Association of State-Issued Mask Mandates and Allowing On-Premises Restaurant Dining with County-Level COVID-19 Case and Death Growth Rates — United States, March 1–December 31, 2020

Abstract

, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). CDC recommends a combination of evidence-based strategies to reduce transmission of SARS-CoV-2, the virus that causes COVID-19 (1). Because the virus is transmitted predominantly by inhaling respiratory droplets from infected persons, universal mask use can help reduce transmission (1). Starting in April, 39 states and the District of Columbia (DC) issued mask mandates in 2020. Reducing person-to-person interactions by avoiding nonessential shared spaces, such as restaurants, where interactions are typically unmasked and physical distancing (≥6 ft) is difficult to maintain, can also decrease transmission (2). In March and April 2020, 49 states and DC prohibited any on-premises dining at restaurants, but by mid-June, all states and DC had lifted these restrictions. To examine the association of state-issued mask mandates and allowing on-premises restaurant dining with COVID-19 cases and deaths during March 1-December 31, 2020, countylevel data on mask mandates and restaurant reopenings were compared with county-level changes in COVID-19 case and death growth rates relative to the mandate implementation and reopening dates. Mask mandates were associated with decreases in daily COVID-19 case and death growth rates 1-20, 21-40, 41-60, 61-80, and 81-100 days after implementation. Allowing any on-premises dining at restaurants was associated with increases in daily COVID-19 case growth rates 41-60, 61-80, and 81-100 days after reopening, and increases in daily COVID-19 death growth rates 61-80 and 81-100 days after reopening. Implementing mask mandates was associated with reduced SARS-CoV-2 transmission, whereas reopening restaurants for on-premises dining was associated with increased transmission. Policies that require universal mask use and restrict any on-premises restaurant dining are important components of a comprehensive strategy to reduce exposure to and transmission of SARS-CoV-2 (1). Such efforts are increasingly important given the emergence of highly transmissible SARS-CoV-2 variants in the United States (3,4). County-level data on state-issued mask mandates and restaurant closures were obtained from executive and administrative orders

Community Transmission of SARS-CoV-2 Associated with a Local Bar Opening Event — Illinois, February 2021

“…As community businesses begin to reopen, these findings underscore the importance of businesses and individuals adhering to public health prevention and mitigation guidelines to reduce additional community transmission, including isolation after receipt of a COVID-19 diagnosis and while experiencing COVID-19-like symptoms, even as vaccination efforts expand. Similar gatherings that involve eating or drinking, such as onpremises dining at restaurants, weddings, and night clubs, have been associated with increased risk for acquiring COVID-19 and have the potential to become super-spreading events for SARS-CoV-2 infection (4)(5)(6)(7)(8). This investigation further demonstrates that inconsistent mask use and inadequate physical distancing in an indoor environment can increase transmission risk** (9,10).…”

Should masks be worn outdoors?

“…Regardless of the precise mechanisms of mitigation, observational data from the US and Germany have shown that regions with mask mandates have had a lower impact from SARS-CoV-2 12. Countries with early adoption of face coverings for the public also achieved an earlier acceptance of a social norm during the pandemic 13…”

Shielding of viruses such as SARS-Cov-2 from ultraviolet radiation in particles generated by sneezing or coughing: Numerical simulations of survival fractions

“…Face mask mandates and usage lead to lower rates of covid-19 cases and deaths (Mitze et al, 2020;Joo et al, 2021;Guy et al, 2021).…”