Social risk factors for SARS-CoV-2 acquisition in university students: cross sectional survey

  1. Eleanor Blakey
  2. Lucy Reeve
  3. Neville Q. Verlander
  4. David Edwards
  5. David Wyllie
  6. Mark Reacher

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

The objectives of this study were to define risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in University of Cambridge (UoC) students during a period of increased incidence in October and November 2020. The study design was a survey.

Routine public health surveillance identified an increase in the numbers of UoC students with confirmed SARS-CoV-2 positivity in the 10 days after a national lockdown was announced in the UK on 5th November 2020. Cases were identified both through symptom-triggered testing and a universal asymptomatic testing programme. An online questionnaire was sent to all UoC students on 25 November to investigate risk factors for testing positive in the period after 30th October 2020. This asked about symptoms, SARS-CoV-2 test results, aspects of university life, and attendance at social events in the week prior to lockdown. Univariate and multivariable analyses were undertaken evaluating potential risk factors for SARS-CoV-2 positivity.

Among 3980 students responding to the questionnaire, 99 (2.5%) reported testing SARS-CoV-2 positive in the period studied; 28 (28%) were asymptomatic. We found strong independent associations with SARS-CoV-2 positivity and attendance at two social settings in the City of Cambridge (adjusted odds ratio favouring disease 13.0 (95% CI 6.2–26.9) and 14.2 (95% CI 2.9–70)), with weaker evidence of association with three further social settings. By contrast, we did not observe strong independent associations between disease risk and accommodation type or attendance at a range of activities associated with the university curriculum.

To conclude attendance at social settings can facilitate widespread SARS-CoV-2 transmission in university students. Constraint of transmission in higher education settings needs to emphasise risks outside university premises, as well as a COVID-safe environment within university premises.

Article activity feed

  1. Version published to 10.1017/s0950268822001698
  2. ScreenIT

    SciScore for 10.1101/2021.07.15.21260006: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed in Stata (StataCorp) versions 15 and 16.1.
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This research study has several notable limitations. Firstly, by design it was anonymous, and so the responses obtained could not be checked against national information systems. Secondly, the survey was retrospective, so attendance at events or recording of symptoms may be subject to recall bias. Finally, we received 3,980 responses to the questionnaire from a potential study population of 25,256, a response rate of 15.8%. While there is evidence of external validity of the responses obtained – in particular, the time course of the development of illness reported matches what actually happened – the low response rates mean that the conclusions require external validation. Such external validation has recently been published, in the form of a genomic analysis of sequences from individuals with SARS-CoV-2 infection[9], which also strongly implicates social mixing outside of university settings as a key risk factor for SARS-CoV-2 infection. Further external validation can be seen through comparison of the cases reported in Cambridge local authority[8], and those by specimen date reported by the University of Cambridge cohort (see supplementary Figure 1). The cases in both figures peak around the same time period (8th – 12th November 2021). This work builds on studies from elsewhere identifying indoor social settings as sites of SARS-CoV-2 transmission[11]. For example, at the start of the pandemic, nightclubs in Seoul reported multiple cases associated with venues of this type[...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.07.15.21260006v1 on medRxiv