Impact of community masking on COVID-19: A cluster-randomized trial in Bangladesh.
Impact of community masking on COVID-19: A cluster-randomized trial in Bangladesh.
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DOI：
10.1126/science.abi9069
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发表时间：
2022-01-14
期刊：
影响因子：
56.9
通讯作者：
Mobarak, Ahmed Mushfiq
中科院分区：
文献类型：
--
作者：
Abaluck, Jason;Kwong, Laura H.;Styczynski, Ashley;Haque, Ashraful;Kabir, Md Alamgir;Bates-Jefferys, Ellen;Crawford, Emily;Benjamin-Chung, Jade;Raihan, Shabib;Rahman, Shadman;Benhachmi, Salim;Bintee, Neeti Zaman;Winch, Peter J.;Hossain, Maqsud;Reza, Hasan Mahmud;Jaber, Abdullah All;Momen, Shawkee Gulshan;Rahman, Aura;Banti, Faika Laz;Huq, Tahrima Saiha;Luby, Stephen P.;Mobarak, Ahmed Mushfiq
即使在强制佩戴口罩的地方，人们也倾向于乐观地夸大自己对戴口罩的遵守情况。那么我们怎样才能说服更多的人为更大的利益而行动呢？阿巴鲁克等人。在孟加拉国进行了一项为期两个月的大型整群随机试验，涉及数十万人（尽管大多数是男性）。免费发放了各种结构的彩色口罩，并伴随着一系列受市场研究启发的戴口罩促销活动。作者利用基层志愿者网络帮助进行研究和收集数据，发现在没有进行干预措施的村庄中，戴口罩的比例平均为 13.3%，而在采取面对面干预措施的村庄中，这一比例上升到 42.3%。亲自加强佩戴口罩的村庄也显示出报告的新冠肺炎类疾病的数量有所减少，特别是高危人群。 —CA 支持戴口罩并告知人们其重要性，鼓励孟加拉国农村人更认真地对待这一流行病。在 COVID-19 大流行期间，世界许多地区的口罩使用率仍然很低，而且增加口罩佩戴率的策略尚未经过检验。我们的目标是确定可以持续增加戴口罩的策略，并评估增加戴口罩对有症状的严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染的影响。我们于 2020 年 11 月至 2021 年 4 月在孟加拉国农村地区进行了社区级口罩推广的整群随机试验（N = 600 个村庄，N = 342,183 名成年人）。我们在村庄和家庭层面交叉随机制定了口罩推广策略，包括布口罩和外科口罩。所有干预组都获得了免费口罩、有关戴口罩重要性的信息、社区领袖的榜样以及为期 8 周的面对面提醒。对照组不接受任何干预。参与者和监测人员没有被告知治疗分配，但项目材料清晰可见。结果包括有症状的 SARS-CoV-2 血清流行率（主要）以及正确佩戴口罩、身体距离、社交距离的流行率以及与 COVID-19 疾病一致的症状（次要）。至少每周在清真寺、市场、通往村庄的主要入口道路和茶摊进行直接观察，评估佩戴口罩和保持距离的情况。如果个体与最近的成年人至少保持一臂距离，则被编码为物理距离；社交距离是根据在公共区域观察到的成年人总数来衡量的。在 5 周和 9 周的随访中，我们对所有可联系到的参与者进行了有关 COVID-19 相关症状的调查。对有症状个体进行 10 至 12 周随访时收集的血液样本进行 SARS-CoV-2 免疫球蛋白 G (IgG) 抗体分析。干预组有 178,322 人，对照组有 163,861 人。干预措施将正确佩戴口罩的比例从对照村庄的 13.3%（N = 806,547 个观察值）增加到治疗村庄的 42.3%（N = 797,715 个观察值）（调整后的百分点差异 = 0.29；95% 置信区间 = [0.26, 0.31]）。在干预期间和干预后的两周内，口罩使用量持续增加了三倍。物理距离从对照村庄的 24.1% 增加到治疗村庄的 29.2%（调整后的百分点差异 = 0.05 [0.04, 0.06]）。我们没有看到社交距离的变化。 5个月后，干预措施对戴口罩的影响减弱，但干预组戴口罩率仍高出10个百分点。除了在家庭、清真寺和市场进行免费分发和促销的核心干预之外；领导认可；通过定期监测和提醒，有几个因素对佩戴口罩没有额外影响，包括文字提醒、公共标牌承诺、货币或非货币激励以及利他信息或口头承诺。干预组中出现类似 COVID-19 症状的个体比例为 7.63% (N = 12,784)，对照组为 8.60% (N = 13,287)，在控制基线协变量后估计减少了 11.6%。血样是从同意的、有症状的成年人身上采集的（N = 10,790）。调整基线协变量后，干预措施使症状血清流行率降低了 9.5%（调整后流行率 = 0.91 [0.82, 1.00]；对照流行率 = 0.76%；治疗流行率 = 0.68%）。我们发现外科口罩对于降低 SARS-CoV-2 症状血清流行率特别有效。在随机使用外科口罩的村庄 (N = 200) 中，整体相对减少率为 11.1%（调整后患病率 = 0.89 [0.78, 1.00]）。干预措施的效果最集中于老年人群；在外科口罩村，我们观察到 60 岁以上个体的症状血清流行率降低了 35.3%（调整后流行率 = 0.65 [0.45, 0.85]）。我们发现，在口罩使用量大幅增加的村庄，症状和症状血清阳性率大幅下降。没有不良事件的报告。一项在 COVID-19 大流行期间在孟加拉国农村地区推广社区层面口罩的随机试验表明，干预措施增加了口罩的使用并减少了有症状的 SARS-CoV-2 感染，这表明促进社区佩戴口罩可以改善公共卫生。该图显示了对照组和治疗组中戴口罩的原始方法（左）、COVID-19 症状（中）和症状血清阳性（右）。每个结果、置信区间和 p 值的估计变化会针对预先注册的协变量进行调整（因此无法根据原始值进行计算）。有症状但不同意采血的个体被从样本中剔除；因此，测量的症状血清阳性率低估了症状血清阳性人群的真实比例。我们进行了一项整群随机试验，以衡量 2020 年 11 月至 2021 年 4 月期间在孟加拉国农村地区分发和推广社区口罩对有症状的严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染的影响（N = 600 个村庄，N = 342,183 名成年人）。我们在村庄和家庭层面交叉随机化了口罩类型（布口罩与外科口罩）和推广策略。正确佩戴口罩的比例从对照组的 13.3% 增加到干预组的 42.3%（调整后的百分点差异 = 0.29；95% 置信区间 = [0.26, 0.31]）。干预措施降低了有症状的血清流行率（调整后的患病率 = 0.91 [0.82, 1.00]），特别是在分发外科口罩的村庄中 60 岁以上的成年人中（调整后的患病率 = 0.65 [0.45, 0.85]）。通过促销分发口罩是减少有症状的 SARS-CoV-2 感染的可扩展且有效的方法。
