SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is thought
to be transmitted mainly by person-to-person contact (
1
). Implementation of nationwide public health orders to limit person-to-person interaction
and of guidance on personal protective practices can slow transmission (
2
,
3
). Such strategies can include stay-at-home orders, business closures, prohibitions
against mass gatherings, use of cloth face coverings, and maintenance of a physical
distance between persons (
2
,
3
). To assess and understand public attitudes, behaviors, and beliefs related to this
guidance and COVID-19, representative panel surveys were conducted among adults aged
≥18 years in New York City (NYC) and Los Angeles, and broadly across the United States
during May 5–12, 2020. Most respondents in the three cohorts supported stay-at-home
orders and nonessential business closures* (United States, 79.5%; New York City, 86.7%;
and Los Angeles, 81.5%), reported always or often wearing cloth face coverings in
public areas (United States, 74.1%, New York City, 89.6%; and Los Angeles 89.8%),
and believed that their state’s restrictions were the right balance or not restrictive
enough (United States, 84.3%; New York City, 89.7%; and Los Angeles, 79.7%). Periodic
assessments of public attitudes, behaviors, and beliefs can guide evidence-based public
health decision-making and related prevention messaging about mitigation strategies
needed as the COVID-19 pandemic evolves.
During May 5–12, 2020, a total of 4,042 adults aged ≥18 years in the United States
were invited to complete a web-based survey administered by Qualtrics, LLC.
†
Surveys were conducted among residents of NYC and Los Angeles to enable comparison
of the two most populous cities in the United States with each other and with the
nationwide cohort (
4
). The nationwide survey did not exclude respondents from NYC and Los Angeles, but
no respondent was counted in more than one cohort. Invited participants were recruited
using methods to create panels representative of the 2010 U.S. Census by age, gender,
race, and ethnicity (
5
). Overall, 2,402 respondents completed surveys (response rate = 59.4%); of these,
2,221 (92.5%) (United States cohort = 1,676, NYC cohort = 286, and Los Angeles cohort
= 259) passed quality screening procedures
§
(
5
); sample sizes provided a margin of error at 95% confidence levels of 2.4%, 5.7%,
and 5.9%, respectively.
Questions about the effects of the COVID-19 pandemic focused on public attitudes,
behaviors, and beliefs regarding stay-at-home orders, nonessential business closures,
and public health guidance. Chi-squared statistics (threshold of α = 0.05) were calculated
to examine differences between the survey cohorts and to examine potential associations
between reported characteristics (gender, age, race, ethnicity, employment status,
essential worker status, rural-urban residence, knowing someone with COVID-19, and
knowing someone who had died from COVID-19). Jupyter Notebook (version 6.0.0; Project
Jupyter) was used to conduct statistical analyses.
Among respondents in the U.S. cohort (1,676), 16.8% knew someone who had positive
test results for COVID-19, compared with 42.0% of respondents in NYC and 10.8% in
Los Angeles (Table 1); 5.9% of respondents in the U.S. survey cohort knew someone
who had died from COVID-19, compared with 23.1% in NYC and 7.3% in Los Angeles.
TABLE 1
Self-reported characteristics of invited participants and survey respondents — United
States, New York City, and Los Angeles,* May 5–12, 2020
Characteristic
%†
United States
New York City
Los Angeles
Invited
Responded
Invited
Responded
Invited
Responded
(N = 3,010)
(N = 1,676)
(N = 507)
(N = 286)
(N = 525)
(N = 259)
Gender
Female
55.9
56.1
52.9
55.2
52.4
52.9
Male
44.0
43.9
47.1
44.8
47.6
47.1
Other
0.1
0.0
0.0
0.0
0.0
0.0
Age group (yrs)
18–24
11.4
3.9
11.2
4.2
11.0
5.8
25–34
14.8
8.5
18.5
11.5
18.1
10.4
35–44
17.6
15.0
15.6
14.0
17.5
12.4
45–54
17.6
19.0
15.0
13.6
16.4
18.5
55–64
18.0
23.4
19.3
26.9
17.1
22.0
≥65
20.6
30.2
20.3
29.7
19.8
30.9
Race
White
78.4
84.7
72.6
82.5
74.3
80.7
Black or African American
9.2
5.0
11.2
4.5
9.1
4.6
Asian
5.7
6.2
6.1
7.3
5.7
7.3
Multiple Race/other
§
6.7
4.2
10.1
5.6
10.9
7.3
Ethnicity
Hispanic or Latino
8.8
5.9
13.6
8.0
17.1
10.8
Not Hispanic or Latino
91.2
94.1
86.4
92.0
82.9
89.2
Rural-urban residence classification¶
Rural
15.3
15.5
0.8
1.4
0.8
0.4
Urban
84.7
84.5
99.2
98.6
99.2
99.6
Employment status**
Employed
††
62.9
49.6
71.2
58.7
68.6
52.5
Essential
—
23.4
—
16.1
—
23.2
Nonessential
—
26.2
—
42.7
—
29.3
Retired
24.4
34.9
19.9
29.4
21.0
32.8
Unemployed
12.8
15.5
8.9
11.9
10.5
14.7
Know someone with positive test results for COVID-19
—
16.8
—
42.0
—
10.8
Know someone who died from COVID-19
—
5.9
—
23.1
—
7.3
Abbreviation: COVID-19 = coronavirus disease 2019.
