Corpus overview


MeSH Disease

Human Phenotype


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    Optimal COVID-19 quarantine and testing strategies

    Authors: Chad R. Wells; Jeffrey P. Townsend; Abhishek Pandey; Gary Krieger; Burton H. Singer; Robert H. McDonald; Seyed M. Moghadas; Alison P. Galvani; Peter K. Jackson; Raul Andino; Xiaokun Shu; Nicholas A. Crossland; Christopher S. Chen; Darrell N. Kotton; Susan C. Baker; John H. Connor; Florian Douam; Andrew Emili; Mohsan Saeed; Ilayda Sahin; Cavit Kerem Kayhan; Fatma Tokat; Gurler Akpinar; Murat Kasap; Ayse Sesin Kocagoz; Ugur Ozbek; Dilek Telci; Fikrettin Sahin; Koray Yalcin; Siret Ratip; Umit Ince; Guldal Suyen; Ercument Ovali; Liam Fergusson; Marta Conti; Marius Rameil; Vanessa Nakonecnij; Jakob Vanhoefer; Leonard Schmiester; Muying Wang; Emily E Ackerman; Jason E Shoemaker; Jeremy Zucker; Kristie L Oxford; Jeremy Teuton; Ebru Kocakaya; Gokce Yagmur Summak; Kristina Hanspers; Martina Kutmon; Susan Coort; Lars Eijssen; Friederike Ehrhart; Rex D. A. B.; Denise Slenter; Marvin Martens; Robin Haw; Bijay Jassal; Lisa Matthews; Marija Orlic-Milacic; Andrea Senff-Ribeiro; Karen Rothfels; Veronica Shamovsky; Ralf Stephan; Cristoffer Sevilla; Thawfeek Mohamed Varusai; Jean-Marie Ravel; Vera Ortseifen; Silvia Marchesi; Piotr Gawron; Ewa Smula; Laurent Heirendt; Venkata Satagopam; Guanming Wu; Anders Riutta; Martin Golebiewski; Stuart Owen; Carole Goble; Xiaoming Hu; Rupert Overall; Dieter Maier; Angela Bauch; John A Bachman; Benjamin M Gyori; Carlos Vega; Valentin Groues; Miguel Vazquez; Pablo Porras; Luana Licata; Marta Iannuccelli; Francesca Sacco; Denes Turei; Augustin Luna; Ozgun Babur; Sylvain Soliman; Alberto Valdeolivas; Marina Esteban-Medina; Maria Pena-Chilet; Tomas Helikar; Bhanwar Lal Puniya; Anastasia Nesterova; Anton Yuryev; Anita de Waard; Dezso Modos; Agatha Treveil; Marton Laszlo Olbei; Bertrand De Meulder; Aurelien Naldi; Aurelien Dugourd; Laurence Calzone; Chris Sander; Emek Demir; Tamas Korcsmaros; Tom C Freeman; Franck Auge; Jacques S Beckmann; Jan Hasenauer; Olaf Wolkenhauer; Egon Willighagen; Alexander R Pico; Chris Evelo; Lincoln D Stein; Henning Hermjakob; Julio Saez-Rodriguez; Joaquin Dopazo; Alfonso Valencia; Hiroaki Kitano; Emmanuel Barillot; Charles Auffray; Rudi Balling; Reinhard Schneider; - the COVID-19 Disease Map Community

    doi:10.1101/2020.10.27.20211631 Date: 2020-10-28 Source: medRxiv

    As economic woes of the COVID-19 pandemic deepen, strategies are being formulated to avoid the need for prolonged stay-at-home orders, while implementing risk-based quarantine, testing, contact tracing TRANS and surveillance protocols. Given limited resources and the significant economic, public health and operational challenges of the current 14-day quarantine recommendation, it is vital to understand if more efficient but equally effective quarantine and testing strategies can be deployed. To this end, we developed a mathematical model to quantify the probability of post-quarantine transmission TRANS that varied across a range of possible quarantine durations, timings of molecular testing, and estimated incubation periods TRANS. We found that a 13-day quarantine with testing on entry, a nine-day quarantine with testing on exit, and an eight-day quarantine with testing on both entry and exit each provide equivalent or lower probability of post-quarantine transmission TRANS compared to a 14-day quarantine with no testing. We found that testing on exit from quarantine is more effective in reducing probability of post-quarantine transmission TRANS than testing upon entry. When conducting a single test, testing on exit was most effective for quarantines of six days or shorter, while testing on day six or seven is optimal for longer quarantines. Optimal timing of testing during quarantine will reduce the probability of post-quarantine transmission TRANS, as false-positive results become less likely, enabling case isolation. Based on 4,040 SARS CoV-2 RT-PCR tests, an exit test 96 hours after the start of quarantine for an offshore oil rig population was demonstrated to identify all known asymptomatic TRANS cases that previously tested negative at entry, and-moreover-successfully prevented an expected seven or more offshore transmission TRANS events, each a serious concern for initiating rapid spread and a disabling outbreak in the close quarters of an offshore rig. This successful outcome highlights the importance of context-specific guidelines for the duration of quarantine and timing of testing that can minimize economic impacts, disruptions to operational integrity, and COVID-related public health risks.

