Lifting Universal Masking in Schools - Covid-19 Incidence among Students and Staff.

BACKGROUND: In February 2022, Massachusetts rescinded a statewide universal masking policy in public schools, and many Massachusetts school districts lifted masking requirements during the subsequent weeks. In the greater Boston area, only two school districts - the Boston and neighboring Chelsea districts - sustained masking requirements through June 2022. The staggered lifting of masking requirements provided an opportunity to examine the effect of universal masking policies on the incidence of coronavirus disease 2019 (Covid-19) in schools. METHODS: We used a difference-in-differences analysis for staggered policy implementation to compare the incidence of Covid-19 among students and staff in school districts in the greater Boston area that lifted masking requirements with the incidence in districts that sustained masking requirements during the 2021-2022 school year. Characteristics of the school districts were also compared. RESULTS: Before the statewide masking policy was rescinded, trends in the incidence of Covid-19 were similar across school districts. During the 15 weeks after the statewide masking policy was rescinded, the lifting of masking requirements was associated with an additional 44.9 cases per 1000 students and staff (95% confidence interval, 32.6 to 57.1), which corresponded to an estimated 11,901 cases and to 29.4% of the cases in all districts during that time. Districts that chose to sustain masking requirements longer tended to have school buildings that were older and in worse condition and to have more students per classroom than districts that chose to lift masking requirements earlier. In addition, these districts had higher percentages of low-income students, students with disabilities, and students who were English-language learners, as well as higher percentages of Black and Latinx students and staff. Our results support universal masking as an important strategy for reducing Covid-19 incidence in schools and loss of in-person school days. As such, we believe that universal masking may be especially useful for mitigating effects of structural racism in schools, including potential deepening of educational inequities. CONCLUSIONS: Among school districts in the greater Boston area, the lifting of masking requirements was associated with an additional 44.9 Covid-19 cases per 1000 students and staff during the 15 weeks after the statewide masking policy was rescinded.

The Burden of Coronavirus Disease 2019-Related Cases, Hospitalizations, and Mortality Based on Vaccination Status and Mandated Mask Use: Statewide Data From Wisconsin and Narrative Review of the Literature.

BACKGROUND: Coronavirus disease 2019 (COVID-19) cases continue to surge in the United States with the emergence of new variants. Statewide variability and inconsistency in implementing risk mitigation strategies are widespread, particularly in regards to enforcing mask mandates and encouraging the public to become fully vaccinated. METHODS: This is a cross-sectional study conducted on July 31, 2021, utilizing publicly available data from the Wisconsin Department of Health Services. The authors abstracted data on total COVID-19-related cases, hospitalizations, and deaths in the state of Wisconsin. The primary objective was comparison of total COVID-19-related cases, hospitalizations, and deaths in vaccinated versus unvaccinated people in the state of Wisconsin over a 31-day period (July 2021). Furthermore, we also performed a narrative review of the literature on COVID-19-related outcomes based on mask use and vaccination status. RESULTS: In the state of Wisconsin during July 2021, total COVID-19 cases was 125.4 per 100,000 fully vaccinated people versus 369.2 per 100,000 not fully vaccinated people (odds ratio [OR] = 0.34, 95% confidence interval [CI], 0.33-0.35; P < .001). Total COVID-19 hospitalizations was 4.9 per 100,000 fully vaccinated people versus 18.2 per 100,000 not fully vaccinated people (OR = 0.27, 98% CI, 0.22-0.32; P < .001). Total COVID-19 deaths was 0.1 per 100,000 fully vaccinated people versus 1.1 per 100,000 not fully vaccinated people (OR = 0.09, 95% CI, 0.03-0.29; P < .001). Narrative review of the literature demonstrated high vaccine effectiveness against COVID-19 infection prevention (79%-100% among fully vaccinated people), COVID-19-related hospitalization (87%-98% among fully vaccinated people), and COVID-19-related death (96.7%-98% among fully vaccinated people). Studies have also generally reported that mask use was associated with increased effectiveness in preventing COVID-19 infection ≤70%. CONCLUSIONS: Strict adherence to public mask use and fully vaccinated status are associated with improved COVID-19-related outcomes and can mitigate the spread, morbidity, and mortality of COVID-19. Anesthesiologists and intensivists should adhere to evidence-based guidelines in their approach and management of patients to help mitigate spread.

