Mobility was a significant determinant of reported COVID-19 incidence during the Omicron Surge in the most populous U.S. Counties

BACKGROUND: Significant immune escape by the Omicron variant, along with the emergence of widespread worry fatigue, have called into question the robustness of the previously observed relation between population mobility and COVID-19 incidence. METHODS: We employed principal component analysis to construct a one-dimensional summary indicator of six Google mobility categories. We related this mobility indicator to case incidence among 111 of the most populous U.S. counties during the Omicron surge from December 2021 through February 2022. RESULTS: Reported COVID-19 incidence peaked earlier and declined more rapidly among those counties exhibiting more extensive decline in mobility between December 20 and January 3. Based upon a fixed-effects, longitudinal cohort model, we estimated that every 1% decline in mobility between December 20 and January 3 was associated with a 0.63% decline in peak incidence during the week ending January 17 (95% confidence interval, 0.40–0.86%). Based upon a cross-sectional analysis including mean household size and vaccination participation as covariates, we estimated that the same 1% decline in mobility was associated with a 0.36% decline in cumulative reported COVID-19 incidence from January 10 through February 28 (95% CI, 0.18–0.54%). CONCLUSION: Omicron did not simply sweep through the U.S. population until it ran out of susceptible individuals to infect. To the contrary, a significant fraction managed to avoid infection by engaging in risk-mitigating behaviors. More broadly, the behavioral response to perceived risk should be viewed as an intrinsic component of the natural course of epidemics in humans. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-022-07666-y.