    Challenges for non-technical implementation of digital proximity tracing TRANS: early experiences from Switzerland

    Authors: Viktor von Wyl; Gianluca Musumeci; Andrea Sigfrido Camperio Ciani; Markus Casper; Frank Lammert; Marcin Krawczyk

    doi:10.1101/2020.10.22.20218057 Date: 2020-10-27 Source: medRxiv

    Background: Several countries have released digital proximity tracing TRANS (DPT) apps in addition to manual contact tracing TRANS (MCT) to combat the Sars-CoV-2 pandemic. The goal of DPT is to notify app users about proximity exposures to persons infected with Sars-CoV-2 so that they can self-quarantine. However, early press reports from Switzerland suggest multiple challenges for non-technical DPT implementation. Objective: Using media articles published during the first three months after the DPT app launch to describe non-technical implementation challenges reported by different stakeholders and to map these reports to the four constructs of normalization process theory (NPT), a framework to develop and evaluate complex digital health interventions. Methods: A Swiss media database was searched for articles on the Swiss DPT app (SwissCovid) published in German or French between 04.07.2020 and 03.10.2020. Topics were extracted manually from articles that were deemed pertinent in a structured process. Extracted topics were mapped to NPT constructs. Results: Out of 94 articles deemed pertinent and selected for closer inspection, 38 provided unique information on implementation challenges. These challenges included unclear DPT benefits, which affected commitment and raised fears among different health system actors regarding resource competition with established pandemic mitigation measures. Moreover, media reports indicated process interface challenges such as delays or unclear responsibilities in the notification cascade, as well as misunderstandings and unmet communication needs from certain health system actors. Finally, some reports suggested misaligned incentives, not only for app usage by the public but also for process engagement by other actors in the app notification cascade. These challenges mapped well to the four constructs of NPT. Conclusions: Early experiences from one of the first adopters of DPT indicate that non-technical implementation challenges warrant attention. The detected implementation challenges fit well into the framework of NPT, which seems well suited to guide the development and evaluation of complex DPT interventions.

    The French Covid-19 contact tracing TRANS app: usage and opinions by students in the health domain

    Authors: Ilaria Montagni; Nicolas Roussel; Rodolphe Thiebaut; Christophe Tzourio; Pietro Ghezzi; Dr. Fauziah Rabbani; iqra chowdry; muhammad Obaid; Iram Sabah; Misbah Kawoosa; Abdul Lone; Shahroz Nabi; Ishtiyaq Sumji; Nikoloz Chkhartishvili; Frédéric Limosin; Carl Kendall

    doi:10.1101/2020.10.23.20218214 Date: 2020-10-27 Source: medRxiv

    Background: Many countries around the world have developed mobile phone apps capable of supporting instantaneous contact tracing TRANS to control the Covid-19 pandemic. In France, a few people have downloaded and are using the StopCovid contact tracing TRANS app. Reasons for this low uptake are unexplored. Students in the health domain are especially concerned and their usage and opinions about the app can inform improvements and diffusion of StopCovid among young people. Objective: To investigate health-related students' usage and opinions about the StopCovid app. Methods: A field survey was conducted among 318 students at the health sciences campus of the University of Bordeaux, France. Quota sampling method was used and descriptive statistics were performed. Results: A total of 77.3% (246/318) students had heard about the app, but only 11.3% (36/318) had downloaded it and 4.7% (15/318) were still using it. Main reasons for not using the app were: belief that it was not effective given its limited diffusion (17.6%, 37/210), lack of interest (17.6%, 37/210) and distrust in data security and fear to be geo-located (15.7%, 33/210). Among those who had not heard about the app, after a brief description of its functioning and confidentiality policy, 52.7% (38/72) would use it. Participants reported that the main solution for increasing the use of the app would be a better communication strategy (71.4%, 227/318). Conclusion: Findings suggest that University-based communication interventions are needed to increase knowledge and uptake of the StopCovid app among students.