Impact of COVID-19 in Immunosuppressed Children With Neuroimmunologic Disorders.

BACKGROUND AND OBJECTIVES: To investigate whether children receiving immunosuppressive therapies for neuroimmunologic disorders had (1) increased susceptibility to SARS-CoV2 infection or to develop more severe forms of COVID-19; (2) increased relapses or autoimmune complications if infected; and (3) changes in health care delivery during the pandemic. METHODS: Patients with and without immunosuppressive treatment were recruited to participate in a retrospective survey evaluating the period from March 14, 2020, to March 30, 2021. Demographics, clinical features, type of immunosuppressive treatment, suspected or confirmed COVID-19 in the patients or cohabitants, and changes in care delivery were recorded. RESULTS: One hundred fifty-three children were included: 84 (55%) female, median age 13 years (interquartile range [8-16] years), 79 (52%) on immunosuppressive treatment. COVID-19 was suspected or confirmed in 17 (11%) (all mild), with a frequency similar in patients with and without immunosuppressive treatment (11/79 [14%] vs 6/74 [8%], p = 0.3085). The frequency of neurologic relapses was similar in patients with (18%) and without (21%) COVID-19. Factors associated with COVID-19 included having cohabitants with COVID-19 (p < 0.001) and lower blood levels of vitamin D (p = 0.039). Return to face-to-face schooling or mask type did not influence the risk of infection, although 43(28%) children had contact with a classmate with COVID-19. Clinic visits changed from face to face to remote for 120 (79%) patients; 110 (92%) were satisfied with the change. DISCUSSION: In this cohort of children with neuroimmunologic disorders, the frequency of COVID-19 was low and not affected by immunosuppressive therapies. The main risk factors for developing COVID-19 were having cohabitants with COVID-19 and low vitamin D levels.

Network assessment and modeling the management of an epidemic on a college campus with testing, contact tracing, and masking.

There remains a great challenge to minimize the spread of epidemics, especially in high-density communities such as colleges and universities. This is particularly true on densely populated, residential college campuses. To construct class and residential networks data from a four-year, residential liberal arts college with 5539 students were obtained from SUNY College at Geneseo, a rural, residential, undergraduate institution in western NY, USA. Equal-sized random networks also were created for each day. Different levels of compliance with mask use (none to 100%), mask efficacy (50% to 100%), and testing frequency (daily, or every 2, 3, 7, 14, 28, or 105 days) were assessed. Tests were assumed to be only 90% accurate and positive results were used to isolate individuals. The effectiveness of contact tracing, and the effect of quarantining neighbors of infectious individuals, was tested. The structure of the college course enrollment and residence networks greatly influenced the dynamics of the epidemics, as compared to the random networks. In particular, average path lengths were longer in the college networks compared to random networks. Students in larger majors generally had shorter average path lengths than students in smaller majors. Average transitivity (clustering) was lower on days when students most frequently were in class (MWF). Degree distributions were generally large and right skewed, ranging from 0 to 719. Simulations began by inoculating twenty students (10 exposed and 10 infectious) with SARS-CoV-2 on the first day of the fall semester and ended once the disease was cleared. Transmission probability was calculated based on an R0 = 2.4. Without interventions epidemics resulted in most students becoming infected and lasted into the second semester. On average students in the college networks experienced fewer infections, shorter duration, and lower epidemic peaks when compared to the dynamics on equal-sized random networks. The most important factors in reducing case numbers were the proportion masking and the frequency of testing, followed by contact tracing and mask efficacy. The paper discusses further high-order interactions and other implications of non-pharmaceutical interventions for disease transmission on a residential college campus.

A worldwide assessment of changes in adherence to COVID-19 protective behaviours and hypothesized pandemic fatigue.

As the COVID-19 pandemic lingers, the possibility of 'pandemic fatigue' has raised worldwide concerns. Here, we examine whether there was a gradual reduction in adherence to protective behaviours against COVID-19 from March through December 2020, as hypothesized in expectations of fatigue. We considered self-report behaviours from representative samples of the populations of 14 countries (N = 238,797), as well as mobility and policy data for 124 countries. Our results show that changes in adherence were empirically meaningful and geographically widespread. While a low-cost and habituating behaviour (mask wearing) exhibited a linear rise in adherence, high-cost and sensitizing behaviours (physical distancing) declined, but this decline decelerated over time, with small rebounds seen in later months. Reductions in adherence to physical distancing showed little difference across societal groups, but were less intense in countries with high interpersonal trust. Alternative underlying mechanisms and policy implications are discussed.

