• Kevin Zhang, Thomas N Vilches, Mehreen Tariq, Alison P Galvani, and Seyed M Moghadas.
• Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1A8 Canada. Electronic address: kevink.zhang@mail.utoronto.ca.
• Int. J. Infect. Dis. 2020 Dec 1; 101: 334-341.

ObjectivesA hasty reopening has led to a resurgence of the novel coronavirus disease 2019 (COVID-19) in the United States (US). We aimed to quantify the impact of several public health measures including non-medical mask-wearing, shelter-in-place, and detection of silent infections to help inform COVID-19 mitigation strategies.MethodsWe extended a previously established agent-based disease transmission model and parameterized it with estimates of COVID-19 characteristics and US population demographics. We implemented non-medical mask-wearing, shelter-in-place, and case isolation as control measures, and quantified their impact on reducing the attack rate and adverse clinical outcomes.ResultsWe found that non-medical mask-wearing by 75% of the population reduced infections, hospitalizations, and deaths by 37.7% (interquartile range (IQR): 36.1-39.4%), 44.2% (IQR: 42.9-45.8%), and 47.2% (IQR: 45.5-48.7%), respectively, in the absence of a shelter-in-place strategy. Sheltering individuals aged 50 to 64 years of age was the most efficient strategy, decreasing attack rate, hospitalizations, and deaths by over 82% when combined with mask-wearing. Outbreak control was achieved in the simulated scenarios and the attack rate was reduced to below 1% when at least 33% of silent pre-symptomatic and asymptomatic infections were identified and isolated.ConclusionsMask-wearing, even with the use of non-medical masks, has a substantial impact on outbreak control. A judicious implementation of shelter-in-place strategies remains an important public health intervention amid ongoing outbreaks.Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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