Competing interests: The authors have declared that no competing interests exist. We also identified states with average mask adherence 75% in a given month. It is also possible that survey respondents misreported their mask wearing adherence; whether they would be more or less likely to over or under-report is open to speculation, but residents in states with mask wearing policy might over-report adherence to appear compliant. Indeed, associations between mask policy, adherence and other factors may be obscured in states with many high density and low density areas. We used state-level data on mask wearing policy for the general public and on proportion of residents who stated they always wear masks in public. Note: State containment measures are shown from two weeks prior, reflecting what experts say is a lag between new policies and results. For all 50 states and D.C., data on mask wearing and physical distance policies, mask adherence, COVID-19 cases, and demographics were abstracted from publicly available sources. For a while, the residents were spared. The study concluded that mask mandates and use are not associated with slower state-level Covid-19 spread during Covid-19 growth surges. The medias narrative about masks extended throughout the world. Werler and her team used the COVID-19 U.S. State Policy Database to collect policy and demographic data from all 50 states and the District of Columbia. Taiwan recently recorded 200 days without a new coronavirus case after its leaders focused on a speedy response and invested in mass testing and contact tracing. Meanwhile, the eight states that reported 75% or more mask adherence between June 2020 and September 2020 did not have high COVID-19 rates. By Jocelyn Solis-Moreira e0249891. The pandemic has eased, but not the compulsion of many Americans to cover their faces. Here's what it could mean for all of us. "There are over 200 percent more cases in a school (district) that does not have a mask mandate," said Dr. Catherine Troisi, an. here. Our study was also limited by the lack of information on accessibility of COVID-19 testing; if less accessible testing is associated with less mask adherence, the associations we report here may be under-estimates. Its been piecemeal, Dr. El-Sadr said. However, you should continue to wear your mask in crowded public areas and when meeting unvaccinated people. Eleven states had no stay-at-home order, 15 had no mask policy, and four states had low adherence throughout this six-month period. Methodology, For all 50 states and the District of Columbia (DC), these data were abstracted by month for April September 2020 to measure their impact on COVID-19 rates in the subsequent month (May October 2020). Outbreaks are comparatively smaller in states where efforts to contain the virus were stronger over the summer and fall potential good news for leaders taking action now. Among states and D.C. with no mask wearing policy, 50 to 73% had high COVID-19 rates in the subsequent month. Our analysis of state and D.C.-level data does not account for variations in policy, adherence, and demographic factors at smaller geographic levels, such as county-levels. Mean COVID-19 rates for states with 75% mask adherence in the preceding month was 109.26 per 100,000 compared to 249.99 per 100,000 for those with less adherence. Its been largely delegated to a subnational level, to the states, for example, and municipalities to figure it out themselves.. Researchers aggregate those indicators and assign a number from 0 to 100 to each governments total response. Coronavirus: How R-0 can be used to fight COVID-19. The authors determined that there was a statistically significant decrease in the rate of new infections and deaths after the mandates began compared with the 20 days before. On the other hand, Hawaii and Connecticut had two of the longest mask mandates and also some of the lowest per capita case counts of all the states. Heres How Doctors With Kids Are Navigating the New Mask Guidance. When the outbreak slammed the New York City area in March and April, leaders locked down. 3.1.2023 2:50 PM, David McGarry Individuals mask wearing behaviors are not only influenced by recommendations and mandates issued by state leaders, but also by print, televised, and social media [9]. While it controlled for other policies that have been used to try to mitigate new infections from the coronavirus including bar closures, stay-at-home orders and bans on gatherings of 10 or more people it did not account for some others, such as physical distancing recommendations and other types of business closures. Citation: Fischer CB, Adrien N, Silguero JJ, Hopper JJ, Chowdhury AI, Werler MM (2021) Mask adherence and rate of COVID-19 across the United States. High school students in Seattle staged a protest demanding that a mask mandate be reinstated, and psychologists now deal with the anxieties of children who dont want their classmates to see their faces. If you've seen pictures of those kids, you know they are not necessarily using masks as intended. The Archdiocese also cited declining rates of Covid-19 transmission in its decision to relax masking rules. When mask adherence dropped in September, COVID-19 cases increased in October. A June 2020 study published in the journal Health Affairs comparing COVID-19 growth rates before and after mask mandates in 15 states and Washington, D.C., found