1904. Health Behavioral Trends and Absenteeism Associated with Acute Respiratory Illness Before and During the SARS-CoV-2 Pandemic in a Community Household Cohort, King County, Washington
Authors: Chung Erin , Heimonen Jessica , O’Hanlon Jessica A , Wang Yongzhe Wang , Chow Eric J , Ogokeh Constance E , Rolfes Melissa A , Hughes James , Uyeki Timothy M , Starita Lea , Englund Janet A , Chu Helen Y , Hoag Samara 
Published: December 2022

Abstract

Background
Non-pharmaceutical interventions (NPIs), such as masking and social distancing, can reduce SARS-CoV-2 transmission. Longitudinal behavioral data in individuals with acute respiratory illness (ARI) during the COVID-19 pandemic are limited. We describe changes in adherence to NPIs and the impact of ARIs on work or school in families before and during the COVID-19 pandemic.

Methods
From November 2019 to June 2021, households with school-aged children in King County, WA, were remotely monitored on a weekly basis for symptoms of respiratory illness. Participants with ARI (cough or ≥2 qualifying symptoms) were asked about illness-related behavior changes (e.g. masking, isolation, hand hygiene, surface cleaning, public transit use) and impacts on school/work 7 days after initial symptom report. Using generalized estimating equations for household clusters, we compared the frequency of behavior changes and school/work impact during 3 time periods: the pre-/early COVID-19 pandemic period (11/14/19-3/22/20), pre-vaccine period (3/23/20-12/10/20), and post-COVID-19 vaccine period (12/11/20-6/19/21).

Results
Of 1861 participants in 470 households, 695 (37%, from 70% of households) reported 1157 ARIs. Over the 3 time periods, the percent of ill participants who reported staying home (34 vs 34 vs 54%, respectively, P&lt; .001), avoiding contact with others (25 vs 28 vs 45%, P&lt; .001), and masking (3 vs 23 vs 38%, P&lt; .001) increased (Fig 1A). Other illness-related behaviors, including washing hands and disinfecting surfaces, were unchanged over time. The percent of ill participants who worked from home (7 vs 9 vs 3%, P= .02) and missed work due to ARI (13 vs 8 vs 8%, P= .03) decreased over time (Fig 1B). Figure 1A.Participant reported illness-related health behaviors in the past week — Seattle, WA, 2019–2021.Figure 1B.Participant reported illness-related school or work impact in the past week due to illness — Seattle, WA, 2019–2021
Time periods were defined as: Period 1: 11/14/19 – 3/22/20 (pre-/early COVID-19 pandemic), Period 2: 3/23/20 – 12/10/20 (post-Washington State Stay at Home order), and Period 3: 12/11/20 – 6/19/21 (United States Food and Drug Administration Emergency Use Authorization for the Pfizer-BioNTech COVID-19 vaccine for those 16 years and older). Illness was defined per Acute Respiratory Illness (ARI) case definition: cough or two qualifying symptoms (fever, sore throat, runny nose, muscle or body aches, headache, difficulty breathing, fatigue, nausea or vomiting; for participants &lt; 18 years of age, ear pain or drainage, rash, and diarrhea were also qualifying symptoms).

Conclusion
As the COVID-19 pandemic progressed, households with school-aged children engaged in isolation, social distancing, and masking more frequently in response to ARI. The impact of ARIs on work decreased during the pandemic.

Disclosures
Janet A. Englund, MD, AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Meissa Vaccines: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant Helen Y. Chu, MD, MPH, Cepheid: Reagents|Ellume: Advisor/Consultant|Gates Ventures: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant.