COVID-19 CENTRAL @THEU

Original story at U of U Health.

Four of 10 Americans surveyed report that they were often less than truthful about whether they had COVID-19 and/or didn’t comply with many of the disease’s preventive measures during the height of the pandemic, according to a new nationwide study led in part by University of Utah Health scientists. The most common reasons were wanting to feel normal and exercise personal freedom.

The study, which appears in the Oct. 10, 2022, issue of JAMA Network Open, raises concerns about how reluctance to accurately report health status and adherence to masking, social distancing, and other public health measures could potentially lengthen the current COVID-19 pandemic or promote the spread of other infectious diseases in the future, according to Angela Fagerlin, Ph.D., senior author of the study and chair of the Department of Population Health Sciences at U of U Health.

“COVID-19 safety measures can certainly be burdensome, but they work,” says Andrea Gurmankin Levy, Ph.D., a professor of social sciences at Middlesex Community College in Connecticut. As co-lead author of the study, she worked in collaboration with Fagerlin and other scientists at U of U Heath as well as researchers elsewhere in the United States.

“When people are dishonest about their COVID-19 status or what precautions they are taking, it can increase the spread of disease in their community.” Levy says. “For some people, particularly before we had COVID vaccines, that can mean death.”

The researchers decided to assess how truthful Americans were being about their COVID-19 disease status and/or compliance with COVID-19 preventive measures after they noticed several media stories about people who were dishonest about their vaccination status, Fagerlin says.

University of Utah Health scientists Angela Fagerlin, Ph.D., and Alistair Thorpe, Ph.D., led a study about how and why some people were less than truthful about their COVID-19 status.

In the survey, conducted in December 2021, more than 1,700 people from across the country were asked to reveal whether they had ever misrepresented their COVID-19 status, vaccination status, or told others that they were following public health measures when they actually weren’t. The sample size is far larger and asked about a broader range of behaviors than previous studies on this topic, according to Fagerlin, who is also a research scientist at the Veteran Affairs Salt Lake City Healthcare System.

Screening questions allowed the health service researchers and psychologists who designed the study to evenly divide the participants: one-third who had had COVID-19, one-third who had not had COVID-19 and were vaccinated, and one-third who had not had COVID-19 and were unvaccinated.

Based on a list of nine behaviors, 721 respondents (42%) reported that they had misrepresented COVID-19 status or failed to follow public health recommendations. Some of the most common incidents were:

• Breaking quarantine rules
• Telling someone they were with, or were about to see, that they were taking more COVID-19 precautions than they actually were
• Not mentioning that they might have had, or knew that they had, COVID-19 when entering a doctor’s office
• Telling someone they were vaccinated when they weren’t
• Saying they weren’t vaccinated when they actually were

All age groups younger than 60 years and those who had a greater distrust of science were more likely to engage in misrepresentation and/or misrepresentation than others. About 60% of respondents said that they had sought a doctor’s advice for COVID-19 prevention or treatment.

 However, the researchers found no association between COVID-19 misrepresentation and political beliefs, political party affiliation, or religion.

“Some individuals may think if they fib about their COVID-19 status once or twice, it’s not a big deal,” Fagerlin says. “But if, as our study suggests, nearly half of us are doing it, that’s a significant problem that contributes to prolonging the pandemic.”

Among the reasons respondents gave for misrepresentation were:

• I didn’t think COVID-19 was real, or it was no big deal
• It’s no one else’s business
• I didn’t feel sick
• I was following the advice of a celebrity or other public figure
• I couldn’t miss work to stay home

Among the study’s limitations, the researchers could not determine if respondents honestly answered survey questions, opening the possibility that their findings underestimated how commonly people misrepresented their health status.

“This study goes a long way toward showing us what concerns people have about the public health measures implemented in response to the pandemic and how likely they are to be honest in the face of a global crisis,” says Alistair Thorpe, Ph.D., co-first author and a post-doctoral researcher in the Department of Population Health Sciences at U of U Health. “Knowing that will help us better prepare for the next wave of worldwide illness.”

