The role of mask mandates, stay at home orders and school closure in curbing the COVID-19 pandemic prior to vaccination

Abstract

Background: COVID-19 has quickly spread throughout the world, necessitating assessment of effective containment methods. The purpose of this study was to examine the impact of government mandated school closures, stay at home orders and mask requirements METHODS: Cumulative incidence rates were calculated at 14-day intervals until the day of the first vaccine administration in the country. Rate ratios were calculated using negative binomial regression while investigating the effects of adjusting for several sociodemographic and medical factors RESULTS: Faster implementation of mask mandates was consistently shown to be protective. States with mask mandates made at three to six months had a 1.61 times higher rate than those who implemented within one month (adjusted rate ratio = 1.61, 95% confidence interval: 1.23-2.10, P = .001). States with mask mandates made after 6 months or with no mandate had a 2.16 times higher rate than those who implemented within 1 month (adjusted rate ratio = 2.16, 95% confidence interval: 1.64-2.88, P < .0001). In contrast, both stay at home orders and school closures had no significant influence on disease trajectory.

Discussion: The benefits of mask mandates are apparent, especially when mandates were issued within a month. The impact of school closing and stay at home orders were less clear.

Conclusions: Our results suggest that of the different physical distancing measures implemented by the government, mask mandates are the most important.

Keywords: COVID-19; Physical distancing.

Fig 1.

Days to Mask Mandate and Cumulative Incidence Rates per 100,000 *Adjusted rate ratio at day 262 shows that the 3-6 month and over 6 month/no mandate groups are significantly different than the 1 month or less group. The adjusted rate ratio between the 1-3 months group and 1 month or less group was not statistically significant.

Fig 2.

Days to school closure and stay at home orders and cumulative incidence rates per 100,000 One week or less to School Closure: Arkansas, Alabama, Alaska, Arizona, Delaware, District of Columbia, Georgia, Kansas, Louisiana, Maine, Minnesota, Michigan, Mississippi, Montana, New, Hampshire, New Mexico, Nevada, North Carolina, North Dakota, Oklahoma, South Carolina, Texas, Vermont, Virginia, West Virginia, Wyoming Over a week to school closure: California, Connecticut, Colorado, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Missouri, Nebraska, New Jersey, New York, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah, Washington, Wisconsin 14 days or less to stay at home orders: Alabama, Alaska, Delaware, Georgia, Idaho, Illinois, Louisiana, Maine, Massachusetts, Michigan, New Jersey, New Mexico, Oklahoma, South Carolina, Vermont, West Virginia, Wisconsin Over 14 days to stay at home orders: Arizona, Arkansas, California, Colorado, Connecticut, District of Columbia, Florida, Hawaii, Indiana, Iowa, Kansas, Kentucky, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, Wyoming. * Rate ratio shows no statistically significant difference between groups at day 262.

Fig 3.

Rate Ratios, Adjusted for Percent in State Age 65 or Over, Comparing COVID-19 Rates Based on Different Lengths of Time to Mask Mandates at Day 262. *All rate ratios adjusted for percent in state age 65 or over.