The good news: More people are wearing masks now than during the pandemic’s early stages. But that’s the only nonpharmaceutical intervention that seems to have gained a large number of followers, which is especially concerning because the pandemic is still raging, COVID-19 vaccination is still rolling out, and several documented instanced of community spread of more transmissible coronavirus variants have been documented in the United States.

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In November, 88.6% of people responding to a survey reported that they wore a mask or face covering, more than double the 39.2% of people who said so in April 2020, according to a research letter recently published in JAMA. Those findings track with other recent surveys on the topic.

For the most part, people reported that they took fewer precautions in November than in April, the research showed. Nationally, the self-reported adherence rate to 16 evidenced-based protective behaviors was 70% in early April. It plateaued in the high 50s in June and increased to 60.1% in late November, according to the research letter, “Change in Reported Adherence to Nonpharmaceutical Interventions During the COVID-19 Pandemic, April–November 2020.”

Which behaviors saw the biggest dip between April and November, before vaccines were available?

  • Remaining in residence except for essential activities or exercise dropped from 79.6% to 41.1%. 
  • Having no close contact with nonhousehold members dropped from 63.5% to 37.8%. 
  • Not having visitors over dropped from 80.3% to 57.6%. 
  • Avoiding eating at restaurants dropped from 87.3% to 65.8%.

When the country’s COVID-19 death toll surpassed the 400,000 mark in January, AMA President Susan R. Bailey, MD, noted that patients have tragically died “often alone, typically away from family and friends—comforted only by physicians and nurses in layers” of personal protective equipment.

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“With a more contagious strain of COVID-19 spreading rapidly across the country, the simple steps we’ve advocated for months are more important than ever: wear your mask, practice physical distancing, and wash your hands, to help reduce illness and deaths,” Dr. Bailey said. “Vaccine distribution is underway, and there is hope on the horizon. Vaccines are safe, effective, prevent illness and save lives. Protect yourselves and your loved ones by getting the COVID-19 vaccine when it’s your turn.”  

Mask messaging

The mask-wearing gains may reflect improved public health messaging, researchers wrote. There is more known about the important role masks can play in helping stop COVID-19’s spread than there was early in the pandemic.

The AMA is part of the #MaskUp campaign, an effort with the American Hospital Association and American Nurses Association to normalize mask-wearing and debunk myths about the vital safety practice. It includes a toolkit with images that can be shared on social media and in your office.

Study authors say one limitation is that the survey relied on self-reported behaviors, which may not reflect people’s actual behaviors. The findings are based on 7,705 responses to the “Coronavirus Tracking Survey” completed between April 1, 2020, and Nov. 24, 2020.

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In related work, as part of its “Understanding Coronavirus in America” study, researchers from the University of Southern California Center for Economic and Social Research recently analyzed data from 6,000 members drawn from its “Understanding America Study.” Data was collected between March 10, 2020, and Jan. 6, 2021, and found that 83% of adults surveyed view wearing a mask as an effective way to stay safe from COVID-19, but that their behavior is inconsistent.

The analysis found:

  • Two-thirds reported being within less than six feet of someone outside their household in early December, but only half mostly or always wore a mask while doing so. 
  • White people were the least likely to consistently wear a mask when in close contact with people from other households, with 46% reporting wearing a mask compared to 67% of black people, 63% of Latinos and 65% of people of other races. 
  • In rural areas, 42% reported always wearing a mask or wearing one most of the time when they were with people outside of their household. In suburban areas, the number jumped to 52% and it was highest in urban areas at 57%. 
  • Among the 81% who said they went grocery shopping in early December, 90% reported wearing a mask.

Stay up to speed on the AMA’s COVID-19 advocacy efforts and track the fast-moving pandemic with the AMA's COVID-19 resource center, which offers a library of the most up-to-date resources from JAMA Network™, the Centers for Disease Control and Prevention, and the World Health Organization.

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