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MeSH Disease


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    Rapid environmental monitoring, capture, and destruction activities of SARS-CoV-2 during the Covid-19 MESHD health emergency

    Authors: Roberto Marchetti; Martina Stella; Debjyoti Talukdar; Rosaria Erika Pileci; Carlo De Cecco; Ali Adibi; Halima Bello-Manga; Reward Audu; Samuel Ige; Grace Nmadu

    doi:10.1101/2020.11.24.20237040 Date: 2020-11-27 Source: medRxiv

    SARS-CoV-2 pandemic is a health emergency for occupational healthcare workers at COVID19 MESHD hospital wards in Italy. The objective of the study was to investigate if U-Earth AIRcel bioreactors were effective in monitoring and improving air quality via detection, capture, and destruction of the SARS-CoV-2 virus, reducing the risk of transmission TRANS among healthcare workers. U-Earth AIRcel bioreactors are a demonstrated effective biomonitoring system. We implemented a methodological approach wherein they were placed at various hospitals treating COVID-19 MESHD patients in Italy. The detection of the SARS-CoV-2 virus was achieved through rapid biomonitoring testing of the solutes from the AIRcel bioreactors via SARS-CoV-2 rapid test SERO antigen and consecutive reverse transcription-polymerase chain reaction (RT-PCR) analysis with the multiplex platform (XABT) and the Real-Time PCR Rotor-Gene. The marked presence of the SARS-CoV-2 virus was found in multiple water samples via the detection of ORF1ab + N and/or E gene involved in gene expression and cellular signaling of the SARS-CoV virus MESHD. The AIRcel bioreactors were able to neutralize the virus effectively as traces TRANS of the viruses were no longer found in multiple solute samples after an overnight period. Transmission TRANS of COVID-19 MESHD via bio-aerosols, transmitted by infected MESHD patients, remains a viable threat for health workers. AIRcel bioreactors allow for rapid biomonitoring testing for early virus detection within the environment, reducing the risk of exponential contagion exposure and maintaining good air quality without endangering health workers. This same protocol can also be extended to public spaces as a bio-monitoring tool for hotpots early detection.

    COVID-19 MESHD: Short term prediction model using daily incidence data

    Authors: Hongwei Zhao; Naveed N Merchant; Alyssa McNulty; Tiffany Radcliff; Murray J Cote; Rebecca Fischer; Huiyan Sang; Marcia G Ory; Peter Bentzer; Areti Angeliki Veroniki; Lehana Thabane; Fanlong Bu; Sarah Klingenberg; Christian Gluud; Janus Christian Jakobsen; Willem Hanekom; Bernadett I Gosnell; COMMIT-KZN Team; Emily Wong; Tulio de Oliveira; Mahomed-Yunus S Moosa; Alasdair Leslie; Henrik Kloverpris; Alex Sigal

    doi:10.1101/2020.11.23.20237024 Date: 2020-11-24 Source: medRxiv

    Background: Prediction of the dynamics of new SARS-CoV-2 infections MESHD during the current COVID-19 pandemic MESHD is critical for public health planning of efficient health care allocation and monitoring the effects of policy interventions. We describe a new approach that forecasts the number of incident cases in the near future given past occurrences using only a small number of assumptions. Methods: Our approach to forecasting future COVID-19 MESHD cases involves 1) modeling the observed incidence cases using a Poisson distribution for the daily incidence number, and a gamma distribution for the series interval; 2) estimating the effective reproduction number TRANS assuming its value stays constant during a short time interval; and 3) drawing future incidence cases from their posterior distributions, assuming that the current transmission TRANS rate will stay the same, or change by a certain degree. Results: We apply our method to predicting the number of new COVID-19 MESHD cases in a single state in the U.S. and for a subset of counties within the state to demonstrate the utility of this method at varying scales of prediction. Our method produces reasonably accurate results when the effective reproduction number TRANS is distributed similarly in the future as in the past. Large deviations from the predicted results can imply that a change in policy or some other factors have occurred that have dramatically altered the disease transmission TRANS over time. Conclusion: We presented a modelling approach that we believe can be easily adopted by others, and immediately useful for local or state planning.

