Social Distancing Associations with COVID-19 Infection and Mortality Are Modified by Crowding and Socioeconomic Status

Abstract

The SARS-CoV-2 virus is a public health emergency. Social distancing is a key approach to slowing disease transmission. However, more evidence is needed on its efficacy, and little is known on the types of areas where it is more or less effective. We obtained county-level data on COVID-19 incidence and mortality during the first wave, smartphone-based average social distancing (0–5, where higher numbers indicate more social distancing), and census data on demographics and socioeconomic status. Using generalized linear mixed models with a Poisson distribution, we modeled associations between social distancing and COVID-19 incidence and mortality, and multiplicative interaction terms to assess effect modification. In multivariable models, each unit increase in social distancing was associated with a 26% decrease (p < 0.0001) in COVID-19 incidence and a 31% decrease (p < 0.0001) in COVID-19 mortality. Percent crowding, minority population, and median household income were all statistically significant effect modifiers. County-level increases in social distancing led to reductions in COVID-19 incidence and mortality but were most effective in counties with lower percentages of black residents, higher median household incomes, and with lower levels of household crowding.

Amplified effect of social vulnerability on health inequality regarding COVID-19 mortality in the USA: the mediating role of vaccination allocation

“…Health inequalities often surface when the structure of a society is affected by a new disease or disease prevention and control measures which benefit only certain communities [ 4 ]. People with lower socioeconomic status are less likely to undertake social distancing since they are typically identified as having jobs as essential workers or labourers [ 50 ]. They tend to live and work in crowded places, having less protection against COVID-19 [ 50 ].…”

“…People with lower socioeconomic status are less likely to undertake social distancing since they are typically identified as having jobs as essential workers or labourers [ 50 ]. They tend to live and work in crowded places, having less protection against COVID-19 [ 50 ]. These people may take more time to understand the disease and ways to protect themselves, especial due to lower educational levels [ 51 , 52 ].…”

How Fear of COVID-19 Affects the Behavioral Intention of Festival Participants—A Case of the HANFU Festival

“…The f 2 values of all supported hypotheses shown in Table 6 are over 0.02, and thus, various exogenous factors have a significant effect on their corresponding endogenous factors [ 97 ]. Moreover, in Table 6 , all VIFs are below five, which ranged from 1.000 to 1.773, indicating the absence of the issue of multicollinearity [ 91 ].…”

“…In response to the COVID-19 pandemic, social distancing measures have been adopted around the globe because COVID-19 incidence and mortality decreased by 26% and 31%, respectively, with each unit increase in social distance [ 91 ]. Consequently, in the post-COVID-19 period, tourists will be more sensitive to crowding and prefer to avoid crowded areas in the short run [ 92 ].…”

Municipal Ethnic Composition and Disparities in COVID-19 Infections in New Jersey: A Blinder–Oaxaca Decomposition Analysis

“…This knowledge would not change the impacts of household crowding, where presumably even masking was ineffective and isolation was impossible. This is an example of how structural conditions can prevent people from being able to act on knowledge regarding effective social distancing and other mitigation measures [ 64 ].…”