Parental COVID-19 vaccine hesitancy and vaccine uptake among children and adolescents in the US: Findings from a prospective national cohort

ObjectivesOur aim was to measure COVID-19 vaccine uptake among children aged 5-17 years old via parents participating in the CHASING COVID Cohort and identify sociodemographic factors associated with it. MethodsIn this longitudinal study, parents of school-aged children were asked about their own vaccination status and that of their children at three time points between June 2021-January 2022, along with reasons for vaccinating immediately or delaying vaccinations for their children. Multivariable log binomial models were used to identify correlates of vaccine uptake among children. ResultsOf the 1,583 children aged 5-17 years, 64.9% were vaccinated. Over 40% of parents of 5-11 year old children who intended to delay vaccinating their child in June 2021 had still not vaccinated them by January 2022, including 30% of the parents who were vaccinated. After adjusting for measured confounders, parents vaccination status was associated with higher likelihood of childrens vaccine uptake (age-specific adjusted odds ratios [aORs]: aOR16-17 3.7, 95% CI 2.3, 5.9, aOR12-15 3.7, 95% CI 2.6, 5.3; aOR5-11 10.6, 95% CI 5.4, 20.9). Parents education (aOR16-17 1.4, 95% CI 1.1, 1.8, aOR12-15 1.5, 95% CI 1.2, 1.9; aOR5-11 2.1, 95% CI 1.5, 2.9) and worry about others getting infected (aOR5-11 1.4, 95% CI 1.1, 1.6) were also associated with higher vaccine uptake among children. A higher proportion of parents of 5-11 year olds (vs. 12-17 year olds) had concerns about vaccine safety and effectiveness. ConclusionTo increase vaccination coverage among young children, vaccination campaigns should focus on both vaccinated and unvaccinated parents and messaging should be specific to the childs age.

The prevalence of SARS-CoV-2 infection and long COVID in US adults during the BA.5 surge, June-July 2022

Due to changes in SARS-CoV-2 testing practices, passive case-based surveillance may be an increasingly unreliable indicator for monitoring the burden of SARS-CoV-2, especially during surges. We conducted a cross-sectional survey of a population-representative sample of 3,042 U.S. adults between June 30 and July 2, 2022, during the Omicron BA.5 surge. Respondents were asked about SARS-CoV-2 testing and outcomes, COVID-like symptoms, contact with cases, and experience with prolonged COVID-19 symptoms following prior infection. We estimated the weighted age and sex-standardized SARS-CoV-2 prevalence, during the 14-day period preceding the interview. We estimated age and gender adjusted prevalence ratios (aPR) for current SARS-CoV-2 infection using a log-binomial regression model. An estimated 17.3% (95% CI 14.9, 19.8) of respondents had SARS-CoV-2 infection during the two-week study period-equating to 44 million cases as compared to 1.8 million per the CDC during the same time period. SARS-CoV-2 prevalence was higher among those 18-24 years old (aPR 2.2, 95% CI 1.8, 2.7) and among non-Hispanic Black (aPR 1.7, 95% CI 1.4, 2.2) and Hispanic (aPR 2.4, 95% CI 2.0, 2.9). SARS-CoV-2 prevalence was also higher among those with lower income (aPR 1.9, 95% CI 1.5, 2.3), lower education (aPR 3.7 95% CI 3.0,4.7), and those with comorbidities (aPR 1.6, 95% CI 1.4, 2.0). An estimated 21.5% (95% CI 18.2, 24.7) of respondents with a SARS-CoV-2 infection more than 4 weeks prior reported long COVID symptoms. The inequitable distribution of SARS-CoV-2 prevalence during the BA.5 surge will likely drive inequities in the future burden of long COVID.