    Aerial transmission TRANS of SARS-CoV-2 virus MESHD (and pathogens in general) through environmental e-cigarette aerosol

    Authors: Roberto A. Sussman; Eliana Golberstein; Riccardo Polosa; Tanya Lam; James Hatcher; Rosie Thistlethwaite; Mark Harris; Timothy Best; Marina Johnson; Helen Wagstaffe; Elizabeth Ralph; Annabelle Mai; Caroline Colijn; Judith Breuer; Matthew Buckland; Kimberly Gilmour; David Goldblatt; - The Co-Stars Study Team; Huong T Kratochvil; - QCRG Structural Biology Consortium; Anthony Aimon; James M Bennett; Jose Brandao Neto; Aina E Cohen; Alexandre Dias; Alice Douangamath; Louise Dunnett; Oleg Fedorov; Matteo P Ferla; Martin Fuchs; Tyler J Gorrie-Stone; James M Holton; Michael G Johnson; Tobias Krojer; George Meigs; Ailsa J Powell; Johannes Gregor Matthias Rack; Victor L Rangel; Silvia Russi; Rachael E Skyner; Clyde A Smith; Alexei S Soares; Jennifer L Wierman; Kang Zhu; Natalia Jura; Alan Ashworth; John Irwin; Michael C Thompson; Jason E Gestwicki; Frank von Delft; Brian K Shoichet; James S Fraser; Ivan Ahel

    doi:10.1101/2020.11.21.20235283 Date: 2020-11-23 Source: medRxiv

    We examine the plausibility, scope and risks of aerial transmission TRANS of pathogens (including the SARS-CoV-2 virus) through respiratory droplets carried by exhaled e-cigarette aerosol (ECA). Observational and laboratory data suggests considering cigarette smoking and mouth breathing MESHD through a mouthpiece as convenient proxies to infer the respiratory mechanics and droplets sizes and their rate of emission that should result from vaping. We model exhaled ECA flow as an intermittent turbulent jet evolving into an unstable puff, estimating for low intensity vaping (practiced by 80-90% of vapers) ECA expirations the emission of 2-230 respiratory submicron droplets per puff a horizontal distance spread of 1-2 meters, with intense vaping possibly carrying hundreds and up to 1000 droplets per puff in the submicron range a distance spread over 2 meters. Bystanders exposed to low intensity expirations from an infectious vaper in indoor spaces (home and restaurant scenarios) face a 1% increase of risk with respect to a ''control case'' scenario defined by exclusively rest breathing without vaping. This relative added risk becomes 5-17% for high intensity vaping, 40-90% and over 200% for speaking or coughing HP (without vaping). We estimate that disinfectant properties of glycols in ECA are unlikely to act efficiently on pathogens carried by vaping expirations under realistic conditions.

    Statistical techniques to estimate the SARS-CoV-2 infection fatality MESHD rate

    Authors: Mikael Mieskolainen; Robert Bainbridge; Oliver Buchmueller; Louis Lyons; Nicholas Wardle; Valery Vechorko; Alexander Tonevitsky; Fanghua Hao; Huaiyu Tian; Sanam Shah; Tessa Whiteley; Gonzalo Solis-Garcia; Foteini Tsotra; Ivan Zhelyazkov; Hira Imeri; Nicola Low; Michel Jacques Counotte; Claudia Langenberg; Maik Pietzner; Dennis Valentine; Elias Allara; Praveen Surendran; Stephen Burgess; Jing Hua Zhao; James E Peters; Bram P Prins; John Danesh; Poornima Devineni; Yunling Shi; Kristine E Lynch; Scott L DuVall; Helene Garcon; Lauren Thomann; Jin J Zhou; Bryan R Gorman; Jennifer E Huffman; Christopher J O'Donnell; Philip S Tsao; Jean C Beckham; Saiju Pyarajan; Sumitra Muralidhar; Grant D Huang; Rachel Ramoni; Adriana M Hung; Kyong-Mi Chang; Yan V Sun; Jacob Joseph; Andrew R Leach; Todd L Edwards; Kelly Cho; J Michael Gaziano; Adam S Butterworth; Juan P Casas

    doi:10.1101/2020.11.19.20235036 Date: 2020-11-22 Source: medRxiv

    AO_SCPLOWBSTRACTC_SCPLOWThe determination of the infection fatality MESHD rate (IFR) for the novel SARS-CoV-2 coronavirus is a key aim for many of the field studies that are currently being undertaken in response to the pandemic. The IFR together with the basic reproduction number TRANS R0 TRANS, are the main epidemic parameters describing severity and transmissibility TRANS of the virus, respectively. The IFR can be also used as a basis for estimating and monitoring the number of infected individuals in a population, which may be subsequently used to inform policy decisions relating to public health interventions and lockdown strategies. The interpretation of IFR measurements requires the calculation of confidence intervals. We present a number of statistical methods that are relevant in this context and develop an inverse problem formulation to determine correction factors to mitigate time-dependent effects that can lead to biased IFR estimates. We also review a number of methods to combine IFR estimates from multiple independent studies, provide example calculations throughout this note and conclude with a summary and "best practice" recommendations. The developed code is available online.

