Decline in COVID-19 Hospitalization Growth Rates Associated with Statewide Mask Mandates — 10 States, March–October 2020

Joo, Heesoo; Miller, Gabrielle F.; Sunshine, Gregory; Gakh, Maxim; Pike, Jamison; Havers, Fiona; Kim, Lindsay; Weber, Regen; Dugmeoglu, Sebnem; Watson, Christina; Coronado, Fátima

doi:10.15585/mmwr.mm7006e2

Cited by 71 publications

(79 citation statements)

References 5 publications

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“…Studies have confirmed the effectiveness of community mitigation measures in reducing the prevalence of COVID-19 (5)(6)(7)(8). Mask mandates are associated with reductions in COVID-19 case and hospitalization growth rates (6,7), whereas reopening on-premises dining at restaurants, a known risk factor associated with SARS-CoV-2 infection (2), is associated with increased COVID-19 cases and deaths, particularly in the absence of mask mandates (8).…”

Section: Figure Association Between Changes In Covid-19 Case and Deamentioning

confidence: 97%

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

Guy¹,

Lee²,

Sunshine³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

Self Cite

119

121

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, 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

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Section: Figure Association Between Changes In Covid-19 Case and Deamentioning

confidence: 97%

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

Guy¹,

Lee²,

Sunshine³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

Self Cite

119

121

View full text Add to dashboard Cite

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“…Overall, our work makes the following novel contributions relative to recent studies: we look at a much larger number of counties (covering 77% of the US population) and all 50 states and the District of Columbia controlling for a number of temporally evolving and geographyspecific variables compared to [9]; we investigate longer time horizon treatment effects and expand beyond hospital populations compared to [7]; we include states beyond New York and Washington compared to [11]; we include outcomes beyond hospitalization, look at all states and investigate county-level effects compared to [36]; we investigate the temporal evolution of mask mandates before and after their introduction compared to [6]; and we analyze much larger populations and include the temporal evolution and geographical heterogeneity of treatment effects compared to [37].…”

Section: Introductionmentioning

confidence: 99%

Association between COVID-19 outcomes and mask mandates, adherence, and attitudes

et al. 2021

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We extend previous studies on the impact of masks on COVID-19 outcomes by investigating an unprecedented breadth and depth of health outcomes, geographical resolutions, types of mask mandates, early versus later waves and controlling for other government interventions, mobility testing rate and weather. We show that mask mandates are associated with a statistically significant decrease in new cases (-3.55 per 100K), deaths (-0.13 per 100K), and the proportion of hospital admissions (-2.38 percentage points) up to 40 days after the introduction of mask mandates both at the state and county level. These effects are large, corresponding to 14% of the highest recorded number of cases, 13% of deaths, and 7% of admission proportion. We also find that mask mandates are linked to a 23.4 percentage point increase in mask adherence in four diverse states. Given the recent lifting of mandates, we estimate that the ending of mask mandates in these states is associated with a decrease of -3.19 percentage points in mask adherence and 12 per 100K (13% of the highest recorded number) of daily new cases with no significant effect on hospitalizations and deaths. Lastly, using a large novel survey dataset of 847 thousand responses in 69 countries, we introduce the novel results that community mask adherence and community attitudes towards masks are associated with a reduction in COVID-19 cases and deaths. Our results have policy implications for reinforcing the need to maintain and encourage mask-wearing by the public, especially in light of some states starting to remove their mask mandates.

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“…For example, a comparison of counties in the US state of Kansas found that mask mandates were associated with lower incidence rates of COVID-19 (Van Dyke et al 2020). A study of 10 US states found that statewide mask mandates were associated with a decline in weekly COVID-19–associated hospitalization growth compared to states without such mandates (Joo et al 2021).…”

Section: Introductionmentioning

confidence: 99%

A comparison of performance metrics for cloth face masks as source control devices for simulated cough and exhalation aerosols

Lindsley¹,

Blachère²,

Beezhold³

et al. 2021

Preprint

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Universal mask wearing is recommended by the Centers for Disease Control and Prevention to help control the spread of COVID-19. Masks reduce the expulsion of respiratory aerosols (called source control) and offer some protection to the wearer. However, masks vary greatly in their designs and construction materials, and it is not clear which are most effective. Our study tested 15 reusable cloth masks (which included face masks, neck gaiters, and bandanas), two medical masks, and two N95 filtering facepiece respirators as source control devices for aerosols <7 μm produced during simulated coughing and exhalation. These measurements were compared with the mask filtration efficiencies, airflow resistances, and fit factors. The source control collection efficiencies for the cloth masks ranged from 17% to 71% for coughing and 35% to 66% for exhalation. The filtration efficiencies of the cloth masks ranged from 1.4% to 98%, while the fit factors were 1.3 to 7.4 on an elastomeric manikin headform and 1.0 to 4.0 on human test subjects. The correlation coefficients between the source control efficacies and the other performance metrics ranged from 0.31 to 0.66 and were significant in all but one case. However, none of the alternative metrics were strong predictors of the source control performance of cloth masks. Our results suggest that a better understanding of the relationships between source control performance and metrics like filtration efficiency, airflow resistance, and fit factor are needed to develop simple methods to estimate the effectiveness of masks as source control devices for respiratory aerosols.

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Decline in COVID-19 Hospitalization Growth Rates Associated with Statewide Mask Mandates — 10 States, March–October 2020

Cited by 71 publications

References 5 publications

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

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

Association between COVID-19 outcomes and mask mandates, adherence, and attitudes

A comparison of performance metrics for cloth face masks as source control devices for simulated cough and exhalation aerosols

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