Cluster infections play important roles in the rapid evolution of COVID-19 transmission: A systematic review

Liu, Tao; Gong, Dexin; Xiao, Jianpeng; Hu, Jianxiong; He, Guanhao; Rong, Zuhua

doi:10.1016/j.ijid.2020.07.073

Cited by 96 publications

(115 citation statements)

References 90 publications

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“…A living systematic review estimated that the proportion of PCR-positive infected contacts that progress to symptomatic disease is approximately 70-80%. 16,17 Mean or median incubation period has been consistently estimated to be between 5 to 7 days. [18][19][20] Although studies have suggested that the viral load of cases might be associated with risk of disease or transmission, no published data so far have directly addressed this question, and little is known about factors that might contribute to variation on the risk of developing COVID-19 symptoms or the incubation periods among individuals who are infected.…”

Section: Introductionmentioning

confidence: 99%

Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study

Marks

Millat-Martinez

Ouchi

et al. 2021

The Lancet Infectious Diseases

336

290

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Background Scarce data are available on what variables affect the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the development of symptomatic COVID-19, and, particularly, the relationship with viral load. We aimed to analyse data from linked index cases of COVID-19 and their contacts to explore factors associated with transmission of SARS-CoV-2. Methods In this cohort study, patients were recruited as part of a randomised controlled trial done between March 17 and April 28, 2020, that aimed to assess if hydroxychloroquine reduced transmission of SARS-CoV-2. Patients with COVID-19 and their contacts were identified by use of the electronic registry of the Epidemiological Surveillance Emergency Service of Catalonia (Spain). Patients with COVID-19 included in our analysis were aged 18 years or older, not hospitalised, had quantitative PCR results available at baseline, had mild symptom onset within 5 days before enrolment, and had no reported symptoms of SARS-CoV-2 infections in their accommodation or workplace within the 14 days before enrolment. Contacts included were adults with a recent history of exposure and absence of COVID-19-like symptoms within the 7 days preceding enrolment. Viral load of contacts, measured by quantitative PCR from a nasopharyngeal swab, was assessed at enrolment, at day 14, and whenever the participant reported COVID-19-like symptoms. We assessed risk of transmission and developing symptomatic disease and incubation dynamics using regression analysis. We assessed the relationship of viral load and characteristics of cases (age, sex, number of days from reported symptom onset, and presence or absence of fever, cough, dyspnoea, rhinitis, and anosmia) and associations between risk of transmission and characteristics of the index case and contacts. Findings We identified 314 patients with COVID-19, with 282 (90%) having at least one contact (753 contacts in total), resulting in 282 clusters. 90 (32%) of 282 clusters had at least one transmission event. The secondary attack rate was 17% (125 of 753 contacts), with a variation from 12% when the index case had a viral load lower than 1 × 10⁶ copies per mL to 24% when the index case had a viral load of 1 × 10¹⁰ copies per mL or higher (adjusted odds ratio per log 10 increase in viral load 1•3, 95% CI 1•1-1•5). Increased risk of transmission was also associated with household contact (3•0, 1•59-5•65) and age of the contact (per year: 1•02, 1•01-1•04). 449 contacts had a positive PCR result at baseline. 28 (6%) of 449 contacts had symptoms at the first visit. Of 421 contacts who were asymptomatic at the first visit, 181 (43%) developed symptomatic COVID-19, with a variation from approximately 38% in contacts with an initial viral load lower than 1 × 10⁷ copies per mL to greater than 66% for those with an initial viral load of 1 × 10¹⁰ copies per mL or higher (hazard ratio per log 10 increase in viral load 1•12, 95% CI 1•05-1•20; p=0•0006). Time to onset of symptomatic disease decreased from a median of 7 da...

