. 2021 Jun 18;12(1):3737.

doi: 10.1038/s41467-021-24115-7.

Association of social distancing and face mask use 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}, Fatma Mohamed Shebl⁵, Erica T Warner^{1

6}, Christina M Astley^{7

8}, Jordi Merino^{9

10

11}, Benjamin Murray¹², Jonathan Wolf¹³, Sebastien Ourselin¹², Claire J Steves¹⁴, Tim D Spector¹⁴, Jaime E Hart^{15

16}, Mingyang Song^{1

2

17

18}, Trang VoPham^{19

20}, Andrew T Chan^{21

22

23

24}

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 Medical Practice Evaluation Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, MA, USA.
⁷ Division of Endocrinology and Computational Epidemiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Broad Institute of MIT and Harvard, Cambridge, MA, USA.
⁹ Diabetes Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
¹¹ Department of Medicine, Harvard Medical School, Boston, MA, USA.
¹² School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
¹³ Zoe Limited, London, UK.
¹⁴ Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
¹⁵ Channing Division of Network Medicine, Department of Medicine, Brigham and Hospital and Harvard Medical School, Boston, MA, USA.
¹⁶ Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁷ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁸ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁹ Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
²⁰ Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.
²¹ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. achan@mgh.harvard.edu.
²² Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. achan@mgh.harvard.edu.
²³ Diabetes Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA. achan@mgh.harvard.edu.
²⁴ Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA. achan@mgh.harvard.edu.

^# Contributed equally.

PMID: 34145289
PMCID: PMC8213701
DOI: 10.1038/s41467-021-24115-7

Association of social distancing and face mask use with risk of COVID-19

Sohee Kwon et al. Nat Commun. 2021.

. 2021 Jun 18;12(1):3737.

doi: 10.1038/s41467-021-24115-7.

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 Medical Practice Evaluation Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital, Boston, MA, USA.
⁷ Division of Endocrinology and Computational Epidemiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Broad Institute of MIT and Harvard, Cambridge, MA, USA.
⁹ Diabetes Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
¹¹ Department of Medicine, Harvard Medical School, Boston, MA, USA.
¹² School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
¹³ Zoe Limited, London, UK.
¹⁴ Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
¹⁵ Channing Division of Network Medicine, Department of Medicine, Brigham and Hospital and Harvard Medical School, Boston, MA, USA.
¹⁶ Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁷ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁸ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁹ Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
²⁰ Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.
²¹ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. achan@mgh.harvard.edu.
²² Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. achan@mgh.harvard.edu.
²³ Diabetes Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA. achan@mgh.harvard.edu.
²⁴ Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA. achan@mgh.harvard.edu.

^# Contributed equally.

PMID: 34145289
PMCID: PMC8213701
DOI: 10.1038/s41467-021-24115-7

Abstract

Given the continued burden of COVID-19 worldwide, there is a high unmet need for data on the effect of social distancing and face mask use to mitigate the risk of COVID-19. We examined the association of community-level social distancing measures and individual face mask use 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 'always' use of face mask was associated with a 62% 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. Despite mass vaccination campaigns in many parts of the world, continued efforts at social distancing and face mask use remain critically important in reducing the spread of COVID-19.

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Conflict of interest statement

J.W., R.D., and J.C. are employees of Zoe Ltd. T.D.S. is a consultant to Zoe Ltd. D.A.D., J.M., and A.T.C. previously served as investigators on a clinical trial of diet and lifestyle using a separate mobile application that was supported by Zoe Ltd. The remaining authors declare no competing interests.

Figures

**Fig. 1. Risk of predicted Covid-19 according to living in a community with overall social-distancing grade at various time lags.**
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. Cox proportional hazards regression models were used to calculate adjusted HRs and 95% CIs of predicted COVID-19. Adjusted models were 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). HR hazard ratio, CI confidence interval.

See this image and copyright information in PMC

Update of

Association of social distancing and masking with risk of COVID-19.
Kwon S, Joshi AD, Lo CH, Drew DA, Nguyen LH, Guo CG, Ma W, Mehta RS, 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. medRxiv [Preprint]. 2020 Nov 13:2020.11.11.20229500. doi: 10.1101/2020.11.11.20229500. medRxiv. 2020. Update in: Nat Commun. 2021 Jun 18;12(1):3737. doi: 10.1038/s41467-021-24115-7. PMID: 33200150 Free PMC article. Updated. Preprint.

References

1. WHO Coronavirus disease (COVID-2019) Situation Reports. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situatio... (2019).
1. Johns Hopkins University of Medicine Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html (2021).
1. Zamira, R. & Arnaud, S. Europe launches mass vaccination program as countries race to contain new variant. CNN. https://www.cnn.com/2020/12/27/europe/europe-vaccine-rollout-intl/index.... (2021).
1. Holder, J. Tracking coronavirus vaccinations around the world. The New York Times. https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracke... (21 March 2021).
1. COVID-19 | Launch and scale speedometer. https://launchandscalefaster.org/COVID-19 (2021).

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Association of social distancing and face mask use with risk of COVID-19

Affiliations

Association of social distancing and face mask use with risk of COVID-19

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Update of

References

Publication types

MeSH terms

Grants and funding

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Full Text Sources

Medical