Millennial zeitgeist: Attitudes about COVID-19 shift as cases among young adults rise

When Laura Mae, 27, first heard about the coronavirus, it didn't seem like a big deal.

"I'm in college, and school was still going on. It didn't really sink in," she said. "And once it did start spreading, I thought, if I did get it, I'm young and healthy, I'll be fine. I don't need to worry."

It was Saturday, March 14, and concerns about the coronavirus were amping up around the nation, said Laura Mae, who lives in Milwaukee. (Kaiser Health News is using Laura Mae's first and middle names to grant her request for partial anonymity due to concern about online harassment.)

She realized it might be the last weekend to go out before everything shut down. Plus, her spring break had just started. So she and a friend decided to party that night.

And she wasn't the only one.

As college and university spring breaks across the country converged that weekend, news coverage showed young people frolicking on Miami beaches, walking down Bourbon Street in New Orleans and crowding music clubs in Nashville, Tennessee. And to celebrate St. Patrick's Day, many cities, such as New York, Washington, Chicago and Austin, Texas, saw throngs of people dressed in green and lining up for beer. There wasn't a lot of social distance to be seen.

Part of the reason these young adults might have felt comfortable going to spots with large crowds was that media reports, buttressed by data from China's outbreak, indicated younger people were not as susceptible to the coronavirus as older age groups or people with underlying conditions. But, that hasn't held true. Now, in several major American cities, young adults between 18 and 40 account for some of the largest shares among groups testing positive.

As of Thursday, in New York City, 39% of cases were among those ages 18 to 44. Out of Los Angeles County's 7,194 confirmed cases, 2,409, or 33%, were in the 18-40 age range. Nearly half of those testing positive in Travis County, Texas, which encompasses much of the Austin metro area, were between 20 and 39. Washington, D.C., the nation's capital, released numbers Wednesday showing that 40% of the district's cases were ages 19-40.

Dissecting the numbers

Epidemiologists say that these high percentages of young adults testing positive for the coronavirus don't necessarily mean that a disproportionate number of young people are becoming infected. What the numbers show is that people in this demographic are just as susceptible to COVID-19 as other age groups.

"Young people are equally at risk of becoming infected and spreading [the coronavirus] to others who then become infected," said Denis Nash, a professor of epidemiology at The City University of New York School of Public Health.

The percentages of coronavirus cases appear high partly because health departments are reporting based on age groups that cover wide spans of years, he added.

New York City, for example, has 3.5 million people in the 18-44 age range, Nash said, and 700,000 people in the 65-74 age range. Since the "young" age group constitutes a large segment of the city's population, it is logical that the numbers of those testing positive for COVID-19 are high. In other words, the numbers make sense once a calibration for population size is done.

"This just means everybody in every age group has the same rate of infection," said Adolfo García-Sastre, director of Mount Sinai's Global Health and Emerging Pathogens Institute in New York.

But fewer 20- and 30-somethings are likely being diagnosed, García-Sastre said, since most of them have milder symptoms compared with older patients and can often recover at home. New York health care providers have been limiting coronavirus testing to individuals who are experiencing the most severe symptoms and need hospitalization.

The more important statistics to consider, Nash said, are whether young people are being hospitalized or dying from COVID-19. And those numbers are much less stark.

He calculated the case fatality rate (with data up to March 23) in New York City by dividing the number of COVID-19 deaths by the hospital admission numbers. He found that 1.8% of deaths were among people 18-44. By comparison, 3.9% of deaths were among people 45-64, 9.5% were 65-74, and 16.3% were 75 and older.

A March 18 CDC report showed a similar trend. While 29% of coronavirus cases were among those ages 20-44, the percentages of ICU admissions were lowest in this age category. In addition, the percentages of people who died from COVID-19 increased with age.

'It was a complete shock'

Young adults are now coming to terms with that new reality — driven in part by statistics that show they are not safe from the coronavirus. News reports, such as that of a 25-year-old dying from COVID-19 or the announcement by Texas public health officials that 44 college students tested positive for the illness after returning from a group spring break trip to Mexico, drove home the point that they, too, were at risk.

A couple of days after her Saturday night out, Laura Mae started to feel sick. First, she had a sore throat. Then she developed a fever and chills and was short of breath and constantly tired - all reported symptoms of COVID-19. She called a local coronavirus hotline and a nurse told her she was presumptive positive, which meant it would be assumed she had the coronavirus but wouldn't be tested for it.

"It was a complete shock," said Laura Mae. "I didn't realize that someone like me, a healthy 27-year-old who has no immune issues, could get so sick."

While she's now mostly back to normal, she said her experience changed her perspective — especially when she thinks about the people she might have unknowingly exposed in the days before her symptoms appeared.

"You might be young and healthy and be able to fight this off on your own, but there are people who could end up hospitalized, and it's not a joke," she said. "I was laughing at all the memes and the jokes [about the coronavirus], and now I’m not. It's real."

Ishaan Shah, a political science major and 22-year-old senior at Washington University in St. Louis, said some of his classmates had similar reactions, staying relatively carefree despite the public health warnings. Then, the university shut down in the middle of its spring break - giving students only a few days to gather their belongings from the dorms before the campus was shuttered.

Once that happened, Shah said, "we knew what was up. That made it immediately serious."

And as he hears more about the coronavirus, his concerns amplify. "Every day that goes by, I personally have become more scared of this virus," he said.

This change in perspective seemed to happen fast in hot spots like New York City, where the virus exploded with a shockingly high daily death rate and case counts. People there now say that almost everyone — whether crossing paths on the street or in line at the grocery - is presumed positive.

Indeed, a tracking poll released last week found that most of the nation has adjusted its behavior to slow the spread of the coronavirus. Eighty-two percent of respondents reported they are sheltering in place and nearly everyone (92%) now reports some kind of social distancing — up from 59% two weeks ago, according to the poll from the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

But there are those who had factored this new reality into their daily habits almost from the beginning.

Take Megan Bohley, a 30-year-old behavioral health nurse who works in an outpatient facility in Flint, Michigan, interacting with patients all day.

When she gets home from work, she drops everything by the door, washes her hands, changes out of her work clothes and then dons a pair of rubber gloves and Clorox wipes to clean off her belongings. She also has talked to her husband about offering to help at a nearby hospital if Flint's circumstances worsen.

But she's scared, knowing that nurses and doctors are getting exposed and falling ill. "Some are dying," Bohley said. "It does make me more nervous about what I do."