During May 5–12, 2020, a survey among adults in New York City (NYC) and Los Angeles (LA) and broadly across the United States (US) found widespread support of stay-at-home orders and nonessential business closures and high degree of adherence to COVID-19 mitigation guidelines. At the time of the survey, most respondents reported that they would feel unsafe if restrictions were lifted.
Current levels of public support for restrictions and adherence to mitigation strategies can inform decisions about reopening and balancing duration and intensity of restrictions.
This week’s national ensemble forecast suggests that there will likely be between 124,000 and 140,000 total reported COVID-19 deaths by July 4. The state-level ensemble forecasts suggest that the number of new deaths over the next four weeks in Arizona, Arkansas, Hawaii, North Carolina, Utah and Vermont will likely exceed the number reported over the last four weeks. For other states, the number of new deaths is expected to be similar or decrease slightly compared to the previous four weeks.
SARS-CoV-2, the virus that cause COVID-19, is thought to be transmitted mainly by person-to-person contact. Implementation of nationwide public health orders to limit person-to-person interaction and of guidance on personal protective practices can slow transmission. Such strategies can include stay-at-home orders, business closures, prohibitions against mass gatherings, use of cloth face coverings and maintenance of a physical distance between persons.
Periodic assessments of public attitudes, behaviors, and beliefs can guide evidence-based public health decision-making and related prevention messaging about mitigation strategies needed as the COVID-19 pandemic evolves.
To assess and understand public attitudes, behaviors and beliefs related to this guidance and COVID-19, during May 5–12, 2020, a total of 4,042 adults aged ≥18 years in the United States were invited to complete a web-based survey administered by Qualtrics, LLC. Surveys were conducted among residents of NYC and LA to enable comparison of the two most populous cities in the US with each other and with the nationwide cohort. Invited participants were recruited using methods to create panels representative of the 2010 US Census by age, gender, race and ethnicity. Questions about the effects of the COVID-19 pandemic focused on public attitudes, behaviors and beliefs regarding stay-at-home orders, nonessential business closures and public health guidance.
Most respondents in the three cohorts supported stay-at-home orders and nonessential business closures (US, 79.5%; NYC, 86.7%; and LA, 81.5%), reported always or often wearing cloth face coverings in public areas (US, 74.1%, NYC, 89.6%; and Los Angeles 89.8%), and believed that their state’s restrictions were the right balance or not restrictive enough (US, 84.3%; NYC, 89.7%; and LA, 79.7%).
Among respondents in the US cohort (1,676), 16.8% knew someone who had positive test results for COVID-19, compared with 42.0% of respondents in NYC and 10.8% in LA); 5.9% of respondents in the US survey cohort knew someone who had died from COVID-19, compared with 23.1% in NYC and 7.3% in LA.
Broad support for recommended COVID-19 mitigation strategies was found nationwide. Overall, 79.5% of respondents in the US cohort supported government-issued stay-at-home orders and nonessential business closures, whereas 86.7% in NYC and 81.5% in LA supported these measures. Further, 67.3% of respondents in the US, 76.6% in NYC, and 69.1% in LA agreed that nonessential workers should stay home. The majority of respondents in NYC and LA and broadly across the US agreed with public health guidelines, including recommendations for maintaining six feet of distance between persons (>87% in each area) and limiting gatherings to fewer than 10 persons (>82% in each area). At the time of the survey, most also agreed that dining inside restaurants should not be allowed, with agreement higher in NYC (81.5%) than in LA (71.8%) and in the US overall (66.6%).
Widespread adherence to recommended COVID-19 mitigation strategies was reported in all three cohorts. Overall, 77.3% of adults nationwide reported self-isolating, with 84.6% reporting this behavior in NYC and 83.0% in LA. Most respondents (79.5%) in the US also reported the behavior of always or often keeping ≥6 feet apart from others, with higher percentages reporting this behavior in NYC (85.7%) and LA (82.6%). Always or often avoiding groups of 10 or more persons was reported by >85% of adults in the three cohorts. Approximately 90% of respondents reported having been in a public area during the preceding week; among those, 74.1% nationwide reported always or often wearing cloth face coverings when in public, with higher percentages reporting this behavior in NYC (89.6%) and LA (89.8%).
Overall, 84.3% of adults in the U.S. survey cohort believed their state’s COVID-19 community mitigation strategies were the right balance or not restrictive enough, compared with 89.7% in NYC and 79.7% in LA. As well, 74.3% of respondents in the US reported they would not feel safe if these restrictions were lifted nationwide at the time the survey was conducted, compared with 81.5% in NYC and 73.4% in LA. In addition, among those who reported that they would not feel safe, some indicated that they would nonetheless want community mitigation strategies lifted and would accept associated risks (17.1%, 12.6%, and 12.7%, respectively).