    Fernando de Noronha: how an island controlled the community transmission TRANS of COVID-19 in Brazil

    Authors: Mozart Julio Tabosa Sales; Ligia S Kerr; Regina Vianna Brizolara; Ivana Cristina de Holanda Cunha Barreto; Rosa Livia Freitas Almeida; Paulo Goes; Luis Odorico Monteiro de Andrade; Leuridan Torres; Flavia Kelly Alvarenga Pinto; Francisco Marto Leal Pinheiro-Junior; Rebeca Valentim Leite; Amanda Carolina Abreu Felix Cavalcanti de Abreu; Rebecca Lucena Theophilo; Fernando Rodrigues Magalhaes; Susane Lindinalva da Silva; Carl Kendall

    doi:10.1101/2020.10.22.20216010 Date: 2020-10-27 Source: medRxiv

    Introduction: Fernando Noronha (FNA) is a small Brazilian archipelago in the Atlantic, part of the state of Pernambuco that COVID-19 has decimated. Anticipating the worst from the pandemic, Island and state authorities implemented a series of public health actions to contain the epidemic. This paper, reporting the results of the first wave of a cohort study, documents the measures and their effects through a cohort study. Methods: Measures were documented at the time of implementation. A random sample of 904 residents were selected from the health register, interviewed and tested for COVID-19 (RT-PCR and serology). The survey explored socioeconomic variables and adherence to prevention behaviors. Results: Flights were reduced from 38 to once a week, FNA was closed to tourism, schools were closed, and testing and tracing contacts TRANS was mandated along with social distancing and use of masks. A household lockdown was briefly imposed for residents. A prevalence SERO of 5.1% was found, and a total of 158 cases of COVID-19 was estimated, although only 28 had been reported in routine surveillance. Half of the population reported food insecurity and applied for government COVID-19 benefits. Adherence to control measures was high, except for intrahousehold mask use with family and friends TRANS. Conclusion: Despite high levels of COVID-19 in Pernambuco, continued exposure through the provision of essential services from the mainland, and lack of direction from national authorities, FNA was able to implement a series of prevention measures unique in Brazil that contained the epidemic on the island.

    Reducing Covid-19 risk in schools: a qualitative examination of staff and family views and concerns

    Authors: Ava Lorenc; Joanna May Kesten; Judith Kidger; Rebecca Langford; Jeremy Horwood; Bernardo Gutierrez; Jayna Raghwani; Jordan Ashworth; Rachel Colquhoun; Thomas Richard Connor; Nuno R. Faria; Benjamin Jackson; Nicholas James Loman; Aine O'Toole; Samuel M. Nicholls; Kris V. Parag; Emily Scher; Tetyana I. Vasylyeva; Erik M. Volz; Alexander Watts; Isaac I. Bogoch; Kamran Khan; - COG-UK consortium; David Aanensen; Moritz U.G. Kraemer; Andrew Rambaut; Oliver Pybus

    doi:10.1101/2020.10.25.20216937 Date: 2020-10-27 Source: medRxiv

    Background The Covid-19 pandemic has necessitated schools implementing Covid-19 risk-reduction measures. Methods We investigated young people, parent TRANS and school staff attitudes towards secondary school Covid-19 mitigation measures. Recruitment used school communication, community organisations and snowball sampling. Audio recorded online/phone individual/group interviews lasted 45 minutes. Interviews focused on social distancing, hand-hygiene and testing. Team framework analysis used interview notes and transcripts. Results Participants were 13 school staff, 20 parents TRANS and 17 young people. Concerns about Covid-19 risk at school, especially to vulnerable individuals, were outweighed by perceived risks of not returning to school. Some teachers anticipated guilt around being a potential spreader. Participants saw school mitigation measures as an acceptable and pragmatic solution to the impossibility of social distancing, although anticipated challenges in changing habitual behaviour. Participants supported school Covid-19 testing but identified the need to consider data security and stigma. Staff were concerned about unintended consequences of risk-reduction strategies and widening inequalities. Conclusion Families and staff supported Covid-19 mitigation measures in schools. Clear messaging and engendering collective responsibility are important for compliance and success. However, schools and policy makers should consider unintended consequences of measures, supporting vulnerable individuals and those with additional needs, and avoiding widening inequalities.

