Passive surveillance assesses compliance with COVID-19 behavioral restrictions in a rural US county

Following the emergence of SARS-CoV-2, early outbreak response relied on behavioral interventions. In the United States, local governments implemented restrictions aimed at reducing movements and contacts to limit viral transmission. In Pennsylvania, restrictions closed schools and businesses in the spring of 2020 and interventions eased later through the summer. In a rural Pennsylvania county, we use passive monitoring of vehicular traffic volume and mobile device derived visits to points of interest as proxies for movements and contacts. Rural areas have limited health care resources, which magnifies the importance of disease prevention. These data show the lowest levels of movement occurred during the strictest phase of restrictions, indicating high levels of compliance with behavioral intervention. We find that increases in movement correlated with increases in SARS-CoV-2 cases 9-18 days later. The methodology used in this study can be adapted to inform outbreak management strategies for other locations and future outbreaks that use behavioral interventions to reduce pathogen transmission.