Food Insecurity During the First Year of COVID-19: An Analysis of Employment and Sociodemographic Factors Among a Longitudinal Cohort (CHASING COVID)

ObjectivesWhile much has been reported about the impact of COVID-19 on U.S. food insecurity, longitudinal data and the variability experienced by people working in different industries are limited. This study aims to further characterize individuals experiencing food insecurity during the pandemic in terms of employment and sociodemographic characteristics and degree of food insecurity. MethodsThe study sample consisted of people enrolled in a U.S. prospective cohort study (CHASING COVID) who completed all food insecurity questionnaires from Visit 1 (April-July 2020) through Visit 7 (May-June 2021). Descriptive statistics and logistic regression models were used to determine employment and sociodemographic correlates of food insecurity (using a screening question from the USDA HFSS). Patterns of food insecurity and utilization of food benefit programs were also examined. ResultsThirty-one percent (1251/4019) of the sample were food insecure. Black and Hispanic respondents, households with children, and those with lower income and education levels had a higher odds of food insecurity. People employed in construction, leisure/hospitality and trade/transportation industries had the highest burden of both food insecurity and income loss. Among those reporting food insecurity, 40% were persistently food insecure ([≥]4 consecutive visits), and 46% did not utilize any food benefit programs. ConclusionsThe pandemic resulted in widespread food insecurity in our cohort, much of which was persistent. In addition to addressing sociodemographic disparities, future policies should focus on the needs of those working in vulnerable industries and ensure those experiencing food insecurity can easily participate in food benefit programs for which they are eligible.

The epidemiology of long COVID in US adults two years after the start of the US SARS-CoV-2 pandemic

ObjectivesTo characterize prevalence and impact of long COVID. MethodsWe conducted a population-representative survey, June 30-July 2, 2022, of a random sample of 3,042 United States adults. Using questions developed by the United Kingdoms Office of National Statistics, we estimated the prevalence by sociodemographics, adjusting for gender and age. ResultsAn estimated 7.3% (95% CI: 6.1-8.5%) of all respondents reported long COVID, approximately 18,533,864 adults. One-quarter (25.3% [18.2-32.4%]) of respondents with long COVID reported their day-to-day activities were impacted a lot and 28.9% had SARS-CoV-2 infection >12 months ago. The prevalence of long COVID was higher among respondents who were female (aPR: 1.84 [1.40-2.42]), had comorbidities (aPR: 1.55 [1.19-2.00]) or were not (versus were) boosted (aPR: 1.67 [1.19-2.34]) or not vaccinated (versus boosted) (aPR: 1.41 (1.05-1.91)). ConclusionsWe observed a high burden of long COVID and substantial variability in prevalence of SARS-CoV-2. Population-based surveys are an important surveillance tool and supplement to ongoing efforts to monitor long COVID.

The prevalence of SARS-CoV-2 infection and uptake of COVID-19 antiviral treatments during the BA.2/BA.2.12.1 surge, New York City, April-May 2022

