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Hand and Respiratory Hygiene Practices and the Risk and Transmission of Human Coronavirus Infections in a UK Community Cohort

19 Pages Posted: 18 Mar 2020

See all articles by Sarah Beale

Sarah Beale

University College London - Research Department of Epidemiology & Public Health

Anne M Johnson

University College London - Institute for Global Health

Maria Zambon

Imperial College London - NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance

Andrew C Hayward

University College London - Research Department of Epidemiology & Public Health

Ellen B Fragaszy

University College London - Department of Infectious Disease Informatics

Flu Watch Group

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Abstract

Background: Respiratory and hand hygiene may mitigate the spread of COVID-19 in community settings; however, empirical evidence is limited. Given reports of similar transmission mechanisms for COVID-19 and seasonal coronaviruses, we investigated whether hand and respiratory hygiene impacted the risk of acquiring or transmitting seasonal coronavirus infections.

Methods: Data were drawn from three successive winter cohorts (2006-2009) of the England-wide Flu Watch study. Participants (n=1605) completed baseline surveys of hand and respiratory hygiene practices. Coronavirus infections were identified from nasal swabs using RT-PCR. Poisson mixed models estimated the effect of hand hygiene on personal risk of coronavirus illness overall and following household exposure, and the effect of respiratory and hand hygiene practices on onwards transmission by household index cases. All models were adjusted for confounding by age.

Findings: Moderate-frequency handwashing predicted a lower personal risk of coronavirus infection (age-adjusted incidence rate ratio (aIRR) =0·65, p=0.03) although results for even higher levels of hand hygiene were not significant. For household index cases, overall practice of respiratory hygiene (aIRR =0·61, p=0.01) and handwashing after coughing or sneezing (aIRR = 0·35, p=0.02) were associated with lower risk of onwards transmission.

Interpretation: This is the first empirical evidence that respiratory hygiene practices including handwashing after coughing or sneezing can reduce household transmission and regular handwashing can reduce personal risk of acquiring seasonal coronavirus. These findings support clear public health messaging around respiratory hygiene, targeted at those with respiratory symptoms, to protect others, and of the value of regular hand washing, regardless of symptoms, for personal protection.

Funding Statement: The Flu Watch study received funding from the Medical Research Council (MRC) and the Wellcome Trust (MR/K006584/1). S.B. is supported by an MRC doctoral studentship (MR/N013867/1).

Declaration of Interests: ACH serves on the UK New and Emerging Respiratory Virus Threats Advisory Group. AMJ was a Governor of Wellcome Trust from 2011-18 and is Chair of the Committee for Strategic Coordination for Health of the Public Research. The other authors declare no competing interests.

Ethics Approval Statement: The protocol was approved by the Oxford Multi-Centre Research Ethics Committee (06/Q1604/103).

Keywords: Respiratory infection; Hand washing; Respiratory Hygiene; Coronavirus; Pandemic; cohort

Suggested Citation

Beale, Sarah and Johnson, Anne M and Zambon, Maria and Hayward, Andrew C and Fragaszy, Ellen B and Group, Flu Watch, Hand and Respiratory Hygiene Practices and the Risk and Transmission of Human Coronavirus Infections in a UK Community Cohort (3/8/2020). Available at SSRN: https://ssrn.com/abstract=3551360 or http://dx.doi.org/10.2139/ssrn.3551360

Sarah Beale (Contact Author)

University College London - Research Department of Epidemiology & Public Health

1-19 Torrington Place
London, WC1E 7HB
United Kingdom

Anne M Johnson

University College London - Institute for Global Health

United Kingdom

Maria Zambon

Imperial College London - NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance

London
United Kingdom

Andrew C Hayward

University College London - Research Department of Epidemiology & Public Health ( email )

1-19 Torrington Place
London, WC1E 7HB
United Kingdom

Ellen B Fragaszy

University College London - Department of Infectious Disease Informatics

222 Euston Rd
London, NW1 2DA
United Kingdom

No contact information is available for Flu Watch Group

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