Mask wearing in pre-symptomatic patients prevents SARS-CoV-2 transmission: An epidemiological analysis

Abstract

Objectives: Pandemic COVID-19 has become a seriously public health priority worldwide. Comprehensive strategies including travel restrictions and mask-wearing have been implemented to mitigate the virus circulation. However, detail information on community transmission is unavailable yet.

Methods: From January 23 to March 1, 2020, 127 patients (median age: 46 years; range: 11-80) with 71 male and 56 female, were confirmed to be infected with the SARS-CoV-2 in Taizhou, Zhejiang, China. Epidemiological trajectory and clinical features of these COVID-19 cases were retrospectively retrieved from electronic medical records and valid individual questionnaire.

Results: The disease onset was between January 9 to February 14, 2020. Among them, 64 patients are local residents, and 63 patients were back home from Wuhan from January 10 to 24, 2020 before travel restriction. 197 local residents had definite close-contact with 41 pre-symptomatic patients back from Wuhan. 123 and 74 of them contact with mask-wearing or with no mask-wearing pre-symptomatic patients back from Wuhan, respectively. Data showed that incidence of COVID-19 was significantly higher for local residents close-contact with no mask-wearing Wuhan returned pre-symptomatic patients (19.0% vs. 8.1%, p < 0.001). Among 57 close-contact individuals, 21 sequential local COVID-19 patients originated from a pre-symptomatic Wuhan returned couple, indicated dense gathering in congested spaces is a high risk for SARS-CoV-2 transmission.

Conclusions: Our findings provided valuable details of pre-symptomatic patient mask-wearing and restriction of mass gathering in congested spaces particularly, are important interventions to mitigate the SARS-CoV-2 transmission.

Keywords: COVID-19; Community; Mask-wearing; Mass gathering; SARS-CoV-2; Transmission.

Fig. 1

Distribution of Taizhou local residents close-contact with 41 Wuhan returned COVID-19 pre-symptomatic patients (a); distribution of Taizhou local residents close-contact with 28 mask-wearing Wuhan returned COVID-19 pre-symptomatic patients (b), distribution of Taizhou local residents close-contact with 13 no mask-wearing Wuhan returned COVID-19 pre-symptomatic patients (c).

Fig. 2

Comparison of the incidence of local COVID-19 patients after close-contact between mask-wearing and without mask-wearing Wuhan returned COVID-19 pre-symptomatic patients (p < 0.001).

Fig. 3

Timeline of epidemiological trajectory of a cluster of 21 sequential local COVID-19 patients originated from a Wuhan returned pre-symptomatic couple in a community.

Suppl. Fig. 1

Schematic protocol of epidemiological survey questionnaire for COVID-19.