BackgroundRoutine case surveillance data for SARS-CoV-2 are incomplete, unrepresentative, missing key variables of interest, and may be increasingly unreliable for both timely surge detection and understanding the burden of infection and access to treatment. MethodsWe conducted a cross-sectional survey of a representative sample of 1,030 New York City (NYC) adult residents [≥]18 years on May 7-8, 2022, when BA.2.12.1 comprised 47% of reported cases per genomic surveillance. We estimated the prevalence of SARS-CoV-2 infection during the preceding 14-day period (April 23-May 8), weighted to represent the 2020 NYC adult population. Respondents were asked about SARS-CoV-2 testing (including at-home rapid antigen tests), testing outcomes, COVID-like symptoms, and contact with SARS-CoV-2 cases. Based on responses, we classified individuals into three mutually exclusive categories of SARS-CoV-2 infection according to a hierarchical case definition as follows: confirmed (positive test with a provider), probable (positive at home rapid test), and possible (COVID-like symptoms and close contact with a confirmed/probable case). SARS-CoV-2 prevalence estimates were age- and sex-adjusted to the 2020 US population. Individuals with SARS-CoV-2 were asked about awareness/use of antiviral medications. We triangulated survey-based prevalence estimates with NYCs official SARS-CoV-2 metrics on cases, hospitalizations, and deaths, as well as SARS-CoV-2 concentrations in wastewater for the same time period. ResultsAn estimated 22.1% (95%CI 17.9%-26.2%) of respondents had SARS-CoV-2 infection during the two-week study period, corresponding to [~]1.5 million adults (95%CI 1.3-1.8 million). The official SARS-CoV-2 case count during the study period was 51,218. This 22.1% prevalence estimate included 11.4%, 6.5%, and 4.3% who met the confirmed, probable, and possible criteria of our case definition, respectively. Prevalence was estimated at 34.9% (95%CI 26.9%-42.8%) among individuals with co-morbidities, 14.9% (95% CI 11.0%-18.8%) among those 65+ years, and 18.9% (95%CI 10.2%-27.5%) among unvaccinated persons. Hybrid immunity (i.e., history of both vaccination and prior infection) was 66.2% (95%CI 55.7%-76.7%) among those with COVID and 46.3% (95%CI 40.2-52.2) among those without. Among individuals with COVID, 44.1% (95%CI 33.0%-55.1%) were aware of the antiviral nirmatrelvir/ritonavir (Paxlovid), and 15.1% (95%CI 7.1%-23.1%) reported receiving it. Deaths and hospitalizations increased, but remained well below the levels of the BA.1 surge. SARS-CoV-2 virus concentrations in wastewater surveillance showed only a modest signal in comparison to that of the BA.1 surge. Conclusions and RelevanceThe true magnitude of NYCs BA.2/BA.2.12.1 surge may have been vastly underestimated by routine SARS-CoV-2 case counts and wastewater surveillance. Hybrid immunity, bolstered by the recent BA.1 surge, likely limited the impact of the BA.2/BA.2.12.1 surge on severe outcomes. Representative surveys are needed as part of routine surveillance for timely surge detection, and to estimate the true burden of infection, hybrid immunity, and uptake of time-sensitive treatments among those most vulnerable to severe COVID. Short abstractChanges in testing practices and behaviors, including increasing at-home rapid testing and decreasing provider-based testing make it challenging to assess the true prevalence of SARS-CoV-2. We conducted a population-representative survey of adults in New York City to estimate the prevalence of SARS-CoV-2 infection during the BA.2./BA.2.12.1 surge in late April/early May 2022. We triangulated survey-based SARS-CoV-2 prevalence estimates with contemporaneous city-wide SARS-CoV-2 metrics on diagnosed cases, hospitalizations, deaths, and SARS-CoV-2 concentration in wastewater. Survey-based prevalence estimates were nearly 30 times higher than official case counts, and estimates of recently acquired hybrid immunity among those with active infection were high. We conclude that no single data source provides a complete or accurate assessment of the epidemiologic situation. Taken together, however, our results suggest that the magnitude of the BA.2/BA.2.12.1 surge was likely significantly underestimated, and high levels of hybrid immunity likely prevented a major surge in BA.2/BA.2.12.1-associated hospitalizations/deaths.

Estimating the period prevalence of SARS-CoV-2 infection during the Omicron (BA.1) surge in New York City (NYC), January 1-March 16, 2022

In a population-based survey of NYC adults, we assessed positive SARS-CoV-2 tests (including via exclusive at-home testing) and possible cases among untested respondents. An estimated 27.4% (95%CI: 22.8%-32.0%) or 1.8 million adults (95%CI: 1.6-2.1 million) had SARS-CoV-2 infection. SARS-CoV-2 prevalence was high among groups that are more vulnerable to severe SARS-CoV-2 and death, including unvaccinated persons (21.7%, 95%CI 9.6%-33.8%) and those aged 65+ (17.8%, 95%CI 10.2-25.4%). Population-based representative surveys are an important adjunct surveillance tool to standard testing-based SARS-CoV-2 surveillance.