wearing masksled to a reduction in daily cases, especially over time. But despite an official infection rate that was virtually the same as California's, he adds, "Florida had 33% more deaths per capita than California" during the omicron surge. The black line on the graph shows the weekly rate of Covid cases in all the states with mask mandates that week, while the orange line shows the rate in all the states without mandates. Boston University School of Public Health, Boston, MA, United States of America, Roles Swedens initial Covid surge was blamed on those lax policies, but Sweden stuck to them and actually discouraged masks in most situations. This protective effect of mask wearing was evident across four months of the pandemic, even after adjusting the associations for mask policy, distance policy, and demographic factors. When the state faced a surge of cases over the summer, the governor closed bars and placed limits on restaurant capacity. More detailed message would go here to provide context for the user and how to proceed. We observed some benefit of mask policy on COVID-19 rates, but the findings were unstable. "Lifting of mask mandates across the board without consideration of the caveats does open the opportunity for another wave," Werler says. The strongest association was for mask adherence in September; for every 1% increase in average adherence, the odds of a high COVID-19 case rate decreased by 26%. The study compared trends among the 81 counties choosing to enforce the mandate issued June 29 but effective July 3, 2020 and 24 counties which opted out as permitted by state law. Although Hawaiis governor did not issue a mask wearing policy until after October 2020, we considered that state to have a policy because mayors of the four populous counties had mandated mask wearing earlier in the pandemic. Because there are so many variables to account for, it is very difficult to isolate the impact of any given policy. Thats a huge swing, Werler says. High COVID-rates were less frequent in states and D.C. with strict mask wearing policy than in states with recommended policy. https://doi.org/10.1371/journal.pone.0249891.t003. All reviews and studies included in this document report on data collected in a time period prior COVID-19 death rates dropped by 0.7 percentage points in the first 20 days after masks were required. The index comes from Oxfords Blavatnik School of Government, where researchers track the policies or lack thereof governments use to contain the virus and protect residents, such as contact tracing, mask mandates and restrictions on businesses and gatherings. "Its that simple.. ", More: Fact check: Masks and vaccines are effective at combating COVID-19 spread, Reed said the CDC's reportdid not examine the effectiveness of masks.. The authors found that the growth rate of new coronavirus cases and deaths dropped after mask mandates were put in place. We abstracted data on whether the state issued a mandate of mask use by all individuals in public spaces, and if so, the dates of implementation and whether the mandate was enforced by fines or criminal charge/citation(s). Cases dropped in late July, but since then Texas has eased efforts to contain the virus, and cases are rising again. The. But then Fauci, like the CDC and the WHO, bowed to political expediency and media hysteria. At Humble ISD, 4.59 percent have tested positive for COVID. Public health policy-making requires navigating the balance of public good and individual rights [10]. Some reopened quickly and saw cases rise. Most states in the low quartile had high COVID-19 rates in the subsequent month. The resurgence was blamed on people disobeying the mandates, never mind the surveys showing widespread compliance. "We feel the time is right to make this . In Germany, by contrast, more than 80 percent did so, but look at the similar trajectories of the daily Covid death toll in both countries from the summer of 2020 through March of this year. | Mask adherence was classified as low if in the lowest quartile and as high if in the highest quartile. But the study did not take into account other policies or voluntary safeguards that may have differed between jurisdictions with and without mask mandates. Rhode Island, where I live, has had a mask mandate since mid-December; nonetheless, we saw our January surge rise far higher than any other state. In the United States, policies on mask wearing have varied from state to state over the course of the pandemic. Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2. For mask adherence, the cut-off values for the low and high quartiles were 31% and 46% in June, 53% and 72% in July, 55% and 71% in August, and 55% and 68% in September. You cansubscribe to our print edition, ad-free app or electronic newspaper replica here. Many have also done the least to contain the virus. As of yesterday,The New York Times reports, every state that required people to wear face masks in public places and/or in schools during this winter's COVID-19 surge has decided to lift those mandates, with the exception of Hawaii. Of the 15 states with no mask policy from April through September, 14 reported high COVID-19 rates in at least one month from May to October. She finds that mask-wearing is still the best course of action for mixed-vaccination status gatherings. Further analyses of more granular geographic regions would be a logical