Estimating the causal impact of non-pharmaceutical interventions on COVID-19 spread in seven EU countries via machine learning

During the COVID-19 pandemic, Non-Pharmaceutical Interventions (NPIs) were imposed all over Europe with the intent to reduce infection spread. However, reports on the effectiveness of those measures across different European countries are inconclusive up to now. Moreover, attempts to predict the effect of NPIs in a prospective and dynamical manner with the aim to support decision makers in future global health emergencies are largely lacking. Here, we explore causal machine learning to isolate causal effects of NPIs in observational public health data from seven EU countries, taking into account specific challenges like their sequential nature, effect heterogeneity, time-dependent confounding and lack of robustness due to violated assumptions. In a pseudo-prospective scenario planning analysis, we investigate which recommendations our model would have made during the second wave of the pandemic in Germany, demonstrating its capacity to generalize to the near future and identifying effective NPIs. In retrospect, our approach indicates that a wide range of response measures curbed COVID-19 across countries, especially in the early phases of the pandemic. Interestingly, this includes controversial interventions like strict school and border closures, but also recommendation-based policies in Sweden. Finally, we discuss important data- and modeling-related considerations that may optimize causal effect estimation in future pandemics.