Effectiveness of Covid-19 vaccines against symptomatic and asymptomatic SARS-CoV-2 infections in an urgent care setting

BackgroundIt is critical to monitor changes in vaccine effectiveness against COVID-19 outcomes for various vaccine products in different population subgroups. MethodsWe conducted a retrospective study in patients [≥]12 years who underwent testing for the SARS-CoV-2 virus from April 1 - October 25, 2021 at urgent care centers in the New York City metropolitan area. Patients self-reported vaccination status at the time of testing. We used a test-negative design to estimate vaccine effectiveness (VE) by comparing odds of a positive test for SARS-CoV-2 infection among vaccinated (n=484,468), partially vaccinated (n=107,573), and unvaccinated (n=466,452) patients, adjusted for demographic factors and calendar time. ResultsVE against symptomatic infection after 2 doses of mRNA vaccines was 96% (95% Confidence Interval [CI]: 95%, 97%) in the pre-delta period and reduced to 79% (95% CI: 77%, 81%) in the delta period. In the delta period, VE for 12-15-year-olds (85%; [95% CI: 81%, 89%]) was higher compared to older age groups (<65% for all other age groups). VE estimates did not differ by sex, race/ethnicity, and comorbidity. VE against symptomatic infection was the highest for individuals with a prior infection followed by full vaccination. VE against symptomatic infection after the mRNA-1273 vaccine (83% [95% CI: 81%, 84%]) was higher compared to the BNT162b2 vaccine (76% [95% CI: 74%, 78%]) in the delta period. VE after the single-dose Ad26.COV2.S vaccine was the lowest compared to other vaccines (29% [95% CI: 26%, 32%]) in the delta period. ConclusionsVE against infection after two doses of the mRNA vaccine was high initially, but significantly reduced against the delta variant for all three FDA-approved vaccines.

Racial/ethnic disparities in exposure to COVID-19, susceptibility to COVID-19 and access to health care - findings from a U.S. national cohort

We examined the influence of racial/ethnic differences in socioeconomic position on COVID-19 seroconversion and hospitalization within a community-based prospective cohort enrolled in March 2020 and followed through October 2021 (N=6740). The ability to social distance as a measure of exposure to COVID-19, susceptibility to COVID-19 complications, and access to healthcare varied by race/ethnicity with non-white participants having more exposure risk and more difficulty with healthcare access than white participants. Participants with more (versus less) exposure had greater odds of seroconversion (aOR:1.64, 95% Confidence Interval [CI] 1.18-2.29). Participants with more susceptibility and more barriers to healthcare had greater odds of hospitalization (respective aOR:2.36; 1.90-2.96 and 2.31; 1.69-2.68). Race/ethnicity positively modified the association between susceptibility and hospitalization (aORnon-White:2.79, 2.06-3.78). Findings may explain the disproportionate burden of COVID-19 infections and complications among Hispanic and non-Hispanic Black persons. Primary and secondary prevention efforts should address disparities in exposure, COVID-19 vaccination, and treatment.

COVID-19 testing among children, parental preferences for testing venues and acceptability of school-based testing: a survey of US parents

In a national survey of 2,074 US parents conducted in March 2021, 35.9% reported their youngest child had been tested at least once for COVID-19. Parents preferred testing venue choice was the pediatricians office. Only half of parent surveyed (50.6%) reported that they would allow their child to be tested for COVID-19 at school/daycare if it was required.

Determinants of COVID-19 vaccine hesitancy and vaccine uptake in a national cohort of U.S. adults

We estimated the trends and correlates of vaccine hesitancy, and its association with subsequent vaccine uptake among 5,458 adults in the United States. Participants belonged to the CHASING COVID Cohort, a national longitudinal study. Trends and correlates of vaccine hesitancy were examined longitudinally in eight interview rounds from October 2020 to July 2021. We also estimated the association between willingness to vaccinate and subsequent vaccine uptake through July 2021. Vaccine delay and refusal decreased from 51% and 8% in October 2020 to 8% and 6% in July 2021, respectively. Compared to Non-Hispanic (NH) White participants, NH Black and Hispanic participants had higher adjusted odds ratios (aOR) for both vaccine delay (aOR: 2.0 [95% CI: 1.5, 2.7] for NH Black and 1.3 [95% CI: 1.0, 1.7] for Hispanic) and vaccine refusal (aOR: 2.5 [95% CI: 1.8, 3.6] for NH Black and 1.4 [95% CI: 1.0, 2.0] for Hispanic) in June 2021. COVID-19 vaccine hesitancy was associated with lower odds of subsequent vaccine uptake (aOR: 0.15, 95% CI: 0.13, 0.18 for vaccine-delayers and aOR: 0.02; 95% CI: 0.01, 0.03 for vaccine-refusers compared to vaccine-willing participants), adjusted for sociodemographic factors and COVID-19 history. Vaccination awareness and distribution efforts should focus on vaccine delayers.

