key: cord-1055674-6aivjett
authors: Tenforde, Mark W.; Feldstein, Leora R.; Lindsell, Christopher J.; Patel, Manish M.; Self, Wesley H.
title: Exposures in adult outpatients with COVID‐19 infection during early community transmission, Tennessee
date: 2020-08-04
journal: Influenza Other Respir Viruses
DOI: 10.1111/irv.12792
sha: 2f3e2b484c50014fcf9d90c83f33ced5f9ec0e0b
doc_id: 1055674
cord_uid: 6aivjett

nan

The peer review history for this article is available at https://publo ns.com/publo n/10.1111/irv.12792. Although not systematically asked, nineteen respondents reported working at a local meat processing plant; of these, only 47% (9/19) reported having known close contact with a person infected with COVID-19 before their illness.

In this cross-sectional survey, we generated insights into individual-level exposures and behaviors among non-hospitalized adults with COVID-19 in Tennessee in the early days following national social distancing guidelines. Notably, only half of respondents could identify a close contact with a COVID-19 case in the two-week period before illness onset. Transmission of SARS-CoV-2 is likely facilitated through a pre-symptomatic or pauci-symptomatic shedding period in infected individuals, 2,3 which, along with limited early testing, could in part explain this common lack of a known case contact and highlights the need for robust testing infrastructure. Respondents reported engaging in practical social distancing behaviors such as avoiding large gatherings. However, a sizeable majority reported working regularly in the two weeks before illness with few able to telework, suggesting workplace-related exposures were an important early source of transmission in Tennessee. As the United States returns to the workplace, these early findings underscore the need for ongoing workplace safety measures to prevent transmission. If teleworking is not feasible, workplaces should employ practices to reduce transmission including identifying where and how workers could be exposed, establishing organizational policies and practices for social distancing more than 6 feet, performing at-work symptom screening, testing, and contact tracing once an infected employee is identified, and providing workplace education. 4 Case-control studies should be considered to better understand workplace-associated risks.

The findings and conclusions of this report are those of the authors and do not necessarily reflect the official position of the Centers 

Conceptualization (equal); Formal analysis (lead)

Investigation (equal)

Supervision (equal)

Leora R Feldstein: Conceptualization (equal); Formal analysis (supporting)

Investigation (equal)

Supervision (equal)

Writing-review & editing (equal)

Data curation (equal)

Investigation (equal)

Resources (equal)

Manish M Patel: Conceptualization (equal)

Investigation (equal)

Resources (equal)

Supervision (equal)

Wesley H Self: Conceptualization (equal); Funding acquisition (equal)

Investigation (equal)

Resources (equal)

Supervision (equal)

Writing-review & editing (equal)

Tenforde 1

Lindsell 2

Self 2 for the IVY Network Investigators

CDC COVID-19 Response Team

CDC COVID-19 Response Team

Mailstop H24-7

Coronavirus Guidelines for America

Temporal dynamics in viral shedding and transmissibility of COVID-19

Serial interval of COVID-19 among publicly reported confirmed cases

Self WH; for the IVY Network Investigators, CDC COVID-19 Response Team. Exposures in adult outpatients with COVID-19 infection during early community transmission