Mask mandate made stark difference in COVID cases for Myrtle Beach and Horry, data show

Wearing a face mask works.

Be it a medical-grade mask or other face covering, wearing one effectively slows the spread of COVID-19.

That’s a conclusion the South Carolina Department of Health and Environmental Control (DHEC) has come to three times now, analyzing how numbers of COVID-19 cases have fallen in municipalities that have face covering mandates in place.

And now, an independent analysis by The Sun News of DHEC’s zip code-level COVID-19 case data appears to show the same thing: The data shows that cases in the unincorporated areas of Horry County spiked in the weeks after the County Council let its mask mandate expire.

The Sun News analyzed COVID-19 data for six zip codes that lie largely, or entirely, in unincorporated areas of Horry County: 29527 (Southwestern Horry County), 29544 (Western Horry County), 29566 (Little River), 29568 (Longs) 29579 (Carolina Forest) and 29588 (Socastee).

The Sun News then compared the case numbers for those areas during two time periods: July 3 to Oct. 30, when Horry County mandated face masks, and Oct. 31 to Dec. 8, after the county’s mandate was lifted.

When Horry County’s mandate was in place, the analysis found, those zip codes together averaged 31 new cases of COVID-19 per day. After the mandate was lifted, however, those zip codes together averaged 46 new cases of COVID-19 per day.

The Sun News also compared those figures to COVID-19 cases in Myrtle Beach, which has had a face mask mandate in place since early July and has not lifted it yet. In the 29572 and 29577 zip codes that encompass Myrtle Beach, the city averaged 10 new cases per day from July 3 to Oct. 30, and 11 new cases per day from Oct. 31 to Dec. 8.

Those findings stand in contrast to the contention of some County Council members who say that a county-wide face mask mandate is not effective.

“(Cases) rose everywhere, I’ve looked at the data and plotted the data out,” council member Johnny Vaught, who represents Carolina Forest, said Friday. “There’s no glitches in the data as to whether we had a mandate in place or not.”

Vaught added that it’s not the county’s place to tell residents to wear face masks: “I’ve never been against someone wearing a mask, I’ve been against someone telling me I have to.”

The analysis also found that Horry County’s mask mandate coincided with a leveling-off of deaths caused by COVID-19. While the county’s mask mandate was in place in July and August, its deadliest months, daily deaths then fell and never reached the highs of the summer months while the mandate was in place.

The face mask debate

The question of whether or not to enforce a face covering mandate in this corner of South Carolina has evoked a heated debate for months now. Horry County, Myrtle Beach, North Myrtle Beach and Conway all enacted mask mandates over the summer, as COVID-19 cases here spiked drastically. Heading into the fall, though, the issue became controversial as some County Council members began calling for the county to lift its mandate. After several weeks of debate back and forth, the council allowed the mandate to expire in late October. A last-ditch effort to reinstate the mandate in November failed.

On Tuesday, council members voted instead to pass a non-binding resolution “strongly recommending” residents to follow DHEC and Centers for Disease Control and Prevention guidelines regarding COVID-19, and to wear a face covering. Council member Cam Crawford, who led the effort on that resolution, said it was the best he could do given the various political beliefs of his fellow council members.

“I would have preferred something stronger but I had to build consensus and that’s where the votes were on council,” he said Friday.

Myrtle Beach Mayor Brenda Bethune said the county’s decision to drop its face covering requirement is “unfortunate.” She said that because of the complicated city limits, a uniform set of rules across the county would help people keep track. Myrtle Beach has 50 “donut holes,” or unincorporated areas of Horry County entirely surrounded by city property.

“It would simplify the process, make it so much easier for people if it were all consistent,” she said. “I do think it’s unfortunate that they are continuing to hold that stance and hopefully they will change it. I mean, the numbers don’t lie, they are what they are, so I do hope they change their minds.”

Like health experts and politicians across the country, Bethune drew parallels between wearing face masks during a pandemic and wearing a seat belt while riding in a car. She questioned why the mask issue has become a political debate in the first place.

“I wear a seat belt because for one thing it’s a state law and for another thing it’s me taking personal responsibility for my safety and that’s how I see a mask,” Bethune said. “And if someone feels that it’s a violation of their civil liberties then I’m truly sorry about that, that’s not what this is about. This is not a political issue, this is a health and public safety issue”

Enforcement and spikes in COVID-19 cases

Throughout the months that Horry County and several of its cities have had mandates in place, enforcement has been a continuous pain point. To date, no police department in the county has issued citations for not wearing a mask. However, the mandates seem to encourage mask-wearing, even with little enforcement. In June, before any local mandates were introduced, a count of certain high-traffic areas by The Sun News found that fewer than 25% of people wore face coverings. In mid July, when The Sun News counted again, more than 80% of people wore masks. A mid-November count found a similar percentage of mask wearing.

The first face covering mandates came as Myrtle Beach and Horry County saw a dramatic spike in daily COVID-19 cases, with a peak of 1,500 new cases during the week of July 4. As fall has turned to winter here, cases have begun spiking again, with a current peak of 1,100 new cases last week.

Then, on Friday, South Carolina recorded a record 3,127 new cases in a single day. Horry County surpassed 15,000 total cases of COVID-19 on Friday, adding 101 new cases, according to DHEC.

“No one else should have to die at the hands of this silent killer,” said Dr. Linda Bell, South Carolina’s state epidemiologist, in a statement Friday. “It is within all of our powers to stop COVID-19. As we each wait patiently for our turn to receive the COVID-19 vaccines, let’s keep doing our part by wearing our masks and practicing social distancing.”

Despite that spike in cases, Horry County Council Chairman Johnny Gardner said this week that the county’s face mask mandate had little to no effect on the number of cases.

“When we did have a mandate, the numbers were going up and areas that did have a mandate, their numbers were going up,” he told reporters Tuesday.

The Sun News’ analysis of Myrtle Beach showed that, while its number of daily cases has grown in recent weeks, it hasn’t grown nearly as much as the unincorporated areas of Horry County. A primary difference between the two areas is that Myrtle Beach’s face mask mandate remains in place.

Still, Gardner encouraged residents to wear a face mask, even if the county doesn’t enforce a mandate. He and others on council have said enforcing a mandate is difficult for the county’s police force.

“What I’ve said from Day 1, is I wear my mask when I go around and if you want to wear your mask I’d encourage you to wear your mask,” he said.

Gardner didn’t return a phone call Friday requesting comment for this story.

Bethune noted she’s unsure how long the City of Myrtle Beach’s mask order will last, but said it’s not the time for people to ease up.

“Realistically we have to look at our numbers from the standpoint of this is by far not the time to let up at all on our vigilance with this,” she said. “People have to take personal responsibility for themselves as well as for others because this is real. We do have people who are dying from this.”

The rising cases in the area haven’t triggered any discussion among city council members on potential further restrictions, Bethune said.

The city recently approved a handful of events during the holiday season expected to draw crowds, which the city doesn’t intend to cancel since they’re outdoors and precautions will be in place, Bethune said. If someone is uncomfortable with the potential risk of these events, they should take “personal responsibility” and stay home, she said.

Doctors say: Wear a mask

For local leaders in healthcare, the choice is clear: wear the mask. Dr. Gerald Harmon, vice president of medical affairs of Tidelands Health and a family medicine specialist, said it’s not his place to comment on local laws but he pointed to the science.

“I won’t comment on any government mandates or local jurisdiction mandates, I will tell you that the peer-reviewed science, the science tends to indicate from what I’m reading as a physician … the more often we are expecting our citizens to wear the mask, they tend to have a lower incidence of covid transmission,” Harmon said.

Harmon said wearing a mask isn’t just a matter of protection, it’s also a symbol to others that he acknowledges the severity of the virus’ spread.

“I have been challenged. In a small community like Georgetown and Horry County, everybody knows everybody anyway and I’m a public figure so I make sure I wear that mask to show how seriously I take it,” he said. “I encourage all of our government leaders to wear their masks and I encourage them to encourage others to wear the masks.”

Tidelands, he said, is seeing hospital bed occupancy nearly three times the rate of occupancy just two months ago. Similarly, McLeod Health administrator Monica Vehige said the system is expecting to reach problematic hospitalization levels parallel to July in the coming weeks.

Hospital bed occupancy in Horry and neighboring Georgetown County is ticking upward, with Horry reporting around 90% occupancy rates several times since the beginning of December as the county adds more than 100 coronavirus cases daily.

The worrisome trend has area hospitals bracing for a post-holiday rush in hospitalizations. Harmon said his staff discusses their preparations and contingency plans daily.

“We’re absolutely preparing for an extra workload after the first of January,” Harmon said.

‘COVID fatigue’ from the perspective of healthcare workers

Both Vehige and Harmon urged residents to resist “COVID fatigue” and “mask fatigue” — they know you’re tired of the precautions, but they’re asking you to push through it, especially as the holiday season presents challenges.

“Maybe this is the one Christmas that you can’t be with your family, so do Zoom or do whatever, but wait for the light at the end of the tunnel because … you don’t want the chair empty next year when you could be together,” Vehige said.

COVID fatigue for healthcare workers takes on a different meaning, Harmon said.

“You get a little bit of battle fatigue, you get up in the morning, you go back into the work and you’re thinking ‘Gee, where am I gonna put those extra nine patients we had at the end of yesterday’s shift? Or the next nine that are coming in?’” he said. “So you do have to have some plans, some occupational plans to handle that and do it in a safe manner.”

A source of hope for many in the area came in the form of the first COVID-19 vaccines distributed in the state and Horry County Monday. With healthcare workers among the first to be vaccinated, experts stress widespread distribution will take time and urge residents to be patient.

In the meantime, hand washing, mask wearing and social distancing are all the more important, Vehige said, calling the vaccine a “light at the end of the tunnel.”

“At this point we know masks work and so it’s the social distancing, it’s the hand-washing and it’s the masks,” she said. “Those are the three main ones and that’s what we know and so by not doing that we’re opening ourselves up for possibly having an issue.”

This story was originally published December 15, 2020 at 6:00 AM.