Plans to vaccinate children for COVID-19: a survey of US parents

In a national online survey of 2,074 US parents conducted in March 2021, 49.4% reported plans to vaccinate their child for COVID-19 when available. Lower income and less education were associated with greater parental vaccine hesitancy/resistance, while safety, effectiveness and lack of need were the primary reasons for vaccine hesitancy/resistance.

Risk Profile of Thanksgiving Gatherers and Subsequent SARS-CoV2 Testing and Diagnosis

BackgroundDuring Fall 2020 in the United States (U.S.), despite high COVID-19 case numbers and recommendations from public health officials not to travel and gather with individuals outside ones household, millions of people gathered for Thanksgiving. The objective of this study was to understand if individuals behaviors and risk perceptions influenced their decision to gather, and if they did gather, their subsequent test seeking and diagnoses. MethodsParticipants were part of the CHASING COVID Cohort study - a U.S. national prospective cohort. The study sample consisted of participants who completed routine questionnaires before and after Thanksgiving. Non-pharmaceutical interventions (NPIs) use informed behavioral risk scores and a score of perceived risk of COVID-19 were assigned to each participant. Multinomial logistic regression models were used to assess the association between higher risk behaviors and gathering with other households, and the association of gathering with subsequent testing and test positivity. ResultsA total of 1,932 (40.5%) cohort participants spent Thanksgiving with individuals from at least one other household. Participants with higher behavioral risk scores had greater odds of gathering with one other household (aOR: 2.35, 95% CI: 2.0, 2.7), two other households (aOR: 4.54, 95% CI: 3.7, 5.6), and three or more other households (aOR: 5.44, 95% CI: 4.1, 7.2). Participants perceiving COVID-19 as a low-risk to themselves and others had greater odds of gathering with one other household (aOR: 1.12, 95% CI: 0.97, 1.3), two other households (aOR: 1.39, 95% CI: 1.1, 1.7), and three or more other households (aOR: 1.86, 95% CI: 1.4, 2.4). Those who spent Thanksgiving with one or more other households had 1.23 times greater odds (95% CI: 1.1, 1.4) of having a COVID-19 test afterward. There was no association between gathering for Thanksgiving and subsequent COVID-19 test positivity or developing COVID-19 symptoms. ConclusionsThose who gathered with other households for Thanksgiving tended to engage in higher-risk activities. Thanksgiving gathering with other households was not associated with subsequently testing positive for COVID-19, but only a small proportion obtained post-travel testing. Public health messaging should emphasize behavior change strategies that promote safer gathering.

The emergence, surge and subsequent wave of the SARS-CoV-2 pandemic in New York metropolitan area: The view from a major region-wide urgent care provider.

BackgroundDescribing SARS-CoV-2 testing and positivity trends among urgent care users is crucial for understanding the trajectory of the pandemic. ObjectiveTo describe demographic and clinical characteristics, positivity rates, and repeat testing patterns among patients tested for SARS-CoV-2 at CityMD, an urgent care provider in the New York City metropolitan area. DesignRetrospective study of all persons testing for SARS-CoV-2 between March 1, 2020 and January 8, 2021 at 115 CityMD locations in the New York metropolitan area. PatientsIndividuals receiving a SARS-CoV-2 diagnostic or serologic test. MeasurementsTest and individual level SARS-CoV-2 positivity by PCR, rapid antigen, or serologic tests. ResultsDuring the study period, 3.4 million COVID tests were performed on 1.8 million individuals. In New York City, CityMD diagnosed 268,298 individuals, including 17% of all reported cases. Testing levels were higher among 20-29 year olds, non-Hispanic Whites, and females compared with other groups. About 24.8% (n=464,902) were repeat testers. Test positivity was higher in non-Hispanic Black (6.4%), Hispanic (8.0%), and Native American (8.0%) patients compared to non-Hispanic White (5.4%) patients. Overall seropositivity was estimated to be 21.7% (95% Confidence Interval [CI]: 21.6-21.8) and was highest among 10-14 year olds (27.3%). Seropositivity was also high among non-Hispanic Black (24.5%) and Hispanic (30.6%) testers, and residents of the Bronx (31.3%) and Queens (30.5%). Using PCR as the gold standard, SARS-CoV-2 rapid tests had a false positive rate of 5.4% (95%CI 5.3-5.5). ConclusionUrgent care centers can provide broad access to critical evaluation, diagnostic testing and treatment of a substantial number of ambulatory patients during pandemics, especially in population-dense, urban epicenters.

