Policy evaluation in COVID-19: A guide to common design issues

Policy responses to COVID-19, particularly those related to non-pharmaceutical interventions, are unprecedented in scale and scope. Researchers and policymakers are striving to understand the impact of these policies on a variety of outcomes. Policy impact evaluations always require a complex combination of circumstance, study design, data, statistics, and analysis. Beyond the issues that are faced for any policy, evaluation of COVID-19 policies is complicated by additional challenges related to infectious disease dynamics and lags, lack of direct observation of key outcomes, and a multiplicity of interventions occurring on an accelerated time scale. The volume, speed, and methodological complications of policy evaluations can make it difficult for decision-makers and researchers to synthesize and evaluate strength of evidence in COVID-19 health policy papers. In this paper, we (1) introduce the basic suite of policy impact evaluation designs for observational data, including cross-sectional analyses, pre/post, interrupted time-series, and difference-in-differences analysis, (2) demonstrate key ways in which the requirements and assumptions underlying these designs are often violated in the context of COVID-19, and (3) provide decision-makers and reviewers a conceptual and graphical guide to identifying these key violations. The overall goal of this paper is to help policy-makers, journal editors, journalists, researchers, and other research consumers understand and weigh the strengths and limitations of evidence that is essential to decision-making.