    Remdesivir induced viral RNA and subgenomic RNA suppression, and evolution of viral variants in SARS-CoV-2 infected MESHD patients.

    Authors: Florencia A.T. Boshier; Juanita Pang; Justin Penner; Joseph Hughes; Matthew Parker; James G Shepherd; Nele Alders; Alasdair Bamford; Louis Grandjean; Stephanie Grunewald; James Hatcher; Timothy Best; Caroline Dalton; Patricia Dyal Bynoe; Claire Frauenfelder; Jutta Koeglmeier; Phoebe Myerson; Sunando Roy; Rachel Williams; - The COVID-19 Genomics UK (COG-UK) Consortium; Emma C Thomson; Thushan I de Silva; Richard A Goldstein; Judith Breuer; Koen Sandra; Surya Gupta; Nicolas Drouin; Amy Harms; Thomas Hankemeier; Donald Jones; Pankaj Gupta; Cathy Lane; Said El Ouadi; Jean-Baptiste Vincendet; Nick Morrice; S. Oehrle; Nikunj Tanna; Steve Silvester; Sally Hannam; Florian Sigloch; Andrea Bhangu-Uhlmann; Jan Claereboudt; Morteza Razavi; Norman Leigh Anderson; Sven Degroeve; Lize Cuypers; Christophe Stove; Katrien Lagrou; Geert Antoine Martens; Dieter Deforce; Lennart Martens; Hans Vissers; Maarten Dhaenens; Mariano Aizpurua; Romina Zadoff; Carla Marchionatti; Natalia Garcia Escude; Romina Romero; Noelia Iraizos; Emmanuel Ezequiel Valls; Patricia Rearte Carvalho; Jimena Franco; Natali Estrada; Juan Rusconi; Guido Ochoa; Maria Veronica Paz; Patricia Lesch; Maria Fernanda Caracciolo; Maria Eugenia Macaneo; Lia Pocket; Silvana Marquez; Gaston Pellegrino; Jorge Geffner; Rocio Zarlenga; Camila Witteveen; Agustina Venditti; Indira Pichetto Olanda; Juan Mauricio Vargas; Micaela Piani; Daniela Carolina Galnarez; Florencia De la Fuente; Andrea Gamarnik; Maria del Carmen Nigro; Susana Villaroel; Cristina Soler Riera; Leonel Langellotti; Clarisa Taffarel; Jose L Scapellato; Mariano Girasolli; Maximiliano de Zan; Juan Sebastian Riera; Enio Garcia; Mario Rovere; Juan Canela; Agostina Pagella; Cecilia Pampuro; Yanina Miragaya; Silvina Kuperman; Alfonso Raggio; Ramiro Manuel Larrea; Maria Dolores Silveyra; Gabriela Leberzstein; Alejandra Debonis; Juan Molinos; Miguel Gonzalez; Eduardo Perez; Nicolas Kreplak; Susana Pastor Arguello; Luz Gibbons; Fernando Althabe; Eduardo Bergel; Fernando P Polack