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Section: Introductionmentioning

confidence: 99%

Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study

Marks

Millat-Martinez

Ouchi

et al. 2021

The Lancet Infectious Diseases

336

290

View full text Add to dashboard Cite

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“…Future studies should explore whether facilities with such mandatory policy have differential infection rates, and whether inpatients and outpatients differ in odds for infection and morbidity. Another potential explanatory mechanism to account for the lower rates of infection is that social isolation, as well as the fact that the majority of individuals with schizophrenia were unmarried and less likely to have been infected by family members (which are considered to be one of the main routes of infection 24 , 25 ), may resulted in reduced chances of infection. Such competing hypotheses should be subjected to future research.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Prevalence and Mortality Among Schizophrenia Patients: A Large-Scale Retrospective Cohort Study

Bitan

Krieger

Kridin

et al. 2021

Schizophrenia Bulletin

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Objective Individuals with schizophrenia may be at an increased risk for COVID-19 morbidity due to the disease characteristics. In this study, we aimed to explore the odds of significant COVID-19 morbidity and mortality among schizophrenia patients while controlling for potential sociodemographic and medical confounders. Methods Schizophrenia patients and age-and-sex matched controls (total n = 51 078) were assessed for frequency of COVID-19 positivity, hospitalizations, and mortality. The odds for COVID-19-associated hospitalization and mortality were calculated using logistic regression models, while controlling for age, sex, marital status, sector, socioeconomic status, diabetes, ischemic heart disease, hypertension, hyperlipidemia, obesity, smoking, and chronic obstructive pulmonary disease. Results Individuals with schizophrenia were less likely to test positive for COVID-19; however, they were twice as likely to be hospitalized for COVID-19 (OR 2.15 95% CI 1.63–2.82, P < .0001), even after controlling for sociodemographic and clinical risk factors (OR 1.88 95% CI 1.39–2.55, P < .0001). Furthermore, they were 3 times more likely to experience COVID-19 mortality (OR 3.27 95% CI 1.39–7.68, P < .0001), compared to controls. Conclusions We found evidence of associations between schizophrenia and increased COVID-19 morbidity and mortality compared to controls regardless of sociodemographic and medical factors. As these patients present with a combination of potential risk factors for mortality, efforts should be made to minimize the effects of the pandemic on this vulnerable population.

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“…These interactions were not perceived as occurring in public. These perceptions are problematic, as cluster infections among family, friends, and colleagues remain a common pattern for COVID-19 transmission [ 22 , 23 ]. Promoting the use of face coverings in social and work settings is needed.…”

Section: Discussionmentioning

confidence: 99%

Motivations and Barriers for the Use of Face Coverings during the COVID-19 Pandemic: Messaging Insights from Focus Groups

Shelus

Frank

Lazard

et al. 2020

IJERPH

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Widespread use of face coverings is a key public health strategy to prevent the spread of COVID-19. However, few studies have examined why Americans use or do not use face coverings, and little is known about the most effective messaging strategies. This study explored perceptions of face coverings, including motivations and barriers for use, and examined reactions to messaging promoting the use of face coverings. Six virtual focus groups were conducted with 34 North Carolina residents in July 2020. Participants reported high compliance with face covering recommendations but often did not wear them around family, friends, and colleagues. The most prevalent motivation for the use of face coverings was to protect or respect other people, including high-risk populations and individuals. Other motivators were self-protection, responsibility, desire for control, requirements, and expert advice. Barriers included physical and social discomfort, confusion or misinformation, low perceived susceptibility to COVID-19, and perceptions of identity and autonomy. Even among individuals who frequently wear face coverings, there are opportunities to improve compliance. Messaging should highlight how face coverings protect the wearer and others around them, normalize the use of face coverings in social settings, and emphasize requirements. Positive messages that focus on unity, personal experiences and the rationale for face coverings are recommended.

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Cluster infections play important roles in the rapid evolution of COVID-19 transmission: A systematic review

Abstract: Highlights This paper summarised the major types of SARS-COV-2 cluster infections worldwide. Sixty-five studies were included, involving 108 cluster infections. The major types of clusters were families, community transmission, etc.

Cited by 96 publications

References 90 publications

Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study

Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study

COVID-19 Prevalence and Mortality Among Schizophrenia Patients: A Large-Scale Retrospective Cohort Study

Motivations and Barriers for the Use of Face Coverings during the COVID-19 Pandemic: Messaging Insights from Focus Groups

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