key: cord-0906284-z6boqpom authors: Barranco, Miguel Rodríguez; García, Lorenzo Rivas; Quiles, José L.; Sánchez, Daniel Redondo; Ramírez, Pilar Aranda; González, Juan Llopis; Sánchez Pérez, María José; González, Cristina Sánchez title: The spread of SARS-CoV-2 in Spain: hygiene habits, sociodemographic profile, mobility patterns and comorbidities date: 2020-09-22 journal: Environ Res DOI: 10.1016/j.envres.2020.110223 sha: 63ffc137f31d657be2402bbb38d27cd86ab95aba doc_id: 906284 cord_uid: z6boqpom COVID-19 constitutes the largest pandemic in the last 100 years. In view of the rapid spread of the virus, it is necessary to study the sociodemographic characteristics, hygiene habits, activity and mobility, and comorbidities of SARS-CoV-2 infection to be able to implement prevention strategies. For this purpose, a survey including the variables of interest was designed to try to understand the exponential spread of the virus despite the implemented severe restrictive mobility measures during the period of maximum confinement in Spain. This study conducted throughout the Spanish territory aims to clarify other routes of transmission of the COVID-19 during confinement, risk factors, and the effectiveness of the recommended hygiene measures to detect critical points of exposure to the virus and thus reduce its spread in this and possible future pandemics that could compromise public health. Our results show that living with a COVID-19 patient increased the risk of contagion by 60 times. Among all the sociodemographic variables analyzed, walking the dog have shown to have the strongest effect by increasing the risk by 78%. The most effective hygiene measure reducing the prevalence of the disease was the disinfection of products purchased from the market upon arrival home (which reduced the risk by 94%), above other hygiene measures, such as wearing masks, gloves, ethanol disinfection, bleaching and others. The mobility variable studied that showed the largest increase in the prevalence of the disease was working on site at the workplace (increased the risk by 76%). A significant higher prevalence of the disease was also detected among respondents who used the modality of acquiring basic commodities using home delivery service compared to those who chose in-store shopping. The survey was completed by 2,086 people, 66% of them were women. The age of more than 4 40% of the participants ranges between 40 and 54 years. A total of 44% of the respondents have 5 completed university studies. Regarding the home conditions, 72% live in a single-family home, 6 and 26.6% live with 3 relatives in the home. 35% live with children at home and 21% with 7 adolescents, only 4.3% had a housemaid working at their house during confinement, and 4.7% 8 of respondents reported living with a COVID-19 infected household member (Table 1) . Only 4.2% of the respondents have used public transport during confinement, the main mean of 21 transport used was bus (2.4%) followed by metro (1.5%). Respondents stated that they had 22 moved to: provision of food and consumer staples (81.8%), pharmacy (67.3%), tobacco shop 23 (19.3%), and bank (20.6%). A total of 56.9% of those surveyed stated that the shopping of basic 24 commodities has been performed once per week. 88.1% of respondents made these purchases in 25 the store and not online, avoiding thus the home delivery service. Only 19.3% of respondents 26 have ordered ready meals for home. Furthermore, 60.5% of the respondents stated that they had surveyed reported that they have traveled abroad within the 2 weeks prior to confinement. During the period studied, only 28.5% of the respondents went to their workplace, which was 2 performed in enclosed areas in 92% of the cases. A total of 32.8% of the respondents reported 3 that they live with someone who had had to work on-site during this period, performed in 83.7% 4 of the cases in enclosed areas (Table 3) . Table 1 shows that among all the variables analyzed, those that exerted a statistically significant 16 effect was walking the pet and living with a COVID-19 patient. No differences in estimated 17 prevalence were found based on sex, age, type of residence, the number of people living in the 18 home, living with children or adolescents or having a housemaid working at their home. People 19 who reported walking their pets had a higher estimated prevalence of COVID-19 compared to 20 those who did not take their pet for a walk (6.9% versus 4.2%, respectively). Table 2 shows the effectiveness of the different hygiene measures recommended by