Abstract

BackgroundHouseholds are important sites for transmission of SARS-CoV-2 and preventive measures are recommended. This study aimed to 1) investigate the impact of living with a person infected with SARS-CoV-2; 2) understand how household members implemented infection control recommendations in their home; and 3) identify the information and support needs of household members.MethodsFor this observational mixed-methods study, households with a person with confirmed SARS-CoV-2 infection were recruited via drive-through testing sites of Municipal Health Services, healthcare worker screening or hospital emergency visits in the University Medical Centre Utrecht, the Netherlands and via primary care physicians, hospital emergency visits or preoperative screening in the University Hospital of Antwerp, Belgium. We recorded household characteristics, including characteristics of all household members, together with their views on prevention measures. In a subset of households one adult household member was asked to participate in an interview investigating their views on preventive measures. Survey data were analysed using descriptive statistics and interview data by rapid framework analysis. A triangulation protocol was used to integrate findings.ResultsThirty-four households (120 household members) were included in the quantitative survey. Twenty-two households were invited to be interviewed, of which 18 completed an interview (response 81.8%). Survey data showed that almost all households implemented some preventive measures, the use of face masks being least frequently reported. Measures taken depended on what was physically possible, the perceived severity of illness of the index patient and to what extent household members were willing to limit social interaction. Respondents did not believe in the effectiveness of wearing face masks within the house, and from the interviews this was explained by media coverage of face masks, impracticality and the stigma associated with wearing masks. Interviewees reported that quarantine had a high emotional burden and wished to have more information about the exact duration of quarantine, their own COVID-19 status, symptoms and when to seek medical help.ConclusionPeople were willing to implement prevention measures, however actual adherence depended on perceived severity of illness and the perceived risk of becoming infected. Homes are social environments and recommendations for infection prevention should account for this context. Incorporating our findings into policy making could provide households with more relevant and actionable advice.

Highlights

  • To preserve hospital capacity for severe COVID-19 patients, public health authorities in many parts of the world, including in Europe, have recommended that COVID-19 patients with mild infection be cared for at home

  • The World Health Organization (WHO) has provided guidelines for home care of patients with mild infection, adapted from those developed for Middle East Coronavirus (MERS-CoV) [1], and the European Centre for Disease Control (ECDC) further specified these with a focus on infection prevention and control in the home [2]

  • Many studies report COVID-19 household secondary attack rates of 15%-20% for those sharing a residential address with the index person, but estimates are highly variable ranging from 4% to 44% [10,11,12,13,14,15]

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Summary

Introduction

To preserve hospital capacity for severe COVID-19 patients, public health authorities in many parts of the world, including in Europe, have recommended that COVID-19 patients with mild infection be cared for at home. In the Netherlands, this is executed by Municipal Health Services (MHS) who send information by email to the household with guidelines for the index person and a separate letter with guidelines for the household members. This study aimed to 1) investigate the impact of living with a person infected with SARS-CoV-2; 2) understand how household members implemented infection control recommendations in their home; and 3) identify the information and support needs of household members

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