* The U.S. survey group did not exclude respondents from New York City and Los Angeles.
† Totals might not all sum to 100 because of rounding.
§ The multiple race/other category includes respondents who self-reported as a race
with <2.5% of respondents in any cohort (e.g., American Indian or Alaska Native, Native
Hawaiian or Pacific Islander, or more than one race).
¶ Rural-Urban classification was determined according to the Federal Office of Rural
Health Policy definition of rurality. https://www.hrsa.gov/rural-health/about-us/definition/datafiles.html.
** Employment status as of December 2019.
††
Essential versus nonessential status was not assessed in relation to employment status
among invited participants. Totals for this category do not all sum to 100 because
of rounding.
Broad support for recommended COVID-19 mitigation strategies was found nationwide
(Table 2). Overall, 79.5% of respondents in the U.S. cohort supported government-issued
stay-at-home orders and nonessential business closures, whereas 86.7% in NYC and 81.5%
in Los Angeles supported these measures. Further, 67.3% of respondents in the United
States, 76.6% in NYC, and 69.1% in Los Angeles agreed that nonessential workers should
stay home. The majority of respondents in NYC and Los Angeles and broadly across the
United States agreed with public health guidelines, including recommendations for
maintaining 6 feet of distance between persons (>87% in each area) and limiting gatherings
to fewer than 10 persons (>82% in each area). At the time of the survey, most also
agreed that dining inside restaurants should not be allowed, with agreement higher
in NYC (81.5%) than in Los Angeles (71.8%) and in the United States overall (66.6%).
TABLE 2
Attitudes, behaviors, and beliefs related to COVID-19, stay-at-home orders, nonessential
business closures, and public health guidance — United States (U.S.),* New York City
(NYC), and Los Angeles (LA), May 5–12, 2020
Attitudes, behaviors, and beliefs
U.S.
NYC
LA
p-value†
p-value†
p-value†
(N = 1,676)
(N = 286)
(N = 259)
U.S. versus NYC
U.S. versus LA
NYC versus LA
Attitudes, no. of respondents (%)
Support stay-at-home order and nonessential business closures
Yes
1,332 (79.5)
248 (86.7)
211 (81.5)
<0.05
§
0.5097
0.1187
No
344 (20.5)
38 (13.3)
48 (18.5)
Nonessential workers should stay home
Agree
1,128 (67.3)
219 (76.6)
179 (69.1)
<0.05
§
0.6722
<0.05
§
Neither agree nor disagree
283 (16.9)
41 (14.3)
38 (14.7)
Disagree
265 (15.8)
26 (9.1)
42 (16.2)
Persons should always keep ≥6-ft of physical distance
Agree
1,470 (87.7)
262 (91.6)
234 (90.3)
0.1242
0.4707
0.6377
Neither agree nor disagree
127 (7.6)
17 (5.9)
15 (5.8)
Disagree
79 (4.7)
7 (2.4)
10 (3.9)
Groups of 10 or more persons should not be allowed
Agree
1,381 (82.4)
247 (86.4)
226 (87.3)
0.1245
0.1374
0.8130
Neither agree nor disagree
156 (9.3)
25 (8.7)
19 (7.3)
Disagree
139 (8.3)
14 (4.9)
14 (5.4)
Dining inside restaurants should not be allowed
Agree
1,117 (66.6)
233 (81.5)
186 (71.8)
<0.05
§
0.1769
<0.05
§
Neither agree nor disagree
244 (14.6)
28 (9.8)
36 (13.9)
Disagree
315 (18.8)
25 (8.7)
37 (14.3)
Behaviors, no. of respondents (%)
In self-isolation
¶
Yes
1,296 (77.3)
242 (84.6)
215 (83.0)
<0.05
§
<0.05
§
0.6954
No
380 (22.7)
44 (15.4)
44 (17.0)
Keep ≥6 ft apart from others
Always
