Factors associated with transmission across three waves of SARS-COV-2 in
a prospective community-based study of households with school-aged
children -- Dane County, Wisconsin, 2020-2022
Abstract
Background: Household transmission of SARS-CoV-2 is a driver of
the ongoing COVID-19 pandemic. Understanding factors that contribute to
secondary infection rates (SIR) can define changing trends and inform
public health policies. Methods: The ORegon CHild Absenteeism
due to Respiratory Disease Study (ORCHARDS) prospectively monitors
respiratory viruses within the Oregon School District (OSD) in
southcentral Wisconsin. Households with students who had ≥2 respiratory
symptoms were eligible and opted to participate in ORCHARDS. Between
October 28, 2020, and May 16, 2022, all household members provided
self-collected nasal specimens on days 0, 7, and 14 for SARS-CoV-2
detection using real-time reverse-transcription-polymerase chain
reaction. We used logistic regression to investigate individual- and
household-level characteristics associated with SARS-CoV-2 transmission.
Results: Overall, 127 households comprising 572 individuals
(48% female; 52% male; 0.4% non-binary; 77% >18 years)
had at least one detection of SARS-CoV-2. The overall SIR was 47% and
decreased over time (pre-Delta=72% [95%CI: 58%-83%]; Delta=51%
[40%-63%]; and Omicron=41% [36%-47%]. Odds of household
transmission were 63% lower during the Omicron period compared to the
pre-Delta period (OR=0.36 [95%CI: 0.13-0.94] P=0.037). Greater
household density (members/bedroom) was significantly associated with
household transmission during the Omicron period (OR=6.8,
[2.19-21.37] P=0.001). Index case age, illness severity, and
individual symptoms were not significantly associated with odds of
household transmission. Conclusions: Greater household density
was associated with higher risk of SARS-CoV-2 transmission, but the risk
declined over time with subsequent variants. Interplay between variants,
prior infection, and individual/household factors may identify
modifiable factors (e.g., behavior, vaccination) to reduce future
transmission risk.