the 23 authorities analyzed in this survey. The hygiene habit that had the highest significant effect on 24 the estimated prevalence of the disease was the application of a disinfectant on the products 1 The variables studied that had a higher effect increasing the prevalence of COVID-19 were the 2 use of public transport, specifically metro, and working on-site at the workplace during 3 confinement (Table 3) . Other activities performed, such as attending the supermarket, 4 pharmacy, medical care center, tobacco shop or bank, the frequency with which basic 5 commodities were purchased, ordering home-delivered meals, the use of e-commerce for non-6 essential products, having traveled abroad within two weeks before the state of alarm was 7 decreed in Spain, or living with a household member who has been working on-site at the 8 workplace, showed no significant effect on the estimated prevalence of COVID-19 (Table 3) . After adjusted for potential confounding between variables, only walking the pet, living with a 17 COVID-19 patient, applying a disinfectant product on the products purchased from the market 18 upon arrival home, using home delivery service, and working on-site at the workplace showed a 19 significant effect on the risk of COVID-19. Specifically, walking the pet was associated with an 20 increased risk of 78% (95% CI, 1.03 to 3.06), not disinfecting the products increased the risk by 21 94% (95% CI, 1.18 to 3.19), the purchase of basic products using home delivery service 22 increased the risk by 94% (95% CI , 0.98 to 3.84), and working on-site at the workplace was 23 associated with a 76% higher risk (95% CI, 1.06 to 2.90). Living with a COVID-19 patient was 24 associated with a 60-fold increased risk of contracting the disease (OR=60.5; 95% CI, 35 to living with their families. The estimated prevalence of COVID-19 found in our sample was 3 4.7%. These data are consistent with the results of the ENE-COVID national study, which 4 reinforces the validity of the self-diagnosis and, therefore, the validity of the results described women in 17 of these countries, whereas in 23 countries the prevalence was higher in women 17 than in men. In one of the countries the prevalence was similar between both men and women. These data clearly indicate that the disease affects both sexes with a higher or lower prevalence 19 based on other variables. Possibly, sex-prevalence might depend on some sociocultural-related 20 aspects to be investigated in the future. The present study did not show effect of age on the estimated prevalence of COVID-19. These 22 data are consistent with those reported for Spain by a published study (Natale F., Ghio D., Tarchi D., Goujon A., Conte A. COVID-19 Cases and Case Fatality Rate by age. 2020. European Comission. https://ec.europa.eu/knowledge4policy/publication/covid-19-cases-case-25 fatality-rate-age_en) in which cases are equally distributed between the age group 20-60 and 26 over 60. This finding was also found for the data about the USA. However, this situation is not highest prevalence was found in the age range of 20-60. The Netherlands and Italy concentrate 1 most of the reported cases in the group over 60. In consistency with other studies, our study show that the level of education is not statistically 3 significant in relation to COVID-19 (N. Liu et al., 2020). However, in the present study, the 4 group of respondents with vocational education was close to the statistical significance towards 5 maximum estimated prevalence among all the educational levels investigated, probably due to 6 the type of profession they perform and their varying degree of exposure to the virus. This 7 aspect will be explored within this study in a later approach. In the same way, household size had no effect on the estimated prevalence of COVID, in 9 consistency with data from New York (Borjas, 2020). Some studies have been performed to try 10 to reveal the spread of disease transmission based on age-specific social patterns (Y. Liu et al., 2020). In this sense, our study did not find significant increases in the estimated prevalence of Depending upon the nature of the surface, pH, temperature and relative humidity of the 11 surrounding, virus persistence time varies from 1-9 days. The highly risk exposed surface areas -19: Evidence from meta-analysis 2020. scRNA-seq Profiling of Human Testes Reveals the Presence of the 13 ACE2 Receptor, A Target for SARS-CoV-2 Infection in Spermatogonia Rational use of personal protective equipment for coronavirus disease 2019 ( 16 COVID-19 )