Even in places where it is obligatory, people tend to optimistically overstate their compliance for mask wearing. How then can we persuade more of the population at large to act for the greater good? Abaluck et al. undertook a large, cluster-randomized trial in Bangladesh involving hundreds of thousands of people (although mostly men) over a 2-month period. Colored masks of various construction were handed out free of charge, accompanied by a range of mask-wearing promotional activities inspired by marketing research. Using a grassroots network of volunteers to help conduct the study and gather data, the authors discovered that mask wearing averaged 13.3% in villages where no interventions took place but increased to 42.3% in villages where in-person interventions were introduced. Villages where in-person reinforcement of mask wearing occurred also showed a reduction in reporting COVID-like illness, particularly in high-risk individuals. —CA Endorsing mask wearing and informing people about its importance encouraged rural Bangladeshis to take the pandemic more seriously. Mask usage remains low across many parts of the world during the COVID-19 pandemic, and strategies to increase mask-wearing remain untested. Our objectives were to identify strategies that can persistently increase mask-wearing and assess the impact of increasing mask-wearing on symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. We conducted a cluster-randomized trial of community-level mask promotion in rural Bangladesh from November 2020 to April 2021 (N = 600 villages, N = 342,183 adults). We cross-randomized mask promotion strategies at the village and household level, including cloth versus surgical masks. All intervention arms received free masks, information on the importance of masking, role modeling by community leaders, and in-person reminders for 8 weeks. The control group did not receive any interventions. Participants and surveillance staff were not informed of treatment assignments, but project materials were clearly visible. Outcomes included symptomatic SARS-CoV-2 seroprevalence (primary) and prevalence of proper mask-wearing, physical distancing, social distancing, and symptoms consistent with COVID-19 illness (secondary). Mask-wearing and distancing were assessed through direct observation at least weekly at mosques, markets, the main entrance roads to villages, and tea stalls. Individuals were coded as physically distanced if they were at least one arm’s length from the nearest adult; social distancing was measured using the total number of adults observed in public areas. At 5- and 9-week follow-ups, we surveyed all reachable participants about COVID-19–related symptoms. Blood samples collected at 10- to 12-week follow-ups for symptomatic individuals were analyzed for SARS-CoV-2 immunoglobulin G (IgG) antibodies. There were 178,322 individuals in the intervention group and 163,861 individuals in the control group. The intervention increased proper mask-wearing from 13.3% in control villages (N = 806,547 observations) to 42.3% in treatment villages (N = 797,715 observations) (adjusted percentage point difference = 0.29; 95% confidence interval = [0.26, 0.31]). This tripling of mask usage was sustained during the intervention period and for 2 weeks after. Physical distancing increased from 24.1% in control villages to 29.2% in treatment villages (adjusted percentage point difference = 0.05 [0.04, 0.06]). We saw no change in social distancing. After 5 months, the impact of the intervention on mask-wearing waned, but mask-wearing remained 10 percentage points higher in the intervention group. Beyond the core intervention of free distribution and promotion at households, mosques, and markets; leader endorsements; and periodic monitoring and reminders, several elements had no additional effect on mask-wearing, including text