5/n The authors ensured that the countries/regions were reasonably comparable by controlling for a few population measures like markers of income and healthcarepic.twitter.com/RczWnQE97n
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16/n On top of that, this study suffers from the same drawbacks that most ecological trials do. To their credit, the authors acknowledge this in the discussion, but it certainly hasn't filtered through to the publicpic.twitter.com/XMeDYJanin
17/n Limitations inherent in this sort of research are many and varied, but as one example it's hard to make any realistic inferences about individuals staying at home when your unit of study is Spain vs the United States of America
18/n Even within Australia, which was included, the massive Victorian outbreak/lockdown skew the figures enormously, because one state with 1/4 of the population locked down while the rest of the country opened up
19/n We might actually expect null findings from an ecological trial of this sort, because at the country level heterogeneity in local policy irons out a lot of the impact
20/n It's also worth noting that the study literally does not address the question of whether government orders influenced COVID-19 deaths. Even if you ignore all the other issues, "residential" mobility data simply can't answer that question!
21/n There are many reasons that people stay at home, and given the opacity of "residential" data it's hard to say much about the results other than that this is a hard question that we may never answer well
22/n That being said, the idea that this study disproves staying at home as a driver of COVID-19 mortality is obviously wrong - at best, it is an example of how difficult answering that question can be
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