Stay-at-home and face mask policy intentions inconsistent with incidence and fatality during the US COVID-19 pandemic

  1. Samuel X. Wu
  2. Xin Wu

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Abstract

During the COVID-19 pandemic, many states imposed stay-at-home (SAH) and mandatory face mask (MFM) orders to supplement the United States CDC recommendations. The purpose of this study was to characterize the relationship between SAH and MFM approaches with the incidence and fatality of COVID-19 during the pandemic period until 23 August 2020 (about 171 days), the period with no vaccines or specific drugs that had passed the phase III clinical trials yet. States with SAH orders showed a potential 50–60% decrease in infection and fatality during the SAH period (about 45 days). After normalization to population density, there was a 44% significant increase in the fatality rate in no-SAH + no-MFM states when compared to SAH + MFM. However, many results in this study were inconsistent with the intent of public health strategies of SAH and MFM. There were similar incidence rates (1.41, 1.81, and 1.36%) and significant differences in fatality rates (3.40, 2.12, and 1.25%; p < 0.05) and mortality rates (51.43, 34.50, and 17.42 per 100,000 residents; p < 0.05) among SAH + MFM, SAH + no-MFM, and no-SAH + no-MFM states, respectively. There were no significant differences in total positive cases, average daily new cases, and average daily fatality when normalized with population density among the three groups. This study suggested potential decreases in infection and fatality with short-term SAH order. However, SAH and MFM orders from some states' policies probably had limited effects in lowering transmission and fatality among the general population. At the policy-making level, if contagious patients would not likely be placed in strict isolation and massive contact tracing would not be effective to implement, we presume that following the CDC's recommendations with close monitoring of healthcare capacity could be appropriate in helping mitigate the COVID-19 disaster while limiting collateral socioeconomic damages.

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  1. Version published to 10.3389/fpubh.2022.990400
  2. ScreenIT

    SciScore for 10.1101/2020.10.25.20219279: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Not applicable

    Table 2: Resources

    Antibodies
    SentencesResources
    The state-level COVID-19 testing rates, SARS-CoV-2 polymerase chain reaction antigen and antibody positivity rates were also examined.
    SARS-CoV-2 polymerase chain reaction antigen and
    suggested: None
    Software and Algorithms
    SentencesResources
    Statistical tests were performed using SAS software (SAS Institute Inc., Cary, NC) and Origin 2020b (OriginLab Corporation, Northampton, MA).
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)
    OriginLab Corporation
    suggested: (Origin, RRID:SCR_014212)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A limitation of this study was its focus on the difference of state-level policies. In order to find out why SAH and MFM orders did not show significant changes in infection and fatality, we may need analysis of individual county or city socioeconomic data, patient isolating data, contact tracing data, health care systems data, and law enforcement efforts during these mandating requirements (see limitations section). Recent studies indicated that not all face masks have equal efficacy in reducing the transmission of particles or droplets, those most likely involved in COVID-19 people-to-people transmission 2, 4. Among all laboratory tested masks, fitted N95, used by health professionals who take care of COVID-19 patients with other necessary PPEs, perform best. Three-layer surgical masks, used by professionals in the hospital and clinical settings, also showed very good results. Some mask alternatives, such as neck fleeces or bandanas, offer very little protection 2. From a public policy perspective, during a pandemic similar to the COVID-19 pandemic, shortages in supply of surgical face masks and N95 respirators, as well as concerns about side effects and the discomfort of prolonged use from the masks, have led to public use of a variety of solutions which are generally less restrictive and usually of unknown efficacy (Table 2). In our opinion, if contagious patients do not strictly isolate themselves in the designated places and stay away from the rest of community, and if ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.10.25.20219279 on medRxiv