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Public Activities Preceding the Onset of Acute Respiratory Infection Syndromes in Adults in England - Implications for the Use of Social Distancing to Control Pandemic Respiratory Infections

17 Pages Posted: 19 Mar 2020

See all articles by Andrew C Hayward

Andrew C Hayward

University College London - Research Department of Epidemiology & Public Health

Sarah Beale

University College London - Research Department of Epidemiology & Public Health

Anne M Johnson

University College London - Institute for Global Health

Ellen B Fragaszy

University College London - Department of Infectious Disease Informatics

Flu Watch Group

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Abstract

Background: Social distancing measures may reduce the spread of emerging respiratory infections however, there is little empirical data on how exposure to crowded places affects risk of acute respiratory infection.

Methods: We used a case-crossover design nested in a community cohort to compare self-reported measures of activities during the week before infection onset and baseline periods. The design eliminates the effect of non-time-varying confounders. Time-varying confounders were addressed by exclusion of illnesses around the Christmas period and seasonal adjustment.

Findings: 626 participants had paired data from the week before 1005 illnesses and the week before baseline. Each additional day of undertaking the following activities in the prior week was associated with illness onset: Spending more than five minutes in a room with someone (other than a household member) who has a cold (Seasonally adjusted OR 1·15, p=0·003); use of underground trains (1·31, p=0·036); use of supermarkets (1·32, p<0·001); attending a theatre, cinema or concert (1·26, p=0·032); eating out at a café, restaurant or canteen (1·25, p=0·003); and attending parties (1·47, p<0·001). Undertaking the following activities at least once in the previous week was associated with illness onset: using a bus, (aOR 1.48, p=0.049), shopping at small shops (1.9, p<0.002) attending a place of worship (1.81, p=0.005).

Interpretation: Exposure to potentially crowded places, public transport and to individuals with a cold increases risk of acquiring circulating acute respiratory infections. This suggests social distancing measures can have an important impact on slowing transmission of emerging respiratory infections.

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: AH serves on 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; Pandemic; Social distancing; transmission; case crossover; cohort

Suggested Citation

Hayward, Andrew C and Beale, Sarah and Johnson, Anne M and Fragaszy, Ellen B and Group, Flu Watch, Public Activities Preceding the Onset of Acute Respiratory Infection Syndromes in Adults in England - Implications for the Use of Social Distancing to Control Pandemic Respiratory Infections (3/8/2020). Available at SSRN: https://ssrn.com/abstract=3551361 or http://dx.doi.org/10.2139/ssrn.3551361

Andrew C Hayward (Contact Author)

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

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

Sarah Beale

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

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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