Absenteeism and Health Behavior Trends Associated With Acute Respiratory Illness Before and During the COVID-19 Pandemic in a Community Household Cohort, King County, Washington
Erin Chung, MD,
Yongzhe Wang, MS,
Eric J. Chow, MD, MS, MPH,
Anne Emanuels, MPH,
Jessica Heimonen, MPH,
Constance E. Ogokeh, MPH,
Melissa A. Rolfes, PhD, MPH,
James P. Hughes, PhD,
Timothy M. Uyeki, MD, MPH, MPP,
Lea M. Starita, PhD,
Samara Hoag, MN, RN,
Michael Boeckh, MD, PhD,
Janet A. Englund, MD,
Helen Y. Chu, MD, MPH
Affiliations
Erin Chung, MD
Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; Address correspondence to: Erin Chung, MD, Department of Pediatrics, University of Washington, Seattle Children's Hospital, UW Medicine Box 358061, 750 Republican Street, Seattle WA 98109.
Yongzhe Wang, MS
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
Eric J. Chow, MD, MS, MPH
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington; Public Health - Seattle & King County, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
Anne Emanuels, MPH
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
Jessica Heimonen, MPH
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
Constance E. Ogokeh, MPH
Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Military and Health Research Foundation, Laurel, Maryland
Melissa A. Rolfes, PhD, MPH
Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
James P. Hughes, PhD
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington
Timothy M. Uyeki, MD, MPH, MPP
Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Lea M. Starita, PhD
Brotman Baty Institute for Precision Medicine, Seattle, Washington; Department of Genome Sciences, University of Washington, Seattle, Washington
Samara Hoag, MN, RN
Student Health Services, Seattle Public Schools, Seattle, Washington
Michael Boeckh, MD, PhD
Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
Janet A. Englund, MD
Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington
Helen Y. Chu, MD, MPH
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
Introduction: Longitudinal data on how acute respiratory illness (ARI) affects behavior, namely school or work participation, and nonpharmaceutical intervention (NPI) usage before and during the COVID-19 pandemic is limited. The authors assessed how ARIs and specific symptoms affected school, work, and health-related behaviors over time. Methods: From November 2019 to June 2021, participating households with children in King County, Washington, were remotely monitored for ARI symptoms weekly. Following ARIs, participants reported illness-related effects on school, work, and NPI use. Using logistic regression with generalized estimating equations, the authors examined associations between symptoms and behaviors. Results: Of 1,861 participants, 581 (31%) from 293 households reported 884 ARIs and completed one-week follow-up surveys. Compared with the prepandemic period, during the period of the pandemic pre–COVID-19 vaccine, ARI-related school (56% vs 10%, p<0.001) absenteeism decreased and masking increased (3% vs 28%, p<0.001). After vaccine authorization in December 2020, more ARIs resulted in masking (3% vs 48%, p<0.001), avoiding contact with non-household members (26% vs 58%, p<0.001), and staying home (37% vs 69%, p<0.001) compared with the prepandemic period. Constitutional symptoms such as fever were associated with work disruptions (OR=1.91; 95% CI=1.06, 3.43), staying home (OR=1.55; 95% CI=1.06, 2.27), and decreased contact with non-household members (OR=1.58; 95% CI=1.05, 2.36). Conclusions: This remote household study permitted uninterrupted tracking of behavioral changes in families with children before and during the COVID-19 pandemic, identifying increased use of some NPIs when ill but no additional illness-associated work or school disruptions.
