Epidemiological Analysis of the COVID-19 Clusters in the Early Stages of the Epidemic in Shanghai, China: Pandemic-to-Epidemic Response Shift

TL;DR

This study analyzes early COVID-19 clusters in Shanghai to understand transmission patterns and inform outbreak prevention strategies.

Contribution

The study identifies household transmission as predominant and highlights risk factors like runny nose and diabetes for contagiousness.

Findings

Most clusters had only two cases, with household transmission accounting for 79.1% of clusters.

Workplace clusters were rare but involved larger outbreaks.

Runny nose and diabetes were associated with higher contagiousness.

Abstract

As COVID-19 transitions from pandemic to endemic, our prevention and control policies have shifted from broad, strict community interventions to focusing on the prevention of cluster outbreaks. Currently, information on the characteristics of cluster outbreaks remains limited. This study describes the features of COVID-19 clusters in Shanghai. It aims to provide valuable insights for managing localized outbreaks. We conducted a retrospective analysis of clusters of confirmed COVID-19 cases. Epidemiological descriptions, the transmission characteristics of clusters, and individual risk factors for contagiousness were analyzed. A total of 381 cases of COVID-19 were confirmed and 67 clusters were identified. Most clusters (58.21%, 39/67) only had two cases, with a declining proportion held by clusters of more cases. Familial transmission was predominant, accounting for 79.10% (53/67) of clusters. Although other types of cluster outbreaks, such as those in workplaces (1.49%, 1/67), occur less frequently compared to household clusters, they tend to involve larger scales and more cases. Workplaces and similar venues are more likely to experience large-scale cluster outbreaks. Contagiousness was higher among cases with runny nose (risk ratio [RR]: 4.8, 95% CI: 1.40–16.44, p-value = 0.01) and those with diabetes (RR: 3.8, 95% CI: 1.01–14.60, p-value = 0.05). In conclusion, household cluster outbreaks, in particular, are both a key priority and a foundational issue. Establishing an indicator system based on the transmissibility of cases holds significant practical value for infectious disease prevention and control. By enhancing household hygiene and developing a case classification and management system based on transmissibility, it is possible to better prevent and control regional COVID-19 outbreaks.

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