Rapid Real-time Tracking of Nonpharmaceutical Interventions and Their Association With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Positivity: The Coronavirus Disease 2019 (COVID-19) Pandemic Pulse Study
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Abstract
Background
Current mitigation strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on the population-wide adoption of nonpharmaceutical interventions (NPIs). Monitoring the adoption of NPIs and their associations with SARS-CoV-2 infection history can provide key information for public health.
Methods
We sampled 1030 individuals in Maryland from 17–28 June 2020 to capture sociodemographically and geographically resolved information about NPI adoption and access to SARS-CoV-2 testing, and examine associations with self-reported SARS-CoV-2 positivity.
Results
Overall, 92% reported traveling for essential services and 66% visited friends/family. Use of public transport was reported by 18%. In total, 68% reported strict social distancing indoors and 53% reported strict masking indoors; indoor social distancing was significantly associated with age, and race/ethnicity and income were associated with masking. Overall, 55 participants (5.3%) self-reported ever testing positive for SARS-CoV-2, with strong dose-response relationships between several forms of movement frequency and SARS-CoV-2 positivity. In a multivariable analysis, a history of SARS-CoV-2 infection was negatively associated with strict social distancing (adjusted odds ratio [aOR] for outdoor social distancing, 0.10; 95% confidence interval, .03–.33). Only public transport use (aOR for >7 times vs never, 4.3) and visiting a place of worship (aOR for ≥3 times vs never, 16.0) remained significantly associated with SARS-CoV-2 infection after adjusting for strict social distancing and demographics.
Conclusions
These results support public health messaging that strict social distancing during most activities can reduce SARS-CoV-2 transmission. Additional considerations are needed for indoor activities with large numbers of persons (places of worship and public transportation), where even NPIs may not be possible or sufficient.
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SciScore for 10.1101/2020.07.29.20164665: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Ethical Clearance: The study was approved by the Institutional Review Board of the Johns Hopkins Bloomberg School of Public Health (IRB00012413) and all participants consented to participate. Randomization Dynata maintains a database of potential participants who are randomized to specific surveys if they meet the specified demographic targets of the survey; participants receive modest compensation for participation. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the …SciScore for 10.1101/2020.07.29.20164665: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Ethical Clearance: The study was approved by the Institutional Review Board of the Johns Hopkins Bloomberg School of Public Health (IRB00012413) and all participants consented to participate. Randomization Dynata maintains a database of potential participants who are randomized to specific surveys if they meet the specified demographic targets of the survey; participants receive modest compensation for participation. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations notwithstanding, we present a rapid cost-efficient approach of monitoring NPI adoption and adherence which can help inform public health response. While our survey illustrated this approach within a single state, the rapidity and efficiency of this methodology can be easily replicated in other settings recognizing the highly variable and geographically localized SARS-CoV-2 transmission patterns and risk mitigation responses. Repeating these surveys over time in a given population can unveil additional insights around changes in population behaviors potentially informing adaptive responses to evolving disease dynamics. Overall, these data continue to highlight the role of movement and social distancing on SARS-CoV-2 transmission risk. In Maryland, these data support targeted COVID-19 messaging to young adults given high rates of positivity as well as the lower rates of adoption of NPIs; establishing partnerships with faith-based organizations could also be critical to curbing the spread. Moreover, measures need to be implemented to make public transportation safe for those who need to use it and to improve access to SARS-CoV-2 testing. Continued monitoring of the adoption of NPIs, access to testing and the subsequent impact on SARS-CoV-2 transmission in Maryland as well as more broadly will be critical for pandemic control.
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.
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Our take
Though causal relationships between individual behaviors and SARS-CoV-2 infection cannot be established in this cross-sectional survey, available as a preprint and thus not yet peer reviewed, the survey tool may be useful for future longitudinal studies to evaluate the role of individual behaviors in transmission dynamics. Mask use and social distancing were associated with lower rates of SARS-CoV-2 test positivity, while more frequent travel, especially via public transportation or to places of worship, were associated with increased SARS-CoV-2 test positivity. While plausible, these results should be considered cautiously in light of several study limitations.
Study design
cross-sectional
Study population and setting
The study included 1,030 individuals (median age: 43 years, 55% female) from …
Our take
Though causal relationships between individual behaviors and SARS-CoV-2 infection cannot be established in this cross-sectional survey, available as a preprint and thus not yet peer reviewed, the survey tool may be useful for future longitudinal studies to evaluate the role of individual behaviors in transmission dynamics. Mask use and social distancing were associated with lower rates of SARS-CoV-2 test positivity, while more frequent travel, especially via public transportation or to places of worship, were associated with increased SARS-CoV-2 test positivity. While plausible, these results should be considered cautiously in light of several study limitations.
Study design
cross-sectional
Study population and setting
The study included 1,030 individuals (median age: 43 years, 55% female) from the US state of Maryland who participated in an online survey between June 17 and June 28, 2020, shortly after Stage Two of Maryland’s phased re-opening plan began. The survey was designed to evaluate adoption of non-pharmaceutical interventions (social distancing and mask use), travel, access to SARS-CoV-2 testing, and SARS-Cov-2 test results. The survey was distributed through an online platform (Dynadata), equipped with security checks, quality verifications, and preset quotas for age, gender, race/ethnicity, and income to accrue a sample representative of the Maryland population. Participants were excluded if they were less than 18 years old, currently resided outside the state of Maryland, did not complete the survey, or did not respond to ever being tested for SARS-CoV-2 (the survey was distributed to 2,322 individuals, 1,466 responded to at least 1 survey question, and 1,030 met all inclusion criteria).
Summary of main findings
Sociodemographic characteristics were broadly representative of Maryland’s population. During the prior two weeks, 96% of participants left their home at least once: 92% travelled for essential services, 66% visited friends/family, 49% went to an indoor venue (bar, restaurant, salon), and 25% went to an outdoor venue (pool, beach). Practicing of social distancing increased with age, and mask use was least common among white individuals. In all, 55 participants self-reported ever testing positive for SARS-CoV-2 in the past, and in the prior 2 weeks, 62/102 participants who wanted/needed a SARS-CoV-2 test received one, of whom 18 tested positive. In multivariable analyses, more frequent use of public transportation and more frequent visits to a place of worship were strongly and positively associated with ever testing positive for SARS-CoV-2, whereas adoption of social distancing was negatively associated with a positive test.
Study strengths
Survey distribution methods allowed for rapid and secure data collection. The study population appeared to be broadly representative of the Maryland population with respect to demographic variables and self-reported SARS-CoV-2 positivity rates counts in Maryland. Some sensitivity analyses were conducted.
Limitations
Self-selection into the study population and the requirement of participants to have an internet connection limit the generalizability of the results. Additionally, because data were collected cross-sectionally, it cannot be established that self-reported behaviors preceded SARS-CoV-2 test results. For example, some individuals who previously tested positive and recovered from SARS-CoV-2 may believe they are immune, thus traveling more often and practicing less social distancing and mask use. Unadjusted sensitivity analyses restricted to self-reported SARS-CoV-2 test positivity in the previous two weeks demonstrated somewhat similar results in the main analysis, but the protective association between social distancing and test positivity was not observed. However, even in these analyses, temporal relationships cannot be established. Self-selection into the study and self-reporting of behaviors and test results may introduce bias, underestimating the association between behaviors and infection rates if individuals with perceived “riskier” behaviors are less likely to participate, inaccurately over-report non-pharmaceutical interventions, or are less likely to report testing positive.
Value added
In this study, a rapid and cost-efficient online survey tool was used to evaluate the association between social distancing, mask use, and SARS-CoV-2 test results.
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