Association between COVID-19 outcomes and mask mandates, adherence, and attitudes.

We extend previous studies on the impact of masks on COVID-19 outcomes by investigating an unprecedented breadth and depth of health outcomes, geographical resolutions, types of mask mandates, early versus later waves and controlling for other government interventions, mobility testing rate and weather. We show that mask mandates are associated with a statistically significant decrease in new cases (-3.55 per 100K), deaths (-0.13 per 100K), and the proportion of hospital admissions (-2.38 percentage points) up to 40 days after the introduction of mask mandates both at the state and county level. These effects are large, corresponding to 14% of the highest recorded number of cases, 13% of deaths, and 7% of admission proportion. We also find that mask mandates are linked to a 23.4 percentage point increase in mask adherence in four diverse states. Given the recent lifting of mandates, we estimate that the ending of mask mandates in these states is associated with a decrease of -3.19 percentage points in mask adherence and 12 per 100K (13% of the highest recorded number) of daily new cases with no significant effect on hospitalizations and deaths. Lastly, using a large novel survey dataset of 847 thousand responses in 69 countries, we introduce the novel results that community mask adherence and community attitudes towards masks are associated with a reduction in COVID-19 cases and deaths. Our results have policy implications for reinforcing the need to maintain and encourage mask-wearing by the public, especially in light of some states starting to remove their mask mandates.

Mathematical modeling of the transmission of SARS-CoV-2-Evaluating the impact of isolation in São Paulo State (Brazil) and lockdown in Spain associated with protective measures on the epidemic of CoViD-19.

Coronavirus disease 2019 (CoViD-19), with the fatality rate in elder (60 years old or more) being much higher than young (60 years old or less) patients, was declared a pandemic by the World Health Organization on March 11, 2020. A mathematical model considering young and elder subpopulations under different fatality rates was formulated based on the natural history of CoViD-19 to study the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The model considered susceptible, exposed, asymptomatic, pre-symptomatic, mild CoViD-19, severe CoViD-19, and recovered compartments, besides compartments of isolated individuals and those who were caught by test. This model was applied to study the epidemiological scenario resulting from the adoption of quarantine (isolation or lockdown) in many countries to control the rapid propagation of CoViD-19. We chose as examples the isolation adopted in São Paulo State (Brazil) in the early phase but not at the beginning of the epidemic, and the lockdown implemented in Spain when the number of severe CoViD-19 cases was increasing rapidly. Based on the data collected from São Paulo State and Spain, the model parameters were evaluated, and we obtained a higher estimation for the basic reproduction number R0 (9.24 for São Paulo State, and 8 for Spain) compared to the currently accepted estimation of R0 around 2 using the SEIR (susceptible, exposed, infectious, and recovered compartments) model. In comparison with the lockdown in Spain, the relatively early adoption of the isolation in São Paulo State resulted in enlarging the period of the first wave of the epidemic and delaying its peak. The model allowed to explain the flattening of the epidemic curves by quarantine when associated with the protective measures (face mask, washing hands with alcohol and gel, and social distancing) adopted by the population. The description of the epidemic under quarantine and protections can be a background to foreseen the epidemiological scenarios from the release strategies, which can help guide public health policies by decision-makers.

The impact of non-pharmaceutical interventions on COVID-19 epidemic growth in the 37 OECD member states.

We estimated the impact of a comprehensive set of non-pharmeceutical interventions on the COVID-19 epidemic growth rate across the 37 member states of the Organisation for Economic Co-operation and Development during the early phase of the COVID-19 pandemic and between October and December 2020. For this task, we conducted a data-driven, longitudinal analysis using a multilevel modelling approach with both maximum likelihood and Bayesian estimation. We found that during the early phase of the epidemic: implementing restrictions on gatherings of more than 100 people, between 11 and 100 people, and 10 people or less was associated with a respective average reduction of 2.58%, 2.78% and 2.81% in the daily growth rate in weekly confirmed cases; requiring closing for some sectors or for all but essential workplaces with an average reduction of 1.51% and 1.78%; requiring closing of some school levels or all school levels with an average reduction of 1.12% or 1.65%; recommending mask wearing with an average reduction of 0.45%, requiring mask wearing country-wide in specific public spaces or in specific geographical areas within the country with an average reduction of 0.44%, requiring mask-wearing country-wide in all public places or all public places where social distancing is not possible with an average reduction of 0.96%; and number of tests per thousand population with an average reduction of 0.02% per unit increase. Between October and December 2020 work closing requirements and testing policy were significant predictors of the epidemic growth rate. These findings provide evidence to support policy decision-making regarding which NPIs to implement to control the spread of the COVID-19 pandemic.