975 (58.2)
191 (66.8)
172 (66.4)
0.0653
0.1576
0.8331
Often
357 (21.3)
54 (18.9)
42 (16.2)
Sometimes
138 (8.2)
16 (5.6)
17 (6.6)
Rarely
69 (4.1)
10 (3.5)
10 (3.9)
Never
137 (8.2)
15 (5.2)
18 (6.9)
Avoid groups of 10 or more persons
Always
1,259 (75.1)
222 (77.6)
196 (75.7)
0.7621
0.9568
0.8975
Often
181 (10.8)
32 (11.2)
29 (11.2)
Sometimes
59 (3.5)
9 (3.1)
7 (2.7)
Rarely
39 (2.3)
5 (1.7)
5 (1.9)
Never
138 (8.2)
18 (6.3)
22 (8.5)
Been to a public area in the previous week
Yes
1,533 (91.5)
260 (90.9)
235 (90.7)
0.8436
0.7851
0.9381
No
143 (8.5)
26 (9.1)
24 (9.3)
Wear cloth face covering when in public**
Always
925 (60.3)
208 (80.0)
183 (77.9)
<0.05†
<0.05
§
0.7659
Often
212 (13.8)
25 (9.6)
28 (11.9)
Sometimes
134 (8.7)
14 (5.4)
16 (6.8)
Rarely
63 (4.1)
5 (1.9)
3 (1.3)
Never
199 (13.0)
8 (3.1)
5 (2.1)
Beliefs, no. of respondents (%)
Believe community mitigation strategies are
Not restrictive enough
302 (18.0)
49 (17.4)
42 (16.3)
0.0500
0.1699
<0.05
§
The right balance
1,112 (66.3)
204 (72.3)
163 (63.4)
Too restrictive
262 (15.6)
29 (10.3)
52 (20.2)
Would feel safe if community mitigation strategies were lifted nationwide at the time
of survey
Yes
431 (25.7)
53 (18.5)
69 (26.6)
<0.05
§
0.8102
0.0304
No
1,245 (74.3)
233 (81.5)
190 (73.4)
No, but would like restrictions lifted and accept risks
287 (17.1)
36 (12.6)
33 (12.7)
Abbreviation: COVID-19 = coronavirus disease 2019.
* The U.S. survey group did not exclude respondents from NYC and LA.
† Calculated with Chi-squared test of independence.
§ P-value is statistically significant (p<0.05).
¶ For this survey, self-isolating means having no contact with others outside of the
respondent’s household unless required for essential services.
** Of respondents who reported having been in a public area in the preceding week.
Widespread adherence to recommended COVID-19 mitigation strategies was reported in
all three cohorts. Overall, 77.3% of adults nationwide reported self-isolating,
¶
with 84.6% reporting this behavior in NYC and 83.0% in Los Angeles. Most respondents
(79.5%) in the United States also reported the behavior of always or often keeping
≥6 feet apart from others, with higher percentages reporting this behavior in NYC
(85.7%) and Los Angeles (82.6%). Always or often avoiding groups of 10 or more persons
was reported by >85% of adults in the three cohorts. Approximately 90% of respondents
reported having been in a public area during the preceding week; among those, 74.1%
nationwide reported always or often wearing cloth face coverings when in public, with
higher percentages reporting this behavior in NYC (89.6%) and Los Angeles (89.8%).
Overall, 84.3% of adults in the U.S. survey cohort believed their state’s COVID-19
community mitigation strategies were the right balance or not restrictive enough,
compared with 89.7% in NYC and 79.7% in Los Angeles. As well, 74.3% of respondents
in the United States reported they would not feel safe if these restrictions were
lifted nationwide at the time the survey was conducted, compared with 81.5% in NYC
and 73.4% in Los Angeles. In addition, among those who reported that they would not
feel safe, some indicated that they would nonetheless want community mitigation strategies
lifted and would accept associated risks (17.1%, 12.6%, and 12.7%, respectively).