Spread and sources of information and misinformation about COVID-19 early during the pandemic in a U.S. national cohort study

BackgroundEarly in the pandemic, misinformation about COVID-19 was spread on social media. The purpose of this study was to describe trusted sources of COVID-19 information and claims seen and believed about COVID-19 early in the pandemic among U.S. adults. Then, we assessed the impact of believing such claims on engaging in personal protective actions (PPA). MethodsWe used baseline data from the CHASING COVID Cohort (n = 7,070) collected March 28, 2020 to April 20, 2020 to describe trusted sources of COVID-19 information as well as claims circulating on social media that had been seen and believed. We used Poisson regression to determine the association of believing certain claims with engaging in a higher number of PPA. ResultsThe top three trusted sources of COVID-19 information were the CDC (67.9%), the WHO (53.7%), and State Health Departments (53.0%). Several COVID-19 claims circulated on social media had been seen, e.g., that the virus was created in a laboratory (54.8%). Moreover, substantial proportions of participants indicated agreement with some of these claims. In multivariable regression, we found that belief in certain claims was associated with engaging in a higher number of PPA. For example, believing that paper masks would prevent transmission of the virus was associated with engaging in a higher number of protective actions ({beta} = 0.02, 95% CI: 0.004 - 0.046). ConclusionsResults suggest the need for public health leadership on social media platforms to combat misinformation and supports social media as a tool to further public health interventions.

Racial and ethnic differences in COVID-19 vaccine hesitancy and uptake

BackgroundRacial and ethnic minorities have been disproportionately impacted by COVID-19. In the initial phase of population-based vaccination in the United States (U.S.) and United Kingdom (U.K.), vaccine hesitancy and limited access may result in disparities in uptake. MethodsWe performed a cohort study among U.S. and U.K. participants in the smartphone-based COVID Symptom Study (March 24, 2020-February 16, 2021). We used logistic regression to estimate odds ratios (ORs) of COVID-19 vaccine hesitancy (unsure/not willing) and receipt. ResultsIn the U.S. (n=87,388), compared to White non-Hispanic participants, the multivariable ORs of vaccine hesitancy were 3.15 (95% CI: 2.86 to 3.47) for Black participants, 1.42 (1.28 to 1.58) for Hispanic participants, 1.34 (1.18 to 1.52) for Asian participants, and 2.02 (1.70 to 2.39) for participants reporting more than one race/other. In the U.K. (n=1,254,294), racial and ethnic minorities had similarly elevated hesitancy: compared to White participants, their corresponding ORs were 2.84 (95% CI: 2.69 to 2.99) for Black participants, 1.66 (1.57 to 1.76) for South Asian participants, 1.84 (1.70 to 1.98) for Middle East/East Asian participants, and 1.48 (1.39 to 1.57) for participants reporting more than one race/other. Among U.S. participants, the OR of vaccine receipt was 0.71 (0.64 to 0.79) for Black participants, a disparity that persisted among individuals who specifically endorsed a willingness to obtain a vaccine. In contrast, disparities in uptake were not observed in the U.K. ConclusionsCOVID-19 vaccine hesitancy was greater among racial and ethnic minorities, and Black participants living in the U.S. were less likely to receive a vaccine than White participants. Lower uptake among Black participants in the U.S. during the initial vaccine rollout is attributable to both hesitancy and disparities in access.

