The impact of mask-wearing and shelter-in-place on COVID-19 outbreaks in the United States

Int J Infect Dis. 2020 Dec;101:334-341. doi: 10.1016/j.ijid.2020.10.002. Epub 2020 Oct 9.


Objectives: A hasty reopening has led to a resurgence of the novel coronavirus disease 2019 (COVID-19) in the United States (US). We aimed to quantify the impact of several public health measures including non-medical mask-wearing, shelter-in-place, and detection of silent infections to help inform COVID-19 mitigation strategies.

Methods: We extended a previously established agent-based disease transmission model and parameterized it with estimates of COVID-19 characteristics and US population demographics. We implemented non-medical mask-wearing, shelter-in-place, and case isolation as control measures, and quantified their impact on reducing the attack rate and adverse clinical outcomes.

Results: We found that non-medical mask-wearing by 75% of the population reduced infections, hospitalizations, and deaths by 37.7% (interquartile range (IQR): 36.1-39.4%), 44.2% (IQR: 42.9-45.8%), and 47.2% (IQR: 45.5-48.7%), respectively, in the absence of a shelter-in-place strategy. Sheltering individuals aged 50 to 64 years of age was the most efficient strategy, decreasing attack rate, hospitalizations, and deaths by over 82% when combined with mask-wearing. Outbreak control was achieved in the simulated scenarios and the attack rate was reduced to below 1% when at least 33% of silent pre-symptomatic and asymptomatic infections were identified and isolated.

Conclusions: Mask-wearing, even with the use of non-medical masks, has a substantial impact on outbreak control. A judicious implementation of shelter-in-place strategies remains an important public health intervention amid ongoing outbreaks.

Keywords: COVID-19; Isolation; Mask-wearing; Shelter-in-place.

MeSH terms

  • COVID-19 / epidemiology*
  • COVID-19 / prevention & control*
  • COVID-19 / therapy
  • COVID-19 / virology
  • Disease Outbreaks
  • Emergency Shelter*
  • Hospitalization
  • Humans
  • Incidence
  • Masks*
  • Pandemics / prevention & control
  • Public Health
  • SARS-CoV-2 / physiology
  • United States / epidemiology