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Duration of Behavioral Policy Interventions and Incidence of COVID-19 by Social Vulnerability of US Counties, April–December 2020

Objective: State-issued behavioral policy interventions (BPIs) can limit community spread of COVID-19, but their effects on COVID-19 transmission may vary by level of social vulnerability in the community. We examined the association between the duration of BPIs and the incidence of COVID-19 across levels of social vulnerability in US counties. Methods: We used COVID-19 case counts from USAFacts and policy data on BPIs (face mask mandates, stay-at-home orders, gathering bans) in place from April through December 2020 and the 2018 Social Vulnerability Index (SVI) from the Centers for Disease Control and Prevention. We conducted multilevel linear regression to estimate the associations between duration of each BPI and monthly incidence of COVID-19 (cases per 100 000 population) by SVI quartiles (grouped as low, moderate low, moderate high, and high social vulnerability) for 3141 US counties. Results: Having a BPI in place for longer durations (ie, ≥2 months) was associated with lower incidence of COVID-19 compared with having a BPI in place for <1 month. Compared with having no BPI in place or a BPI in place for <1 month, differences in marginal mean monthly incidence of COVID-19 per 100 000 population for a BPI in place for ≥2 months ranged from –4 cases in counties with low SVI to –401 cases in counties with high SVI for face mask mandates, from –31 cases in counties with low SVI to –208 cases in counties with high SVI for stay-at-home orders, and from –227 cases in counties with low SVI to –628 cases in counties with high SVI for gathering bans. Conclusions: Establishing COVID-19 prevention measures for longer durations may help reduce COVID-19 transmission, especially in communities with high levels of social vulnerability.