reminders, public signage commitments, monetary or nonmonetary incentives, and altruistic messaging or verbal commitments. The proportion of individuals with COVID-19–like symptoms was 7.63% (N = 12,784) in the intervention arm and 8.60% (N = 13,287) in the control arm, an estimated 11.6% reduction after controlling for baseline covariates. Blood samples were collected from consenting, symptomatic adults (N = 10,790). Adjusting for baseline covariates, the intervention reduced symptomatic seroprevalence by 9.5% (adjusted prevalence ratio = 0.91 [0.82, 1.00]; control prevalence = 0.76%; treatment prevalence = 0.68%). We find that surgical masks are particularly effective in reducing symptomatic seroprevalence of SARS-CoV-2. In villages randomized to surgical masks (N = 200), the relative reduction was 11.1% overall (adjusted prevalence ratio = 0.89 [0.78, 1.00]). The effect of the intervention is most concentrated among the elderly population; in surgical mask villages, we observe a 35.3% reduction in symptomatic seroprevalence among individuals ≥60 years old (adjusted prevalence ratio = 0.65 [0.45, 0.85]). We see larger reductions in symptoms and symptomatic seropositivity in villages that experienced larger increases in mask use. No adverse events were reported. A randomized-trial of community-level mask promotion in rural Bangladesh during the COVID-19 pandemic shows that the intervention increased mask usage and reduced symptomatic SARS-CoV-2 infections, demonstrating that promoting community mask-wearing can improve public health. The figure shows the raw means of mask-wearing (left), COVID-19 symptoms (middle), and symptomatic seropositivity (right) in the control and treatment arms. The estimated change in each outcome, confidence intervals, and p values adjust for preregistered covariates (and thus are not computable from the raw values). Individuals who were symptomatic but did not consent to blood collection were dropped from the sample; measured symptomatic seropositivity thus understates the true fraction of the population that was symptomatic seropositive. We conducted a cluster-randomized trial to measure the effect of community-level mask distribution and promotion on symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in rural Bangladesh from November 2020 to April 2021 (N = 600 villages, N = 342,183 adults). We cross-randomized mask type (cloth versus surgical) and promotion strategies at the village and household level. Proper mask-wearing increased from 13.3% in the control group to 42.3% in the intervention arm (adjusted percentage point difference = 0.29; 95% confidence interval = [0.26, 0.31]). The intervention reduced symptomatic seroprevalence (adjusted prevalence ratio = 0.91 [0.82, 1.00]), especially among adults ≥60 years old in villages where surgical masks were distributed (adjusted prevalence ratio = 0.65 [0.45, 0.85]). Mask distribution with promotion was a scalable and effective method to reduce symptomatic SARS-CoV-2 infections.
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影响因子：
6.3
作者：
Chernozhukov V;Kasahara H;Schrimpf P
通讯作者：
Schrimpf P
DOI：
10.1126/science.abg6296
发表时间：
2021-05-20
期刊：
Science (New York, N.Y.)
影响因子：
--
作者：
Cheng Y;Ma N;Witt C;Rapp S;Wild PS;Andreae MO;Pöschl U;Su H
通讯作者：
Su H
影响因子：
10.7
作者：
Ashraf, Nava;Bandiera, Oriana;Lee, Scott S.
通讯作者：
Lee, Scott S.
影响因子：
9.8
作者：
Ashraf, Nava;Bandiera, Oriana;Jack, B. Kelsey
通讯作者：
Jack, B. Kelsey
影响因子：
39.2
作者：
Bundgaard, Henning;Bundgaard, Johan Skov;Iversen, Kasper
通讯作者：
Iversen, Kasper