Cluster of COVID-19 in northern France: A retrospective closed cohort study

Fontanet, Arnaud; Tondeur, Laura; Madec, Yoann; Grant, Rebecca; Besombes, Camille; Jolly, Nathalie; Fernandes Pellerin, Sandrine; Ungeheuer, Marie-Noelle; Cailleau, Isabelle; Kuhmel, Lucie; Temmam, Sarah; Huon, Christele; Chen, Kuang-Yu; Crescenzo, Bernadette; Munier, Sandie; Demeret, Caroline; Grzelak, Ludivine; Staropoli, Isabelle; Bruel, Timothee; Gallian, Pierre; Cauchemez, Simon; van der Werf, Sylvie; Schwartz, Olivier; Eloit, Marc; Hoen, Bruno

Background: The Oise department in France has been heavily affected by COVID-19 in early 2020. Methods: Between 30 March and 4 April 2020, we conducted a retrospective closed cohort study among pupils, their parents and siblings, as well as teachers and non-teaching staff of a high-school located in Oise. Participants completed a questionnaire that covered history of fever and/or respiratory symptoms since 13 January 2020 and had blood tested for the presence of anti-SARS-CoV-2 antibodies. The infection attack rate (IAR) was defined as the proportion of participants with confirmed SARS-CoV-2 infection based on antibody detection. Blood samples from two blood donor centres collected between 23 and 27 March 2020 in the Oise department were also tested for presence of anti-SARS-CoV-2 antibodies. Findings: Of the 661 participants (median age: 37 years), 171 participants had anti-SARS-CoV-2 antibodies. The overall IAR was 25.9% (95% confidence interval (CI) = 22.6-29.4), and the infection fatality rate was 0% (one-sided 97.5% CI = 0-2.1). Nine of the ten participants hospitalised since mid-January were in the infected group, giving a hospitalisation rate of 5.3% (95% CI = 2.4-9.8). Anosmia and ageusia had high positive predictive values for SARS-CoV-2 infection (84.7% and 88.1%, respectively). Smokers had a lower IAR compared to non-smokers (7.2% versus 28.0%, P <0.001). The proportion of infected individuals who had no symptoms during the study period was 17.0% (95% CI = 11.2-23.4). The proportion of donors with anti-SARS-CoV-2 antibodies in two nearby blood banks of the Oise department was 3.0% (95% CI = 1.1-6.4). Interpretation: The relatively low IAR observed in an area where SARS-CoV-2 actively circulated weeks before confinement measures indicates that establishing herd immunity will take time, and that lifting these measures in France will be long and complex.