Public Activities Preceding the Onset of Acute Respiratory Infection Syndromes in Adults in England - Implications for the Use of Social Distancing to Control Pandemic Respiratory Infections

Abstract

Background: Social distancing measures may reduce the spread of emerging respiratory infections however, there is little empirical data on how exposure to crowded places affects risk of acute respiratory infection. Methods: We used a case-crossover design nested in a community cohort to compare self-reported measures of activities during the week before infection onset and baseline periods. The design eliminates the effect of non-time-varying confounders. Time-varying confounders were addressed by exclusion of illnesses around the Christmas period and seasonal adjustment. Findings: 626 participants had paired data from the week before 1005 illnesses and the week before baseline. Each additional day of undertaking the following activities in the prior week was associated with illness onset: Spending more than five minutes in a room with someone (other than a household member) who has a cold (Seasonally adjusted OR 1·15, p=0·003); use of underground trains (1·31, p=0·036); use of supermarkets (1·32, p<0·001); attending a theatre, cinema or concert (1·26, p=0·032); eating out at a cafe, restaurant or canteen (1·25, p=0·003); and attending parties (1·47, p<0·001). Undertaking the following activities at least once in the previous week was associated with illness onset: using a bus, (aOR 1.48, p=0.049), shopping at small shops (1.9, p<0.002) attending a place of worship (1.81, p=0.005). Interpretation: Exposure to potentially crowded places, public transport and to individuals with a cold increases risk of acquiring circulating acute respiratory infections. This suggests social distancing measures can have an important impact on slowing transmission of emerging respiratory infections. Funding Statement: The Flu Watch study received funding from the Medical Research Council (MRC) and the Wellcome Trust (MR/K006584/1). S.B. is supported by an MRC doctoral studentship (MR/N013867/1). Declaration of Interests: AH serves on UK New and Emerging Respiratory Virus Threats Advisory Group. AMJ was a Governor of Wellcome Trust from 2011-18 and is Chair of the Committee For Strategic Coordination for Health of the Public Research. The other authors declare no competing interests. Ethics Approval Statement: The protocol was approved by the Oxford Multi-Centre Research Ethics Committee (06/Q1604/103).