Differential Associations of Mask Mandates on COVID-19 Infection and Mortality by Community Social Vulnerability

BACKGROUND: The COVID-19 pandemic in the U.S. has disproportionately impacted communities deemed vulnerable to disease outbreaks. Our objectives were to test 1) whether infection and mortality decreased in counties in the most vulnerable (highest) tercile of the Social Vulnerability Index (SVI), and 2) whether disparities between terciles of SVI were reduced, as the length of mask mandates increased. METHODS: Using the New York Times COVID-19 and the CDC SVI and mask mandate datasets, we conducted negative binomial regression analyses of county-level COVID-19 cases and deaths from 1/2020 to 11/2021 on interactions of SVI and mask mandate durations. RESULTS: Mask mandates were associated with decreases in mid-SVI cases (IRR: 0.79) and deaths (IRR: 0.90) and high-SVI cases (IRR: 0.89) and deaths (IRR: 0.88). Mandates were associated with mitigation of infection disparities (Change in IRR: 0.92) and mortality disparities (Change in IRR: 0.85) between low and mid-SVI counties and mortality disparities between low and high-SVI counties (Change in IRR: 0.84). DISCUSSION: Mask mandates were associated with reductions in COVID-19 infection and mortality, and mitigation of disparities for mid and high vulnerability communities. CONCLUSION: Ongoing COVID-19 response efforts may benefit from longer-standing infection control policies, particularly in the most vulnerable communities.