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COVID spreads quickly among household members, who should isolate and wear masks after initial infection, CDC study finds

MassLive.com logo MassLive.com 10/31/2020 Melissa Hanson, masslive.com

Coronavirus transmission within households happens quickly, according to a new study from the Centers for Disease Control and Prevention, and can start with both children and adults.

Findings of the study, released Friday, suggest that after one family member has been potentially exposed to the virus, that person should promptly self-isolate while other household members wear masks to reduce the likelihood of household transmission.

“Because prompt isolation of persons with COVID-19 can reduce household transmission, persons who suspect that they might have COVID-19 should isolate, stay at home, and use a separate bedroom and bathroom if feasible,” the study reads. “Isolation should begin before seeking testing and before test results become available because delaying isolation until confirmation of infection could miss an opportunity to reduce transmission to others.”

The CDC studied households in Nashville, Tennessee, and Marshfield, Wisconsin, from April to September. Households were eligible for the study if the first patient had coronavirus symptom onset fewer than seven days before enrollment and lived with at least one other person who was not symptomatic at the time of the first patient’s illness onset.

Of the households studied, there were 101 initial patients and 191 household members. The median index patient age was 32 years old and among index patients, 75 were white, eight were non-Latinx persons of other races and 18 were Hispanic or Latinx.

Seventy index patients reported spending more than four hours in the same room with one or more household members the day before and 40 the day after illness onset, while 40 index patients reported sleeping in the same room with one or more household members before illness onset and 30 after illness onset, according to the study.

Of all the household members, 102 had nasal swabs or saliva specimens in which COVID-19 was detected during the first seven days, a secondary infection rate of 53%, per the study. Secondary infection rates based only on nasal swabs saw similar results of 47%. Excluding 54 household members who had COVID-19 detected in specimens taken at enrollment, the secondary infection rate was 35%.

“Secondary infections occurred rapidly, with approximately 75% of infections identified within 5 days of the index patient’s illness onset. Secondary infection rates were high across all racial/ethnic groups. Substantial transmission occurred whether the index patient was an adult or a child,” the study reads.

Rates of symptomatic and asymptomatic coronavirus infection among household members were 36% and 18%, respectively.

“An important finding of this study is that fewer than one half of household members with confirmed SARS-CoV-2 infections reported symptoms at the time infection was first detected, and many reported no symptoms throughout 7 days of follow-up, underscoring the potential for transmission from asymptomatic secondary contacts and the importance of quarantine,” the study reads.

The study was limited by several factors, the CDC said. While the first household member who got sick was considered the index patient, it is possible that others were infected at the same time but were asymptomatic. Although living in the same household may bring a high risk of infection, some transmission of the virus could have happened outside the household, the study said.

The CDC also noted that respiratory samples were self-collected, which could have reduced the sensitivity of detections, and that families in the study might not be representative of the general U.S. population.

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