    Seroprevalence SERO of SARS-CoV-2 antibodies SERO and associated factors in health care workers: a systematic review and meta-analysis

    Authors: Petros A Galanis; Irene Vraka; Despoina Fragkou; Angeliki Bilali; Daphne Kaitelidou; tanzeela Qazi; iqra chowdry; muhammad Obaid; Iram Sabah; Misbah Kawoosa; Abdul Lone; Shahroz Nabi; Ishtiyaq Sumji; Nikoloz Chkhartishvili; Frédéric Limosin; Carl Kendall

    doi:10.1101/2020.10.23.20218289 Date: 2020-10-27 Source: medRxiv

    Background: Health care workers (HCWs) represent a high risk population for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection MESHD. Aim: To determine the seroprevalence SERO of SARS-CoV-2 antibodies SERO among HCWs, and to find out the factors that are associated with this seroprevalence SERO. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were applied for this systematic review and meta-analysis. Databases including PubMed/MEDLINE and pre-print services (medR{chi}iv and bioR{chi}iv) were searched from inception up to August 24, 2020. Findings: Fifty studies, including 184,898 HCWs met the inclusion criteria. The estimated overall seroprevalence SERO of SARS-CoV-2 antibodies SERO among HCWs was 8.4% (95% CI: 6.1-11.1%). Seroprevalence SERO was higher in studies that were conducted in North America (12.7%) compared to those in Africa (8.2), Europe (8.1%) and Asia (4%). Meta-regression showed that increased sensitivity SERO of antibodies test SERO was associated with increased seroprevalence SERO. The following factors were associated with seropositivity: male TRANS gender TRANS, Black, Asian, and Hispanic HCWs, work in a coronavirus disease MESHD 2019 (COVID-19) unit, patient-related work, frontline health care workers, health care assistants, personal protective equipment shortage, self-reported belief for previous SARS-CoV-2 infection MESHD, previous positive polymerase chain reaction test, and household contact TRANS with suspected or confirmed COVID-19 patients. Conclusion: The seroprevalence SERO of SARS-CoV-2 antibodies SERO among HCWs is high. Excellent adherence to infection MESHD prevention and control measures, sufficient and adequate personal protective equipment, and early recognition, identification and isolation of HCWs that are infected with SARS-CoV-2 are imperative to decrease the risk of SARS-CoV-2 infection MESHD.

    Perceived Risk and Distress related to COVID-19: Comparing Healthcare versus non-Healthcare Workers of Pakistan

    Authors: Dr. Adeel Abid; Dr. Hania Shahzad; Dr. Hyder Ali Khan; Dr. Suneel Piryani; Areeba Raza Khan; Dr. Fauziah Rabbani; iqra chowdry; muhammad Obaid; Iram Sabah; Misbah Kawoosa; Abdul Lone; Shahroz Nabi; Ishtiyaq Sumji; Nikoloz Chkhartishvili; Frédéric Limosin; Carl Kendall

    doi:10.1101/2020.10.23.20218297 Date: 2020-10-27 Source: medRxiv

    Background Healthcare workers (HCWs) find themselves susceptible to contracting COVID-19 or being the source of exposure for their family members TRANS. This puts them at a high risk of psychological distress which may compromise patient care. In this study we aim to explore the risk perceptions and psychological distress between HCWs and non-healthcare workers (NHCWs) in Pakistan. Methods A cross-sectional study was conducted in Pakistan using an online self-administered questionnaire. Respondents were categorized into HCWs (completed or aspiring to complete education in Medicine or allied fields) and NHCWs. HCWs were further categorized into front-line (direct patient care) and back-end HCWs. Results Data from 1406 respondents (507 HCWs and 899 NHCWs) was analyzed. No significant difference was observed between HCWs and NHCWs perception of susceptibility and severity towards COVID-19. Healthcare graduates perceived themselves (66% students vs. 80% graduates, p-value 0.011) and their family (67% students vs. 82% graduates, p-value 0.008) to be more susceptible to COVID-19 than the healthcare students. Frontline HCWs perceived themselves (83% frontline vs. 70% back-end, p-value 0.003) and their family (84% frontline vs. 72% back-end, p-value 0.006) as being more susceptible to COVID-19 than back-end healthcare professionals. Over half of the respondents were anxious (54% HCWs and 55% NHCWs). Female TRANS gender TRANS, younger age TRANS and having COVID-19 related symptoms had a significant effect on the anxiety HP anxiety MESHD levels of both HCWs and NHCWs. Conclusion Frontline HCWs, healthcare students, young people, females TRANS and individuals with lower income were at a higher risk of psychological distress MESHD due to the pandemic. Government policies should thus be directed at ensuring the mental well-being of frontline HCWs, and improving their satisfaction in order to strengthen health care delivery system.

