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

Abstract

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.

Keywords: COVID-19; absenteeism; households; illness behavior; non-pharmaceutical interventions; viral infections.

Figure 1

Participant-reported illness-related work (A) and school (B) impacts and changes in health behaviors (C) in the past week due to acute respiratory illness. Frequency plots show the percentage of individuals with acute respiratory illnesses reporting school or work impacts or changes in health behaviors in the week following their illness by period: Period 1 (red): November 14, 2019–March 22, 2020 (pre–COVID-19 pandemic), Period 2 (blue): March 23, 2020–December 10, 2020 (early, pre–COVID-19 vaccine COVID-19 pandemic), and Period 3 (green): December 11, 2020–June 19, 2021 (post–COVID-19 vaccine). Annotated brackets indicate a significant change in percentage (*p<0.05, **p<0.01, ***p<0.001, and NS calculated using Wald's test with GEE, adjusted for household clusters) from Period 1 to Period 2 or 3 for the work or school impact or health behavior. GEE, generalized estimating equations; NS, not significant.

Figure 2

Associations between acute respiratory illness signs or symptoms and impacts on work (A), school (B), and health behaviors (C). Forest plots demonstrate the ORs of specific behaviors or impacts associated with an illness including the symptom or meeting the case definition in question, compared with an illness without the symptom or not meeting the case definition, respectively. Horizontal lines show 95% CIs. Individual models for each impact or behavior were adjusted for period, age group, sex, race/ethnicity, household income, and number of symptoms. Illness was defined per acute respiratory illness case definition: cough or 2 qualifying symptoms (fever, sore throat, runny nose, muscle or body aches, headache, difficulty breathing, fatigue, nausea or vomiting; for participants <18 years of age, ear pain or drainage, rash, and diarrhea were also qualifying symptoms). Constitutional syndrome was defined as at least 1 symptom among fever, fatigue, muscle/body aches, chills, sweats, and headache. Respiratory syndrome was defined as at least 1 symptom among runny nose, sore throat, cough, and trouble breathing. Gastrointestinal syndrome was defined as illnesses including nausea/vomiting and/or diarrhea. Influenza-like illness was defined per CDC case definition: fever and cough and/or sore throat. COVID-like illness 1 was defined per initial CDC COVID-19 case definition: fever AND symptoms of lower respiratory illness (e.g., cough, shortness of breath). COVID-like illness 2 was defined by the following CDC case definition (April 5, 2020): at least 2 of the following symptoms (fever, chills, rigors, myalgia, headache, sore throat, new olfactory and taste disorder[s]) or at least 1 of the following symptoms (cough, shortness of breath, or difficulty breathing). For the health behavior “cover a cough or sneeze,” the authors excluded cough or runny nose in the model due to a high degree of overlap between the predictor and outcome. CDC, Centers for Disease Control and Prevention.