    doi:10.1101/2020.11.18.20230599 Date: 2020-11-20 Source: medRxiv

    While changes in SARS-CoV-2 viral load over time have been documented, detailed information on the impact of remdesivir and how it might alter intra-host viral evolution is limited. Sequential viral loads and deep sequencing of SARS-CoV-2 recovered from the upper respiratory tract of hospitalised children TRANS revealed that remdesivir treatment suppressed viral RNA levels in one patient but not in a second infected with an identical strain. Evidence of drug resistance to explain this difference was not found. Reduced levels of subgenomic (sg) RNA during treatment of the second patient, suggest an additional effect of remdesivir on viral replication that is independent of viral RNA levels. Haplotype reconstruction uncovered persistent SARS-CoV-2 variant genotypes in four patients. We conclude that these are likely to have arisen from within-host evolution, and not co- transmission TRANS, although superinfection cannot be excluded in one case. Sample-to-sample heterogeneity in the abundances of variant genotypes is best explained by the presence of discrete viral populations in the lung with incomplete population sampling in diagnostic swabs. Such compartmentalisation is well described in serious lung infections MESHD caused by influenza and Mycobacterium tuberculosis MESHD and has been associated with poor drug penetration, suboptimal treatment and drug resistance. Our data provide evidence that remdesivir is able to suppress SARS-CoV-2 replication in vivo but that its efficacy may be compromised by factors reducing penetration into the lung. Based on data from influenza and Mycobacterium tuberculosis lung infections MESHD we conclude that early use of remdesivir combined with other agents should now be evaluated. Summary SentenceDeep sequencing of longitudinal samples from SARS-CoV-2 infected paediatric patients identifies evidence of remdesivir-associated inhibition of viral replication in vivo and uncovers evidence of within host evolution of distinct viral genotypes.

    SARS-CoV-2 epidemic MESHD after social and economic reopening in three US states reveals shifts in age TRANS structure and clinical characteristics

    Authors: Nathan Wikle; Thu Nguyen-Anh Tran; Bethany Gentilesco; Scott M Leighow; Joseph Albert; Emily R Strong; Karel Brinda; Haider Inam; Fuhan Yang; Sajid Hossain; Philip Chan; William P Hanage; Maria Messick; Justin R Pritchard; Ephraim M Hanks; Maciej F Boni; David Chien Boon Lye; Christine Cheung; Sam T Douthwaite; Gaia Nebbia; Jonathan D Edgeworth; Ali R Awan; - The COVID-19 Genomics UK (COG-UK) consortium

    doi:10.1101/2020.11.17.20232918 Date: 2020-11-18 Source: medRxiv

    In the United States, state-level re-openings in spring 2020 presented an opportunity for the resurgence of SARS-CoV-2 transmission TRANS. One important question during this time was whether human contact and mixing patterns could increase gradually without increasing viral transmission TRANS, the rationale being that new mixing patterns would likely be associated with improved distancing, masking, and hygiene practices. A second key question to follow during this time was whether clinical characteristics of the epidemic would improve after the initial surge of cases. Here, we analyze age TRANS-structured case, hospitalization, and death time series from three states - Rhode Island, Massachusetts, and Pennsylvania - that had successful re-openings in May 2020 without summer waves of infection. Using a Bayesian inference framework on eleven daily data streams and flexible daily population contact parameters, we show that population-average TRANS mixing rates dropped by >50% during the lockdown period in March/April, and that the correlation between overall population mobility and transmission TRANS-capable mobility was broken in May as these states partially re-opened. We estimate the reporting rates (fraction of symptomatic cases reporting to health system) at 96.0% (RI), 72.1% (MA), and 75.5% (PA); in Rhode Island, when accounting for cases caught through general-population screening programs, the reporting rate estimate is 94.5%. We show that elderly TRANS individuals were less able to reduce contacts during the lockdown period when compared to younger individuals, leading to the outbreak being concentrated in elderly TRANS congregate settings despite the lockdown. Attack rate TRANS estimates through August 31 2020 are 6.4% (95% CI: 5.8% - 7.3%) of the total population infected for Rhode Island, 5.7% (95% CI: 5.0% - 6.8%) in Massachusetts, and 3.7% (95% CI: 3.1% - 4.5%) in Pennsylvania, with some validation available through published seroprevalence SERO studies. Infection fatality rates (IFR) estimates are higher in our analysis (>2%) than previously reported values, likely resulting from the epidemics in these three states affecting the most vulnerable sub-populations, especially the most vulnerable of the [≥]80 age group TRANS. We make several suggestions for enhancements to current data collection practices that could improve response efforts in winter.

