Trends in Risk Factors and Symptoms Associated With SARS-CoV-2 and Rhinovirus Test Positivity in King County, Washington, June 2020 to July 2022

Abstract

ImportanceFew US studies have reexamined risk factors for SARS-CoV-2 positivity in the context of widespread vaccination and new variants or considered risk factors for cocirculating endemic viruses, such as rhinovirus.ObjectivesTo evaluate how risk factors and symptoms associated with SARS-CoV-2 test positivity changed over the course of the pandemic and to compare these with the risk factors associated with rhinovirus test positivity.Design, Setting, and ParticipantsThis case-control study used a test-negative design with multivariable logistic regression to assess associations between SARS-CoV-2 and rhinovirus test positivity and self-reported demographic and symptom variables over a 25-month period. The study was conducted among symptomatic individuals of all ages enrolled in a cross-sectional community surveillance study in King County, Washington, from June 2020 to July 2022.ExposuresSelf-reported data for 15 demographic and health behavior variables and 16 symptoms.Main Outcomes and MeasuresReverse transcription–polymerase chain reaction–confirmed SARS-CoV-2 or rhinovirus infection.ResultsAnalyses included data from 23 498 individuals. The median (IQR) age of participants was 34.33 (22.42-45.08) years, 13 878 (59.06%) were female, 4018 (17.10%) identified as Asian, 654 (2.78%) identified as Black, and 2193 (9.33%) identified as Hispanic. Close contact with an individual with SARS-CoV-2 (adjusted odds ratio [aOR], 3.89; 95% CI, 3.34-4.57) and loss of smell or taste (aOR, 3.49; 95% CI, 2.77-4.41) were the variables most associated with SARS-CoV-2 test positivity, but both attenuated during the Omicron period. Contact with a vaccinated individual with SARS-CoV-2 (aOR, 2.03; 95% CI, 1.56-2.79) was associated with lower odds of testing positive than contact with an unvaccinated individual with SARS-CoV-2 (aOR, 4.04; 95% CI, 2.39-7.23). Sore throat was associated with Omicron infection (aOR, 2.27; 95% CI, 1.68-3.20) but not Delta infection. Vaccine effectiveness for participants fully vaccinated with a booster dose was 93% (95% CI, 73%-100%) for Delta, but not significant for Omicron. Variables associated with rhinovirus test positivity included being younger than 12 years (aOR, 3.92; 95% CI, 3.42-4.51) and experiencing a runny or stuffy nose (aOR, 4.58; 95% CI, 4.07-5.21). Black race, residing in south King County, and households with 5 or more people were significantly associated with both SARS-CoV-2 and rhinovirus test positivity.Conclusions and RelevanceIn this case-control study of 23 498 symptomatic individuals, estimated risk factors and symptoms associated with SARS-CoV-2 infection changed over time. There was a shift in reported symptoms between the Delta and Omicron variants as well as reductions in the protection provided by vaccines. Racial and sociodemographic disparities persisted in the third year of SARS-CoV-2 circulation and were also present in rhinovirus infection. Trends in testing behavior and availability may influence these results.

Racial Disparities and Common Respiratory Infectious Diseases in Children of the United States: A Systematic Review and Meta-Analysis

“…Nineteen studies (95%) identified the presence of racial disparities in the occurrence rate of common infectious respiratory diseases, such as SARS-CoV-2 (COVID-19), SARS-CoV-2 (COVID-19)-related illnesses, influenza virus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs), streptococcus, staphylococcus aureus, and rhinovirus [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], among children in the United States. One study conducted by Perez et al [ 13 ] identified the presence of racial disparities in the occurrence rate of infectious respiratory diseases, such as influenza, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs), and SARS-CoV-2 (COVID-19), with Blacks or African Americans and Hispanics/Latinos carrying the majority (59%) of the burden of infection.…”

“…Finally, studies by Gualandi et al [ 29 ] and Hansen et al [ 30 ] further validated a relationship between racial discrimination and respiratory infectious diseases by identifying that Black children have higher rates of Methicillin-resistant Staphylococcus aureus infections [ 29 ] and cases of rhinovirus than White children [ 30 ].…”

“…Higher rates of poverty among Black, Hispanic, American Indian or Alaska Native, and Pacific Islander children compared to White children seem to contribute to racial gaps in the occurrence of common infectious respiratory diseases [ 20 , 21 , 22 , 31 ]. Factors related to living in poverty result in increased risks of disease occurrence because Black and Hispanic children often live in multifamily dwellings, with limited financial means and no insurance [ 18 , 24 , 28 , 30 , 31 ]. These factors lead to easy transmission of infectious respiratory diseases and to difficulty in seeking treatment or paying for medicines.…”

Human mobility impacts the transmission of common respiratory viruses: A modeling study of the Seattle metropolitan area

“…Each respiratory specimen was screened in duplicate for a panel of respiratory pathogens using a custom TaqMan RT-PCR OpenArray panel (Thermo Fisher). Laboratory methods are described in detail elsewhere (20,22). A substantial number of specimens tested positive for SPn, a common commensal, with SPn detected in 27.3% of positive samples prior to March 2020 and 18.7% of positive samples after March 2020 (Figure S2).…”

Prevalence of Olfactory Dysfunction with the Omicron Variant of SARS-CoV-2: A Systematic Review and Meta-analysis

“…Studies which were deemed eligible for the systematic review met all of the following inclusion criteria: (1) studies reporting the numerical prevalence of olfactory dysfunction in humans infected with the omicron variant (B.1.1.529) and any of the omicron subvariants, BA.1, BA.2, BA.1.1, BA.2.2, BA.2.10, BA.2.38, BA.2.75, BA.5, BQ.1, XBB. Report of an odds ratio only was not sufficient for inclusion [24]; (2) studies on adults or adolescents (when a small number of children was included, this was considered acceptable), but studies that focused entirely on children were not included, because it is known that children with COVID have a significantly lower prevalence of olfactory dysfunction than adults with COVID [25]; (3) evidence of infection with SARS-CoV-2; genomic proof of variant type was not deemed necessary when it was known that the vast majority of infections during the period and in the region of data collection were omicron cases rather than cases caused by another virus variant; (4) olfactory dysfunction was monitored through subjective recall, and all members of the cohort were specifically asked about changes in smell, changes in smell or taste, or changes in smell and taste; review of medical records for entries about loss of smell, but without universal and specific questioning of patients, was not acceptable (e.g., [26]); (5) the olfactory dysfunction occurred during the acute phase of infection – long-term studies inquiring about changes of smell persisting for weeks or months after the infection were not included. Comparison with variants other than omicron was not a required inclusion criterion.…”