By Carol A. Kemper, MD, FACP

Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley Medical Center

Party Affiliation and Social Distancing

SOURCE: Leventhal A, Hongying D, et al. Association of political party affiliation with physical distancing among young adults during the COVID-19 pandemic. JAMA Intern Med 2021;181:399-403.

Disparate public health messaging from political officials, news media, and internet outlets has occurred throughout the COVID-19 pandemic in the United States. Some have wanted to ascribe lower rates of compliance with public health guidance to political affiliation.

These authors examined the political affiliation of a group of young adults, aged 18 to 25 years, mostly residing in Los Angeles County, with their compliance with physical distancing guidelines and risk activities for COVID-19 infection between May 18 and Aug. 3, 2020. The cohort (n = 3,396) was recruited originally in high school in 2013 as part of an existing health behavior survey. Of those with currently valid contact information, 2,179 (67.5%) agreed to participate in this study. The mean age of the participants was 21.2 years, 61% were female, and 84.8% lived in Los Angeles County. Political party affiliation was collapsed into four categories: Democrat (43.1%), Republican (7.2%), Independent/other (15.8%), or don’t know/declined to answer (34%). Questions regarding physical distancing (sometimes/rarely vs. always/usually/have not been in public places) were given a binary outcome (0 or 1). Engaging in four different kinds of social/recreational activities (visiting a public venue, e.g., a mall, attending or hosting a party > 10 people, or going to a restaurant) also were given binary scores (1 or 0), which were summed as continuous outcomes.

Those who identified as Republican were twice as likely to engage in social/recreational activities as Democrats (mean standard deviation [SD] 3.6 vs. 1.9, P < 0.001), and somewhat more likely than either Independents/other (mean SD 2.2) or those who don’t know/declined to state (mean SD 2.2) (both  P < 0.001). Participants identifying as Republicans also were significantly more likely to engage in infrequent physical distancing (24.3%) compared with any of the other three groups (Democrats [5.2%], Independent/other [6.6%] or don’t know/decline to state [5.7%]; each comparison, P < 0.001). The proportion of participants who perceived a risk of contracting COVID-19 or a chance of dying of COVID-19 was no different between any of the groups. Further, substance use, impulsivity, and delinquency scores (as measured by inventory impulsivity scales or a sum of generally bad behavior in 9th grade) also had no apparent relationship with a willingness to disregard social distancing and to engage in social/recreational activities.  

The psychology of behavior is difficult to pin down. We once participated in study of safer sex behavior involving five medical centers on the West Coast. I was struck that none of our ongoing, repetitive, safe sex messaging, T-shirts, posters, and free condoms made much of a difference in either the frequency of safer sex or the number of partners. But one fundamental finding was that outcomes differed depending on where people fell on the pessimism vs. optimism personality scales. Only those classified as “pessimists” actually believed that bad things could happen to them and were willing to modify their behavior, whereas those scoring higher on the “optimism” scale only saw the future as getting better, regardless. So perhaps mask wearers are simply more pessimistic about the future? 

Ethnicity and Occupation as Risk Factors for COVID Infection

SOURCE: Pathela P, Crawley A, Weiss D, et al. Seroprevalence of SARS-CoV-2 following the largest initial epidemic wave in the United States: Findings from New York City, May 13-July 21, 2020. J Infect Dis 2021; Apr 9:jiab200. doi: 10.1093/infdis/jiab200. [Online ahead of print].

A large serosurvey of COVID-19 antibody was conducted in a convenience sample of 52,941 New Yorkers following the first surge of COVID-19 infection in that city in the spring of 2020. Free antibody testing (using the Liaison SARS-CoV-2 S1/S2 assay, DiaSorin, Saluggia, Italy) was offered to New York City residents 18 years of age or older during May 13 to July 21, 2020. The project was advertised through the media, local channels, and the internet, although recruitment was done online, where participants scheduled an appointment for testing and completed a survey. Approximately 14.3% of participants did not have a fully completed survey and were excluded, leaving 45,367 participants. Non-Hispanic whites (908/100,000 residents) and Staten Island residents (2,512/100,000) were disproportionately represented compared with people 65 years of age or older (260/100,000), non-Hispanic Blacks (236/100,000), and those residing in Brooklyn, the Bronx, or other poorer neighborhoods (all below 460/100,000). Men and women were similarly recruited for participation. 

Nearly one-quarter of the participants (23.6%) had antibodies to SARS-CoV-2. If this figure is extrapolated, it implies that more than 1.5 million New Yorkers had COVID-19 infection during the first wave of infection in that city. Hispanics and non-Hispanic
Blacks had the highest prevalence of antibody (35.3% and 33.5%, respectively) compared with Asians/Pacific Islanders (20.2%) and non-Hispanic whites (16%). Geographically, the highest prevalence of antibody was found in the Bronx (37%) and other poorer neighborhoods (35.3%), compared with Manhattan (19.4%) and Staten Island (21%).
At the time of the survey, about 72% of participants were employed. Antibodies were observed in 27.4% of those who worked outside the home compared with 22.2% of those who did not work outside the home. Seroprevalence was observed in 31.6% of essential workers, 30% of healthcare workers, and 20% of those in education, compared with 23.8% of those who were not working.

Roughly two-thirds of participants (60%) provided a history of symptoms of COVID-like illness (CLI). This observation suggests that study recruitment was perhaps skewed toward those individuals interested in confirming previous infection. Approximately one-third (34%) of those reporting CLI symptoms were seropositive, compared with 21% of participants with no CLI who were seropositive. Of all the key CLI symptoms observed, loss of taste or smell was the most strongly associated with the presence of antibody.

New York City Public Health officials concluded these data show how certain groups of people were disproportionately affected by the epidemic, in part because they were working in the front-line lower-paying jobs in healthcare, grocery stores, and transit with higher levels of exposure. However, unemployment also was seen as a risk factor for COVID-19 infection in this survey. Poorer neighborhoods and households with increased numbers of people were also disproportionately hit harder.

Interestingly, in the southern San Francisco Bay Area, the Asian/Pacific Islander community was disproportionately affected for some of the same reasons — in our area, they tend to take the positions in skilled nursing facilities and as home health aides, and also live in multigenerational households. COVID-19 infection literally ripped through our local skilled nursing facilities, sometimes infecting the entire resident population and most of the workers within weeks with a single SARS-CoV-2 strain. However, I believe this says more about the lack of good infection prevention practices and ability to quickly test and cohort the sick in these kinds of facilities than the ethnicity of the workers or their pay.

One important finding in this study was the lack of participation of the elderly. Although 61% of participants were 18-44 years of age, only 7% were 65 years of age or older. Strategies for recruiting the elderly for COVID-19 studies and vaccination programs must overcome their lack of computer skills and ability to enlist online.