What is already known about this topic? Wearing masks is recommended to mitigate the spread of COVID-19.

What is added by this report? During March 22–October 17, 2020, 10 sites participating in the COVID-19–Associated Hospitalization Surveillance Network in states with statewide mask mandates reported a decline in weekly COVID-19–associated hospitalization growth rates by up to 5.5 percentage points for adults aged 18–64 years after mandate implementation, compared with growth rates during the 4 weeks preceding implementation of the mandate.

What are the implications for public health practice? Mask-wearing is a component of a multipronged strategy to decrease exposure to and transmission of SARS-CoV-2 and reduce strain on the health care system, with likely direct effects on COVID-19 morbidity and associated mortality.

SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is transmitted predominantly by respiratory droplets generated when infected persons cough, sneeze, spit, sing, talk, or breathe. CDC recommends community use of face masks to prevent transmission of SARS-CoV-2 (1). As of October 22, 2020, statewide mask mandates were in effect in 33 states and the District of Columbia (2). This study examined whether implementation of statewide mask mandates was associated with COVID-19–associated hospitalization growth rates among different age groups in 10 sites participating in the COVID-19–Associated Hospitalization Surveillance Network (COVID-NET) in states that issued statewide mask mandates during March 1–October 17, 2020. Regression analysis demonstrated that weekly hospitalization growth rates declined by 2.9 percentage points (95% confidence interval [CI] = 0.3–5.5) among adults aged 40–64 years during the first 2 weeks after implementing statewide mask mandates. After mask mandates had been implemented for ≥3 weeks, hospitalization growth rates declined by 5.5 percentage points among persons aged 18–39 years (95% CI = 0.6–10.4) and those aged 40–64 years (95% CI = 0.8–10.2). Statewide mask mandates might be associated with reductions in SARS-CoV-2 transmission and might contribute to reductions in COVID-19 hospitalization growth rates, compared with growth rates during <4 weeks before implementation of the mandate and the implementation week. Mask-wearing is a component of a multipronged strategy to decrease exposure to and transmission of SARS-CoV-2 and reduce strain on the health care system, with likely direct effects on COVID-19 morbidity and associated mortality.

Data on statewide mask mandates during March 1–October 22, 2020, were obtained by CDC and the University of Nevada, Las Vegas, from state government websites containing executive or administrative orders, which were analyzed and coded to extract effective dates of statewide mask mandates. A statewide mask mandate was defined as the requirement that persons operating in a personal capacity (i.e., not limited to specific professions or employees) wear a mask 1) anywhere outside their home or 2) in retail businesses and in restaurants or food establishments. All coding and analyses underwent secondary review and quality assurance checks by two or more raters; upon agreement among all raters, coding and analyses were published in a freely available data set (2).

Suggested citation for this article: Joo H, Miller GF, Sunshine G, et al. Decline in COVID-19 Hospitalization Growth Rates Associated with Statewide Mask Mandates — 10 States, March–October 2020. MMWR Morb Mortal Wkly Rep. ePub: 5 February 2021.

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