From crowded bars in South Boston to spring break beaches in Florida, throngs of young people have treated the coronavirus as a curiosity, an inconvenience, or a petty nuisance that cannot puncture their shield of invulnerability.
Even after Governor Charlie Baker and counterparts in other states shut down restaurants, closed pubs, and limited public gatherings to 10 people or fewer, many Americans in their 20s and 30s stuck to early thinking that older people are much more at risk.
But that perception — and behavior, too — has shifted as global data are evaluated. Now, millennials and other young adults appear more likely to contract coronavirus than had first been believed.
“It’s the next level,” said Burhan Azeem of Cambridge, a 23-year-old MIT graduate and engineer at a health care company, speaking of the possibly heightened risk for his generation.
The most severe cases in the US, and the highest rate of death, continue to be among patients 65 and older. But new data show that up to one-fifth of people from 20 to 44 years old with reported cases of coronavirus -- a group that makes up nearly 30 percent of reported cases across all ages — have been hospitalized, according to the US Centers for Disease Control and Prevention.
The 20 percent hospitalization rate for younger people with reported cases of the virus tells only part of the story, said Dr. Eric Feigl-Ding, an epidemiologist and senior fellow at the Federation of American Scientists. The number also means that many younger people are unwitting carriers of the disease.
“If you think you’re being safe by not visiting your grandparents” but continuing to go to parties, Feigl-Ding said, “you could pass it on to someone else, who could pass it on to your mailman or grocery store clerk, who could then pass it on to your grandparents.”
“You’re contributing to the contagion that could eventually infect your loved ones,” he said.
Seniors continue to be hit hardest. Patients 65 and older have accounted for 45 percent of hospitalizations for the virus and 80 percent of deaths, the CDC reported. State officials announced Friday that an 87-year-old Winthrop man became the first person in Massachusetts to die from an illness related to the coronavirus.
Azeem and his three Cambridge roommates had been cautious as the first reported cases of coronavirus were confirmed, the numbers began to climb, and state and local officials told residents to hunker down and practice “social distancing," that now-all-too-familiar term.
The roommates started working from home and did not invite friends over. As members of a younger generation, Azeem said, they felt a duty not to spread the disease to older people or those with compromised immune systems.
“The reason before was because you didn’t want to get other people infected,” Azeem added. “Now it’s like, we also have to be more careful to not get it ourselves.”
Dr. Thomas Heyne, an internist and pediatrician at Massachusetts General Hospital, echoed Feigl-Ding’s warning that young people who appear and feel healthy can transmit the disease.
“Even though many children or young adults might have mild or no symptoms, they can still be potent vectors for spreading the disease,” Heyne said.
“To my fellow millennials and Generation Z-ers, please: Give us a break. The more you are out, the more you may be spreading a virus without realizing it,” he said. “That birthday party could inadvertently lead to more people dying, particularly if the number of sick overwhelms our health system, and we don’t have the beds, staff, breathing machines, or personal protective equipment to care for these people like we should.”
Benji Bromberg, 20, a sophomore at Lewis & Clark College in Portland, Ore., has changed his thinking about the risks for himself and others in his age group. Bromberg returned to his Brookline home Sunday and has stayed quarantined there, just to be safe.
“I wasn’t as concerned [at first] if I did get it, because I knew I was going to go into self-isolation, and people were saying it wasn’t that bad for young people,” Bromberg said.
Now, given the latest statistics, he has changed his approach and hopes other people in his age bracket will take the risks more seriously, too.
“I have a bunch of friends who are still going outside and stuff, and hanging out with friends and not taking it too seriously,” Bromberg said. “Especially with the newest news, it’s more disconcerting.”
Cavalier or dismissive attitudes among the young in Europe, who continued to flock to bars and cafes as the virus spread, are seen as contributing to the contagion overseas.
However, much remains unknown about the effect of the disease on various age groups, said Dr. Yonatan Hagai Grad, assistant professor of immunology and infectious diseases at the T.H. Chan School of Public Health at Harvard University.
“It’s quite possible that what we’re seeing here reflects a bias in who had the risk factors that prompted testing,” Grad said. “The data we have so far from other countries is that younger individuals are at lower risk than those who are older, and that’s likely true here, too, once more data — and more unbiased data — come in."
However, “these results remind us that lower risk does not mean no risk, and individuals in younger age groups can end up with severe manifestations of disease,” he added.
Dr. Nahid Bhadelia, medical director of the Special Pathogens Unit at the Boston University School of Medicine, agreed that more information is needed to complete the picture of risk.
“We have only been testing the sickest in this country — that’s changing now. As we test more people, the percentages may change to reflect a bigger burden is still borne by those who are older,” Bhadelia said. "But this data tell us that in every age group, there are people who are vulnerable. I think that reasserts for us how we all need to try our hardest to employ social distancing, for all of our sakes.”
Heyne, the MGH physician, said small children also are at risk of infection, which could have broad repercussions.
“One child with a mild cold could be spreading COVID through a day care, and all those children could bring COVID home with them. Thus, the governor’s decision to close day cares across Massachusetts makes good public health sense,” Heyne said.
“Particularly as the number of infections, hospitalizations, and deaths continue to rise nationally, we cannot emphasize enough: Social distancing should be practiced by people of all ages. We must learn the hard lessons from Italy,” Heyne said.
Dr. Deborah Birx, the White House’s coronavirus response coordinator, echoed that warning this week.
“You have the potential then to spread it to someone who does have a condition that none of us knew about and cause them to have a disastrous outcome,” Birx said.
The data for younger people, Grad said, “is a reminder that all of us, no matter our age, have a role to play in ‘flattening the curve’ and slowing the spread of the epidemic by social distancing.”