Mask adherence and rate of COVID-19 across the United States.

Mask wearing has been advocated by public health officials as a way to reduce the spread of COVID-19. In the United States, policies on mask wearing have varied from state to state over the course of the pandemic. Even as more and more states encourage or even mandate mask wearing, many citizens still resist the notion. Our research examines mask wearing policy and adherence in association with COVID-19 case rates. We used state-level data on mask wearing policy for the general public and on proportion of residents who stated they always wear masks in public. For all 50 states and the District of Columbia (DC), these data were abstracted by month for April ─ September 2020 to measure their impact on COVID-19 rates in the subsequent month (May ─ October 2020). Monthly COVID-19 case rates (number of cases per capita over two weeks) >200 per 100,000 residents were considered high. Fourteen of the 15 states with no mask wearing policy for the general public through September reported a high COVID-19 rate. Of the 8 states with at least 75% mask adherence, none reported a high COVID-19 rate. States with the lowest levels of mask adherence were most likely to have high COVID-19 rates in the subsequent month, independent of mask policy or demographic factors. Mean COVID-19 rates for states with at least 75% mask adherence in the preceding month was 109.26 per 100,000 compared to 249.99 per 100,000 for those with less adherence. Our analysis suggests high adherence to mask wearing could be a key factor in reducing the spread of COVID-19. This association between high mask adherence and reduced COVID-19 rates should influence policy makers and public health officials to focus on ways to improve mask adherence across the population in order to mitigate the spread of COVID-19.

Examining Common Characteristics Among Healthcare Personnel Positive for COVID-19 and the Effectiveness of Healthcare Personnel Mask Use in Preventing COVID-19 in a Large Health System in Central Michigan.

The aim of this quality improvement project was to survey commonalities among healthcare personnel (HCP) who tested positive for COVID-19 and to evaluate the effectiveness the organizational intervention to require HCP wear masks throughout their shift. Information regarding the 40 HCP who tested positive for COVID-19 between the dates of March 18, 2020 and May 13, 2020 were included in the analysis. Nurses (n = 9) made up the majority of HCP positive for COVID-19. The most common types of symptoms reported were cough (n = 26), headache (n = 20), and fever (n = 13). Fourteen days after the requirement for HCP across the organization to wear masks throughout their shift was implemented, a 67% reduction in positive tests among HCP involved in a workplace exposure was observed.

Pandemia da COVID-19: adaptação e avaliação psicométrica da "Face Mask Use Scale" / Pandemia de COVID-19: adaptación y evaluación psicométrica de la Face Mask Use Scale / COVID-19 pandemic: adaptation and psychometric assessment of the Face Mask Use Scale

Resumo Objetivo Adaptar culturalmente para o português do Brasil a Face Mask Use Scale e avaliar suas propriedades psicométricas. Métodos Estudo metodológico, transversal, com abordagem quantitativa, que compreendeu as etapas de: tradução; consenso da versão em português; avaliação por comitê de especialistas; retrotradução e comparação com a versão original; teste piloto e avaliação psicométrica da Face Mask Use Scale (FMUS). Resultados A versão original da FMUS foi traduzida para o português do Brasil. A validade de conteúdo foi realizada por um painel de cinco especialistas. O índice de validade de conteúdo para a escala (IVC-S/Ave) foi 0,87 e para os itens (IVC-I) variou de 0,6 a 1,0. A versão para o português do Brasil da FMUS (FMUS-PB) foi aplicada em 4822 adultos com idade média de 30 anos (DP = 11,7). Na consistência interna, o Alfa de Cronbach foi de 0,86. O modelo original de dois fatores da FMUS não se mostrou adequado para a população brasileira pelo uso da análise fatorial confirmatória e exploratória. Assim, realizou-se uma análise fatorial exploratória para investigar a estrutura fatorial da FMUS-PB novamente e um novo modelo potencial da FMUS-PB para melhor explicação. A FMUS-PB apresentou estrutura fatorial diferente do modelo original. Os itens foram alinhados em um único fator, criando um instrumento unidimensional que explicou 59,7% da variância total. A validade de construto por grupos conhecidos foi satisfatória (p <0,001). Conclusão A FMUS-PB é confiável e válida para medir a prática do uso de máscaras entre a população brasileira, sobretudo na pandemia da COVID-19.

