Fewer stayed home, more wore masks as pandemic wore on

Self-reported adherence to such coronavirus-curbing behaviors as physical distancing fell substantially—while mask wearing rose significantly—from spring to fall 2020, regardless of US Census region, according to a research letter published late last week in JAMA.

The study, led by scientists from Johns Hopkins University, analyzed responses to 16 waves of the national Coronavirus Tracking Survey from Apr 1 to Nov 24, 2020. The respondents were recruited from the University of Southern California's Understanding America Study, an ongoing nationwide panel of US residents.

The researchers asked all participants to complete a survey every 14 days on 16 evidence-based nonpharmaceutical interventions (NPIs) vulnerable to COVID-19 pandemic fatigue, or apathy due to prolonged coronavirus-related isolation, uncertainty, and disruptions. Participants were provided with internet-connected tablet computers if they didn't have a way to access the survey website.

The authors scored the responses by creating an NPI adherence index that adds the number of self-reported protective behaviors during the week before the survey, with scores ranging from 0 to 100, with higher scores indicating better compliance.

Among the 7,705 participants who completed all survey waves, the NPI index showed peak compliance at the beginning of the pandemic (70.0 in early April), a leveling off in June (high 50s), and a slight climb to 60.1—but still much lower than in the spring—at the end of the survey in November.

Midwest sees largest drop in compliance

All regions saw decreases in NPI index scores from April to November, including a decline from 70.0 to 60.5 in the South, 71.5 to 62.2 in the West, and 70.8 to 62.4 in the Northeast, with the biggest drop in the Midwest (70.3 to 54.4).

In the final survey week in November, the NPI adherence index was significantly lower in the Midwest compared with the South (P = 0.003), West (P < 0.001), and Northeast (P = 0.001).

Participants reported the largest declines in weighted and adjusted compliance over the study in staying home except for exercise or essential activities (79.6% to 41.1%), having no close contact with people outside of their household (63.5% to 37.8%), refraining from having visitors in their home (80.3% to 57.6%), and avoiding restaurant dining (87.3% to 65.8%) (all P < 0.001).

However, participants reported significantly more compliance with wearing face coverings (39.2% to 88.6%) (P  < 0.001). The authors said that the rise in mask wearing is similar to that reported in other national surveys and may reflect more effective or pervasive public health messaging.

They noted that their study was limited by a reliance on self-reported behaviors and the use of an unvalidated NPI compliance index.

"Strategic approaches to combating pandemic fatigue have been proposed, such as precision in government mandates and consistent communication from authorities," the researchers wrote. "Additional research is necessary to understand the differential effect of NPIs in reducing COVID-19 transmission and to inform where policy interventions and public health messaging may be most effective."

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