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The COVID-19 Pandemic, Community Mobility and the Effectiveness of Non-pharmaceutical Interventions: The United States of America, February to May 2020

Background: The impact of individual non-pharmaceutical interventions (NPI) such as state-wide stay-at-home orders, school closures and gathering size limitations, on the COVID-19 epidemic is unknown. Understanding the impact that above listed NPI have on disease transmission is critical for policy makers, particularly as case counts increase again in some areas. Methods: Using a Bayesian framework, we reconstructed the incidence and time-varying reproductive number (Rt) curves to investigate the relationship between Rt, individual mobility as measured by Google Community Mobility Reports, and NPI. Results: We found a strong relationship between reproductive number and mobility, with each 10% drop in mobility being associated with an expected 10.2% reduction in Rt compared to baseline. The effects of limitations on the size of gatherings, school and business closures, and stay-at-home orders were dominated by the trend over time, which was associated with a 48% decrease in the reproductive number, adjusting for the NPI. Conclusions: We found that the decrease in mobility associated with time may be due to individuals changing their behavior in response to perceived risk or external factors.