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Comparing Associations of State Reopening Strategies with COVID-19 Burden.

Publication ,  Journal Article
Kaufman, BG; Whitaker, R; Mahendraratnam, N; Smith, VA; McClellan, MB
Published in: J Gen Intern Med
December 2020

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.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

December 2020

Volume

35

Issue

12

Start / End Page

3627 / 3634

Location

United States

Related Subject Headings

  • United States
  • SARS-CoV-2
  • Restaurants
  • Public Health
  • Physical Distancing
  • Pandemics
  • Non-Randomized Controlled Trials as Topic
  • Masks
  • Interrupted Time Series Analysis
  • Humans
 

Citation

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ICMJE
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Kaufman, B. G., Whitaker, R., Mahendraratnam, N., Smith, V. A., & McClellan, M. B. (2020). Comparing Associations of State Reopening Strategies with COVID-19 Burden. J Gen Intern Med, 35(12), 3627–3634. https://doi.org/10.1007/s11606-020-06277-0
Kaufman, Brystana G., Rebecca Whitaker, Nirosha Mahendraratnam, Valerie A. Smith, and Mark B. McClellan. “Comparing Associations of State Reopening Strategies with COVID-19 Burden.J Gen Intern Med 35, no. 12 (December 2020): 3627–34. https://doi.org/10.1007/s11606-020-06277-0.
Kaufman BG, Whitaker R, Mahendraratnam N, Smith VA, McClellan MB. Comparing Associations of State Reopening Strategies with COVID-19 Burden. J Gen Intern Med. 2020 Dec;35(12):3627–34.
Kaufman, Brystana G., et al. “Comparing Associations of State Reopening Strategies with COVID-19 Burden.J Gen Intern Med, vol. 35, no. 12, Dec. 2020, pp. 3627–34. Pubmed, doi:10.1007/s11606-020-06277-0.
Kaufman BG, Whitaker R, Mahendraratnam N, Smith VA, McClellan MB. Comparing Associations of State Reopening Strategies with COVID-19 Burden. J Gen Intern Med. 2020 Dec;35(12):3627–3634.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

December 2020

Volume

35

Issue

12

Start / End Page

3627 / 3634

Location

United States

Related Subject Headings

  • United States
  • SARS-CoV-2
  • Restaurants
  • Public Health
  • Physical Distancing
  • Pandemics
  • Non-Randomized Controlled Trials as Topic
  • Masks
  • Interrupted Time Series Analysis
  • Humans