At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area

Ann E Woolley; Scott Dryden-Peterson; Andy Kim; Sarah Naz-McLean; Christina Kelly; Hannah H Laibinis; Josephine Bagnall; Jonathan Livny; Peijun Ma; Marek Orzechowski; James Gomez; Noam Shoresh; Stacey Gabriel; Deborah T Hung; Lisa A Cosimi

doi:10.1093/ofid/ofac505

At-home Testing and Risk Factors for Acquisition of SARS-CoV-2 Infection in a Major US Metropolitan Area

Open Forum Infect Dis. 2022 Oct 5;9(11):ofac505. doi: 10.1093/ofid/ofac505. eCollection 2022 Nov.

Authors

Ann E Woolley^{1

2}, Scott Dryden-Peterson^{1

3

4}, Andy Kim¹, Sarah Naz-McLean¹, Christina Kelly¹, Hannah H Laibinis², Josephine Bagnall², Jonathan Livny², Peijun Ma², Marek Orzechowski², James Gomez², Noam Shoresh², Stacey Gabriel², Deborah T Hung^{1

2

5}, Lisa A Cosimi^{1

2}

Affiliations

¹ Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.
² Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.
³ Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
⁴ Botswana Harvard AIDS Institute, Boston, Massachusetts, USA.
⁵ Department of Molecular Biology and Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, Massachusetts, USA.

Abstract

Background: Unbiased assessment of the risks associated with acquisition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical to informing mitigation efforts during pandemics. The objective of our study was to understand the risk factors for acquiring coronavirus disease 2019 (COVID-19) in a large prospective cohort of adult residents in a large US metropolitan area.

Methods: We designed a fully remote longitudinal cohort study involving monthly at-home SARS-CoV-2 polymerase chain reaction (PCR) and serology self-testing and monthly surveys.

Results: Between October 2020 and January 2021, we enrolled 10 289 adults reflective of the Boston metropolitan area census data. At study entry, 567 (5.5%) participants had evidence of current or prior SARS-CoV-2 infection. This increased to 13.4% by June 15, 2021. Compared with Whites, Black non-Hispanic participants had a 2.2-fold greater risk of acquiring COVID-19 (hazard ratio [HR], 2.19; 95% CI, 1.91-2.50; P < .001), and Hispanics had a 1.5-fold greater risk (HR, 1.52; 95% CI, 1.32-1.71; P < .016). Individuals aged 18-29, those who worked outside the home, and those living with other adults and children were at an increased risk. Individuals in the second and third lowest disadvantaged neighborhood communities were associated with an increased risk of acquiring COVID-19. Individuals with medical risk factors for severe disease were at a decreased risk of SARS-CoV-2 acquisition.

Conclusions: These results demonstrate that race/ethnicity and socioeconomic status are the biggest determinants of acquisition of infection. This disparity is significantly underestimated if based on PCR data alone, as noted by the discrepancy in serology vs PCR detection for non-White participants, and points to persistent disparity in access to testing. Medical conditions and advanced age, which increase the risk for severity of SARS-CoV-2 disease, were associated with a lower risk of COVID-19 acquisition, suggesting the importance of behavior modifications. These findings highlight the need for mitigation programs that overcome challenges of structural racism in current and future pandemics.

Keywords: COVID-19; SARS-CoV-2; at-home testing; risk factors; seroprevalence.

Grants and funding

R01 CA236546/CA/NCI NIH HHS/United States