Impact of community masking on COVID-19: A cluster-randomized trial in Bangladesh
Jason Abaluck, Laura H Kwong, Ashley Styczynski, Md Ashraful Alamgir Haque, Md Md. Alamgir Kabir, Ellen Bates-Jefferys, Emily Crawford, Jade Benjamin-Chung, Shabib Raihan, Shadman Rahman, Salim Benhachmi, Neeti Zaman Bintee, Peter J Winch, Maqsud Hossain, Hasan Mahmud Reza, Abdullah All Jaber, Shawkee Gulshan Momen, Aura Rahman, Faika Laz Banti, Tahrima Saiha Huq, Stephen P Luby, Ahmed Mushfiq Mobarak
Science, doi:10.1126/science.abi9069
INTRODUCTION: Mask usage remains low across many parts of the world during the COVID-19 pandemic, and strategies to increase maskwearing 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.
RATIONALE: 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 maskimprove public health.
SCoV-2 Detect IgG ELISA kit (InBios, Seattle, WA). This assay detects IgG antibodies against the spike protein subunit (S1) of SARS-CoV-2. The assays were performed according to the manufacturer's instructions. Additional details are presented in appendix H.
Symptomatic seropositivity Our primary outcome is symptomatic seropositivity. As noted above, individuals are symptomatic if they (i) meet the WHO surveillance definition of probable COVID-19 illness and (ii) are seropositive in our blood test at endline. If either of these conditions fail to hold, Y ij ¼ 0, where Y ij is an indicator for whether individual i in village j is symptomatic seropositive. To assess seropositivity, we tested all individuals who were symptomatic in either our 5-or 9-week household survey. Our goal is to estimate the impact of the intervention on symptomatic seropositivity, defined as y 0 ¼ E x ½EðY ij jT j ¼ 1; x j Þ À EðY ij jT j ¼ 0; x j Þ where T j is an indicator for whether a village was treated and x j are village-level covariates, including baseline mask use in each village (constructed as described below) and baseline influenza-like illness and COVID-19 illness based on reported symptoms, as well as indicators for each pair of villages from our pairwise stratification method. In our preregistered specification, we estimate this parameter by ordinary least squares, clustering at the village level using the approach in (74) (75) (76) . The dependent variable is Y ij , the independent..
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"abstract": "<jats:title>Persuading people to mask</jats:title>\n <jats:p>\n 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\n <jats:italic>et al</jats:italic>\n . 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\n </jats:p>",
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