Inconsistent with the intent of public health strategies on incidence and fatality in states with extra mandatory stay-at-home and face masks orders during COVID-19 pandemic in the US

Wu, X.; Wu, S. X.

Backgrounds: Coronavirus disease 2019 (COVID-19) is now recognized as a multi-system disease. The CDC recommends multiple preventive methods, including social distancing, hand hygiene, and wearing masks. In addition, some states imposed mandatory stay-at-home (SAH) and mandatory face mask (MFM) orders, to reduce the spread of COVID-19. The purpose of this study was to characterize the relationship between SAH and MFM approaches with the incidence and fatality. The research design is a cross-sectional study examining changes in incidence and fatality between states with and without SAH and MFM using available database from CDC during the pandemic periods of the date of the first positive case of each state to the date of 2020-08-23. Results: The daily new cases curve of the nation was flattened under the order of SAH and increased following the end of SAH and several nation-wide social gathering events. There were similar incidence rates among SAH + MFM states (95% CI, 1.19% to 1.64%. n=34), SAH + no-MFM states (95% CI, 1.26% to 2.36%. n=9) and no-SAH + no-MFM (95% CI, 1.08% to 1.63%. n=7). However, SAH+MFM states (n=34), SAH+no-MFM states (n=9) had significantly higher averages in daily new cases and daily fatality, case-fatality-ratio (CFR) and mortality rate (per 100,000 residents) than no-SAH+no-MFM states during pandemic periods (about 171 days), respectively. When normalized to population density, beside higher CFR in no-SAH+no-MFM, there were no significant differences in total positive cases, average daily new cases and average daily fatality among the 3 groups during the pandemic periods. When comparing incidence during the period of SAH (about 45 days. n=43 states), there were significantly higher incidence rates and average daily new cases in MFM states (n=12) than in no-MFM states (n=31). When normalized to population density, there were no significant differences in total positive cases and average daily new cases between the 2 groups during the period of SAH. Conclusion: This study provided direct evidence of a potential decreased in testing positivity rates, and a decreased fatality to save life when normalized by population density through strategies of SAH + MFM order during the COVID-19 pandemic. However, overall, our results were inconsistent with the intent of public health strategies of SAH and MFM in lowering transmission and fatality. From the policy making level, even if we can not strictly isolate contagious source patients in separate isolated places and without effective massive contact tracing, we presume that following the CDC recommendations with sufficient testing, could be appropriate to help in mitigate the COVID-19 disaster with close monitoring of healthcare capacity.