Exposure and risk factors for COVID-19 and the impact of staying home on Michigan residents

  1. Kuan-Han H. Wu
  2. Whitney E. Hornsby
  3. Bethany Klunder
  4. Amelia Krause
  5. Anisa Driscoll
  6. John Kulka
  7. Ryan Bickett-Hickok
  8. Austin Fellows
  9. Sarah Graham
  10. Erin O. Kaleba
  11. Salim S. Hayek
  12. Xu Shi
  13. Nadia R. Sutton
  14. Nicholas Douville
  15. Bhramar Mukherjee
  16. Kenneth Jamerson
  17. Chad M. Brummett
  18. Cristen J. Willer

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Abstract

COVID-19 has had a substantial impact on clinical care and lifestyles globally. The State of Michigan reports over 80,000 positive COVID-19 tests between March 1, 2020 and July 29, 2020. We surveyed 8,041 Michigan Medicine biorepository participants in late June 2020. We found that 55% of COVID-19 cases reported no known exposure to family members or to someone outside the house diagnosed with COVID-19. A significantly higher rate of COVID-19 cases were employed as essential workers (45% vs 19%, p = 9x10 -12 ). COVID-19 cases reporting a fever were more likely to require hospitalization (categorized as severe; OR = 4.4 [95% CI: 1.6–12.5, p = 0.005]) whereas respondents reporting rhinorrhea was less likely to require hospitalization (categorized as mild-to-moderate; OR = 0.16 [95% CI: 0.04–0.73, p = 0.018]). African-Americans reported higher rates of being diagnosed with COVID-19 (OR = 4.0 [95% CI: 2.2–7.2, p = 5x10 -6 ]), as well as higher rates of exposure to family or someone outside the household diagnosed with COVID-19, an annual household income < $40,000, living in rental housing, and chronic diseases. During the Executive Order in Michigan, African Americans, women, and the lowest income group reported worsening health behaviors and higher overall concern for the potential detrimental effects of the pandemic. The higher risk of contracting COVID-19 observed among African Americans may be due to the increased rates of working as essential employees, lower socioeconomic status, and exposure to known positive cases. Continued efforts should focus on COVID-19 prevention and mitigation strategies, as well as address the inequality gaps that result in higher risks for both short-term and long-term health outcomes.

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  1. ScreenIT

    SciScore for 10.1101/2020.08.25.20181800: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Prior to March 2020, Michigan Medicine biorepository participants provided broad consent for biospecimen collection, electronic health data, future and ongoing use of data for undefined research, and re-contact in future studies [14].
    IRB: The protocol and study procedures were approved by the University of Michigan Institutional Review Board (HUM00180827).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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 study has several limitations that should be considered when reviewing the findings. First, this study was conducted at a single center with a limited geographic area and it utilized a retrospective design. The study design engaged previously consented biorepository participants to enroll and recall their COVID-19 exposures, symptoms, diagnosis, precautions, and experience. It is possible that there is respondent bias as participants from the various biorepositories may have responded differently. Furthermore, we excluded 134 individuals who were self-diagnosed with possible COVID-19 but were not diagnosed by a doctor or a test. We cannot determine the impact of personal precautions reported to be used at high rates, such as mask wearing and frequent hand washing because of lack of power. Additionally, we do not have power to distinguish which socioeconomic, employment exposure or health factors that differ between ethnic groups may be the cause of higher COVID-19 rates in African-American. Lastly, because our survey was only taken once, we did not capture longitudinal data, or information on pre-symptomatic individuals who later tested positive. Understanding exposure risks are critical to educating the public and to saving lives. Our data provides insight into exposure risks, confirms that precautions work, although being an essential worker or medical professional increases the susceptibility of transmission. Overall, African Americans, women, and those with low house...

    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.

    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.

  2. Version published to 10.1371/journal.pone.0246447
  3. Version published to 10.1101/2020.08.25.20181800v1 on medRxiv