Exposure and Risk Factors for COVID-19 and the Impact of Staying Home on 8,047 Biorepository Participants

Background: COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, has had a substantial impact on clinical care and lifestyles globally. The State of Michigan reports over 80,000 positive COVID-19 tests between March 1, 2020 until July 29, 2020.Methods: We surveyed 8,047 Michigan Medicine biorepository participants in late June 2020 to evaluate diagnoses of COVID-19 (N=133), symptoms, exposure, and clinical risk factors as well as the impact on health behaviors and level of concern.Results: Based on survey results, we found that 58% of COVID-19 cases reported no known exposure to family members or to someone outside the house diagnosed with COVID-19. A significantly higher rate of COVID-19 cases were employed as essential workers (45% vs 19%, p=3x10 -11). COVID-19 cases reporting a fever were more likely to require hospitalization (categorized as severe; OR = 4.6 [95% CI: 1.7-13.0, p=0.004]) whereas respondents reporting rhinorrhea was less likely to require hospitalization (categorized as mild-to-moderate; OR = 0.16 [95% CI: 0.04-0.70, p=0.016]). African-Americans reported higher rates of being diagnosed with COVID-19 (OR = 4.0 [95% CI: 2.2-7.2, p=1x10-4]), as well as higher rates of an annual household income < $40,000, living in rental housing, exposure to family or someone outside the household diagnosed with COVID-19, and chronic diseases. During the Executive Order in Michigan, African Americans, women, and the lowest income group reported worsening health behaviors and higher overall concern for the potential detrimental effects of the pandemic.Interpretation: The higher risk of contracting COVID-19 observed among African Americans may be due to the increased rates of working as essential employees, lower socioeconomic status, and exposure to known positive cases. Continued efforts should focus on COVID-19 prevention and mitigation strategies, as well as address the inequality gaps that result in higher risks for both short-term and long-term health outcomes.Funding Statement: Dr. Willer is supported by National Institutes of Health grants R35-HL135824, R01- HL142023, R01-DK075787, and R01-HL109946 Dr. Douville is supported by the Foundation for Anesthesia Education and Research (FAER) - Mentored Research Training Grant. Declaration of Interests: Dr. Willer’s spouse works for Regeneron Pharmaceuticals Inc. Dr. Brummett is a consultant for Heron Therapeutics and Alosa Health, not related to the present study. All others have no conflicts to declare. Ethics Approval Statement: The protocol and study procedures were approved by the University of Michigan Institutional Review Board (HUM00180827).