    Seroprevalence SERO of SARS-CoV-2 IgG in healthcare workers and other staff at North Bristol NHS Trust: a sociodemographic analysis

    Authors: Christopher R Jones; Fergus W Hamilton; Ameeka Thompson; Tim T Morris; Ed Moran; Alexandra L Gerber; Ana Paula de C Guimaraes; Isabela C Leitao; Diana Mariani; Victor Akira Ota; - Covid19-UFRJ Workgroup; - LNCC-Workgroup; Cristiano Xavier Lima; Mauro M Teixeira; Ana Carolina F Dias; Rafael Mello Galliez; Debora Souza Faffe; Luis Cristovao Porto; Renato S Aguiar; Terezinha M P P Castineira; Orlando C Ferreira Jr.; Amilcar Tanuri; Ana Tereza R de Vasconcelos; Praful Pandey; Santosh KN; Shitij Chaudhary; Vishakh C Keri; Vishal Singh Chauhan; Niranjan Mahishi; Anand Shahi; Ragu R; Baidhnath Gupta; Richa Aggarwal; Kapil Dev Soni; Neeraj Nischal; Manish Soneja; Sanjeev Lalwani; Chitra Sarkar; Randeep Guleria; Naveet Wig; Anjan Trikha

    doi:10.1101/2020.11.12.20230458 Date: 2020-11-16 Source: medRxiv

    Background: Healthcare workers (HCWs) are at increased risk of infection TRANS infection with Severe HP Severe Acute Respiratory Syndrome Coronavirus 2 MESHD (SARS-CoV-2). There are limited data exploring the relative impact of geographical and socioeconomic factors on risk of SARS-CoV-2 infection MESHD among HCWs. Aim: To estimate and explore SARS-CoV-2 IgG antibody SERO seroprevalence SERO in HCWs and support staff at a hospital in South West England. Methods: We conducted a nested cross-sectional study from May-July 2020. Inverse probability weighted regression was used to estimate seroprevalence SERO of SARS-CoV-2 and associations with demographic and socioeconomic risk factors that were robust to selection into testing. Findings: Attendance for testing varied by demographic and socioeconomic factors. The overall rate of SARS-CoV-2 IgG seroprevalence SERO among tested staff was 9.3% (638/6858). The highest seroprevalence SERO was found in wards associated with SARS-CoV-2 outbreaks and among junior staff with patient-facing roles. Black, Asian and Minority Ethnic (BAME) staff had increased odds of SARS-CoV-2 seroprevalence SERO (adjusted OR: 1.99, 95%CI: 1.69, 2.34; p<0.001) relative to White staff, except for those categorised as Medical/Dental. We found a significant association between neighbourhood deprivation MESHD and seroprevalence SERO (p<0.01). Seroprevalence SERO ranged from 12% in staff residing in areas with the greatest relative deprivation to 8.4% in the least deprived. Conclusion: Transmission TRANS between staff groups is evident within the healthcare setting. BAME individuals were at increased risk of infection TRANS with SARS-CoV-2. Work role, area of residence, and neighbourhood deprivation MESHD all contribute to SARS-CoV-2 infection MESHD infection risk TRANS. As hospitals introduce routine staff SARS-CoV-2 testing they should consider differential uptake of testing among staff groups.

    Examining the Persistence of Human Coronaviruses on Fresh Produce

    Authors: Madeleine Blondin-Brosseau; Jennifer Harlow; Tanushka Doctor; Neda Nasheri; Hua Wang; Xuemei Feng; Gennadiy Zelinskyy; Mirko Trilling; Kathrin Sutter; Mengji Lu; Baoju Wang; Dongliang Yang; Xin Zheng; Jia Liu; Davey Smith; Daniela Weiskopf; Alessandro Sette; Shane Crotty; Jian Jin; Xian Chen; Andrew Pekosz; Sabra Klein; Irina Burd

    doi:10.1101/2020.11.16.385468 Date: 2020-11-16 Source: bioRxiv

    Human coronaviruses (HCoVs) are mainly associated with respiratory infections MESHD. However, there is evidence that highly pathogenic HCoVs, including severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) and Middle East Respiratory Syndrome MESHD ( MERS-CoV MESHD), infect the gastrointestinal MESHD ( GI MESHD) tract and are shed in the fecal matter of the infected individuals. These observations have raised questions regarding the possibility of fecal-oral route as well as foodborne transmission TRANS of SARS-CoV-2 and MERS-CoV. Studies regarding the survival of HCoVs on inanimate surfaces demonstrate that these viruses can remain infectious for hours to days, however, to date, there is no data regarding the viral survival on fresh produce, which is usually consumed raw or with minimal heat processing. To address this knowledge gap, we examined the persistence of HCoV-229E, as a surrogate for highly pathogenic HCoVs, on the surface of commonly consumed fresh produce, including: apples, tomatoes and cucumbers. Herein, we demonstrated that viral infectivity declines MESHD within a few hours post-inoculation (p.i) on apples and tomatoes, and no infectious virus was detected at 24h p.i, while the virus persists in infectious form for 72h p.i on cucumbers. The stability of viral RNA was examined by droplet-digital RT-PCR (ddRT-PCR), and it was observed that there is no considerable reduction in viral RNA within 72h p.i.