Reported prevalence of self-isolation and feeling safe if community mitigation strategies
were lifted differed significantly by age, employment status, and essential worker
status among adults in the U.S. survey cohort (Table 3). The percentage of respondents
who reported that they were in self-isolation was highest among persons aged 18–24
years (92.3%) and lowest among those aged 45–54 years (71.5%). The percentage who
reported that they would feel safe if community mitigation strategies were lifted
was approximately twice as high among persons aged 18–24 as it was among those aged
≥65 years (43.1% versus 19.2%). Respondents who reported that they were essential
workers** accounted for 47.2% of employed respondents in the U.S. cohort and were
significantly less likely than were nonessential workers to report self-isolating
(63.1% versus 80.6%). Essential workers were also significantly more likely than were
nonessential workers to report that they would feel safe if COVID-19 community mitigation
strategies were lifted (37.7% versus 23.7%).
TABLE 3
Attitudes, behaviors, and beliefs related to COVID-19, stay-at-home orders, nonessential
business closures, and public health guidance, by respondent characteristics* — United
States, May 5–12, 2020
By gender, age group, and ethnicity, %
Attitudes, behaviors and, beliefs
Gender
Age group (yrs)
Ethnicity
Male
Female
18–24
25–34
35–44
45–54
55–64
≥65
Hispanic
Non- Hispanic
Attitudes
Support stay-at-home orders and nonessential business closures
Yes
76.3
81.9
84.6
85.2
83.7
75.2
76.0
80.4
83.8
79.2
p-value†
0.0521
0.1803
1.0
Nonessential workers should stay home
Agree
64.9
69.2
55.4
76.8
72.2
62.7
62.0
70.8
72.7
67.0
Disagree
17.8
14.2
13.8
7.7
11.5
20.7
19.6
14.4
11.1
16.1
p-value†
0.9043
<0.05§
1.0
Persons should always keep ≥6-ft of physical distance
Agree
86.5
88.6
73.8
82.4
86.9
85.0
91.1
90.5
77.8
88.3
Disagree
4.8
4.7
4.6
5.6
2.8
7.2
4.8
3.8
6.1
4.6
p-value†
1.0
<0.05§
<0.05§
Groups of 10 or more persons should not be allowed
Agree
80.4
84.0
70.8
80.3
83.7
76.8
82.9
87.0
80.8
82.5
Disagree
9.9
7.0
10.8
8.5
6.0
11.9
9.2
6.1
5.1
8.5
p-value†
0.7238
<0.05§
1.0
Dining inside restaurants should not be allowed
Agree
62.2
70.1
67.7
72.5
68.3
60.8
65.6
68.6
66.7
66.6
Disagree
21.8
16.5
9.2
12.0
15.9
23.8
23.2
16.8
14.1
19.1
p-value†
<0.05§
<0.05§
1.0
Behaviors
In self-isolation
Yes
75.8
78.5
92.3
81.7
77.8
71.5
72.7
81.2
87.9
76.7
p-value†
1.0
<0.05§
0.1246
Keep ≥6 ft apart from others
Always
54.6
61.0
29.2
56.3
60.3
55.2
56.4
64.6
54.5
58.4
Often
22.6
20.3
30.8
23.2
18.3
21.6
23.5
19.2
18.2
21.5
Sometimes
9.0
7.7
26.2
7.0
9.1
9.1
7.7
5.7
14.1
7.9
Rarely
5.0
3.4
9.2
5.6
2.8
4.4
4.6
3.2
7.1
3.9
Never
8.8
7.7
4.6
7.7
9.5
9.7
7.9
7.3
6.1
8.3
p-value†
0.7508
<0.05§
0.8299
Avoid groups of 10 or more persons
Always
72.5
77.2
52.3
68.3
74.2
73.4
73.7
82.6
63.6
75.8
Often
12.2
9.7
15.4
18.3
11.9
8.8
12.0
7.9
14.1
10.6
Sometimes
3.9
3.2
15.4
2.1
4.4
4.4
3.1
1.8
6.1
3.4
Rarely
2.4
2.2
15.4
2.8
0.4
2.2
2.0
1.8
6.1
2.1
Never
8.8
7.8
1.5
8.5
9.1
11.3
9.2
5.9
10.1
8.1
p-value†
1.0
<0.05§
0.1843
Been to a public area in the preceding week
Yes
94.7
88.9
96.9
88.0
92.5
90.6
94.4
89.5
90.9
91.5
p-value†
<0.05§
0.3145
1.0
