Sharing a household with children and risk of COVID-19: a study of over 300,000 adults living in healthcare worker households in Scotland

Wood, Rachael; Thomson, Emma C.; Galbraith, Robert M.; Gribben, Ciara; Caldwell, David; Bishop, Jennifer; Reid, M M; Shah, Anoop; Templeton, Kate; Goldberg, David J.; Robertson, Chris; Hutchinson, Sharon; Colhoun, Helen M.; McAllister, David

doi:10.1101/2020.09.21.20196428

Cited by 14 publications

(13 citation statements)

References 21 publications

(49 reference statements)

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“…One previous cohort study of 310,097 healthcare workers and other adults in their household in Scotland has also addressed whether the risk of SARS-CoV-2 infection and severe outcomes from COVID-19 differs between adults living in households with and without children aged 0 to 11 years. 21 Similar to our results they find no increase in hospitalisation due to COVID-19 for people living with young children. However, they find a slightly reduced rate of testing positive for COVID-19 for adults living with young children, and evidence that the protective effect increased with a greater number of children.…”

Section: Discussionsupporting

confidence: 90%

Association between living with children and outcomes from COVID-19: an OpenSAFELY cohort study of 12 million adults in England

Forbes

Morton

Bacon

et al. 2020

Preprint

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Background: Close contact with children may provide cross-reactive immunity to SARs-CoV-2 due to more frequent prior coryzal infections from seasonal coronaviruses. Alternatively, close contact with children may increase risk of SARs-CoV-2 infection. We investigated whether risk of infection with SARs-CoV-2 and severe outcomes differed between adults living with and without children. Methods: Working on behalf of NHS England, we conducted a population-based cohort study using primary care data and pseudonymously-linked hospital and intensive care admissions, and death records, from patients registered in general practices representing 40% of England. Using multivariable Cox regression, we calculated fully-adjusted hazard ratios (HR) of outcomes from 1st February-3rd August 2020 comparing adults living with and without children in the household. Findings: Among 9,157,814 adults ≤65 years, living with children 0-11 years was not associated with increased risks of recorded SARS-CoV-2 infection, COVID-19 related hospital or ICU admission but was associated with reduced risk of COVID-19 death (HR 0.75, 95%CI 0.62-0.92). Living with children aged 12-18 years was associated with a small increased risk of recorded SARS-CoV-2 infection (HR 1.08, 95%CI 1.03-1.13), but not associated with other COVID-19 outcomes. Living with children of any age was also associated with lower risk of dying from non-COVID-19 causes. Among 2,567,671 adults >65 years there was no association between living with children and outcomes related to SARS-CoV-2. We observed no consistent changes in risk following school closure. Interpretation: For adults living with children there is no evidence of an increased risk of severe COVID-19 outcomes. These findings have implications for determining the benefit-harm balance of children attending school in the COVID-19 pandemic. Funding This work was supported by the Medical Research Council MR/V015737/1.

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Section: Discussionsupporting

confidence: 90%

Association between living with children and outcomes from COVID-19: an OpenSAFELY cohort study of 12 million adults in England

Forbes

Morton

Bacon

et al. 2020

Preprint

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“…We and others have previously reported lower risk in teachers compared with others of the same age and sex [7,14]. The inverse association of severe disease with the number of school-age children in the household extends and confirms the findings of an earlier study of health care workers and their families [15]. In the OPENSAFELY cohort, the rate ratio for fatal COVID-19 associated with living with children aged 0-11 years was 0.75 after adjusting for covariates, but no dose-response relationship was reported [16].…”

