Household factors and the risk of severe COVID-like illness early in the US pandemic

Nash, Denis; Qasmieh, Saba; Robertson, McKaylee; Rane, Madhura S.; Zimba, Rebecca; Kulkarni, Sarah; Berry, Amanda; You, William; Mirzayi, Chloe; Westmoreland, Drew; Parcesepe, Angela M.; Kochhar, Shivani; Maroko, Andrew; Grov, Christian

doi:10.1101/2020.12.03.20243683

Cited by 9 publications

(14 citation statements)

References 36 publications

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“…Household transmission of SARS-CoV-2 occurs with very high attack rates, and may also increase the risk of more severe COVID-19 disease, requiring hospitalization. 23 Household crowding, more than population density, was shown to be a characteristic of community transmission ‘hotspots’ in a recent ecological analysis from the early phase of the pandemic. 24 When there are possible or confirmed cases of SARS-CoV-2 among household members, when background community transmission is substantial, or when the possibility of exposure outside the household is high (e.g., essential workers), our study and others 25 suggest mask use in the household should be considered, especially when it is otherwise not possible to limit potential exposure and spread in the household by isolating or sequestering away from others.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 incidence and risk factors in a national, community-based prospective cohort of U.S. adults

Nash

Rane

Chang

et al. 2021

Preprint

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Background Epidemiologic risk factors for incident SARS-CoV-2 infection are best characterized via prospective cohort studies, complementing case-based surveillance and cross-sectional seroprevalence studies. Methods We estimated the cumulative incidence of SARS-CoV-2 infection and incidence rates of seroconversion in a national prospective online cohort of 6,745 U.S. adults, enrolled March-July 2020. A subset (n=4,459) underwent serologic testing (Bio-Rad Platelia Total Ab, IgA/IgM/IgG), offered initially May-September 2020 and again November 2020-January 2021. Results A total of 303 of 4,459 individuals showed serologic evidence of past SARS-CoV-2 infection (cumulative incidence of 6.8%; 95% Confidence Interval [CI] 6.1%-7.6% [6.3%, 95% CI 5.7%-7.1% adjusting for laboratory test error]). Among 3,280 initially seronegative participants with a subsequent serologic test, we observed 145 seroconversions during 1,562 person years of follow-up (incidence rate of 9.3 per 100 person-years [95% CI 17.9-11.0]). Racial/ethnic disparities in crude incidence rates were apparent through January 2021 (rate ratio [RRHispanic vs Whites]=2.1; 95% CI 1.4-3.1; RRnon-Hispanic Blacks vs Whites=1.8; 95% CI 0.96-3.1). Incidence was higher in the southern (RRSouth vs Northeast=1.7; 95% CI 1.1-2.8) and midwestern (RRMidwest vs Northeast=1.6; 95% CI 0.98-2.7) regions, in rural vs urban areas (RR=1.5; 95% CI 1.0-2.2), and among essential workers (RR=1.7; 95% CI 1.1-2.5). Household crowding (RR=1.6, 95% CI 1.1-2.3), dining indoors at restaurants/bars (RR=2.0; 95% CI 1.4-2.8), visiting places of worship (RR=2.0; 95% CI 1.3-2.9), wearing masks sometimes vs always while grocery shopping (RR=2.5; 95% CI 1.3-4.4), indoor visits with people outside the household with masks (RRalways mask vs no visit=2.6; 95% CI 1.6-4.4) and without masks (RRsometimes mask vs no visit=3.5; 95% CI 2.7-5.7; RRnever mask vs no visit=5.3; 95% CI 3.1-8.9); working indoors at a place of employment with masks (RRalways mask vs no in-person=2.0, 95% CI 1.4-2.8) and without masks (RRsometimes mask vs no in-person= 2.0, 95% CI 1.1-3.5; RRnever mask vs no in-person=3.7, 95% CI 1.3-8.5); attending a salon or gym with masks (RRalways mask vs no salon/gym=1.7 (95% CI 1.1-2.4), gathering indoors and outdoors in groups of >10 (RR=1.9, 95% CI 1.2-2.0); and air travel during the pandemic (RR=1.7; 95% CI 1.1-2.6) were also associated with higher incidence rates. Among 303 seropositive individuals, 27.4% had asymptomatic infection, and 32% reported a positive SARS-CoV-2 PCR test or provider diagnosis of COVID-19. In this group, there were major gaps in the coverage of public health interventions aimed at isolation (31% isolated) and contact tracing (asked about contacts [18%]; told about exposure to a confirmed case [7.6%]). Conclusions Modifiable risk factors and low reach of public health strategies drive SARS-CoV-2 transmission across the U.S. It is critical to address inequities in incidence, reduce risk factors, and improve the reach of public health strategies in the vaccine era.