Reported prevalence of self-isolation and feeling safe if community mitigation strategies were lifted differed significantly by age, employment status, and essential worker status among adults in the US survey cohort. The percentage of respondents who reported that they were in self-isolation was highest among persons aged 18–24 years (92.3%) and lowest among those aged 45–54 years (71.5%). The percentage who reported that they would feel safe if community mitigation strategies were lifted was approximately twice as high among persons aged 18–24 as it was among those aged ≥65 years (43.1% versus 19.2%). Respondents who reported that they were essential workers accounted for 47.2% of employed respondents in the US cohort and were significantly less likely than were nonessential workers to report self-isolating (63.1% versus 80.6%). Essential workers were also significantly more likely than were nonessential workers to report that they would feel safe if COVID-19 community mitigation strategies were lifted (37.7% versus 23.7%).
Reported prevalence of always or often wearing a cloth face covering in public and maintaining ≥6 feet of physical distance also varied significantly across respondent demographics and characteristics. Respondents who were male, employed, or essential workers were significantly more likely to report having been in public areas in the past week. Among respondents who had been in public areas during the preceding week, significantly higher percentages of women, adults aged ≥65 years, retired persons, and those living in urban areas reported wearing cloth face coverings. A significantly higher percentage of adults aged ≥65 years and nonessential workers reported maintaining six feet of physical distance between themselves and others and abiding by the recommendation to avoid gatherings of 10 or more persons than did others. Adherence to recommendations to maintain six feet of physical distance and limit gatherings to fewer than 10 persons also differed significantly by employment status and race, respectively, with employed persons less likely than were retired persons to have maintained six feet of distance and black persons less likely than were white or Asian persons to have limited gatherings to fewer than 10 persons.
There was broad support for stay-at-home orders, nonessential business closures, and adherence to public health recommendations to mitigate the spread of COVID-19 in early- to mid-May 2020. Most adults reported they would not feel safe if government-ordered community mitigation strategies such as stay-at-home orders and nonessential business closures were lifted nationwide at the time the survey was conducted, although a minority of these adults who did not feel safe wanted these restrictions lifted despite the risks.
There was a significant association between age and feeling safe without community mitigation strategies, with younger adults feeling safer than those aged ≥65 years, which might relate to perceived risk for infection and severe disease. As of May 16, adults aged ≥65 years accounted for approximately 80% of reported COVID-19–associated deaths, compared with those aged 15–24 years, who accounted for 0.1% of such deaths. Identifying variations in public attitudes, behaviors, and beliefs by respondent characteristics can inform tailored messaging and targeted nonpharmacological interventions that might help to reduce the spread of COVID-19.
Other variations in attitudes, behaviors, and beliefs by respondent characteristics have implications for implementation of COVID-19 mitigation strategies and related prevention messaging. For example, a lower percentage of respondents in the US survey cohort reported wearing cloth face coverings and self-isolating than did those in NYC and LA. However, although use of cloth face coverings in NYC and LA were similar, NYC experienced substantially higher COVID-19-related mortality during the initial months of the pandemic than did LA. Nationwide, higher percentages of respondents from urban areas reported use of cloth face coverings than did rural area respondents.
Because outbreaks have been reported in rural communities and among certain populations since March 2020, these data suggest a need for additional and culturally-effective messaging around the benefits of cloth face coverings targeting these areas. Essential workers also reported lower adherence to recommendations for self-isolation, six feet of physical distancing, and limiting gatherings to fewer than 10 persons. These behaviors might be related to job requirements and other factors that could limit the ability to effectively adhere to these recommendations. Nevertheless, the high rate of person-to-person contact associated with these behaviors increases the risk for widespread transmission of SARS-CoV-2 and underscores the potential value of tailored and targeted public health interventions.
Widespread support for community mitigation strategies and commitment to COVID-19 public health recommendations indicate that protecting health and controlling disease are public priorities amid this pandemic, despite daily-life disruption and adverse economic impacts. These findings of high public support might inform reopening policies and the timelines and restriction levels of these mitigation strategies as understanding of public support for and adherence to these policies evolves.
Absent a vaccine, controlling COVID-19 depends on community mitigation strategies that require public support to be effective. As the pandemic progresses and mitigation strategies evolve, understanding public attitudes, behaviors, and beliefs is critical. Adherence to recommendations to wear cloth face coverings and physical distancing guidelines are of public health importance. Strong public support for these behaviors suggests an opportunity to normalize safe practices and promote continued use of these and other recommended personal protective behaviors to minimize further spread of COVID-19 as jurisdictions reopen. These findings and periodic assessments of public attitudes, behaviors, and beliefs can also inform future planning if subsequent outbreak waves occur, and if additional periods of expanded mitigation efforts are necessary to prevent the spread of COVID-19 and save lives.
