Hoskins Susan, Beale Sarah, Nguyen Vincent, Fragaszy Ellen, Navaratnam Annalan M D, Smith Colette, French Clare, Kovar Jana, Byrne Thomas, Fong Wing Lam Erica, Geismar Cyril, Patel Parth, Yavlinksy Alexei, Johnson Anne M, Aldridge Robert W, Hayward Andrew
Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, Greater London, WC1E 6BT, UK.
Institute of Epidemiology and Healthcare, University College London, London, Greater London, WC1E 7HB, UK.
Wellcome Open Res. 2022 Aug 3;7:199. doi: 10.12688/wellcomeopenres.17981.1. eCollection 2022.
: "Lockdowns" to control serious respiratory virus pandemics were widely used during the coronavirus disease 2019 (COVID-19) pandemic. However, there is limited information to understand the settings in which most transmission occurs during lockdowns, to support refinement of similar policies for future pandemics. : Among Virus Watch household cohort participants we identified those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outside the household. Using survey activity data, we undertook multivariable logistic regressions assessing the contribution of activities on non-household infection risk. We calculated adjusted population attributable fractions (APAF) to estimate which activity accounted for the greatest proportion of non-household infections during the pandemic's second wave. : Among 10,858 adults, 18% of cases were likely due to household transmission. Among 10,475 participants (household-acquired cases excluded), including 874 non-household-acquired infections, infection was associated with: leaving home for work or education (AOR 1.20 (1.02 - 1.42), APAF 6.9%); public transport (more than once per week AOR 1.82 (1.49 - 2.23), public transport APAF 12.42%); and shopping (more than once per week AOR 1.69 (1.29 - 2.21), shopping APAF 34.56%). Other non-household activities were rare and not significantly associated with infection. During lockdown, going to work and using public or shared transport independently increased infection risk, however only a minority did these activities. Most participants visited shops, accounting for one-third of non-household transmission. Transmission in restricted hospitality and leisure settings was minimal suggesting these restrictions were effective. If future respiratory infection pandemics emerge these findings highlight the value of working from home, using forms of transport that minimise exposure to others, minimising exposure to shops and restricting non-essential activities.
在2019冠状病毒病(COVID-19)大流行期间,“封锁”措施被广泛用于控制严重的呼吸道病毒大流行。然而,关于封锁期间大多数传播发生的环境的信息有限,这不利于为未来大流行完善类似政策。在病毒监测家庭队列参与者中,我们识别出那些在家庭以外感染严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的人。利用调查活动数据,我们进行了多变量逻辑回归,评估活动对家庭外感染风险的影响。我们计算了调整后的人群归因分数(APAF),以估计在大流行第二波期间,哪种活动占家庭外感染的比例最大。在10858名成年人中,18%的病例可能是由于家庭传播。在10475名参与者(不包括家庭感染病例)中,包括874例非家庭感染病例,感染与以下因素相关:离家上班或上学(调整后比值比[AOR]为1.20[1.02 - 1.42],APAF为6.9%);公共交通(每周不止一次,AOR为1.82[1.49 - 2.23],公共交通APAF为12.42%);以及购物(每周不止一次,AOR为1.69[1.29 - 2.21],购物APAF为34.56%)。其他家庭外活动很少,且与感染无显著关联。在封锁期间,上班以及独立使用公共或共享交通工具会增加感染风险,然而只有少数人进行这些活动。大多数参与者会去商店,这占家庭外传播的三分之一。在受限的餐饮和休闲场所的传播极少,表明这些限制措施是有效的。如果未来出现呼吸道感染大流行,这些发现凸显了在家工作、使用能减少与他人接触的交通方式、尽量减少去商店以及限制非必要活动的价值。