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[Preprint]. 2020 Nov 13:2020.11.11.20229500.

doi: 10.1101/2020.11.11.20229500.

Association of social distancing and masking with risk of COVID-19

Sohee Kwon^{1

2}, Amit D Joshi^{1

2}, Chun-Han Lo^{1

2}, David A Drew^{1

2}, Long H Nguyen^{1

2

3}, Chuan-Guo Guo^{1

2

4}, Wenjie Ma^{1

2}, Raaj S Mehta^{1

2}, Erica T Warner^{1

5}, Christina M Astley^{6

7}, Jordi Merino^{8

9

10}, Benjamin Murray¹¹, Jonathan Wolf¹², Sebastien Ourselin¹¹, Claire J Steves¹³, Tim D Spector¹³, Jaime E Hart^{14

15}, Mingyang Song^{1

2

16

17}, Trang VoPham^{18

19}, Andrew T Chan^{1

2

8

20

21}

Affiliations

¹ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
² Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
³ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁴ Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
⁵ Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, MA, USA.
⁶ Division of Endocrinology and Computational Epidemiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
⁷ Broad Institute of MIT and Harvard, Cambridge, MA, USA.
⁸ Diabetes Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁹ Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
¹⁰ Department of Medicine, Harvard Medical School, Boston, MA, USA.
¹¹ School of Biomedical Engineering & Imaging Sciences, King's College London, London, U.K.
¹² Zoe Global Limited, London, U.K.
¹³ Department of Twin Research and Genetic Epidemiology, King's College London, London, U.K.
¹⁴ Channing Division of Network Medicine, Department of Medicine, Brigham and Hospital and Harvard Medical School, Boston, MA, USA.
¹⁵ Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁷ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁸ Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 15 Seattle, WA, USA.
¹⁹ Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.
²⁰ Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
²¹ Massachusetts Consortium on Pathogen Readiness.

PMID: 33200150
PMCID: PMC7668763
DOI: 10.1101/2020.11.11.20229500

Association of social distancing and masking with risk of COVID-19

Sohee Kwon et al. medRxiv. 2020.

[Preprint]. 2020 Nov 13:2020.11.11.20229500.

doi: 10.1101/2020.11.11.20229500.

Authors

Affiliations

¹ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
² Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
³ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁴ Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
⁵ Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, MA, USA.
⁶ Division of Endocrinology and Computational Epidemiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
⁷ Broad Institute of MIT and Harvard, Cambridge, MA, USA.
⁸ Diabetes Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁹ Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
¹⁰ Department of Medicine, Harvard Medical School, Boston, MA, USA.
¹¹ School of Biomedical Engineering & Imaging Sciences, King's College London, London, U.K.
¹² Zoe Global Limited, London, U.K.
¹³ Department of Twin Research and Genetic Epidemiology, King's College London, London, U.K.
¹⁴ Channing Division of Network Medicine, Department of Medicine, Brigham and Hospital and Harvard Medical School, Boston, MA, USA.
¹⁵ Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁷ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁸ Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 15 Seattle, WA, USA.
¹⁹ Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.
²⁰ Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
²¹ Massachusetts Consortium on Pathogen Readiness.

PMID: 33200150
PMCID: PMC7668763
DOI: 10.1101/2020.11.11.20229500

Update in

Association of social distancing and face mask use with risk of COVID-19.
Kwon S, Joshi AD, Lo CH, Drew DA, Nguyen LH, Guo CG, Ma W, Mehta RS, Shebl FM, Warner ET, Astley CM, Merino J, Murray B, Wolf J, Ourselin S, Steves CJ, Spector TD, Hart JE, Song M, VoPham T, Chan AT. Kwon S, et al. Nat Commun. 2021 Jun 18;12(1):3737. doi: 10.1038/s41467-021-24115-7. Nat Commun. 2021. PMID: 34145289 Free PMC article.

Abstract

Given the continued burden of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) disease (COVID-19) across the U.S., there is a high unmet need for data to inform decision-making regarding social distancing and universal masking. We examined the association of community-level social distancing measures and individual masking with risk of predicted COVID-19 in a large prospective U.S. cohort study of 198,077 participants. Individuals living in communities with the greatest social distancing had a 31% lower risk of predicted COVID-19 compared with those living in communities with poor social distancing. Self-reported masking was associated with a 63% reduced risk of predicted COVID-19 even among individuals living in a community with poor social distancing. These findings provide support for the efficacy of mask-wearing even in settings of poor social distancing in reducing COVID-19 transmission. In the current environment of relaxed social distancing mandates and practices, universal masking may be particularly important in mitigating risk of infection.

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Conflict of interest statement

CONFLICT OF INTEREST JW, RD, and JC are employees of Zoe Global Ltd. TDS is a consultant to Zoe Global Ltd. DAD, JM, and ATC previously served as investigators on a clinical trial of diet and lifestyle using a separate mobile application that was supported by Zoe Global Ltd. Other authors have no conflict of interest to declare.

Figures

**Figure 1.**
Risk of predicted Covid-19 according to living in a community with overall social distancing grade ^a at various time lags Abbreviations: HR (hazard ratio), CI (confidence interval) ^a Overall social distancing grades are denoted as Poor (F grade), Fair (D grade), Good (C grade), and Excellent (A+B grade). Overall social grade categories (A, B, C, D, and F) are provided by Unacast. Multivariable model was stratified by age (<25, 25–34, 35–44, 45–54, 55–64, ≥65), state, and calendar date at study entry and further adjusted for race (white, black, Asian, or other), sex (male or female), population density of residence (quartiles), current smoking, frontline healthcare worker, interaction with suspected or documented Covid-19, history of diabetes, heart disease, lung disease, and kidney disease (each yes or no).

See this image and copyright information in PMC

References

1. Coronavirus: The world in lockdown in maps and charts. BBC. https://www.bbc.com/news/world-52103747. Published April 7, 2020.
1. Gatto M, Bertuzzo E, Mari L, et al. Spread and dynamics of the COVID-19 epidemic in Italy: Effects of emergency containment measures. Proc Natl Acad Sci. 2020;117(19):10484–10491. doi: 10.1073/pnas.2004978117 - DOI - PMC - PubMed
1. Islam N, Sharp SJ, Chowell G, et al. Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries. BMJ. 2020;370. doi: 10.1136/bmj.m2743 - DOI - PMC - PubMed
1. Shi L, Lu Z-A, Que J-Y, et al. Prevalence of and Risk Factors Associated With Mental Health Symptoms Among the General Population in China During the Coronavirus Disease 2019 Pandemic. JAMA Netw Open. 2020;3(7):e2014053–e2014053. doi: 10.1001/jamanetworkopen.2020.14053 - DOI - PMC - PubMed
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This is a preprint.

Association of social distancing and masking with risk of COVID-19

Affiliations

Association of social distancing and masking with risk of COVID-19

Authors

Affiliations

Update in

Abstract

Conflict of interest statement

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References

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