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Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 incidence and risk factors in a national, community-based prospective cohort of U.S. adults

Nash

Rane

Chang

et al. 2021

Preprint

Self Cite

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“…associated with an increased likelihood of SARS-CoV-2 spread. 16 The role of such exposures as well as the role of the presence of children in the household have not been investigated as risk factors for severe COVID-19like illness (ie, hospitalisation). We found that the risk of hospitalisation due to COVID-19 was higher among participants who had (vs those who did not have) children in the home, with an adjusted OR (aOR) of hospitalisation of 10.5 (95% CI: 5.7 to 19.1) among study participants living in multiunit dwellings and 2.2 (95% CI: 1.2 to 6.5) among those living in single-unit dwellings.…”

Section: Covid-19 Symptoms and Care Outcomesmentioning

confidence: 99%

Cohort profile: a national, community-based prospective cohort study of SARS-CoV-2 pandemic outcomes in the USA—the CHASING COVID Cohort study

et al. 2021

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PurposeThe Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study is a community-based prospective cohort study launched during the upswing of the USA COVID-19 epidemic. The objectives of the cohort study are to: (1) estimate and evaluate determinants of the incidence of SARS-CoV-2 infection, disease and deaths; (2) assess the impact of the pandemic on psychosocial and economic outcomes and (3) assess the uptake of pandemic mitigation strategies.ParticipantsWe began enrolling participants from 28 March 2020 using internet-based strategies. Adults≥18 years residing anywhere in the USA or US territories were eligible. 6740 people are enrolled in the cohort, including participants from all 50 US states, the District of Columbia, Puerto Rico and Guam. Participants are contacted regularly to complete study assessments, including interviews and dried blood spot specimen collection for serologic testing.Findings to dateParticipants are geographically and sociodemographically diverse and include essential workers (19%). 84.2% remain engaged in cohort follow-up activities after enrolment. Data have been used to assess SARS-CoV-2 cumulative incidence, seroincidence and related risk factors at different phases of the US pandemic; the role of household crowding and the presence of children in the household as potential risk factors for severe COVID-19 early in the US pandemic; to describe the prevalence of anxiety symptoms and its relationship to COVID-19 outcomes and other potential stressors; to identify preferences for SARS-CoV-2 diagnostic testing when community transmission is on the rise via a discrete choice experiment and to assess vaccine hesitancy over time and its relationship to vaccine uptake.Future plansThe CHASING COVID Cohort Study has outlined a research agenda that involves ongoing monitoring of the incidence and determinants of SARS-CoV-2 outcomes, mental health outcomes and economic outcomes. Additional priorities include assessing the incidence, prevalence and correlates of long-haul COVID-19.

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“…The results presented here suggest that communities in which people interact more densely from the perspective of disease transmission (e.g., downtowns) may similarly act as contagion reservoirs which may prolong the duration of outbreaks and potentially create secondary reinfection waves. However, the factors that lead to a higher density of social interactions in one community, for example, household size 24,25 or employment in the service industry or essential worker status 26 , can often be the result of long term structural inequalities [47][48][49][50] . These factors must be accounted for when attempting to explain causal sources of differences in transmission rates within cities and in planning responses to outbreaks.…”

Section: Discussionmentioning

confidence: 99%

“…However, we do not expect this to hold later in the pandemic, as social distancing and lockdowns disrupt the social networks of cities, specifically to reduce contacts, and this modifies the urban scaling laws. Later in the pandemic, when mitigation measures have been implemented, we expect neighborhood and individual variations in social network size after social distancing [during complete lockdowns this is roughly equivalent to household size, which has been demonstrated to be a significant risk factor for COVID-19 transmission 24,25 ], face covering compliance, and availability of work-from-home 26 to influence transmission rates. In addition, neighborhood and individual differences in co-morbidities are likely relevant to understanding the variance in morbidity and mortality outcomes within cities, but are not accounted for here where the focus is on transmission rates.…”

Section: Introductionmentioning

confidence: 99%

Early pandemic COVID-19 case growth rates increase with city size

2021

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The current outbreak of COVID-19 poses an unprecedented global health and economic threat to interconnected human societies. Strategies for controlling the outbreak rely on social distancing and face covering measures which largely disconnect the social network fabric of cities. We demonstrate that early in the US outbreak, COVID-19 spread faster on average in larger cities and discuss the implications of these observations, emphasizing the need for faster responses to novel infectious diseases in larger cities.

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Household factors and the risk of severe COVID-like illness early in the US pandemic

Cited by 9 publications

References 36 publications

SARS-CoV-2 incidence and risk factors in a national, community-based prospective cohort of U.S. adults

SARS-CoV-2 incidence and risk factors in a national, community-based prospective cohort of U.S. adults

Cohort profile: a national, community-based prospective cohort study of SARS-CoV-2 pandemic outcomes in the USA—the CHASING COVID Cohort study

Early pandemic COVID-19 case growth rates increase with city size

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