    Rapid feedback on hospital onset SARS-CoV-2 infections MESHD combining epidemiological and sequencing data

    Authors: Oliver T Stirrup; Joseph Hughes; Matthew Parker; David Partridge; James G Shepherd; James Blackstone; Francesc Coll; Alexander James Keeley; Benjamin B Lindsey; Aleksandra Marek; Christine Peters; Joshua B Singer; - The COVID-19 Genomics UK (COG-UK) consortium; Asif Tamuri; Thushan I de Silva; Emma C Thomson; Judith C Breuer

    doi:10.1101/2020.11.12.20230326 Date: 2020-11-15 Source: medRxiv

    Background: Rapid identification and investigation of healthcare-associated infections (HCAIs) is important for suppression of SARS-CoV-2, but the infection source for hospital onset COVID-19 MESHD infections (HOCIs) cannot always be readily identified based only on epidemiological data. Viral sequencing data provides additional information regarding potential transmission TRANS clusters, but the low mutation rate of SARS-CoV-2 can make interpretation using standard phylogenetic methods difficult. Methods: We developed a novel statistical method and sequence reporting tool (SRT) that combines epidemiological and sequence data in order to provide a rapid assessment of the probability of HCAI among HOCI cases (defined as first positive test >48 hours following admission) and to identify infections that could plausibly constitute outbreak events. The method is designed for prospective use, but was validated using retrospective datasets from hospitals in Glasgow and Sheffield collected February-May 2020. Results: We analysed data from 326 HOCIs. Among HOCIs with time-from-admission [≥]8 days the SRT algorithm identified close sequence matches from the same ward TRANS for 160/244 (65.6%) and in the remainder 68/84 (81.0%) had at least one similar sequence elsewhere in the hospital, resulting in high estimated probabilities of within-ward and within-hospital transmission TRANS. For HOCIs with time-from-admission 3-7 days, the SRT probability of healthcare acquisition was >0.5 in 33/82 (40.2%). Conclusions: The methodology developed can provide rapid feedback on HOCIs that could be useful for infection prevention and control teams, and warrants further prospective evaluation. The integration of epidemiological and sequence data is important given the low mutation rate of SARS-CoV-2 and its variable incubation period TRANS.

    Association of social distancing and masking with risk of COVID-19 MESHD

    Authors: Sohee Kwon; Amit D. Joshi; Chun-Han Lo; David Alden Drew; Long Nguyen; Chuan-Guo Guo; Wenjie Ma; Raaj S. Mehta; Erica T. Warner; Christina M. Astley; Jordi Merino; Benjamin Murray; Jonathan Wolf; Sebastien Ourselin; Claire Steves; Timothy Spector; Jaime E. Hart; Mingyang Song; Trang VoPham; Andrew T. Chan; Evangelia Ntzani; Konstantinos Vakalis; Konstantinos K Tsilidis

    doi:10.1101/2020.11.11.20229500 Date: 2020-11-13 Source: medRxiv

    Given the continued burden of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) disease MESHD ( COVID-19 MESHD) across the U.S., there is a high unmet need for data to inform decision-making regarding social distancing and universal masking. We examined the association of community-level social distancing measures and individual masking with risk of predicted COVID-19 MESHD in a large prospective U.S. cohort study of 198,077 participants. Individuals living in communities with the greatest social distancing had a 31% lower risk of predicted COVID-19 MESHD compared with those living in communities with poor social distancing. Self-reported masking was associated with a 63% reduced risk of predicted COVID-19 MESHD even among individuals living in a community with poor social distancing. These findings provide support for the efficacy of mask-wearing even in settings of poor social distancing in reducing COVID-19 MESHD transmission TRANS. In the current environment of relaxed social distancing mandates and practices, universal masking may be particularly important in mitigating risk of infection TRANS.

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