LAUSR

Abstract Background: The objectives of the present study are to understand the longitudinal variability in COVID-19 reported cases at the county level and to associate the observed rates of infection with the adoption and lifting of stay-home orders. Materials and Methods: The study uses the trajectory of the pandemic in a county and controls for social and economic risk factors, physical environment, and health behaviors to elucidate the social determinants contributing to the observed rates of infection. Results and conclusion: Results indicated that counties with higher percentages of young individuals, racial and ethnic minorities and, higher population densities experienced greater difficulty suppressing transmission.Except for Education and the Gini Index, all factors were influential on the rate of COVID-19 spread before and after stay-home orders. However, after lifting the orders, six of the factors were not influential on the rate of spread; these included: African-Americans, Population Density, Single Parent Households, Average Daily PM2.5, HIV Prevalence Rate, and Home Ownership. It was concluded that different factors from the ones controlling the initial spread of COVID-19 are at play after stay-home orders are lifted. KEY MESSAGES Observed rates of COVID-19 infection at the County level in the U.S. are not directly associated with adoption and lifting of stay-home orders. Disadvantages in sociodemographic determinants negatively influence the rate of COVID-19 spread. Counties with more young individuals, racial and ethnic minorities, and higher population densities have greater difficulty suppressing transmission.