Resumen Objetivo Adaptar culturalmente la Face Mask Use Scale al portugués de Brasil y evaluar sus propiedades psicométricas. Métodos Estudio metodológico, transversal, con enfoque cualitativo, que comprendió las siguientes etapas: traducción, consenso de la versión en portugués, evaluación de comité de especialistas, retrotraducción y comparación con la versión original, prueba piloto y evaluación psicométrica de la Face Mask Use Scale (FMUS). Resultados La versión original de la FMUS fue traducida al portugués de Brasil. La validez de contenido fue realizada por un panel de cinco especialistas. El índice de validez de contenido de la escala (IVC-S/Ave) fue 0,87 y el de los ítems (IVC-I) varió de 0,6 a 1,0. La versión en portugués de Brasil de la FMUS (FMUS-PB) fue aplicada a 4.822 adultos de edad promedio de 30 años (DP = 11,7). En la consistencia interna, el Alfa de Cronbach fue de 0,86. El modelo original de dos factores de la FMUS demostró no ser adecuado para la población brasileña mediante el uso del análisis factorial confirmatorio y exploratorio. De esta forma, se realizó un análisis factorial exploratorio para investigar la estructura factorial de la FMUS-PB nuevamente y un nuevo modelo posible de la FMUS-PB para una mejor explicación. La FMUS-PB presentó una estructura factorial diferente al modelo original. Los ítems fueron alineados en un único factor y se creó un instrumento unidimensional que explicó el 59,7 % de la varianza total. La validez del constructo por grupos conocidos fue satisfactoria (p < 0,001). Conclusión La FMUS-PB es confiable y válida para medir la práctica del uso de mascarillas en la población brasileña, sobre todo durante la pandemia de COVID-19.

Abstract Objective To culturally adapt the Face Mask Use Scale to Brazilian Portuguese and assess its psychometric properties. Methods This is a methodological, cross-sectional, quantitative study, which comprised the following steps: translation; Portuguese version consensus; assessment by an expert committee; back-translation and comparison with the original version; pilot test; and psychometric assessment of the Face Mask Use Scale (FMUS). Results The original version of FMUS was translated into Brazilian Portuguese. Content validity was performed by a panel of five experts.The Content Validity Index for the scale (CVI-S/Ave) was 0.87 and for the items (CVI-I) it ranged from 0.6 to 1.0. The FMUS - Brazilian Portuguese version (FMUS-BP) was applied to 4822 adults with a mean age of 30 years (SD = 11.7).For internal consistency, Cronbach's alpha was 0.86. The original two-factor model of the FMUS was not suitable for the Brazilian population due to the use of Exploratory Factor Analysis and Confirmatory Factor Analysis. Thus, an Exploratory Factor Analysis was carried out to investigate the factor structure of the FMUS-BP again and a new potential model of the FMUS-BP for better explanation.The FMUS-BP presented a factor structure different from the original model. Items were aligned on a single factor, creating a one-dimensional instrument that explained 59.7% of the total variance. Construct validity by known-groups was satisfactory (p <0.001). Conclusion The FMUS-BP is reliable and valid to measure the practice of using masks among the Brazilian population, especially in the COVID-19 pandemic.

Low-cost measurement of face mask efficacy for filtering expelled droplets during speech.