Wear cloth face covering when in public¶
Always
54.6
65.1
44.4
59.2
57.9
56.1
55.1
71.1
57.8
60.5
Often
14.9
12.9
15.9
16.0
12.9
13.1
17.6
10.8
13.3
13.9
Sometimes
10.1
7.6
15.9
8.8
8.6
8.7
10.3
6.6
13.3
8.5
Rarely
4.6
3.7
12.7
4.0
4.7
4.5
3.5
2.9
4.4
4.1
Never
15.8
10.6
11.1
12.0
15.9
17.6
13.5
8.6
11.1
13.1
p-value†
<0.05§
<0.05§
1.0
Beliefs
State restrictions are
The right balance
64.5
67.8
61.5
57.0
65.1
63.3
67.3
71.3
60.6
66.7
Not restrictive enough
18.0
18.1
21.5
31.7
19.0
16.9
16.1
15.4
26.3
17.5
p-value†
1.0
<0.05§
0.7720
Would feel safe if restrictions were lifted nationwide at the time the survey was
conducted
Yes
28.8
23.3
43.1
26.8
27.4
30.1
26.3
19.2
25.3
25.7
p-value†
0.1019
<0.05§
1.0
By race, employment status, and essential worker status, %
Attitudes, behaviors, and beliefs
Race**
Employment status
Essential worker††
White
Black
Asian
Multiple race/Other
Unemployed
Retired
Employed
Yes
No
Attitudes
Support stay-at-home orders and nonessential business closures
Yes
77.9
89.2
90.4
84.3
81.9
80.0
78.4
75.6
80.9
p-value†
<0.05§
1.0
0.6953
Nonessential workers should stay home
Agree
66.4
63.9
78.8
72.9
68.3
69.9
65.1
58.3
71.3
Disagree
16.8
16.9
4.8
11.4
13.9
14.9
17.1
19.6
14.8
p-value†
0.4225
1.0
<0.05§
Persons should always keep ≥6-ft of physical distance
Agree
88.2
81.9
89.4
81.4
83.0
92.5
85.8
81.7
89.5
Disagree
4.9
6.0
1.9
4.3
8.1
2.1
5.5
7.1
4.1
p-value†
1.0
<0.05§
<0.05§
Groups of 10 or more persons should not be allowed
Agree
82.0
84.3
89.4
78.6
79.5
87.5
79.7
74.8
84.1
Disagree
8.9
7.2
1.9
7.1
9.7
5.8
9.6
10.7
8.7
p-value†
1.0
<0.05§
<0.05§
Dining inside restaurants should not be allowed
Agree
65.8
75.9
72.1
64.3
66.0
69.6
64.8
59.5
69.5
Disagree
20.5
7.2
6.7
15.7
19.3
16.9
20.0
22.4
17.8
p-value†
<0.05§
1.0
0.0899
Behaviors
In self-isolation
Yes
77.2
78.3
73.1
84.3
81.1
82.7
72.4
63.1
80.6
p-value†
1.0
<0.05§
<0.05§
Keep ≥6 ft apart from others
Always
58.2
48.2
67.3
55.7
58.3
65.8
52.8
44.8
59.9
Often
21.6
20.5
17.3
21.4
21.6
19.0
22.8
26.0
20.0
Sometimes
8.0
14.5
4.8
11.4
5.8
5.5
10.9
13.0
9.1
Rarely
3.9
9.6
1.0
5.7
5.4
2.9
4.6
6.6
2.7
Never
8.2
7.2
9.6
5.7
8.9
6.8
8.9
9.7
8.2
p-value†
0.5507
<0.05§
<0.05§
Avoid groups of 10 or more persons
Always
76.2
56.6
77.9
71.4
73.0
81.2
71.5
65.6
76.8
Often
10.8
15.7
6.7
11.4
10.8
8.2
12.6
16.0
9.6
Sometimes
3.0
12.0
1.9
5.7
4.2
2.2
4.2
5.6
3.0
Rarely
2.0
8.4
1.9
2.9
2.3
2.1
2.5
4.1
1.1
Never
8.0
7.2
11.5
8.6
9.7
6.3
9.1
8.7
9.6
p-value†
<0.05§
0.1179
<0.05§
Been to a public area in the preceding week
Yes
91.8
91.6
87.5
91.4
88.4
89.1
94.1
97.5
91.1
p-value†
1.0
<0.05§
<0.05§
Wear cloth face covering when in public¶
Always
60.1
55.3
71.4
54.7
58.5
70.4
54.2
49.3
58.8
Often
13.7
19.7
9.9
14.1
10.0
11.1
16.7
20.4
13.3
Sometimes
8.4
13.2
8.8
10.9
10.5
5.6
10.3
9.7
11.0
Rarely
3.8
7.9
3.3
7.8
2.2
3.1
5.4
6.5
4.3
Never
14.0
3.9
6.6
12.5
18.8
9.8
13.4
14.1
12.8
p-value†
0.3708
<0.05§
0.1843
Beliefs
State restrictions are
The right balance
66.7
65.1
67.3
60.0
67.6
68.7
64.3
64.9
63.8
Not restrictive enough
16.7
28.9
22.1
25.7
18.5
17.4
18.3
14.5
21.6
p-value†
0.0523
1.0
0.0563
Would feel safe if restrictions were lifted nationwide at the time the survey was
conducted
Yes
25.8
37.3
15.4
25.7
22.4
20.7
30.3
37.7
23.7