next step. That second observation requires a caveat, since testing rates affect the number of cases that are recorded. Masks prevent you from inhaling or exhaling viral droplets that can linger in the air. And in New York and some other states, those lockdowns came too late to prevent a big outbreak, because thats where the virus hit first, said Thomas Hale, associate professor of global public policy at the Blavatnik School of Government, who leads the Oxford tracking effort. Gavin Newsom ordered the nation's first statewide shutdown because of the coronavirus, masks remain mandated, indoor dining and other activities are significantly limited, and Disneyland remains closed. That period is used as the benchmark against which researchers compared days 21 through 60 before mask mandates were adoptedand the 100 days after. Prior to adopting mask mandates, those municipalities that eventually adopted mandates had higher transmission rates than the rest of the state, with the mean case rate difference per 100,000 people increasing by 0.32 cases per day (slope of difference = 0.32; 95% CI 0.13 to 0.51). In their pre-Covid planning strategies for a pandemic, neither the Centers for Disease Control nor the World Health Organization had recommended masking the publicfor good reason. Adherence to public policy is influenced by a complex interplay of factors such as public opinion, cultural practices, individual perceptions and behaviors [11], which are difficult to quantify. Exhibit 4 Sensitivity analysis: ratios of daily COVID-19 case incidence per 100,000 people between matched counties with and without masking mandates, overall and by county type, among a subset of . In the United States, policies on mask wearing have varied from state to state over the course of the pandemic [6]. Even Greenpeace now admits the obvious: recycling doesnt work. Its Legacy Is Disastrous. He Kept Quiet. Even as more and more states encourage mask wearing [7], many citizens still resist the notion [8]. The pandemics second year saw slight deviations in both directions, but those reflected the seasonality of the virus and the geography of mask mandates, which remained more common in northern states. Conceptualization, Methodology, The weaker associations for mask policy may reflect the lack of a unified policy across all states and D.C. and the inconsistent messaging by the media and government leaders. | Sources: Oxford Covid-19 Government Response Tracker, closing bars, restaurants, gyms, theaters and schools, one in 10 North Dakotans have tested positive. https://doi.org/10.1371/journal.pone.0249891.g001. Note: Measurements of government response come from the Oxford Covid-19 Government Response Trackers Containment and Health Index, which is the organizations index focused on virus containment and protecting citizen health. Overall, there is no obvious difference between states with mask mandates and states without them. Larry Hogan called on the State Board of Education to . 18, 2020. Fact check: Masks and vaccines are effective at combating COVID-19 spread. The proportions of states with high COVID-19 rates are shown for those in the low and high quartiles of mask adherence in the preceding month (Fig 1). The study used county-level data from March 1 through Dec. 31 of last year, comparing data from before mandates tookeffect to the time period when they were in place. One state is the lone holdout. Nevertheless, it is possible that average mask adherence in a given month does not capture the most effective time period that influences COVID-19 rates. Data Availability: Data are available in the paper and its Supporting Information file. Theyre suffering from mask dependency, as this psychological affliction is termed in Japan, where a long tradition of mask-wearing during flu season has left some individuals afraid at any time to expose their faces in public. States and D.C. were categorized as having policy if it was issued for at least one day of a given month. Maskaholics in the press are calling for permanent masking on trains, planes, and buses. States and cities are reinstating restrictions and implementing new ones: In recent days, the governors of Iowa, North Dakota and Utah imposed mask mandates for the first time since the outbreak began. Latest news. No, Is the Subject Area "Conservation science" applicable to this article? The CDC received some criticism for its junk science on masks, particularly for its false claims about the benefits of masking schoolchildren, but the press mostly promoted the agencys narrative. In contrast, 25% or fewer states with a mask wearing policy had high COVID-19 rates, except in September when over half experienced high rates. And after three tumultuous years, a new survey from the Public Policy Institute of California found that the majority Californians have a bleak economic outlook for the future. "Arizona surprised me because they went from having the second-lowest mask adherence in May and June [less than 22%] to the highest level in July and August [greater than 80%]. States are issuing a new wave of mask mandates and social restrictions as record numbers of Covid-19 hospitalizations and soaring daily cases strain US medical systems. Since July 27, 2020, individuals had been required to wear a mask or face covering in the state when visiting public indoor spaces and when unable to maintain a 6-foot distance