Household transmissions of SARS-CoV-2 in the time of unprecedented travel lockdown in China

Importance Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in the city of Wuhan, China, in December 2019 and then spread globally. Limited information is available for characterizing epidemiological features and transmission patterns in the regions outside of Hubei Province. Detailed data on transmission at the individual level could be an asset to understand the transmission mechanisms and respective patterns in different settings. Objective To reconstruct infection events and transmission clusters of SARS-CoV-2 for estimating epidemiological characteristics at household and non-household settings, including super-spreading events, serial intervals, age- and gender-stratified risks of infection in China outside of Hubei Province. Design, Setting, and Participants 9,120 confirmed cases reported online by 264 Chinese urban Health Commissions in 27 provinces from January 20 to February 19, 2020. A line-list database is established with detailed information on demographic, social and epidemiological characteristics. The infection events are categorized into the household and non-household settings. Exposures Confirmed cases of SARS-CoV-2 infections. Main Outcomes and Measures Information about demographic characteristics, social relationships, travel history, timelines of potential exposure, symptom onset, confirmation, and hospitalization were extracted from online public reports. 1,407 infection events formed 643 transmission clusters were reconstructed. Results In total 34 primary cases were identified as super spreaders, and 5 household super-spreading events were observed. The mean serial interval is estimated to be 4.95 days (standard deviation: 5.24 days) and 5.19 days (standard deviation: 5.28 days) for households and non-household transmissions, respectively. The risk of being infected outside of households is higher for age groups between 18 and 64 years, whereas the hazard of being infected within households is higher for age groups of young (65) people. Conclusions and Relevance The identification of super-spreading events, short serial intervals, and a higher risk of being infected outside of households for male people of age between 18 and 64 indicate a significant barrier to the case identification and management, which calls for intensive non-pharmaceutical interventions (e.g. cancellation of public gathering, limited access of public services) as the potential mitigation strategies. Key Points Question What epidemiological characteristics and risk factors are associated with household and non-household transmissions of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China outside of Hubei Province? Findings In this epidemiological study analyzing 1,407 SARS-CoV-2 infection events reported between 20 January 2020 and 19 February 2020, 643 transmission clusters were reconstructed to demonstrate the non-negligible frequency of super-spreading events, short duration of serial intervals, and a higher risk of being infected outside of household for male people of age between 18 and 64 years. Meaning These findings provide epidemiological features and risk estimates for both household and non-household transmissions of SARS-CoV-2 in China outside of Hubei Province.