More than 40% of Americans misled others about having COVID-19 and use of precautions

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.”


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.

Study: in much of the U.S., virtual school did not lower COVID-19 case rates in surrounding communities

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.

# # #

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

Watching wastewater

The U is monitoring samples of municipal wastewater for signs of COVID-19 in a joint project started by the School of Medicine and the College of Engineering. Jennifer Weidhass, assistant professor in Civil and Environmental Engineering, and Jim Vanderslice, associate professor in Family & Preventive Medicine, lead the study to track the presence of the virus in sewage so that local health officials can recommend behavior changes—masking and social distancing—to slow the spread of COVID-19. After an initial pilot program, the state is funding a large-scale study of more than 40 facilities in Utah, covering about 80 percent of the population, in partnership with BYU, Utah State University, Utah Department of Environmental Quality, and the Utah Department of Health.

Find current data online.

COVID-19 and the metropolis

Many have assumed that densely populated areas like city centers are more conducive to the spread of COVID-19. A new study, published in the Journal of the American Planning Association, finds that the opposite may be true. Researchers from the University of Utah and the Johns Hopkins Bloomberg School of Public Health examined both infection and death rates in 913 U.S. metropolitan counties and found that population size, not density, corresponded to mortality rates. One possible explanation could be faster and more widespread adoption of social distancing practices and better quality of health care in areas of denser population.

“Our findings run counter to the recent narrative about escaping compact cities for sprawling suburbs as a way of staying safe from COVID-19,” said co-author Reid Ewing, distinguished professor in the Department of City & Metropolitan Planning at the University of Utah. “This is one more reason for urban planners and public officials to favor compact urban development over suburban sprawl. Compact places seem to promote better adherence to social distancing and provide better acute health care, so those contracting the coronavirus are less likely to die.”

A map of the 913 U.S. metropolitan counties included in the survey.

The three-member team chose to examine county data, not individual cities, between Jan. 20-May 25, 2020. Large cities alone have multiple unknown variables. Counties, on the other hand, have multiple known factors that allowed the team to find the “activity density” of each and make comparisons. Activity density = (population of a county + jobs in the county)/area of the county.

Activity density takes into account both the county residents and workers commuting within a given area. Other factors, such as population size, education levels, and demographic variables, including age and race and health care infrastructure (ICU bed capacity), were also considered.

“Our analysis shows that metropolitan size is more important than density,” said co-author Sadegh Sabouri, doctoral student in the Department of City & Metropolitan Planning at the U. “Take Dutchess County, New York, for example, being surrounded by one of the largest metropolitan areas—New York, Newark and New Jersey City. The activity density is 518.1 and death rate of 4.63 per 10,000. Salt Lake County, by comparison, is located in a metropolitan area that is one-twentieth the population and has a density four times higher at 2060.2 and a death rate of only 0.61.”

The analysis did not indicate a significant association with infection rates. However, higher activity density did have a significant and unexpected association with death rates. They found that after controlling for factors such as metropolitan size, education, race and age, doubling the activity density was associated with an 11.3% lower death rate.

They also conclude that counties with higher proportions of people ages 60 and older, lower proportions of college-educated people, and higher proportions of African Americans experienced greater infection and mortality rates.

The researchers have been updating the data as the pandemic has progressed and are finding that the associations uncovered in their study are becoming even stronger. The team is also conducting a longitudinal study that tracks the relationships among county density, infection and mortality rates and explanatory factors as they change over time. They have found consistent results regarding the inverse relationship between density and the COVID-19 mortality rate.

Find the full study here.

Find original post here.

Masks save lives and livelihoods

Statewide mask requirements not only reduce the transmission of COVID-19, but they also spur more economic activity, while countywide mask requirements actually depress economic activity, according to researchers at the Marriner S. Eccles Institute for Economics and Quantitative Analysis.

The thing that really pops out,” said lead research Nathan Seegert, assistant professor of finance at the Eccles School, “is that statewide mask mandates are much more effective at both saving lives and livelihoods.”

The statewide mask requirements signal that safety measures are being taken seriously, and that boosts consumer confidence.

“If people feel safe, they’re going to go out and spend more,” Seegert said.

The study showed that the positive effects of the statewide mask requirements were seen immediately after they were enacted and up to two months afterward. The economic impact of statewide mask requirements was directly measured, showing an average of about $24 more spent per person per month, which adds up to millions of dollars per month in increased sales.

In addition to Seegert, the research was conducted by Mac Gaulin, assistant professor of Accounting, Mu-Jeung Yang, visiting assistant professor of finance, and Francisco Navarro-Sanchez, a finance doctoral candidate.

The research findings were announced at a press conference on Monday, Nov. 23 with Taylor Randall, dean of the David Eccles School of Business, and Natalie Gochnour, assistant dean at the Eccles School and director of the Kem C. Gardner Policy Institute.

Randall addressed the protests happening in Utah around the country against mask requirements.

We’re all facing a set of tradeoffs here. If you choose to not wear masks, you’re causing the confidence of your community to decrease, which means you will see reduced economic activity,” Randall said. “If we want to push the boundary, meaning we want to have better health and a better economy during this really critical time, we really should wear masks.”

Randall pointed out the connection between health and the economy.

“At the core of this relationship is mask-wearing and consumer confidence,” Randall said.

Gochnour said that Utah’s economy is performing much better than the U.S. economy, and the unemployment rate is much lower in the Beehive State compared to the U.S. But she warned that rising case counts increase safety fears, which decreases consumer confidence and leads to people shopping less.

Wearing a mask “is part of controlling our destiny” by increasing economic confidence so “we can get back on our feet faster.”

Find original post here.