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Association Between COVID-19 Exposure and Self-reported Compliance With Public Health Guidelines Among Essential Employees at an Institution of Higher Education in the US

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What was the prevalence of SARS-CoV-2 infection and associated protective behaviors among essential employees at an institution of higher education during the first 6 months of the COVID-19 pandemic in the US?

Findings  In this cross-sectional study of 508 essential employees, no cases of SARS-CoV-2 infection were verified by quantitative reverse transcriptase–polymerase chain reaction, and only 2 participants had measurable seroreactive IgG antibodies. High levels of handwashing and mask wearing were reported at work and outside work, and social distancing was reported significantly less often at work than outside work.

Meaning  The findings suggest that compliance with protective behaviors both at work and outside work may be commensurate with the safe operation of complex work environments during a pandemic.


Importance  Detailed analysis of infection rates paired with behavioral and employee-reported risk factors is vital to understanding how transmission of SARS-CoV-2 infection may be exacerbated or mitigated in the workplace. Institutions of higher education are heterogeneous work units that supported continued in-person employment during the COVID-19 pandemic, providing a test site for occupational health evaluation.

Objective  To evaluate the association between self-reported protective behaviors and prevalence of SARS-CoV-2 infection among essential in-person employees during the first 6 months of the COVID-19 pandemic in the US.

Design, Setting, and Participants  This cross-sectional study was conducted from July 13 to September 2, 2020, at an institution of higher education in Fort Collins, Colorado. Employees 18 years or older without symptoms of COVID-19 who identified as essential in-person workers during the first 6 months of the pandemic were included. Participants completed a survey, and blood and nasal swab samples were collected to assess active SARS-CoV-2 infection via quantitative reverse transcriptase–polymerase chain reaction (qRT-PCR) and past infection by serologic testing.

Exposure  Self-reported practice of protective behaviors against COVID-19 according to public health guidelines provided to employees.

Main Outcomes and Measures  Prevalence of current SARS-CoV-2 infection detected by qRT-PCR or previous SARS-CoV-2 infection detected by an IgG SARS-CoV-2 testing platform. The frequency of protective behavior practices and essential workers’ concerns regarding contracting COVID-19 and exposing others were measured based on survey responses.

Results  Among 508 participants (305 [60.0%] women, 451 [88.8%] non-Hispanic White individuals; mean [SD] age, 41.1 [12.5] years), there were no qRT-PCR positive test results, and only 2 participants (0.4%) had seroreactive IgG antibodies. Handwashing and mask wearing were reported frequently both at work (480 [94.7%] and 496 [97.8%] participants, respectively) and outside work (465 [91.5%] and 481 [94.7%] participants, respectively). Social distancing was reported less frequently at work (403 [79.5%]) than outside work (465 [91.5%]) (P < .001). Participants were more highly motivated to avoid exposures because of concern about spreading the infection to others (419 [83.0%]) than for personal protection (319 [63.2%]) (P < .001).

Conclusions and Relevance  In this cross-sectional study of essential workers at an institution of higher education, when employees reported compliance with public health practices both at and outside work, they were able to operate safely in their work environment during the COVID-19 pandemic.

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Article Information

Accepted for Publication: May 7, 2021.

Published: July 21, 2021. doi:10.1001/jamanetworkopen.2021.16543

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Nelson TL et al. JAMA Network Open.

Corresponding Author: Tracy L. Nelson, MPH, PhD, Colorado School of Public Health, Colorado State University, 215D Moby Complex B, Ft Collins, CO 80523 (Tracy.Nelson@Colostate.edu).

Author Contributions: Drs Nelson and Fosdick had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Nelson, Fosdick, Biela, Lynn, Pabilonia, Ehrhart, VandeWoude.

Acquisition, analysis, or interpretation of data: Nelson, Fosdick, Schoenberg, Mast, McGinnis, Young, Fahrner, Nolt, Dihle, Quicke, Gallichotte, Fitzmeyer, Ebel, Pabilonia, Ehrhart, VandeWoude.

Drafting of the manuscript: Nelson, Fosdick, Nolt, Ehrhart.

Critical revision of the manuscript for important intellectual content: Nelson, Fosdick, Biela, Schoenberg, Mast, McGinnis, Young, Lynn, Fahrner, Dihle, Quicke, Gallichotte, Fitzmeyer, Ebel, Pabilonia, Ehrhart, VandeWoude.

Statistical analysis: Nelson, Fosdick, Nolt.

Obtained funding: Nelson, Ehrhart, VandeWoude.

Administrative, technical, or material support: Nelson, Biela, Schoenberg, Mast, McGinnis, Young, Lynn, Fahrner, Dihle, Ebel, Pabilonia, Ehrhart, VandeWoude.

Supervision: Nelson, Biela, Ehrhart, VandeWoude.

Conflict of Interest Disclosures: Dr Pabilonia reported receiving infrastructure support through Colorado State University. Dr Ehrhart reported receiving grant support from the State of Colorado during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was funded by the Boettcher Foundation.

Role of the Funder/Sponsor: The Boettcher Foundation had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Mary Nehring, MPA, Colorado State University, assisted with transportation and organization of samples and was supported by the Boettcher Foundation grant.

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