Public Attitudes, Behaviors, and Beliefs Related to COVID-19, Stay-at-Home Orders, Nonessential Business Closures, and Public Health Guidance — United States, New York City, and Los Angeles, May 5–12, 2020

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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.

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%).

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%).

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.

Acknowledgments

Survey respondents; Kinghorn Family Foundation; Australian-American Fulbright Commission; Mallory Colys, Sneha Baste, Daniel Chong, Qualtrics, LLC.

Corresponding author: Michael A. Tynan, mtynan@cdc.gov, 404-498-1202.

¹Monash University, Melbourne, Australia; ²Austin Health, Melbourne, Australia; ³CDC COVID-19 Response Team; ⁴University of Melbourne, Melbourne, Australia; ⁵Brigham and Women’s Hospital, Boston, Massachusetts; ⁶Harvard Medical School, Boston, Massachusetts.

References

1. CDC. How COVID-19 spreads. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html
2. CDC. Implementation of mitigation strategies for communities with local COVID-19 transmission. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/community/community-mitigation.html
3. CDC. Social distancing. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html
4. CDC. COVID data tracker. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://www.cdc.gov/covid-data-tracker
5. Czeisler MÉ, Howard ME, Robbins R, et al. COVID-19: Public compliance with and public support for stay-at-home mitigation strategies [Preprint]. medRxiv 2020. https://www.medrxiv.org/content/10.1101/2020.04.22.20076141v1
6. National Center for Health Statistics. Provisional COVID-19 death counts by sex, age, and state. Atlanta, GA: US Department of Health and Human Services, CDC; 2020. https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Sex-Age-and-S/9bhg-hcku
7. James A, Eagle L, Phillips C, et al. High COVID-19 attack rate among attendees at events at a church—Arkansas, March 2020. MMWR Morb Mortal Wkly Rep 2020;69:632–5. CrossRef PubMed
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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.

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.

* 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.