    Seroprevalence SERO of anti-SARS-CoV-2 IgG Antibodies SERO in the Staff of a Public School System in the Midwestern United States

    Authors: Lilah Lopez; Graham Weber; Thao Nguyen; Katlyn Kleimola; Megan Bereda; Yiling Liu; Emma K. Accorsi; Steven J. Skates; John P. Santa Maria; Kendal R. Smith; Mark Kalinich; Walter Krugluger; Christian Sebesta; Harald Herkner; Brenda Laky; Ali Bellamine; Anita Burgun; Frédéric Limosin

    doi:10.1101/2020.10.23.20218651 Date: 2020-10-27 Source: medRxiv

    Background Since March 2020, the United States has lost over 200,000 lives to severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2), which causes COVID-19. A growing body of literature describes population-level SARS-CoV-2 exposure, but studies of antibody SERO seroprevalence SERO within school systems are critically lacking, hampering evidence-based discussions on school reopenings. The Lake Central School Corporation (LCSC), a public school system in suburban Indiana, USA, assessed SARS-CoV-2 seroprevalence SERO in its staff and identified correlations between seropositivity and subjective histories and demographics. Methods This study is a cross-sectional, population-based analysis of the seroprevalence SERO of SARS-CoV-2 in LCSC staff measured in July 2020. We tested for seroprevalence SERO with the Abbott Alinity SARS-CoV-2 MESHD IgG antibody SERO test. The primary outcome was the total seroprevalence SERO of SARS-CoV-2, and secondary outcomes included trends of antibody SERO presence in relation to baseline attributes. Findings 753 participants representative of the staff at large were enrolled. 22 participants (2.9%, 95% CI: 1.8% - 4.4%) tested positive for SARS-CoV-2 antibodies SERO. Correcting for test performance SERO parameters, the seroprevalence SERO is estimated at 1.7% (90% Credible Interval: 0.27% - 3.3%). Multivariable logistic regression including mask wearing, travel TRANS history, symptom history, and contact history revealed a 48-fold increase in the odds of seropositivity if an individual previously tested positive for COVID-19 (OR: 48.2, 95% CI: 4 - 600). Amongst individuals with no previous positive test, exposure to a person diagnosed with COVID-19 increased the odds of seropositivity by 7-fold (OR: 6.5, 95% CI: 2.06 - 18.9). Interpretation Assuming the presence of antibodies SERO is associated with immunity against SARS-CoV-2 infection MESHD, these results demonstrate a broad lack of herd immunity amongst the school corporation staff irrespective of employment role or location. Protective measures like contact tracing TRANS face coverings, and social distancing are therefore vital to maintaining the safety of both students and staff as the school year progresses.

    Inconsistent with the intent of public health strategies on incidence and fatality in states with extra mandatory stay-at-home and face masks orders during COVID-19 pandemic in the US

    Authors: Xin Wu; Samuel Xi Wu; Courtney A. Moore; Javier A. Granados Samayoa; Shelby T. Boggs; Jesse T. Ladanyi; Johnny Downs; Robert Stewart; Robert Harland; Philip McGuire; David A Drew; Long H Nguyen; Tove Fall; Maria F Gomez; Paul W Franks; Andrew T Chan; Richard Davies; Jonathan Wolf; Claire J Steves; Tim D Spector; Sebastien Ourselin

