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Comparing Associations of State Reopening Strategies with COVID-19 Burden.
Kaufman, Brystana G; Whitaker, Rebecca; Mahendraratnam, Nirosha; Smith, Valerie A; McClellan, Mark B.
  • Kaufman BG; Margolis Center for Health Policy, Duke University, Durham, NC, USA. Brystana.kaufman@duke.edu.
  • Whitaker R; Population Health Sciences, Duke University, Durham, NC, USA. Brystana.kaufman@duke.edu.
  • Mahendraratnam N; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC, USA. Brystana.kaufman@duke.edu.
  • Smith VA; Margolis Center for Health Policy, Duke University, Durham, NC, USA.
  • McClellan MB; Margolis Center for Health Policy, Duke University, Durham, NC, USA.
J Gen Intern Med ; 35(12): 3627-3634, 2020 12.
Article in English | MEDLINE | ID: covidwho-834045
ABSTRACT

BACKGROUND:

The novel coronavirus disease 2019 (COVID-19) infected over 5 million United States (US) residents resulting in more than 180,000 deaths by August 2020. To mitigate transmission, most states ordered shelter-in-place orders in March and reopening strategies varied.

OBJECTIVE:

To estimate excess COVID-19 cases and deaths after reopening compared with trends prior to reopening for two groups of states (1) states with an evidence-based reopening strategy, defined as reopening indoor dining after implementing a statewide mask mandate, and (2) states reopening indoor dining rooms before implementing a statewide mask mandate.

DESIGN:

Interrupted time series quasi-experimental study design applied to publicly available secondary data.

PARTICIPANTS:

Fifty United States and the District of Columbia.

INTERVENTIONS:

Reopening indoor dining rooms before or after implementing a statewide mask mandate. MAIN

MEASURES:

Outcomes included daily cumulative COVID-19 cases and deaths for each state. KEY

RESULTS:

On average, the number of excess cases per 100,000 residents in states reopening without masks is ten times the number in states reopening with masks after 8 weeks (643.1 cases; 95% confidence interval (CI) = 406.9, 879.2 and 62.9 cases; CI = 12.6, 113.1, respectively). Excess cases after 6 weeks could have been reduced by 90% from 576,371 to 63,062 and excess deaths reduced by 80% from 22,851 to 4858 had states implemented mask mandates prior to reopening. Over 50,000 excess deaths were prevented within 6 weeks in 13 states that implemented mask mandates prior to reopening.

CONCLUSIONS:

Additional mitigation measures such as mask use counteract the potential growth in COVID-19 cases and deaths due to reopening businesses. This study contributes to the growing evidence that mask usage is essential for mitigating community transmission of COVID-19. States should delay further reopening until mask mandates are fully implemented, and enforcement by local businesses will be critical for preventing potential future closures.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Public Health / COVID-19 / Masks Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Country/Region as subject: North America Language: English Journal: J Gen Intern Med Journal subject: Internal Medicine Year: 2020 Document Type: Article Affiliation country: S11606-020-06277-0

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Public Health / COVID-19 / Masks Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Country/Region as subject: North America Language: English Journal: J Gen Intern Med Journal subject: Internal Medicine Year: 2020 Document Type: Article Affiliation country: S11606-020-06277-0