Mandates for mask use in public during the recent coronavirus disease 2019 (COVID-19) pandemic, worsened by global shortage of commercial supplies, have led to widespread use of homemade masks and mask alternatives. It is assumed that wearing such masks reduces the likelihood for an infected person to spread the disease, but many of these mask designs have not been tested in practice. We have demonstrated a simple optical measurement method to evaluate the efficacy of masks to reduce the transmission of respiratory droplets during regular speech. In proof-of-principle studies, we compared a variety of commonly available mask types and observed that some mask types approach the performance of standard surgical masks, while some mask alternatives, such as neck gaiters or bandanas, offer very little protection. Our measurement setup is inexpensive and can be built and operated by nonexperts, allowing for rapid evaluation of mask performance during speech, sneezing, or coughing.

Measures of infection prevention and incidence of SARS-CoV-2 infections in cancer patients undergoing radiotherapy in Germany, Austria and Switzerland.

PURPOSE: COVID-19 infection has manifested as a major threat to both patients and healthcare providers around the world. Radiation oncology institutions (ROI) deliver a major component of cancer treatment, with protocols that might span over several weeks, with the result of increasing susceptibility to COVID-19 infection and presenting with a more severe clinical course when compared with the general population. The aim of this manuscript is to investigate the impact of ROI protocols and performance on daily practice in the high-risk cancer patients during this pandemic. METHODS: We addressed the incidence of positive COVID-19 cases in both patients and health care workers (HCW), in addition to the protective measures adopted in ROIs in Germany, Austria and Switzerland using a specific questionnaire. RESULTS: The results of the questionnaire showed that a noteworthy number of ROIs were able to complete treatment in SARS-CoV­2 positive cancer patients, with only a short interruption. The ROIs reported a significant decrease in patient volume that was not impacted by the circumambient disease incidence, the type of ROI or the occurrence of positive cases. Of the ROIs 16.5% also reported infected HCWs. About half of the ROIs (50.5%) adopted a screening program for patients whereas only 23.3% also screened their HCWs. The range of protective measures included the creation of working groups, instituting home office work and protection with face masks. Regarding the therapeutic options offered, curative procedures were performed with either unchanged or moderately decreased schedules, whereas palliative or benign radiotherapy procedures were more often shortened. Most ROIs postponed or cancelled radiation treatment for benign indications (88.1%). The occurrence of SARS-CoV­2 infections did not affect the treatment options for curative procedures. Non-university-based ROIs seemed to be more willing to change their treatment options for curative and palliative cases than university-based ROIs. CONCLUSION: Most ROIs reported a deep impact of SARS-CoV­2 infections on their work routine. Modification and prioritization of treatment regimens and the application of protective measures preserved a well-functioning radiation oncology service and patient care.

Face mask use in the general population and optimal resource allocation during the COVID-19 pandemic.

The ongoing novel coronavirus disease (COVID-19) pandemic has already infected millions worldwide and, with no vaccine available, interventions to mitigate transmission are urgently needed. While there is broad agreement that travel restrictions and social distancing are beneficial in limiting spread, recommendations around face mask use are inconsistent. Here, we use mathematical modeling to examine the epidemiological impact of face masks, considering resource limitations and a range of supply and demand dynamics. Even with a limited protective effect, face masks can reduce total infections and deaths, and can delay the peak time of the epidemic. However, random distribution of masks is generally suboptimal; prioritized coverage of the elderly improves outcomes, while retaining resources for detected cases provides further mitigation under a range of scenarios. Face mask use, particularly for a pathogen with relatively common asymptomatic carriage, is an effective intervention strategy, while optimized distribution is important when resources are limited.

Older Adults' Intention to Socially Isolate Once COVID-19 Stay-at-Home Orders Are Replaced With "Safer-at-Home" Public Health Advisories: A Survey of Respondents in Maryland.

Background: The Theory of Planned Behavior (TPB) and the Health Belief Model (HBM) were used to examine the opinion and behaviors of older adults regarding Coronavirus Disease 2019 (COVID-19), social distancing practices, stay-at-home orders, and hypothetical public policy messaging strategies. Method: A convenience sample (N = 242) of adults 60 and older in the state of Maryland took part in an online survey. Respondents filled out questions regarding demographic information, political affiliation, current social distancing behaviors, and TPB and HBM constructs in our proposed model. Linear regression analysis and analysis of covariance (ANCOVA) were conducted to test the model. Results: Attitude toward social isolation was affected by perceived benefits and barriers to social distancing measures, perceived severity of COVID-19, and political affiliation. Behavior intention was influenced by attitude, subjective norms, political affiliation, and messaging strategies. Conclusion: The study provides support for the conceptual model and has public policy implications as authorities begin to lift stay-at-home orders.

Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus.

A pandemic of a novel Coronavirus emerged in December of 2019 (COVID-19), causing devastating public health impact across the world. In the absence of a safe and effective vaccine or antivirals, strategies for controlling and mitigating the burden of the pandemic are focused on non-pharmaceutical interventions, such as social-distancing, contact-tracing, quarantine, isolation, and the use of face-masks in public. We develop a new mathematical model for assessing the population-level impact of the aforementioned control and mitigation strategies. Rigorous analysis of the model shows that the disease-free equilibrium is locally-asymptotically stable if a certain epidemiological threshold, known as the reproduction number (denoted by ℛc), is less than unity. Simulations of the model, using data relevant to COVID-19 transmission dynamics in the US state of New York and the entire US, show that the pandemic burden will peak in mid and late April, respectively. The worst-case scenario projections for cumulative mortality (based on the baseline levels of anti-COVID non-pharmaceutical interventions considered in the study) decrease dramatically by 80% and 64%, respectively, if the strict social-distancing measures implemented are maintained until the end of May or June, 2020. The duration and timing of the relaxation or termination of the strict social-distancing measures are crucially-important in determining the future trajectory of the COVID-19 pandemic. This study shows that early termination of the strict social-distancing measures could trigger a devastating second wave with burden similar to those projected before the onset of the strict social-distancing measures were implemented. The use of efficacious face-masks (such as surgical masks, with estimated efficacy ≥ 70%) in public could lead to the elimination of the pandemic if at least 70% of the residents of New York state use such masks in public consistently (nationwide, a compliance of at least 80% will be required using such masks). The use of low efficacy masks, such as cloth masks (of estimated efficacy less than 30%), could also lead to significant reduction of COVID-19 burden (albeit, they are not able to lead to elimination). Combining low efficacy masks with improved levels of the other anti-COVID-19 intervention strategies can lead to the elimination of the pandemic. This study emphasizes the important role social-distancing plays in curtailing the burden of COVID-19. Increases in the adherence level of social-distancing protocols result in dramatic reduction of the burden of the pandemic, and the timely implementation of social-distancing measures in numerous states of the US may have averted a catastrophic outcome with respect to the burden of COVID-19. Using face-masks in public (including the low efficacy cloth masks) is very useful in minimizing community transmission and burden of COVID-19, provided their coverage level is high. The masks coverage needed to eliminate COVID-19 decreases if the masks-based intervention is combined with the strict social-distancing strategy.

Impact of the Healthcare System, Macro Indicator, General Mandatory Quarantine, and Mask Obligation on COVID-19 Cases and Death in Six Latin American Countries: An Interrupted Time Series Study.

Background: Different coping strategies have been implemented by various governments worldwide to address the emerging health crisis of COVID-19. While most developed countries count on supporting healthcare and social systems, developing countries face additional challenges due to low macro indicators. The implementation of measurements such as quarantine are shown to be successful to flatten the curve of infection and death. In this context, it is important to test whether those measurements have an impact on the distribution of cases of COVID-19 in developing countries that face additional challenges such as lack of social security due to informal employment. A country comparison for Colombia, Costa Rica, Peru, Ecuador, Mexico, and Chile has therefore been conducted. Method: The healthcare systems and macro indicator as well as the distribution of death due to COVID-19 per thousand inhabitants are compared descriptively. Using Multiple Interrupted Time Series Analysis with synthetic control units the impact of the General Mandatory Quarantine in Colombia, Peru, and Ecuador as well as the impact of Mask Obligation in public in Colombia and Chile have been tested. Results: No clear impact of the poverty headcount ratio at the national poverty line and urban population on the percentage of death within the confirmed cases has been found. The out-of-pocked spending within health expenditure as a barrier in access to healthcare can be considered as a determinant of death within the confirmed cases of COVID-19. The implementation of a general mandatory quarantine did not show a curve-flattening effect in Ecuador and Peru but did so in Colombia. The implementation of Mask obligation in public spaced showed positive impact on the distribution of confirmed case in both countries tested. Conclusion: The implementation of a general mandatory quarantine does not guarantee the curve-flattening effect. Various macro indicators should therefore always be considered while analyzing the effect of policies.