Recent SARS-CoV-2 seroconversion in a national, community-based prospective cohort of U.S. adults

BackgroundEpidemiologic risk factors for incident SARS-CoV-2 infection as determined via prospective cohort studies greatly augment and complement information from case-based surveillance and cross-sectional seroprevalence surveys. MethodsWe estimated the incidence of SARS-CoV-2 infection and risk factors in a well-characterized, national prospective cohort of 6,738 U.S. adults, enrolled March-August 2020, a subset of whom (n=4,510) underwent repeat serologic testing between May 2020 and January 2021. We examined the crude associations of sociodemographic factors, epidemiologic risk factors, and county-level community transmission with the incidence of seroconversion. In multivariable Poisson models we examined the association of social distancing and a composite score of several epidemiologic risk factors with the rate of seroconversion. FindingsAmong the 4,510 individuals with at least one serologic test, 323 (7.3%, 95% confidence interval [CI] 6.5%-8.1%) seroconverted by January 2021. Among 3,422 participants seronegative in May-September 2020 and tested during November 2020-January 2021, we observed 161 seroconversions over 1,646 person-years of follow-up (incidence rate of 9.8 per 100 person-years [95%CI 8.3-11.5]). In adjusted models, participants who reported always or sometimes social distancing with people they knew (IRRalways vs. never 0.43, 95%CI 0.21-1.0; IRRsometimes vs. never 0.47, 95%CI 0.22-1.2) and people they did not know (IRRalways vs. never 0.64, 95%CI 0.39-1.1; IRRsometimes vs. never 0.60, 95%CI 0.38-0.97) had lower rates of seroconversion. The rate of seroconversion increased across tertiles of the composite score of epidemiologic risk (IRRmedium vs. low 1.5, 95%CI 0.92-2.4; IRRhigh vs. low 3.0, 95%CI 2.0-4.6). Among the 161 observed seroconversions, 28% reported no symptoms of COVID-like illness (i.e., were asymptomatic), and 27% reported a positive SARS-CoV-2 diagnostic test. Ultimately, only 29% reported isolating and 19% were asked about contacts. InterpretationModifiable epidemiologic risk factors and poor reach of public health strategies drove SARS-CoV-2 transmission across the U.S during May 2020-January 2021. FundingU.S. National Institutes of Allergy and Infectious Diseases (NIAID).

Patterns of SARS-CoV-2 testing preferences in a national cohort in the United States

In order to understand preferences about SARS-CoV-2 testing, we conducted a discrete choice experiment among 4793 participants in the Communities, Households, and SARS-CoV-2 Epidemiology (CHASING COVID) Cohort Study from July 30-September 8, 2020. We used latent class analysis to identify distinct patterns of preferences related to testing and conducted a simulation to predict testing uptake if additional testing scenarios were offered. Five distinct patterns of SARS-CoV-2 testing emerged. "Comprehensive testers" (18.9%) ranked specimen type as most important and favored less invasive specimen types, with saliva most preferred, and also ranked venue and result turnaround time as highly important, with preferences for home testing and fast result turnaround time. "Fast track testers" (26.0%) ranked result turnaround time as most important and favored immediate and same day turnaround time. "Dual testers" (18.5%) ranked test type as most important and preferred both antibody and viral tests. "Non-invasive dual testers" (33.0%) ranked specimen type and test type as similarly most important, preferring cheek swab specimen type and both antibody and viral tests. "Home testers" (3.6%) ranked venue as most important and favored home-based testing. By offering less invasive (saliva specimen type), dual testing (both viral and antibody tests), and at home testing scenarios in addition to standard testing scenarios, simulation models predicted that testing uptake would increase from 81.7% to 98.1%. We identified substantial differences in preferences for SARS-CoV-2 testing and found that offering additional testing options, which consider this heterogeneity, would likely increase testing uptake. SIGNIFICANCEDuring the COVID-19 pandemic, diagnostic testing has allowed for early detection of cases and implementation of measures to reduce community transmission of SARS-CoV-2 infection. Understanding individuals preferences about testing and the service models that deliver tests are relevant in efforts to increase and sustain uptake of SARS-CoV-2 testing, which, despite vaccine availability, will be required for the foreseeable future. We identified substantial differences in preferences for SARS-CoV-2 testing in a discrete choice experiment among a large national cohort of adults in the US. Offering additional testing options that account for or anticipate this heterogeneity in preferences (e.g., both viral and antibody tests, at home testing), would likely increase testing uptake. ClassificationBiological Sciences (major); Psychological and Cognitive Sciences (minor)

