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Mask-wearing and control of SARS-CoV-2 transmission in the USA: a cross-sectional study.
Lancet Digit Health. 2021 03; 3(3):e148-e157.LD

Abstract

BACKGROUND

Face masks have become commonplace across the USA because of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic. Although evidence suggests that masks help to curb the spread of the disease, there is little empirical research at the population level. We investigate the association between self-reported mask-wearing, physical distancing, and SARS-CoV-2 transmission in the USA, along with the effect of statewide mandates on mask uptake.

METHODS

Serial cross-sectional surveys were administered via a web platform to randomly surveyed US individuals aged 13 years and older, to query self-reports of face mask-wearing. Survey responses were combined with instantaneous reproductive number (Rt) estimates from two publicly available sources, the outcome of interest. Measures of physical distancing, community demographics, and other potential sources of confounding (from publicly available sources) were also assessed. We fitted multivariate logistic regression models to estimate the association between mask-wearing and community transmission control (Rt<1). Additionally, mask-wearing in 12 states was evaluated 2 weeks before and after statewide mandates.

FINDINGS

378 207 individuals responded to the survey between June 3 and July 27, 2020, of which 4186 were excluded for missing data. We observed an increasing trend in reported mask usage across the USA, although uptake varied by geography. A logistic model controlling for physical distancing, population demographics, and other variables found that a 10% increase in self-reported mask-wearing was associated with an increased odds of transmission control (odds ratio 3·53, 95% CI 2·03-6·43). We found that communities with high reported mask-wearing and physical distancing had the highest predicted probability of transmission control. Segmented regression analysis of reported mask-wearing showed no statistically significant change in the slope after mandates were introduced; however, the upward trend in reported mask-wearing was preserved.

INTERPRETATION

The widespread reported use of face masks combined with physical distancing increases the odds of SARS-CoV-2 transmission control. Self-reported mask-wearing increased separately from government mask mandates, suggesting that supplemental public health interventions are needed to maximise adoption and help to curb the ongoing epidemic.

FUNDING

Flu Lab, Google.org (via the Tides Foundation), National Institutes for Health, National Science Foundation, Morris-Singer Foundation, MOOD, Branco Weiss Fellowship, Ending Pandemics, Centers for Disease Control and Prevention (USA).

Authors+Show Affiliations

Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA.SurveyMonkey, San Mateo, CA, USA.SurveyMonkey, San Mateo, CA, USA.SurveyMonkey, San Mateo, CA, USA.Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York City, NY, USA.Pandefense Advisors, San Francisco, CA, USA.Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA; Department of Zoology, University of Oxford, Oxford, UK; Harvard Medical School, Harvard University, Boston, MA, USA.Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA.Network Science Institute, Northeastern University, Boston, MA, USA; Santa Fe Institute, Santa Fe, NM, USA.Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA; Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA; Broad Institute of Harvard and MIT, Cambridge, MA, USA.Computational Epidemiology Lab, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA. Electronic address: john.brownstein@childrens.harvard.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

33483277

Citation

Rader, Benjamin, et al. "Mask-wearing and Control of SARS-CoV-2 Transmission in the USA: a Cross-sectional Study." The Lancet. Digital Health, vol. 3, no. 3, 2021, pp. e148-e157.
Rader B, White LF, Burns MR, et al. Mask-wearing and control of SARS-CoV-2 transmission in the USA: a cross-sectional study. Lancet Digit Health. 2021;3(3):e148-e157.
Rader, B., White, L. F., Burns, M. R., Chen, J., Brilliant, J., Cohen, J., Shaman, J., Brilliant, L., Kraemer, M. U. G., Hawkins, J. B., Scarpino, S. V., Astley, C. M., & Brownstein, J. S. (2021). Mask-wearing and control of SARS-CoV-2 transmission in the USA: a cross-sectional study. The Lancet. Digital Health, 3(3), e148-e157. https://doi.org/10.1016/S2589-7500(20)30293-4
Rader B, et al. Mask-wearing and Control of SARS-CoV-2 Transmission in the USA: a Cross-sectional Study. Lancet Digit Health. 2021;3(3):e148-e157. PubMed PMID: 33483277.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mask-wearing and control of SARS-CoV-2 transmission in the USA: a cross-sectional study. AU - Rader,Benjamin, AU - White,Laura F, AU - Burns,Michael R, AU - Chen,Jack, AU - Brilliant,Joseph, AU - Cohen,Jon, AU - Shaman,Jeffrey, AU - Brilliant,Larry, AU - Kraemer,Moritz U G, AU - Hawkins,Jared B, AU - Scarpino,Samuel V, AU - Astley,Christina M, AU - Brownstein,John S, Y1 - 2021/01/19/ PY - 2020/08/28/received PY - 2020/11/19/revised PY - 2020/11/30/accepted PY - 2021/1/24/pubmed PY - 2021/3/6/medline PY - 2021/1/23/entrez SP - e148 EP - e157 JF - The Lancet. Digital health JO - Lancet Digit Health VL - 3 IS - 3 N2 - BACKGROUND: Face masks have become commonplace across the USA because of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic. Although evidence suggests that masks help to curb the spread of the disease, there is little empirical research at the population level. We investigate the association between self-reported mask-wearing, physical distancing, and SARS-CoV-2 transmission in the USA, along with the effect of statewide mandates on mask uptake. METHODS: Serial cross-sectional surveys were administered via a web platform to randomly surveyed US individuals aged 13 years and older, to query self-reports of face mask-wearing. Survey responses were combined with instantaneous reproductive number (Rt) estimates from two publicly available sources, the outcome of interest. Measures of physical distancing, community demographics, and other potential sources of confounding (from publicly available sources) were also assessed. We fitted multivariate logistic regression models to estimate the association between mask-wearing and community transmission control (Rt<1). Additionally, mask-wearing in 12 states was evaluated 2 weeks before and after statewide mandates. FINDINGS: 378 207 individuals responded to the survey between June 3 and July 27, 2020, of which 4186 were excluded for missing data. We observed an increasing trend in reported mask usage across the USA, although uptake varied by geography. A logistic model controlling for physical distancing, population demographics, and other variables found that a 10% increase in self-reported mask-wearing was associated with an increased odds of transmission control (odds ratio 3·53, 95% CI 2·03-6·43). We found that communities with high reported mask-wearing and physical distancing had the highest predicted probability of transmission control. Segmented regression analysis of reported mask-wearing showed no statistically significant change in the slope after mandates were introduced; however, the upward trend in reported mask-wearing was preserved. INTERPRETATION: The widespread reported use of face masks combined with physical distancing increases the odds of SARS-CoV-2 transmission control. Self-reported mask-wearing increased separately from government mask mandates, suggesting that supplemental public health interventions are needed to maximise adoption and help to curb the ongoing epidemic. FUNDING: Flu Lab, Google.org (via the Tides Foundation), National Institutes for Health, National Science Foundation, Morris-Singer Foundation, MOOD, Branco Weiss Fellowship, Ending Pandemics, Centers for Disease Control and Prevention (USA). SN - 2589-7500 UR - https://www.unboundmedicine.com/medline/citation/33483277/Mask_wearing_and_control_of_SARS_CoV_2_transmission_in_the_USA:_a_cross_sectional_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2589-7500(20)30293-4 DB - PRIME DP - Unbound Medicine ER -