The changing contributory role to infections of work, public transport, shopping, hospitality and leisure activities throughout the SARS-CoV-2 pandemic in England and Wales

TL;DR

This study shows how work and public transport were major infection sources during the pandemic, while leisure and hospitality became more significant as restrictions eased.

Contribution

The study identifies changing risk factors for SARS-CoV-2 infections linked to specific non-household activities during different pandemic phases in England and Wales.

Findings

Work and public transport were key infection sources during strict restrictions.

Leisure and hospitality activities became more significant as restrictions eased.

Indoor use of hospitality and leisure venues posed higher infection risks than outdoor use.

Abstract

Understanding how non-household activities contributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections under different levels of national health restrictions is vital.

Among adult Virus Watch participants in England and Wales, we used multivariable logistic regressions and adjusted-weighted population attributable fractions (aPAF) assessing the contribution of work, public transport, shopping, and hospitality and leisure activities to infections.

Under restrictions, among 17,256 participants (502 infections), work [adjusted odds ratio (aOR) 2.01 (1.65–2.44), (aPAF) 30% (22–38%)] and transport [(aOR 1.15 (0.94–1.40), aPAF 5% (-3–12%)], were risk factors for SARS-CoV-2 but shopping, hospitality and leisure were not. Following the lifting of restrictions, among 11,413 participants (493 infections), work [(aOR 1.35 (1.11–1.64), aPAF 17% (6–26%)] and transport [(aOR 1.27 (1.04–1.57), aPAF 12% (2–22%)] contributed most, with indoor hospitality [(aOR 1.21 (0.98–1.48), aPAF 7% (-1–15%)] and leisure [(aOR 1.24 (1.02–1.51), aPAF 10% (1–18%)] increasing. During the Omicron variant, with individuals more socially engaged, among 11,964 participants (2335 infections), work [(aOR 1.28 (1.16–1.41), aPAF (11% (7–15%)] and transport [(aOR 1.16 (1.04–1.28), aPAF 6% (2–9%)] remained important but indoor hospitality [(aOR 1.43 (1.26–1.62), aPAF 20% (13–26%)] and leisure [(aOR 1.35 (1.22–1.48), aPAF 10% (7–14%)] dominated.

Work and public transport were important to transmissions throughout the pandemic with hospitality and leisure’s contribution increasing as restrictions were lifted, highlighting the importance of restricting leisure and hospitality alongside advising working from home, when facing a highly infectious and virulent respiratory infection.

Establishing which activities and venues that were restricted in England and Wales during lockdowns were the most likely to lead to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections will help us understand how useful the restrictions were and will help us to develop proportional responses to future public health threats. We found that during periods of intense restrictions (October 2020–May 2021) many people became infected with SARS-CoV-2 if they left home to go to work or used public transport. During the period after most public health restrictions were lifted (September–mid-December 2021), while many people continued to become infected at work or if they used public transport, indoor hospitality and indoor leisure venues became increasingly important as places where people became infected. During the Omicron wave of the pandemic (December 2021–April 2022), by which point there were very few restrictions on people’s activities and many people were visiting hospitality and leisure venues with increasing frequency, people continued to become infected at work and on public transport, but hospitality and leisure venues were nearly as important places where people became infected. As essential activities led to most cases during periods of tight restrictions and leisure and hospitality activities became increasingly important under periods when rules were more relaxed, it is important to recognise how vital it was to encourage people to work from home, reduce public transport use and restrict visits to leisure and hospitality settings when the country was faced with a fast-spreading virus which killed many people. Outdoor use of leisure and hospitality venues appeared to be safer than indoor use.

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