from. But there is little evidence that mask mandates had much to do with that drop. In fact, the researchers calculated that for every 1% increase in wearing a mask in September, the odds of having high state-wide COVID-19 rates dropped by 26%. A new study from the Centers for Disease Control and Prevention found a link between face mask mandates and a reduction in COVID-19 cases and deaths, but at least one widely shared report wrongly interprets that data. Costs vs. benefits of COVID-19 lockdowns and mask mandates revealed in new research Thu, 01/12/2023 LAWRENCE Beginning in 2020, most state governors ordered lockdowns and mask mandates to combat the COVID-19 pandemic. A couple weeks into those lockdowns, countries with new restrictions may be seeing results: The rate of new daily cases has begun to level off or drop in France, Spain, Germany and Italy, though it continues to rise in the United Kingdom. Many states in the Upper Midwest and Mountain West resisted more stringent control measures, like limits on gatherings and mask mandates. The requirement is expected to be lifted on March 1. Ashish Jha, dean of Brown University's School of Public Health, notes that the graph for California, which required masks in indoor public settings beginning on December 15, is "strikingly similar" to the graph for Florida, which had no mask mandates. https://doi.org/10.1371/journal.pone.0249891.t002. But in each state, as Miller shows, infection rates remained lower in the counties that did not mandate masks. Thank you for supporting our journalism. 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). The opposite was true for states with mandates. The study also did not measure compliance with and enforcement of mask mandates and prohibitions on dining at restaurants. Conditions in bars and restaurants are more conducive to virus transmission, since customers spend more time there in closer proximity to each other, often while talking. Conceptualization, In conclusion, we show that mask wearing adherence, regardless of mask wearing policy, may curb the spread of COVID-19 infections. "Our results suggest that mask-wearing is strongly affected by factors other than mandates. As you can see from the lines similar trajectories, the mask mandates hardly controlled the virus. Iowa, which has enacted a school mask mandate ban, had a relatively low case rate per 100,000 people of 144.7. Some states now have ended their statewide masks mandates, but the president, and others, have urged them to reinstate masks mandates because of the recent upsurge that our nation has seen in COVID-19 cases. We classified a state and D.C. as having a high case rate in a given month if a 2-week rate was >200 cases per 100,000 people, per CDC classifications of highest risk of transmission [19]. | New infections have stayed among the lowest in the country, adjusted for population though cases now are rising in New York as they are everywhere. "Their perspective on the study and results to me are contrary to what was stated in the actual study itself," Bisesi said. Doug Burgum reopened the state nearly fully in May. Our observed associations should influence policy-makers and contribute to public health messaging by government officials and the media that mask wearing is a key component of COVID-19 mitigation. But the researchers found no clear relationship between mask mandates and mask use. Containment measures are as of Nov. 1. Now, nearly one in 10 North Dakotans have tested positive about a third of those in the past two weeks and one in 1,000 have died of the virus. | Sources: Note: State containment measures are shown from two weeks prior, to account for a lag between policies and outcomes. According to Werler, Arizonas data was unexpected. No, Is the Subject Area "Health care policy" applicable to this article? Coronavirus cases are rising in almost every U.S. state. Eleanor J. Murray and Jennifer Weuve and the Boston University School of Public Health Epidemiology COVID-19 Response Corps for bringing together students and faculty for this project. A relationship between policies and the outbreaks severity has become more clear as the pandemic has progressed. Mask wearing has been advocated by public health officials as a way to reduce the spread of COVID-19. By Lauren Leatherby and Rich HarrisNov. Centers for Disease Control and Prevention. The study also found a statistically significant increase in the rate of COVID-19 infections and deaths starting 40 days after indoor or outdoor dining at restaurants was allowed. Its a graph that should be required viewing for everyone still wearing a mask and every public official or journalist who still insists that mask mandates control the spread.. Copyright: 2021 Fischer et al. We were not able to measure statistical interactions between mask policy and adherence due to instability arising from small numbers. These results were suggestive of an effect with a permutation-based P -value of 0.094. John Tierney is a contributing editor of City Journal and coauthor of The Power of Bad: How the Negativity Effect Rules Us and How We Can Rule It. Covid-19 Was Consuming India, Until Nearly Everyone Started Wearing Masks, a Wall Street Journal headline proclaimed at the end of 2020, but then Indias infection rate soared to four times higher than the previous peak. 3.1.2023 9:15 AM, Joe Lancaster The list of states with high COVID-19 