Countries with early interest in face mask use had milder COVID-19 infection rates, according to a letter-to-the-editor published in the American Journal of Respiratory and Critical Care Medicine.

Researchers with the Chinese University of Hong Kong reported findings from an analysis of how public interest in face masks, based on Google Trends relative search volume data, may have affected the severity of COVID-19 infection and potentially contained the outbreak in 42 countries around the world.

“There is a clear dichotomous pattern, with regions having an early awareness and interest in face masks having milder outbreaks of COVID-19, and vice-versa,” Sunny H. Wong, MBChB, DPhil, FRCPE, FRCPath, FHKCP, FHKAM, associate professor in the department of medicine and therapeutics at the Chinese University of Hong Kong, and colleagues wrote. “Our results support that face masks can slow the spread of COVID-19.”

To gauge public interest in face masks, Wong and colleagues retrieved Google Trends relative search volume data on the topic “surgical mask” and COVID-19 global incidence data from January 2020 to May 2020.

Wong and colleagues observed a “divergent pattern” of Google Trends relative search volume values for “surgical mask” during the timeline of COVID-19, showing peak relative search volume values in some regions early in the COVID-19 epidemic.

“This led us to question whether early awareness in face mask[s] can help contain the outbreak,” they wrote.

When Wong and colleagues analyzed relative search volume values for “surgical mask” from Jan. 21 to March 11, when the WHO officially declared COVID-19 a pandemic, they observed a significant inverse correlation between interest in face masks and average daily number of COVID-19 cases among 42 regions. The researchers observed a lower number of daily COVID-19 cases in Asian regions, including Hong Kong, Taiwan, Cambodia and Vietnam, that correlated with high search volumes, according to the letter. Wong and colleagues noted that this inverse correlation remained significant after they adjusted for relative search value volume values for “hand washing” and “social distancing” over the same period.

“Despite [Hong Kong’s] proximity to mainland China, its infection rate of COVID-19 is generally modest with only 1,110 cases to date. This correlates with an almost ubiquitous use of face masks in the city (up to 98.8% by respondents in a survey). Similar patterns are seen in other Asian areas, such as Taiwan, Thailand and Malaysia,” Wong said in a press release issued by the American Thoracic Society.

Although Google Trends relative search volume values do not equate to face mask purchases or use, the researchers observed significant correlations with global e-commerce face mask sales and public opinion surveys. These findings suggest that relative search volume index may reflex public interest, the researchers wrote.

“We believe that face mask use, handwashing and social distancing are all important components of the non-pharmaceutical measures against COVID-19,” Wong said in the release.

Moving forward, “further epidemiology analysis is needed to distinguish the roles of different policies, behavioral and non-pharmaceutical interventions in the control of COVID-19,” Wong told Healio.

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