    doi:10.1101/2020.10.25.20219279 Date: 2020-10-27 Source: medRxiv

    Backgrounds: Coronavirus disease 2019 (COVID-19) is now recognized as a multi-system disease. The CDC recommends multiple preventive methods, including social distancing, hand hygiene, and wearing masks. In addition, some states imposed mandatory stay-at-home (SAH) and mandatory face mask (MFM) orders, to reduce the spread of COVID-19. The purpose of this study was to characterize the relationship between SAH and MFM approaches with the incidence and fatality. The research design is a cross-sectional study examining changes in incidence and fatality between states with and without SAH and MFM using available database from CDC during the pandemic periods of the date of the first positive case of each state to the date of 2020-08-23. Results: The daily new cases curve of the nation was flattened under the order of SAH and increased following the end of SAH and several nation-wide social gathering events. There were similar incidence rates among SAH + MFM states (95% CI, 1.19% to 1.64%. n=34), SAH + no-MFM states (95% CI, 1.26% to 2.36%. n=9) and no-SAH + no-MFM (95% CI, 1.08% to 1.63%. n=7). However, SAH+MFM states (n=34), SAH+no-MFM states (n=9) had significantly higher averages in daily new cases and daily fatality, case-fatality-ratio (CFR) and mortality rate (per 100,000 residents) than no-SAH+no-MFM states during pandemic periods (about 171 days), respectively. When normalized to population density, beside higher CFR in no-SAH+no-MFM, there were no significant differences in total positive cases, average daily new cases and average daily fatality among the 3 groups during the pandemic periods. When comparing incidence during the period of SAH (about 45 days. n=43 states), there were significantly higher incidence rates and average daily new cases in MFM states (n=12) than in no-MFM states (n=31). When normalized to population density, there were no significant differences in total positive cases and average daily new cases between the 2 groups during the period of SAH. Conclusion: This study provided direct evidence of a potential decreased in testing positivity rates, and a decreased fatality to save life when normalized by population density through strategies of SAH + MFM order during the COVID-19 pandemic. However, overall, our results were inconsistent with the intent of public health strategies of SAH and MFM in lowering transmission TRANS and fatality. From the policy making level, even if we can not strictly isolate contagious source patients in separate isolated places and without effective massive contact tracing TRANS, we presume that following the CDC recommendations with sufficient testing, could be appropriate to help in mitigate the COVID-19 disaster with close monitoring of healthcare capacity.

    Transmission TRANS of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study

    Authors: Michael Marks; Pere Millat; Dan Ouchi; Chrissy h Roberts; Andrea Alemany; Marc Corbacho-Monne; Maria Ubals; Marti Vall-Mayans; Camila Gonzalez Beiras; Nuria Prat; Jordi Ara; Bonaventura Clotet; Oriol Mitja

    doi:10.1101/2020.10.27.20220277 Date: 2020-10-27 Source: medRxiv

    Background There remains limited data on what variables affect the risk of transmission TRANS of SARS-CoV-2 and developing symptomatic Covid-19 and in particular the relationship to viral load (VL). Methods We analysed data collected in a trial of hydroxychloroquine post-exposure prophylaxis. Covid-19 cases and their contacts were identified through the local epidemiological surveillance system. VL, estimated by quantitative PCR, was assessed at enrollment, at day 14, and whenever the participant reported Covid-19-like symptoms. Risk of transmission TRANS, risk of developing symptomatic disease and incubation dynamics were evaluated using random-effects regression analysis. Findings We identified 314 cases, 282 of which had at least one contact (753 contacts in total). Ninety (33%) of 282 clusters had at least one transmission TRANS event. The secondary attack rate TRANS was 16% (125/753), with a variation from 12% to 24% for VL of the index case of <106, and >109 copies/mL, respectively (OR per log10 increase in VL 1.3 95%CI 1.1 to 1.6). Increased risk of transmission TRANS was also associated with household contact TRANS (OR 2.7; 1.4 to 5.06) and age TRANS of the contact (OR 1.02; 1.01 to 1.04). The proportion of PCR positive contacts who developed symptomatic Covid-19 was 40.3% (181/449), with a variation from 25% to 60% for VL of the contact <107, and >109 copies/mL (HR log10 increase in VL 1.12; 95% CI 1.05 to 1.2). Time to onset of symptomatic disease decreased from a median of 7 days (IQR 5 to 10) for individuals with an initial viral load <107 to 6 days (4 to 8) and 5 days (3 to 8) for individuals with an initial viral load of 107 to 109 and >109, respectively. Interpretation We show that the viral load of the index case is a leading driver of SARS-CoV-2 transmission TRANS. The risk of symptomatic Covid-19 is strongly associated with viral load of the contact at baseline, which shortens the incubation time in a dose-dependent manner.

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MeSH Disease
Human Phenotype

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