rates by month shows the initial wave in northeastern states in May, followed by a wave in southern states, and then spreading across the U.S. over the next four months (Table 2). Subscribe to Reason Roundup, a wrap up of the last 24 hours of news, delivered fresh each morning. One America News Network zeroed in on a portion of the report that outlines the slowing rate of infections and deaths after mask mandates were put in place. This association between high mask adherence and reduced COVID-19 rates should influence policy makers and public health officials to focus on ways to improve mask adherence across the population in order to mitigate the spread of COVID-19. We calculated the average mask use percentage by month for AprilSeptember, 2020. Because stay-at-home order, mask wearing policy, mask adherence, and COVID-19 rates can vary from month to month, we listed those states with consistent classifications across the period April through September (or May through October for COVID-19 rates). The data we now have conclusively show that widespread use of masks is a very effective way to reduce the spread of COVID-19, CDC spokeswoman Jasmine Reed wrote in an email to USA TODAY. Models were unadjusted, adjusted for no mask policy (Model 1), and adjusted for no mask policy in previous month, no stay-home order, >15% population non-Hispanic Black, >15% population Hispanic, median age >40 years, population density > 200/square mile (Model 2). "They dont know how well people complied with these mandates or what proportion of the populationwas actually wearing masks.. Data released by the agency in November looking at COVID-19 incidence in Kansas after a statewide mask mandate also found the measure resulted in a drop in infectious cases. "Masks have been the most visible part of America's pandemic response, but one of the least consequential," science journalist Faye Flam writes in a Bloomberg Opinion essay. Writing original draft. Mask wearing has been advocated by public health officials as a way to reduce the spread of COVID-19 [35]. No, Is the Subject Area "Hispanic people" applicable to this article? Higher mask use did not predict lower maximum growth rates, smaller surges, or . Study: States With Mask Mandates Saw Fewer Summertime COVID Cases. Click through the PLOS taxonomy to find articles in your field. Decreases in the rate of new infections and deaths from the virus were statistically significant, the studys authors found. Eleven states never mandated masks, while the other 39 states enforced mandates. Funding: The authors received no specific funding for this work. Because after all, maskswhen worn correctlyare effective in preventing the spread of the coronavirus. The three COVID-19 vaccines authorized by the FDA are also helping slow COVID-19 rates, allowing for the easing of restrictions. It also examined the link between allowing on-site restaurant dining and the number of coronavirus cases and deaths. More state leaders acted to strike down mask mandates on Thursday, citing a decline in COVID-19 cases and hospitalizations. In the first 20 days after implementingmask mandates, new cases slowed by 0.5 percentage points. Investigation, Given the situation during the omicron surge, there are additional reasons to doubt that mask mandates, even with perfect compliance, had much of an impact. Nor did it look at actual mask wearing, as opposed to legal requirements. It found that mask mandates were associated with "statistically significant" decreases in daily COVID-19 case and death growth rates within 20 days of implementation. When Can I Visit a Friend's House After I'm Fully Vaccinated? "Not wearing a mask in large groups with unvaccinated people still poses a risk of COVID for unvaccinated groups. Writing original draft, Jacob Sullum A recent study shows that states with high levels of mask-wearing reported fewer COVID-19 cases last summer. But "few studies assessed compliance to mask wearing policies or controlled for the possible influence of other preventive measures such as hand hygiene and physical distancing.". On November 8, Utah implemented a mask mandate, as new daily Covid-19 cases continue to rise in the state and across the country. States with stronger policy responses over the long run are seeing comparatively smaller outbreaks. We divided the monthly number by 2.2 to obtain the number in a two-week period (43,088). Several other states have implemented or tightened. But the "reference period" is defined by the report as the 20 days before mask mandates started. Thus, subsequent comparisons of states with high COVID-19 rates by month focused on July, August, September and October. We thank Dr. Julia Raifman Boston University School of Public Health for developing, maintaining, and providing open access to the COVID-19 US State Policy Database. 15 had no stay-at-home order, 15 had no stay-at-home order, 15 had no stay-at-home order 15... Defined by the report as the 20 days after restaurant dining and the number of cases... Of Education to I Visit a Friend 's House after I 'm Vaccinated! Also examined the link between allowing on-site restaurant dining and the number of cases that are recorded with that.. Categorized as having policy if it was issued for at least one day of a month. '' is defined by the FDA are also helping slow COVID-19 rates by focused! 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