Nearly half of Americans acknowledged they weren’t truthful about their COVID-19 status or didn’t follow public health measures at the height of the pandemic in a new nationwide survey led in part by a team of University of Utah Health researchers.
Wanting to feel normal and exercise personal freedom were the most cited reasons for a list of behaviors that included lying about what precautions they were taking against spreading the virus, breaking quarantine rules, avoiding testing and failing to disclose they had COVID-19 when asked.
The findings “suggest that misrepresentation and non-adherence regarding COVID-19 public health measures constitute a serious public health challenge,” according to an article on the study published Monday in the Journal of the American Medical Association’s JAMA Network Open.
“This gave us a much better idea of what kind of behaviors people were engaging with and how prevalent it was. I think more importantly, we got a really good idea of the reasons why,” said Alistair Thorpe, the study’s co-first author and a postdoctoral researcher in the Department of Population Health Sciences at U Health.
Thorpe said the findings were more concerning than surprising.
Many of the behaviors people were asked if they had engaged in “can have very severe consequences,” he said, such as not being forthcoming about having COVID-19 when going to a doctor’s office, “a place where there’s potentially very vulnerable people who you’re exposing, without them knowing, to a very serious virus.”
The online survey of 1,733 participants, including six respondents who said they lived in Utah, was conducted in December 2021, when the highly transmissible omicron variant of COVID-19 that drove cases to record-breaking levels worldwide started sweeping through the country.
In Utah, the omicron surge led to reimposing mask mandates in Salt Lake and Summit counties, an effort that was quickly stopped by state lawmakers, while hospitals ended up being so overcrowded that patients had to be turned away.
But just under 42% of the Americans who participated in the survey reported misrepresentation or nonadherence for at least one of nine behaviors, most commonly telling someone they were spending time with that they were taking more measures against COVID-19 than they actually were.
Respondents who’d admitted they hadn’t been truthful with others and/or weren’t following the rules intended to protect the public were asked to answer yes or no to a long list of possible reasons for their behavior. The most popular choices were:
- “I wanted my life to feel ‘normal’ (how I felt before the COVID-19 pandemic began).”
- “I wanted to exercise my freedom to do what I want.”
- “It’s no one else’s business.”
- “I didn’t feel very sick.”
- “I was following guidance from a public figure I trust (politicians, scientists, people on the news, celebrities).”
However, the survey also found “a substantial portion of participants” also agreed with these reasons:
- “I didn’t think COVID-19 was real.”
- “I didn’t think COVID-19 was a big deal.”
- “I didn’t want someone to judge or think badly of me.”
A third of the participants had already had COVID-19, while the remaining participants who had not had the virus were split between the vaccinated and the unvaccinated. About 60% having sought a doctor’s advice for prevention or treatment.
While those younger than 60 — and those who expressed a greater distrust of science — were more likely to engage in misrepresentation or nonadherence behaviors, no association was found with political beliefs, party affiliation or religion.
“We don’t believe that these are simple behaviors, that people do one thing because of one reason,” Thorpe said. ”We really need to work to address them all, so it’s not the case, ‘Oh, if we change one thing, it will have the desired outcome.’ It’s a very complex behavioral process.”
A theme that emerged was “people wanting to maintain autonomy, that they felt it was no one else’s business, that they wanted to exercise personal freedom. The fact that these similar concepts were consistently prevalent across a number of reasons, that tells us something about how we can work better to communicate,” he said.
Making it easier to comply with public health measures can help people feel less resistant, Thorpe said. But he said public health officials also need to “figure out how you can talk to people about these concerns that they have in a way that can help them become more engaged with these measures” and see their collective benefit.
“That’s why this study is so important. We need to try and figure out who we’re not communicating as well with and how we can do better,” Thorpe said. The challenge during the COVID-19 pandemic is that “people have been asked to do things that they never even had to comprehend before in their lives. So it’s a challenge.”
Many people struggled to shift their perspective from viewing adherence to public health measures in terms of personal concerns to focusing more on how their actions could protect others. This “ties back to how a lot of these things have been really burdensome. You can have the best of intentions,” he said.
Thorpe said the pandemic placed people “under an extremely long period of uncertainty, stress in all aspects of your life — your social life, your financial life, your philosophies of life — those kind of situations, those extreme situations like we’ve seen here can make it difficult to engage in more proactive behavior.”
Besides Thorpe and others from the University of Utah, including Angela Fagerlin, senior author of the study and chair of the Department of Population Health Sciences, researchers from the Veterans Administration in Salt Lake City along with institutions in Connecticut, Colorado, Iowa and the American Heart Association also contributed to the study.