Comparing Associations of State Reopening Strategies with COVID-19 Burden

Abstract

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) infected over 5 million United States (US) residents resulting in more than 180,000 deaths by August 2020. To mitigate transmission, most states ordered shelter-in-place orders in March and reopening strategies varied. OBJECTIVE: To estimate excess COVID-19 cases and deaths after reopening compared with trends prior to reopening for two groups of states: (1) states with an evidence-based reopening strategy, defined as reopening indoor dining after implementing a statewide mask mandate, and (2) states reopening indoor dining rooms before implementing a statewide mask mandate. DESIGN: Interrupted time series quasi-experimental study design applied to publicly available secondary data. PARTICIPANTS: Fifty United States and the District of Columbia. INTERVENTIONS: Reopening indoor dining rooms before or after implementing a statewide mask mandate. MAIN MEASURES: Outcomes included daily cumulative COVID-19 cases and deaths for each state. KEY RESULTS: On average, the number of excess cases per 100,000 residents in states reopening without masks is ten times the number in states reopening with masks after 8 weeks (643.1 cases; 95% confidence interval (CI) = 406.9, 879.2 and 62.9 cases; CI = 12.6, 113.1, respectively). Excess cases after 6 weeks could have been reduced by 90% from 576,371 to 63,062 and excess deaths reduced by 80% from 22,851 to 4858 had states implemented mask mandates prior to reopening. Over 50,000 excess deaths were prevented within 6 weeks in 13 states that implemented mask mandates prior to reopening. CONCLUSIONS: Additional mitigation measures such as mask use counteract the potential growth in COVID-19 cases and deaths due to reopening businesses. This study contributes to the growing evidence that mask usage is essential for mitigating community transmission of COVID-19. States should delay further reopening until mask mandates are fully implemented, and enforcement by local businesses will be critical for preventing potential future closures.

The role of mask mandates, stay at home orders and school closure in curbing the COVID-19 pandemic prior to vaccination

“…Additionally, they did not adjust for epidemics beginning at different time points in different locations or socio-demographic variables ( 14 ). The studies by Kaufman et al, Chernozhukov et al and Gallaway et al all suggest wearing masks in public locations is beneficial ( 20 , 21 , 23 ).…”

“…It has also been estimated. the number of excess cases per 100,000 residents in states reopening indoor dining rooms without masks was ten times the number in states reopening with masks after 8 weeks (643.1 cases; 95% confidence interval (CI) = 406.9, 879.2 and 62.9 cases; CI = 12.6, 113.1, respectively) ( 20 ). Moreover, an analysis of the impact of policy measures has suggested that nationally mandating face masks for employees early in the pandemic could have reduced the weekly growth rate of cases and deaths by more than 10 percentage points in late April and could have led to as much as 19 to 47 percent less deaths nationally by the end of May.…”

Misinformation about COVID-19: evidence for differential latent profiles and a strong association with trust in science

“…Other concerning outcomes have also begun to manifest. Perhaps most notably, the U.S. Federal Bureau of Investigation prevented an attempted kidnapping and overthrow of the Governor of the State of Michigan in early October 2020 that was predicated, at least in part, by the perception that a statewide mask mandate for COVID-19 was unconstitutional [38]. Coincidentally, an interrupted time-series study published the same week illustrated the efficacy of nonpharmaceutical preventive behaviors, such as mask use, on reducing morbidity and mortality from COVID-19 [39].…”

“…While evidence continues to accumulate that COVID-19 is a more serious health threat than influenza (e.g., US Centers for Disease Control and Prevention provisional death counts [66]), there may still be disagreement about the appropriate public health response. For example, even given the evidence for substantial and positive outcomes from mask-wearing requirements [38], their implementation continues to be contentious. Thus, in some ways, failure to reject all alternative narratives with complete certainty better reflects true scientific work better than would absolute rejection of all alternative narratives [40], because they may reflect complex and interlinked systems of beliefs.…”

Misinformation about COVID-19: Evidence for Differential Latent Profiles and a Strong Association with Trust in Science

“…[ 38 Coincidentally, an interrupted time-series study published the same week illustrated the e cacy of non-pharmaceutical preventive behaviors, such as mask use, on reducing morbidity and mortality from COVID-19. 39 Clearly, research on COVID-19 misinformation has both a theoretical and practical underpinning.…”