Stay-at-home orders are considered an essential component of COVID-19 management in the United States. As we begin to lift these restrictions, voluntary public compliance with health recommendations will significantly influence the COVID-19 infection rate. Population risk from the re-opening may therefore be predicated from public intent to comply with public health recommendations. We are studying this via an ongoing convergent design mixed-methods survey. To offer insights on the public health risk of re-opening, we have conducted a preliminary analysis of public intent to comply with public health recommendations, and found that there are marked regional differences across the United States and widespread lack of intent to follow key public health recommendations.
Between April 9, 2020 and April 15, 2020, 5,879 adults completed the survey, of whom 5,143 reported a three-digit zip code prefix. (This is a global survey; this analysis looks only at U.S. data.) Adjacent prefix clusters (cities) with 40 or more respondents were analyzed. Fifteen metropolitan areas (n=1,809) met this criteria (New York City, NY; Pittsburgh, PA; State College, PA; Harrisburg, PA; Philadelphia, PA; DC Metro; Atlanta, GA; Detroit, MI; Madison, WI; Minneapolis, MN; Chicago, IL; Dallas, TX; Denver, CO; San Diego, CA; Seattle, WA). Overall knowledge of the CDC recommendation that all people wear facemasks in public was high (92.5%), as was overall intent to comply with all five public health recommendations (95.6%). Intent to follow individual recommendations was also high, except for the recommendation to avoid touching eyes, nose and mouth, which had an average compliance intent of 85.6%, with statistically significant differences between metro areas (p=.0079), and ranged between 77.8%-92.7% among cities. Using a more stringent criterion for compliance of “Most Certainly”, intent to follow drops to 56.7%, ranging from a high of 44%-71% among cities.
In summary, as the United States and the world begins the reopening phase, a phase that has consequences based directly on public choice in behavior, risk of resurgence in COVID-19 may be estimated by measuring intended compliance. Intent to comply in the United State is not uniform across recommendations or regions. Municipalities with higher risk populations would do well to conduct targeted education campaigns to modify behavior and decrease this risk.
