Post by Nadica (She/Her) on Aug 22, 2024 23:50:55 GMT
Transmission of COVID-19 in Nightlife, Household, and Health Care Settings in Tokyo, Japan, in 2020 - Published Feb 24, 2023
Key Points
Question
Which social settings are associated with large outbreaks and onward transmission of COVID-19?
Findings
this case series study that analyzed 44 054 confirmed COVID-19 cases, transmission events in nightlife and health care settings were more likely to involve 5 or more cases. Household and health care cases were significantly less likely to generate onward transmission than nightlife cases.
Meaning
This case series highlights the heterogenic characteristics of social settings regarding their roles in COVID-19 transmission and the significance of nightlife settings for further COVID-19 spread.
Abstract
Importance
There have been few studies on the heterogeneous interconnection of COVID-19 outbreaks occurring in different social settings using robust, surveillance epidemiological data.
Objectives
To describe the characteristics of COVID-19 transmission within different social settings and to evaluate settings associated with onward transmission to other settings.
Design, Setting, and Participants
This is a case series study of laboratory-confirmed COVID-19 cases in Tokyo between January 23 and December 5, 2020, when vaccination was not yet implemented. Using epidemiological investigation data collected by public health centers, epidemiological links were identified and classified into 7 transmission settings: imported, nightlife, dining, workplace, household, health care, and other.
Main Outcomes and Measures
The number of cases per setting and the likelihood of generating onward transmissions were compared between different transmission settings.
Results
Of the 44 054 confirmed COVID-19 cases in this study, 25 241 (57.3%) were among male patients, and the median (IQR) age of patients was 36 (26-52) years. Transmission settings were identified in 13 122 cases, including 6768 household, 2733 health care, and 1174 nightlife cases. More than 6600 transmission settings were detected, and nightlife (72 of 380 [18.9%]; P < .001) and health care (119 [36.2%]; P < .001) settings were more likely to involve 5 or more cases than dining, workplace, household, and other settings. Nightlife cases appeared in the earlier phase of the epidemic, while household and health care cases appeared later. After adjustment for transmission setting, sex, age group, presence of symptoms, and wave, household and health care cases were less likely to generate onward transmission compared with nightlife cases (household: adjusted odds ratio, 0.03; 95% CI, 0.02-0.05; health care: adjusted odds ratio, 0.57; 95% CI, 0.41-0.79). Household settings were associated with intergenerational transmission, while nonhousehold settings mainly comprised transmission between the same age group. Among 30 932 cases without identified transmission settings, cases with a history of visiting nightlife establishments were more likely to generate onward transmission to nonhousehold settings (adjusted odds ratio, 5.30 [95% CI, 4.64-6.05]; P < .001) than those without such history.
Conclusions and Relevance
In this case series study, COVID-19 cases identified in nightlife settings were associated with a higher likelihood of spreading COVID-19 than household and health care cases. Surveillance and interventions targeting nightlife settings should be prioritized to disrupt COVID-19 transmission, especially in the early stage of an epidemic.
Key Points
Question
Which social settings are associated with large outbreaks and onward transmission of COVID-19?
Findings
this case series study that analyzed 44 054 confirmed COVID-19 cases, transmission events in nightlife and health care settings were more likely to involve 5 or more cases. Household and health care cases were significantly less likely to generate onward transmission than nightlife cases.
Meaning
This case series highlights the heterogenic characteristics of social settings regarding their roles in COVID-19 transmission and the significance of nightlife settings for further COVID-19 spread.
Abstract
Importance
There have been few studies on the heterogeneous interconnection of COVID-19 outbreaks occurring in different social settings using robust, surveillance epidemiological data.
Objectives
To describe the characteristics of COVID-19 transmission within different social settings and to evaluate settings associated with onward transmission to other settings.
Design, Setting, and Participants
This is a case series study of laboratory-confirmed COVID-19 cases in Tokyo between January 23 and December 5, 2020, when vaccination was not yet implemented. Using epidemiological investigation data collected by public health centers, epidemiological links were identified and classified into 7 transmission settings: imported, nightlife, dining, workplace, household, health care, and other.
Main Outcomes and Measures
The number of cases per setting and the likelihood of generating onward transmissions were compared between different transmission settings.
Results
Of the 44 054 confirmed COVID-19 cases in this study, 25 241 (57.3%) were among male patients, and the median (IQR) age of patients was 36 (26-52) years. Transmission settings were identified in 13 122 cases, including 6768 household, 2733 health care, and 1174 nightlife cases. More than 6600 transmission settings were detected, and nightlife (72 of 380 [18.9%]; P < .001) and health care (119 [36.2%]; P < .001) settings were more likely to involve 5 or more cases than dining, workplace, household, and other settings. Nightlife cases appeared in the earlier phase of the epidemic, while household and health care cases appeared later. After adjustment for transmission setting, sex, age group, presence of symptoms, and wave, household and health care cases were less likely to generate onward transmission compared with nightlife cases (household: adjusted odds ratio, 0.03; 95% CI, 0.02-0.05; health care: adjusted odds ratio, 0.57; 95% CI, 0.41-0.79). Household settings were associated with intergenerational transmission, while nonhousehold settings mainly comprised transmission between the same age group. Among 30 932 cases without identified transmission settings, cases with a history of visiting nightlife establishments were more likely to generate onward transmission to nonhousehold settings (adjusted odds ratio, 5.30 [95% CI, 4.64-6.05]; P < .001) than those without such history.
Conclusions and Relevance
In this case series study, COVID-19 cases identified in nightlife settings were associated with a higher likelihood of spreading COVID-19 than household and health care cases. Surveillance and interventions targeting nightlife settings should be prioritized to disrupt COVID-19 transmission, especially in the early stage of an epidemic.