Abstract
Background: Concern about the health impact of novel coronavirus SARS-CoV-2 has resulted in widespread enforced reductions in people's movement ("lockdowns"). However, there are increasing concerns about the severe economic and wider societal consequences of these measures. Some countries have begun to lift some of the rules on physical distancing in a stepwise manner, with differences in what these "exit strategies" entail and their timeframes. The aim of this work was to inform such exit strategies by exploring the types of indoor and outdoor settings where transmission of SARS-CoV-2 has been reported to occur and result in clusters of cases. Identifying potential settings that result in transmission clusters allows these to be kept under close surveillance and/or to remain closed as part of strategies that aim to avoid a resurgence in transmission following the lifting of lockdown measures. Methods: We performed a systematic review of available literature and media reports to find settings reported in peer reviewed articles and media with these characteristics. These sources are curated and made available in an editable online database. Results: We found many examples of SARS-CoV-2 clusters linked to a wide range of mostly indoor settings. Few reports came from schools, many from households, and an increasing number were reported in hospitals and elderly care settings across Europe. Conclusions: We identified possible places that are linked to clusters of COVID-19 cases and could be closely monitored and/or remain closed in the first instance following the progressive removal of lockdown restrictions. However, in part due to the limits in surveillance capacities in many settings, the gathering of information such as cluster sizes and attack rates is limited in several ways: inherent recall bias, biased media reporting and missing data.
Highlights
The novel coronavirus SARS-CoV-2, responsible for coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China at the end of 2019, and has since spread around the world (European Centre for Disease Prevention and Control, 2020)
Determining particular places that are linked to clusters of cases could reveal settings that are responsible for amplifying the heterogeneity in transmission that has been reported: potentially 80% of transmission is being caused by only 10% of infected individuals (Endo et al, 2020)
We found evidence of SARS-CoV-2 transmission clusters for 152 events, which we classified into 18 types of settings (Table 1 and Table 2)
Summary
The novel coronavirus SARS-CoV-2, responsible for coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China at the end of 2019, and has since spread around the world (European Centre for Disease Prevention and Control, 2020). The capacity of the virus for human-to-human transmission, coupled with the lack of immunity in the population due to the novelty of SARS-CoV-2, has led to the implementation of severe reductions in people’s movements in an effort to reduce disease impact These strong measures are broadly described as “lockdowns”. Due to the highly restrictive nature of lockdowns, and their impact on people’s health, wellbeing and finances, it is likely that such interventions cannot be sustained for prolonged periods of time, and will have to be lifted, at least to some extent, before an effective vaccine becomes available To successfully remove these lockdown restrictions while avoiding a resurgence in SARS-CoV-2 transmission, we must better understand in which types of settings the virus is most likely to be transmitted. In part due to the limits in surveillance capacities in many settings, the gathering of information such as cluster sizes and attack rates is limited in several ways: inherent recall bias, biased media reporting and missing data
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