As COVID-19 once again grips the Northeast and the country, the message to twenty-somethings in particular has been consistent and clear: Get serious. Stop partying. You are endangering your communities.
Across the country and the world, young adults are making up an ever-increasing share of known COVID-19 cases, and public officials are not letting the trend go unnoticed.
In a recent overhaul of its daily dashboard, the Massachusetts Department of Public Health began highlighting the age breakdown of new cases, increasingly skewed toward young adults. Governor Charlie Baker — along with leaders across the region — has repeatedly admonished young people for flouting pandemic rules, pointing to house parties and other risky gatherings as drivers of the current surge.
But epidemiologists worry that officials' reprimands might be misdirected — and counterproductive.
“It may very well be true that small social gatherings or large social gatherings among young people are driving the pandemic, but I haven’t yet seen data to support that,” said Julia Marcus, an epidemiologist and associate professor at Harvard Medical School and Harvard Pilgrim Health Care Institute.
Though infection rates have risen rapidly among young adults, Marcus and other experts warn that data explaining that trend are limited. Young people themselves say some of their peers may remedy isolation in irresponsible ways, but the social and economic realities of early adulthood also increase their risk: service industry work, reliance on public transit, crowded housing that helps lower costs but increases their exposure.
Regardless of why certain age groups are contracting COVID-19 — at work or parties, due to their recklessness or responsibilities — scientists said public officials should use compassion, not shame, to inform policy and curb infections.
“We know from other areas of public health, with HIV and substance use, that blaming people for their risky health behavior is not just ineffective, it can also be counterproductive,” Marcus said. “It perpetuates stigma, which drives people away from public health rather than engaging them, which is what we really want to do.”
The 7-day average of new COVID-19 cases in Massachusetts has been over 1,000 since Oct. 24, marking the longest stretch since May with such high levels.
While all age groups have seen numbers rise throughout most of the late summer and fall, people in their 20s saw the highest rates of new probable and confirmed COVID-19 cases per 100,000 people, data from the Public Health Department’s weekly reports show. In the past two weeks, 4,600 people aged 20-29 have tested positive for the disease.
Other working-age adults also have infection rates that exceed the state average. In recent weeks, rates among thirty-somethings have nearly kept pace with those among twenty-somethings, with people in their 40s not far behind. The distribution of cases has shifted dramatically since spring, with most reported cases showing up in people under 50 today, versus elders earlier in the pandemic.
“Our young people need to be serious about dealing with COVID,” Baker said in an October press conference. “COVID is a very contagious virus, and it will rear its ugly head wherever it gets the chance.”
Experts said there is good reason to be concerned about rising cases in young adults, as COVID-19 can be fatal for people of any age and the long-term effects of milder infections remain unknown.
Young people can also seed infection in their communities, said Anne Rimoin, a professor of epidemiology at UCLA Fielding School of Public Health. “We’re seeing the same pattern here [in the United States] that we’ve seen in Europe and other places, which is you see cases expand in the younger age groups, but then it’s followed by cases in older age groups and vulnerable populations,” she said.
The question of why young adults are getting infected is more complicated, experts said.
“I think there’s a tendency to envision that there are all these young people out at bars and parties, and that somehow it is irresponsible behavior [driving cases],” said Dr. Sarah Fortune, chair of the Department of Immunology and Infectious Diseases at Harvard T.H. Chan School of Public Health. “I do not think the data per se can be interpreted to mean that.”
The same “overlapping social-political factors” that contribute to COVID-19 risk among the general population also apply to young people, she said.
For Maggie Timboe, 22, and Curt Mai, 21, what they see as the riskiest part of their routines is also the most necessary: Going to work.
Timboe, a food service worker, restricts her social circle to her boyfriend, with whom she lives in Allston, and four or five friends she only meets outdoors. She said she feels safe in her workplace but worries about contracting COVID-19 during her hourlong commute on the T.
“Mostly the experience [of the pandemic] has been the anxiety about traveling to work,” she said. “And really, in the last two weeks, the anxiety has gotten worse.”
“I’m a restaurant manager. Probably I interact with 1,000 customers a week,” said Mai, who lives with two roommates in Lowell. “I have no choice. That’s what I have to do to pay my bills, you know?”
Mai said he believed that in addition to service industry work, people his age are also put at risk by a “you only live once” mindset that leads some to throw caution — and their communities' health — to the wind, even though he said he and his friends take COVID-19 seriously.
Several young people voiced similar concerns about their peers more broadly, while insisting that they and the people they know are being careful. All balked at the idea that partying is driving infections. Several of the activities they think other young people are irresponsible for doing — dining in groups, going to the gym, traveling between states, taking public transit for leisure outings — are, in fact, allowed and deemed safe by officials.
“That people take their lead from the government is natural,” said one 32-year-old in Cambridge who has struggled to find common ground on pandemic safety with his roommate, who spends time in settings he thinks are unsafe, including gyms. He asked to stay anonymous out of concern that his roommate, the one person he sees regularly, would be upset.
Reopening “puts more undue burden on the individual” to determine what is safe, he said.
Soraya Pierre-Louis, a 22-year-old Northeastern University student, said that burden has been a defining feature of her senior year in college. Pierre-Louis plans to pursue a career in public health, in part because of the pandemic. But even for rule-followers like herself, she said, “There’s this kind of ever-looming fear on our campus of if someone gets caught [breaking a pandemic rule], they don’t know what’s going to happen."
Pervasive fear will not keep young people, or anyone, from taking risks, said Jennifer Nuzzo, a Johns Hopkins epidemiologist. But she said empathy might.
“We’re telling people to stay home as much as possible, but we have to recognize that that’s easier for some people than others,” Nuzzo said. “For someone in their early 20s who potentially doesn’t have a built-in social unit at home, their one source of social support is their friends.
“I say that not to absolve people but just to be realistic about what it’s going to take to control this virus,” she said.
“If we take a minute before yelling at people to actually ask why are people gathering right now, the answer is probably going to be that they need social connection,” said Marcus, the Harvard epidemiologist who studies stigma. “Once we can see what that unmet need is, we can help people find safer ways to do that.”
Alexandria Whitted, 22, has resorted to making new friends at the grocery store, one of the few places she ventures since moving to Brookline from North Carolina in August. Whitted, who is pursuing a masters in public health at Boston University, said social distancing is a no-brainer for her, no matter how difficult. Still, she said, she scrolls through Instagram, wistful and frustrated as less cautious acquaintances vacation and socialize.
She said an effective public health response would meet young people where they are.
“Being in your 20s is a very unique place in life. Some of us have families. Some of us have children. Some of us have responsibility for parents who are getting older. Some of us have been in school for 20 years. Some of us think because we’re younger, we’re immune to the virus," she said. “It’s more work to tailor the messages to fit those different groups, but regardless, everyone in the state — everyone in the country — deserves support.”