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In addition to Fagerlin and Thorpe, University of Utah Health researchers Holly Shoemaker, Frank A. Drews, Jorie M. Butler, and Vanessa Stevens contributed to this study. Other participating institutions include Middlesex Community College in Middletown, Connecticut; University of Colorado School of Medicine, Aurora; Veterans Affairs Denver Center for Innovation; University of Iowa School of Medicine, Iowa City; Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation; VA Salt Lake City Health Care System; and the American Heart Association.

The study, “Misrepresentation and Nonadherence Regarding COVID-19 Public Health Measures,” appears in the Oct. 10, 2022, issue of JAMA Network Open. It was supported by the Jon M. Huntsman Presidential Endowment and an American Heart Association Children’s Strategically Focused Research Network Fellowship.

Analysis shows no difference in COVID-19 rates between U.S. counties where school was held in-person and those that had virtual school, except in the South

Since March 2020, parents, educators, and politicians have debated whether to send children to school in person during the COVID-19 pandemic. New research suggests that in most regions, with the exception of the South, opening schools for in-person learning was not associated with an increase in COVID-19 case rates in the community. The results of the nationwide study, published in Nature Medicine, included 895 school districts across the United States.

“The results suggest it is possible for schools to operate safely and in-person without increasing case rates in the community,” says Richard Nelson, Ph.D., associate professor of epidemiology at University of Utah Health and co-senior author with Westyn Branch-Elliman, M.D., of the VA Boston Healthcare System. “But the flip side is true, too. In some areas, in-person school did appear to be a source of community spread.”

The researchers analyzed data gathered during the 12 weeks from July to September 2020 by region, and categorized them as the Northeast, Midwest, South, and Mountain West. The Pacific West was not included because nearly all public schools were virtual. The study found that:

• In every region analyzed, COVID-19 cases increased during the weeks following the start of school.
• The South was the only region where case rates were higher in counties with in-person or hybrid school as compared to counties with virtual learning, after controlling for other contributing factors.
• In all other regions, community case rates during the period following school opening were similar regardless of whether school was virtual, hybrid, or in-person.

“We know that cases increased substantially last fall throughout the country,” Nelson says. “In some areas of the country, school mode was a contributing factor to those increasing rates, whereas in other areas it was not.”

“The results suggest it is possible for schools to operate safely and in-person without increasing case rates in the community. But the flip side is true, too.”

In the South, which included 191 counties from Delaware to Texas, traditional in-person school was associated with an increase in community cases of COVID-19 beginning two weeks after the school reopened. The increase was chiefly among people between the ages of 0-9, or 20 and older. Data were not available for stratification that would allow the scientists to analyze impacts on different school-age groups (e.g. elementary, middle, and high school).

The researchers controlled for local policies, including closings of workplaces and public transportation, canceling of public events, COVID testing and contact tracing policies, and mask requirements.

However, because people follow policies imperfectly, another important piece of data the researchers considered was community mobility. This is data collected from Google location history that reflects how much people are actually moving around the community in four categories: residences, workplaces, grocery/pharmacy, and retail/recreation locations.

In communities where people are moving around more, there is more social interaction outside of school and thus more opportunity for infection to spread, Nelson explains. “Traditional school in an area where there’s lots of movement looks different than traditional school where there’s not much movement in the community, in terms of case rates,” Nelson says. “For this reason, it is important to take community-level mobility into account when evaluating the impact that schools had on cases.”

Together, the data suggest that the impact of traditional and hybrid school on community spread varied throughout the country, Nelson says. Further investigation into factors that may have contributed to community spread in the South could help determine the most effective mitigation measures for in-person school.

Branch-Elliman explains that it’s possible that regional differences in community-level and in-school mitigation strategies, or other factors such as environmental conditions, may have played a role. “It is important to appreciate that schools are not islands,” Branch-Elliman says. “They exist as part of a broader community network.”

At the time the study data were collected, vaccinations were not available and the Delta variant had not yet emerged in the U.S. Additional research will also need to investigate how these factors affect the spread of COVID-19.

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The research was published as “The Impact of School Opening Model on SARS-CoV-2 Community Incidence and Mortality” and was supported by the National Institutes of Health.

Additional centers that participated in the study include Binghamton University, Boston University School of Medicine, Brown University, Beth Israel Deaconess Medical Center, Iowa City VA Health Care System, University of Iowa, VA Salt Lake City Health Care System, and Harvard Medical School