Risk Factors for COVID-19: Community Exposure and Mask-Wearing

19 Pages Posted: 8 Sep 2020

See all articles by Eline van den Broek-Altenburg

Eline van den Broek-Altenburg

University of Vermont Larner College of Medicine - Department of Radiology

Adam Atherly

Center for Health Services Research, Larner College of Medicine, University of Vermont

Sean Diehl

University of Vermont Larner College of Medicine - Microbiology and Molecular Genetics

Kelsey Gleason

University of Vermont - Larner College of Medicine

Victoria Hart

University of Vermont - Larner College of Medicine

Charles MacLean

University of Vermont - Larner College of Medicine

Daniel Barkhuff

University of Vermont - Emergency Department

Mark Levine

University of Vermont - Department of Medicine

Jan Carney

University of Vermont - Department of Medicine

Date Written: August 18, 2020

Abstract

Importance: Many studies have focused on characteristics of symptomatic COVID-19 patients and clinical risk factors. This study reports prevalence of COVID-19 in the general population and identifies factors that affect exposure to the virus.

Objective: To measure the prevalence of COVID-19 in a hospital service area and identify factors that may increase or decrease the risk of infection and exposure.

Design: This cohort study collected survey information relating to work and living situations, income, behavior, socio-demographic characteristics and pre-pandemic health characteristics. This data was combined with polymerase chain reaction (PCR) testing and two different serologic assays.

Setting and Participants: Our sampling frame was the primary care population of a Level 1 medical center in the Northeast U.S.. A random sample was drawn, stratified by age and gender. About 20 percent opted in and 1,694 completed the survey. Participants were invited to receive PCR and serologic testing. A total of 454 individuals provided samples between June 25th and June 28th, 2020.

Research Methods: Survey data was collected via Redcap. PCR testing was conducted at a community testing site using nasopharyngeal swabs. Serologic testing was done using two different methods to ensure the reliability of the results.

Main Outcomes: Positivity rate was used to calculate approximate prevalence, hospitalization rate and infection fatality rate (IFR). Survey data was used to analyze risk factors, including the number of contacts reported by study participants.

Results: We found a positivity rate of 2.2 percent, a hospitalization rate of 1.2 percent and an adjusted IFR of 0.55 percent. The number of contacts with adults and seniors increases the probability of becoming infected. Occupation, living in apartment versus a house, and wearing a facial mask outside work increased probability of COVID-19 infection.

Conclusions and Relevance: Based on the IFR and the number of deaths, estimations about the total number of infections in similar demographic areas with different infection rates can be made. Comparing this number with the number of officially reported infections leads to an estimate of unreported cases. Occupational, living-situation, and behavioral data may aid in the identification of non-clinical factors affecting SARS-CoV-2 exposure and infection.

Note: Funding: Serology tests performed at UVM were funded by a pilot grant to SAD from the UVM Translational Global Infectious Disease Research Center (National Institute of Health grant P20GM125498). Additional funding was from NIH grant U01AI141997 to SAD, and the University of Vermont Larner College of Medicine Departments Emergency Medicine and Surgery. The University of Vermont Department of Radiology funded serologic tests performed at Mayo. The Vermont Department of Health funded PCR tests performed at the state laboratory. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Declaration of Interest: None to declare

Ethical Approval Statement: This study has been approved by the University of Vermont and State Agricultural College Institutional Review Board: FWA 00000723, Expiration Date: March 14, 2024 and the UVM Medical Center: FWA 00000727, Expiration Date: March 14, 2024; IRB number 00000485.

Keywords: COVID-19, random sample testing approach, population health research, mask wearing, risk factors, social distancing

JEL Classification: I12, I18, I19, H51

Suggested Citation

van den Broek-Altenburg, Eline and Atherly, Adam and Diehl, Sean and Gleason, Kelsey and Hart, Victoria and MacLean, Charles and Barkhuff, Daniel and Levine, Mark and Carney, Jan, Risk Factors for COVID-19: Community Exposure and Mask-Wearing (August 18, 2020). Available at SSRN: https://ssrn.com/abstract=3676570 or http://dx.doi.org/10.2139/ssrn.3676570

Eline Van den Broek-Altenburg (Contact Author)

University of Vermont Larner College of Medicine - Department of Radiology ( email )

89 Beaumont avenue
Burlington, VT Vermont 05405
United States

Adam Atherly

Center for Health Services Research, Larner College of Medicine, University of Vermont ( email )

89 Beaumont Avenue
Burlington, VT 05405-0158
United States

Sean Diehl

University of Vermont Larner College of Medicine - Microbiology and Molecular Genetics ( email )

95 Carrigan Ave
Burlington, VT 05405
United States

Kelsey Gleason

University of Vermont - Larner College of Medicine ( email )

89 Beaumont avenue
Burlington, VT Vermont 05405
United States

Victoria Hart

University of Vermont - Larner College of Medicine ( email )

89 Beaumont avenue
Burlington, VT Vermont 05405
United States

Charles MacLean

University of Vermont - Larner College of Medicine ( email )

89 Beaumont avenue
Burlington, VT Vermont 05405
United States

Daniel Barkhuff

University of Vermont - Emergency Department ( email )

Burlington, VT
United States

Mark Levine

University of Vermont - Department of Medicine ( email )

Burlington, VT
United States

Jan Carney

University of Vermont - Department of Medicine ( email )

Burlington, VT
United States

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