist and Assistant Professor in Rehabilitation Sciences at the University of Texas at El Paso. His research interests include health policy, civic engagement, and public health. He is the coauthor of published articles in American Journal of Kidney Diseases, Political Behavior, Journal of Development Studies, and other journals.

 

 

 

 

Silvia M. Chavez-Baray, PhD, currently works at the Department of Social Work, University of Texas at El Paso. Silvia does research in Applied Psychology, Cognitive Psychology and Clinical Psychology.

 

 

 

 

 

Eva M. Moya, PhD, LMSW, is an Associate Professor in Social Work at the University of Texas at El Paso. Dr. Moya’s scholarly work spans the public health and macro practice areas, where she has conducted funded research. Areas of specialization are border health disparities, participatory action research and social work practice. Eva has conducted research on knowledge, attitudes and practices in tuberculosis; TB stigma; HIV/AIDS; advocacy; Photovoice; intimate partner violence; sexual and reproductive health; and homelessness. Her research is considered innovative and can be replicated by others.