Household factors and the risk of severe COVID-like illness early in the US pandemic

ObjectiveTo investigate the role of children in the home and household crowding as risk factors for severe COVID-19 disease. MethodsWe used interview data from 6,831 U.S. adults screened for the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study in April 2020. ResultsIn logistic regression models, the adjusted odds ratio [aOR] of hospitalization due to COVID-19 for having (versus not having) children in the home was 10.5 (95% CI:5.7-19.1) among study participants living in multi-unit dwellings and 2.2 (95% CI:1.2-6.5) among those living in single unit dwellings. Among participants living in multi-unit dwellings, the aOR for COVID-19 hospitalization among participants with more than 4 persons in their household (versus 1 person) was 2.5 (95% CI:1.0-6.1), and 0.8 (95% CI:0.15-4.1) among those living in single unit dwellings. ConclusionEarly in the US SARS-CoV-2 pandemic, certain household exposures likely increased the risk of both SARS-CoV-2 acquisition and the risk of severe COVID-19 disease.

The relationship between anxiety, health, and potential stressors among adults in the United States during the COVID-19 pandemic

ObjectiveTo estimate the prevalence of anxiety symptoms and the association between moderate or severe anxiety symptoms and health and potential stressors among adults in the U.S. during the COVID-19 pandemic MethodsThis analysis includes data from 5,250 adults in the Communities, Households and SARS/CoV-2 Epidemiology (CHASING) COVID Cohort Study surveyed in April 2020. Poisson models were used to estimate the association between moderate or severe anxiety symptoms and health and potential stressors among U.S. adults during the COVID-19 pandemic. ResultsGreater than one-third (35%) of participants reported moderate or severe anxiety symptoms. Having lost income due to COVID-19 (adjusted prevalence ratio [aPR] 1.27 (95% CI 1.16, 1.30), having recent COVID-like symptoms (aPR 1.17 (95% CI 1.05, 1,31), and having been previously diagnosed with depression (aPR 1.49, (95% CI 1.35, 1.64) were positively associated with anxiety symptoms. ConclusionsAnxiety symptoms were common among adults in the U.S. during the COVID-19 pandemic. Strategies to screen and treat individuals at increased risk of anxiety, such as individuals experiencing financial hardship and individuals with prior diagnoses of depression, should be developed and implemented.

Testing, Testing: What SARS-CoV-2 testing services do adults in the United States actually want?

ImportanceAscertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission. ObjectiveTo determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission. DesignA discrete choice experiment (DCE) was used to assess the relative importance of type of SARS-CoV-2 test, specimen type, testing venue, and results turnaround time. Uptake of an optimized testing scenario was simulated relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal (NP) swab in a providers office or urgent care clinic with results in >5 days. SettingOnline survey, embedded in an existing cohort study, conducted during July 30 - September 8, 2020. ParticipantsParticipants (n=4,793) were enrolled in the CHASING COVID Cohort Study, a national longitudinal cohort of adults >18 years residing in the 50 US states, Washington, DC, Puerto Rico, or Guam. Main Outcome(s) and Measure(s)Relative importance of SARS-CoV-2 testing method attributes, utilities of specific attribute levels, and probability of choosing a testing scenario based on preferences estimated from the DCE, the current typical testing option, or choosing not to test. ResultsTurnaround time for test results had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). Participants preferred fast results on both past and current infection and using a noninvasive specimen, preferably collected at home. Simulations suggested that providing immediate or same day test results, providing both PCR and serology, or collecting oral specimens would substantially increase testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test. Conclusions and RelevanceTesting strategies that offer both PCR and serology with non-invasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2.