Section: Association With Household Compositionsupporting

confidence: 86%

Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study

McAllister

Caldwell

Gribben

et al. 2021

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ObjectivesTo investigate:(1) the risk of severe COVID-19 in those eligible for shielding, and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population.DesignMatched case-control study (REACT-SCOT).SettingPopulation of Scotland from 1 March 2020 to 28 January 2021.ParticipantsAll 160307 diagnosed cases of COVID-19 and 1564782 controls matched for age, sex and primary care practice, linked with all 204913 individuals identified as eligible for shielding by Public Health Scotland.Main outcome measureSevere COVID-19, defined as cases that entered critical care or were fatal.ResultsWith those without risk conditions as reference category, the univariate rate ratio for severe COVID-19 was 5.3 (95% CI 5.0 to 5.7, p=4 × 10−527) in those with moderate risk conditions and 7.6 (95% CI 7.1 to 8.3, p=1 × 10−527) in those eligible for shielding. The highest rate was in solid organ transplant recipients: rate ratio 13.6 (95% CI 9.6 to 19.2, p=8 × 10−50). In both the shielded and the general population, the risk of severe COVID-19 increased with the number of adults but decreased with the number of school-age children in the household. Severe COVID-19 was strongly associated with recent exposure to hospital (defined as 5 to 14 days before presentation date): rate ratio 12.6 (95% CI 11.7 to 13.6, p=2 × 10−989) overall. In a case-crossover analysis with less recent exposure only (15 to 24 days before first testing positive) as reference category, the rate ratio associated with recent exposure only was 6.3 (95% CI 3.6 to 11.1, p=2 × 10−10). Among those eligible for shielding, the population attributable risk fraction (PARF) of severe cases for recent exposure to hospital was 36%. In the general population the PARF for recent exposure to hospital peaked at 46% in May 2020 and again at 64% in December 2020.ConclusionsThe effectiveness of shielding vulnerable individuals was limited by the inability to control transmission in hospital and from other adults in the household. For solid organ transplant recipients, in whom the efficacy of vaccines is uncertain, these results support a policy of offering vaccination to household contacts. Mitigating the impact of the epidemic requires control of nosocomial transmission.SummaryWhat is already known on this topic?Individuals designated as “clinically extremely vulnerable” – about 3% of the population – have been advised to shield themselves during the COVID-19 epidemicThe effectiveness of this shielding programme has not been evaluated.What this study addsHospital-acquired infection has made a substantial contribution to the burden of COVID-19 in the population, accounting for more than half of severe cases in early December 2020.For vulnerable individuals to be shielded, the risk of hospital-acquired infection must be reduced and support must be provided for other adults in the household to co-isolate with the vulnerable individual.Solid organ transplant recipients are at the highest risk; vaccination of household contacts should be considered for this group.

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“…An important finding of our study is that participants living with children under the age of 12 were clearly less likely to be seropositive. A large study among over 300’000 HCW households from Scotland has recently found a similar association 17 . In contrast to the Scottish study, we corrected our result for important confounders, including age of HCW, full-time working, and leisure activities.…”

Section: Discussionmentioning

confidence: 82%

Non-occupational and occupational factors associated with specific SARS-CoV-2 antibodies among Hospital Workers – a multicentre cross-sectional study

Kahlert

Persi

Güsewell

et al. 2020

Preprint

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Background Protecting healthcare workers (HCW) from Coronavirus Disease-19 (COVID-19) is critical to preserve the functioning of healthcare systems. We therefore assessed seroprevalence and identified risk factors for Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) seropositivity in this population. Methods Between June 22nd and August 15th 2020, employees from healthcare institutions in Northern/Eastern Switzerland were screened for SARS-CoV-2 antibodies. We recorded baseline characteristics, non-occupational and occupational risk factors. We used pairwise tests of associations and multivariable logistic regression to identify factors associated with seropositivity. Findings Among the 4664 included HCW from 23 healthcare facilities, 139 (3%) were seropositive. Non-occupational exposures independently associated with seropositivity were contact with a COVID-19 positive household (adjusted OR=54, 95%-CI: 31-97) and stay in a COVID 19 hotspot (aOR=2.2, 95%-CI: 1.1-3.9). Blood group 0 vs. non-0 (aOR=0.4, 95%-CI: 0.3-0.7), active smoking (aOR=0.5, 95%-CI: 0.3-0.9) and living with children <12 years (aOR=0.3, 95%-CI: 0.2-0.6) were associated with decreased risk. Occupational risk factors were close contact to COVID-19 patients (aOR=2.8, 95%-CI: 1.5-5.5), exposure to COVID-19 positive co-workers (aOR=2.0, 95%-CI: 1.2-3.1), poor knowledge of standard hygiene precautions (aOR=2.0, 95%-CI: 1.3-3.2), and frequent visits to the hospital canteen (aOR=1.9, 95%-CI: 1.2-3.1). Interpretation We identified several modifiable factors associated with SARS-CoV-2 seropositivity among our HCW. Living with COVID-19 positive households showed by far the strongest association. The lower risk among those living with children, even after correction for multiple confounders, is remarkable and merits further study. Funding Swiss National Sciences Foundation, Federal Office of Public Health, Health Department Canton of St. Gallen

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Sharing a household with children and risk of COVID-19: a study of over 300,000 adults living in healthcare worker households in Scotland

Cited by 14 publications

References 21 publications

Association between living with children and outcomes from COVID-19: an OpenSAFELY cohort study of 12 million adults in England

Association between living with children and outcomes from COVID-19: an OpenSAFELY cohort study of 12 million adults in England

Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study

Non-occupational and occupational factors associated with specific SARS-CoV-2 antibodies among Hospital Workers – a multicentre cross-sectional study

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