Why Young Adults Took COVID-19 Risks: Winnebago County, Wisconsin, 2020

This page describes a study from the early COVID-19 pandemic. It reflects the guidance and conditions of 2020.

On May 13, 2020, the Wisconsin Supreme Court declared the state's Safer at Home emergency order "unlawful, invalid, and unenforceable," opening the way for more social and business contact. By mid-June, Winnebago County saw COVID-19 cases rise, most of all among young adults aged 18–23, who make up 12.5% of the county's population. The county health department, CDC and the state health department set out to learn why.

How the study worked

• Case data: records from Wisconsin's Electronic Disease Surveillance System for young adults with COVID-19 from March 1 to July 18, 2020.
• Interviews: in-person interviews on July 9–22 with 30 people — 13 young adults, 9 owners of businesses that employ and serve young adults (such as restaurants and bars), and 8 community leaders — found through referrals, and continued until no new themes emerged.

The cases

Young adults accounted for 240 (32%) of the county's 757 cases from March through mid-July.

• 72% were non-Hispanic White, 7% Hispanic and 4% non-Hispanic Black (14% other or unknown); 54% were female.
• 72% had jobs. Of those, 83% worked outside the home during the period they were likely exposed, and 58% worked outside the home while contagious.
• 38% had been to a social gathering while likely exposed, and 84% had symptoms.

Cumulative confirmed COVID-19 cases by age group (N = 757), Winnebago County, March 1–July 18, 2020. CDC figure.

What young adults said

The 13 young adults interviewed — nine women, all employed, all in college or recent graduates — described:

• Peer pressure against masks: getting disapproving looks or reactions when wearing one, or feeling awkward doing so.
• Socializing anyway: most said they limited contact, but many still went to bonfires, bars and other gatherings.
• Low risk to themselves: most expected mild or no symptoms if infected, often because friends who tested positive had hardly been ill.
• Responsibility to others: they worried about infecting at-risk loved ones and the wider community — which may be why they wore masks when shopping and mostly supported masks.
• Workplace worries about exposure on the job.
• Mixed messages: most had encountered misinformation, conflicting messages or opposing views about whether masks were needed or worked. A few who doubted masks or distancing stressed wanting to make their own choices.

What business owners and community leaders said

• All business owners, but not all community leaders, trusted local health officials for COVID-19 information; the leaders who didn't appeared to have been swayed by misinformation about how serious the pandemic was.
• Many had also met misinformation or mixed messages about masks.
• Businesses had put in place measures such as hand-hygiene stations and masks, but many had dropped mask requirements so as not to offend customers or lose them to competitors. Owners saw the lack of a countywide mask ordinance as a barrier to bringing masks back, and some said they would comply with one.

Conclusions

Social contact, work and community spread likely all drove cases among young adults — and with so many working while contagious, they could pass the virus on widely. The authors suggested:

• clear, consistent messages about why masks are needed and that they work;
• messages that are empathetic, stress personal responsibility and protecting others, and address peer pressure not to wear masks;
• businesses working with trusted local health officials on control measures, since a countywide mask ordinance might make masking easier for businesses to require.

At the time, CDC recommended universal masking to prevent SARS-CoV-2 transmission.

Limitations: the findings come from one county; self-reports may understate risky behavior; people found by referral may resemble each other; and missing data may have led to undercounts.

Sources

• Wilson RF, Sharma AJ, Schluechtermann S, et al. "Factors Influencing Risk for COVID-19 Exposure Among Young Adults Aged 18–23 Years — Winnebago County, Wisconsin, March–July 2020." Morbidity and Mortality Weekly Report 69(41), Centers for Disease Control and Prevention.