p-value†
0.0765
<0.05§
<0.05§
* Nationwide cohort (n = 1,676) only unless otherwise specified. The six respondent
characteristic categories shown in the table (gender, age, ethnicity, race, employment
status, and essential worker status) account for 32 of 34 significant associations
among the 108 potential interactions evaluated. Responses and p-values values for
significant associations with characteristics not presented in the table that are
associated with the attitudes, behaviors, and beliefs include the following: Use of
cloth face coverings when in public × Rural-urban classification, (p-value = 0.0324);
Rural: Always = 51.4%, Often = 15.5%, Sometimes = 10.2%, Rarely = 7.8%, Never = 15.1%;
Urban: Always = 62.0%, Often = 13.5%, Sometimes = 8.5%, Rarely = 3.4%, Never = 12.6%;
attitude that dining inside restaurants should not be allowed × Know someone with
COVID-19 (p-value = 0.0243), Know someone: Agree = 75.1%, Disagree = 12.5%; Do not
know someone: Agree = 64.9%, Disagree = 20.1%.
† Calculated with Chi-squared test of independence.
§ P-value is statistically significant.
¶ Of respondents who reported having been in a public area in the preceding week.
** The multiple race/other category includes respondents who self-reported as a race
with <2.5% of respondents in any cohort (e.g., American Indian or Alaska Native, Native
Hawaiian or Pacific Islander, or more than one race).
†† Of 832 employed respondents in the U.S. cohort.
Reported prevalences of always or often wearing a cloth face covering in public and
maintaining ≥6 feet of physical distance also varied significantly across respondent
demographics and characteristics. Respondents who were male, employed, or essential
workers were significantly more likely to report having been in public areas in the
past week. Among respondents who had been in public areas during the preceding week,
significantly higher percentages of women, adults aged ≥65 years, retired persons,
and those living in urban areas reported wearing cloth face coverings. A significantly
higher percentage of adults aged ≥65 years and nonessential workers reported maintaining
6 feet of physical distance between themselves and others and abiding by the recommendation
to avoid gatherings of 10 or more persons than did others. Adherence to recommendations
to maintain 6 feet of physical distance and limit gatherings to fewer than 10 persons
also differed significantly by employment status and race, respectively, with employed
persons less likely than were retired persons to have maintained 6 feet of distance
and black persons less likely than were white or Asian persons to have limited gatherings
to fewer than 10 persons.
Discussion
There was broad support for stay-at-home orders, nonessential business closures, and
adherence to public health recommendations to mitigate the spread of COVID-19 in early-
to mid-May 2020. Most adults reported they would not feel safe if government-ordered
community mitigation strategies such as stay-at-home orders and nonessential business
closures were lifted nationwide at the time the survey was conducted, although a minority
of these adults who did not feel safe wanted these restrictions lifted despite the
risks.
