COVID-19: state population coverage by mask orders in the US

Introduction

As the COVID-19 pandemic proceeded through the US in 2020, face masks as preventive devices grew in importance¹. The US Centers for Disease Control (CDC) and US President Trump first recommended the wearing of face masks on April 3, 2020^2,3. The World Health Organization made a interim recommendation on April 6⁴. The first local government order in the US that we found was issued by the San Diego County Council on April 3⁵; this order covered retail employees. New Jersey was the first state to have a mask order, issued by Governor Phil Murphy on April 8⁶. Since then US city and county lawmakers, tribal councillors, and state governors have enacted an assortment of mask orders and, in some cases, subsequently altered them^7‐9. The result is a patchwork of orders across the nation, with a mixture of types of authorities, varying start dates, change or termination dates, and opt-out rules, all of which have contributed to the amount of COVID-19 protection within each state. Given the importance of masks in slowing down the spread of the virus¹⁰, we estimated the degree of protection - measured in terms of person days of coverage - across states.

Methods

Our goal is to estimate the percentage of person days in each state that were either covered by city, tribal council, county, or state orders, or that were not covered, during the period April 3 to November 30, 2020 (a maximum of 241 days). Person days are the product of days in a region (241) and the region’s population. Mask days (days in a region during which there was a mask order in effect) were calculated for each type of government. The calculated percentage is obtained by t mask days divided by person days.

There are a few cities that are not in any county; they are standalone entities called “independent cities.” Baltimore, Maryland; St. Louis, Missouri; Carson City, Nevada; and 38 cities in Virginia²³ are independent cities; we classify them as cities. Also, there are several cities - New Orleans, Louisiana; Anchorage and Juneau, Alaska- whose boundaries coincide with those of the counties. The Census Bureau calls them “consolidated cities”²⁴; we consider these as counties.

Results

By the first half of April 2020, legislators in nine states had issued mask orders (See Figure 1) and by the end of June, this number had grown to 40. Data for the initiation dates for each state are provided in a data set.

Figure 1. Distribution among states of the period that a mask order came into effect.

We divided time periods into 15 day increments, beginning April 1, 2020. The first mask order was on April 3.

The average degree of coverage for all states between April 3 and November 30 was 57.7%. Of the nation’s population, 48.6% received coverage under statewide mandates, 6.5% under county mandates, and 2.7% under municipal orders. During the time period covered in our study, states which enacted statewide mandates had an average coverage of 67.1% for all mask days (including those generated by municipal and county mandates); states in which the governors did not introduce statewide mandates had 27.1% coverage from municipal or county orders.

The degree of coverage and source of order by state is shown in Figure 2. New Jersey had the highest degree of coverage (97.9% of all person days) because of its early start in introducing a statewide mandate. Of those states without statewide coverage, Arizona and Florida had large county components which kept their non-coverage ratios in the mid-range. Among the states with lower levels of mask coverage, Alaska and Oklahoma had relatively high degrees of municipal coverage.

Figure 2. Mask days: state breakdowns by source of order.

Percent breakdown in each state of person days into days under mask order and days without any mask order. Days under mask orders are further broken down by source of mandate - state (green), municipal (yellow) and county (blue). Mask-days with no government orders are colored red.

Discussion

The proportion of person days between April 3 and November 30, 2020 that came under face mask orders varied considerably by state. South Dakota had the lowest percent coverage and New Jersey the highest. There was also a variation by the source of the order: states with only local orders exhibited an average coverage of 27.1% of all person days while those which included state orders exhibited an average of 67.1%.

We brought together mask order duration and population to measure the relative degree of coverage of mask policies by state. There are numerous lists of mask orders that indicate the dates of the orders; these were found in news reports and in state and local government web pages^7‐9. However, they have not been brought together to indicate duration of coverage that was weighted by populations. Thus, the degree of population coverage of the mask policies are not indicated in any of these sources.

While the ratio of mask days to person days for each state has been estimated, we should point out some qualifications when interpreting these statistics as indicators of COVID-19 preventive activities.

In conclusion, leadership regarding mask-wearing came from the state level of government. Among the states with the greatest percentage of mask-order person days, state leadership was prominent. In those states with the lowest level of coverage, local government leadership predominated.

Data availability