Transmission Dynamics of SARS-CoV-2 during an Outbreak in a Roma Community in Thessaly, Greece—Control Measures and Lessons Learned

Koureas, Michalis; Speletas, Matthaios; Bogogiannidou, Zacharoula; Babalis, Dimitris; Pinakas, Vassilios; Pinaka, Ourania; Komnos, Apostolos; Tsoutsa, Stella; Papadamou, Georgia; Kyritsi, Maria A.; Vontas, Alexandros; Nakoulas, Vasileios; Sapoynas, Spyros; Kanellopoulos, Nikolaos; Kalompatsios, Dimitrios; Papadouli, Vassiliki; Dadouli, Katerina; Soteriades, Soteris; Mina, Paraskevi; Mouchtouri, Varvara A.; Anagnostopoulos, Lemonia; Stamoulis, Kostantinos E.; Agorastos, Kostantinos; Petinaki, Efthimia A.; Prezerakos, Panagiotis; Tsiodras, Sotirios; Hadjichristodoulou, Christos

A COVID-19 outbreak occurred among residents of a Roma settlement in Greece (8 April–4 June 2020). The aim of this study was to identify factors associated with an increased risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to evaluate the effectiveness of control measures implemented. Data were analyzed from individuals that were tested for SARS-CoV-2 during contact tracing, population screening or hospital visits. RT-PCR was used for the detection of SARS-CoV-2 in oropharyngeal samples. Risk factors for household secondary attack rates (SAR) and hospitalization with COVID-19 were examined using chi-square tests, Fisher’s exact tests and logistic regression analyses. During the outbreak, 142 cases, 20 hospitalizations and 1 death were recorded, with a total of 2273 individuals tested. The risk of hospitalization was associated with age (OR: 1.04, 95% CI: 1.02–1.07) and Cycle threshold (Ct) values (OR for a decrease in Ct values by 1: 1.18, 95% CI: 1.07–1.31). Household SAR was estimated at 38.62% (95% CI: 32.50–45.01%). After the designation of an isolation facility for cases, household SAR declined from 74.42% to 31.03%. Household size was associated with the risk of infection (OR: 2.65, 95% CI: 1.00–7.07). The presence of COVID-19 symptoms among index cases was correlated with higher transmission (OR: 23.68, 95% CI 2.21–253.74) in multivariate analysis, while age was found to be associated with SAR only in univariate analysis. Roma communities can be particularly vulnerable to the spread of SARS-CoV-2. In similar settings, symptomatic cases are more important transmitters of SARS-CoV-2. Within these communities, immediate measures should be implemented to mitigate disease spread.