There was a significant association between age and feeling safe without community
mitigation strategies, with younger adults feeling safer than those aged ≥65 years,
which might relate to perceived risk for infection and severe disease. As of May 16,
adults aged ≥65 years accounted for approximately 80% of reported COVID-19–associated
deaths, compared with those aged 15–24 years, who accounted for 0.1% of such deaths
(
6
). Identifying variations in public attitudes, behaviors, and beliefs by respondent
characteristics can inform tailored messaging and targeted nonpharmacological interventions
that might help to reduce the spread of COVID-19.
Other variations in attitudes, behaviors, and beliefs by respondent characteristics
have implications for implementation of COVID-19 mitigation strategies and related
prevention messaging. For example, a lower percentage of respondents in the U.S. survey
cohort reported wearing cloth face coverings and self-isolating than did those in
NYC and Los Angeles. However, although use of cloth face coverings in NYC and Los
Angeles were similar, NYC experienced substantially higher COVID-19-related mortality
during the initial months of the pandemic than did Los Angeles (
4
). Nationwide, higher percentages of respondents from urban areas reported use of
cloth face coverings than did rural area respondents. Because outbreaks have been
reported in rural communities and among certain populations since March 2020 (
7
,
8
), these data suggest a need for additional and culturally effective messaging around
the benefits of cloth face coverings targeting these areas. Essential workers also
reported lower adherence to recommendations for self-isolation, 6 feet of physical
distancing, and limiting gatherings to fewer than 10 persons. These behaviors might
be related to job requirements and other factors that could limit the ability to effectively
adhere to these recommendations. Nevertheless, the high rate of person-to-person contact
associated with these behaviors increases the risk for widespread transmission of
SARS-CoV-2 and underscores the potential value of tailored and targeted public health
interventions.
The findings in this report are subject to at least four limitations. First, behaviors
and adherence to recommendations were self-reported; therefore, responses might be
subject to recall, response, and social desirability biases. Second, responses were
cross-sectional, precluding inferences about causality. Third, respondents were not
necessarily representative among all groups; notably a lower percentage of African
Americans responded than is representative of the U.S. population. In addition, participation
might have been higher among persons who knew someone who had tested positive or had
died from COVID-19, which could have affected support for and adherence to mitigation
efforts. Finally, given that the web-based survey does not recruit participants using
population-based probability sampling and respondents might not be fully representative
of the U.S. population, findings might have limited generalizability. However, this
survey did apply screening procedures to address issues related to web-based panel
quality.
Widespread support for community mitigation strategies and commitment to COVID-19
public health recommendations indicate that protecting health and controlling disease
are public priorities amid this pandemic, despite daily-life disruption and adverse
economic impacts (
5
,
9
). These findings of high public support might inform reopening policies and the timelines
and restriction levels of these mitigation strategies as understanding of public support
for and adherence to these policies evolves. Absent a vaccine, controlling COVID-19
depends on community mitigation strategies that require public support to be effective.
As the pandemic progresses and mitigation strategies evolve, understanding public
attitudes, behaviors, and beliefs is critical. Adherence to recommendations to wear
cloth face coverings and physical distancing guidelines are of public health importance.
Strong public support for these behaviors suggests an opportunity to normalize safe
practices and promote continued use of these and other recommended personal protective
behaviors to minimize further spread of COVID-19 as jurisdictions reopen. These findings
and periodic assessments of public attitudes, behaviors, and beliefs can also inform
future planning if subsequent outbreak waves occur, and if additional periods of expanded
mitigation efforts are necessary to prevent the spread of COVID-19 and save lives.
Summary
What is already known about this topic?
Stay-at-home orders and recommended personal protective practices were disseminated
to mitigate the spread of COVID-19 in the United States.
What is added by this report?
During May 5–12, 2020, a survey among adults in New York City and Los Angeles and
broadly across the United States found widespread support of stay-at-home orders and
nonessential business closures and high degree of adherence to COVID-19 mitigation
guidelines. Most respondents reported that they would feel unsafe if restrictions
were lifted at the time of the survey.
What are the implications for public health practice?
Routine assessment of public priorities can guide public health decisions requiring
collective action. Current levels of public support for restrictions and adherence
to mitigation strategies can inform decisions about reopening and balancing duration
and intensity of restrictions.