Community and Close Contact Exposures Associated with COVID-19 Among Symptomatic Adults ≥18 Years in 11 Outpatient Health Care Facilities — United States, July 2020

Fisher, Kiva A.; Tenforde, Mark W.; Feldstein, Leora R.; Lindsell, Christopher J.; Shapiro, Nathan I.; Files, D. Clark; Gibbs, Kevin W.; Erickson, Heidi L.; Prekker, Matthew E.; Steingrub, Jay S.; Exline, Matthew C.; Henning, Daniel J.; Wilson, Jennifer G.; Brown, Samuel M.; Peltan, Ithan D.; Rice, Todd W.; Hager, David N.; Ginde, Adit A.; Talbot, H. Keipp; Casey, Jonathan D.; Grijalva, Carlos G.; Flannery, Brendan; Patel, Manish M.; Self, Wesley H.; Hart, Kimberly W.; McClellan, Robert; Tan, Hsi-nien; Baughman, Adrienne; Hennesy, Nora A.; Grear, Brittany; Wu, Michael; Mlynarczyk, Kristin; Marzano, Luc; Plata, Zuwena; Caplan, Alexis; Olson, Samantha M.; Ogokeh, Constance E.; Smith, Emily R.; Kim, Sara S.; Griggs, Eric P.; Richards, Bridget; Robinson, Sonya; Kim, Kaylee; Kassem, Ahmed M.; Sciarratta, Courtney N.; Marcet, Paula L.

Community and close contact exposures continue to drive the coronavirus disease 2019 (COVID-19) pandemic. CDC and other public health authorities recommend community mitigation strategies to reduce transmission of SARS-CoV-2, the virus that causes COVID-19 (1,2). Characterization of community exposures can be difficult to assess when widespread transmission is occurring, especially from asymptomatic persons within inherently interconnected communities. Potential exposures, such as close contact with a person with confirmed COVID-19, have primarily been assessed among COVID-19 cases, without a non-COVID-19 comparison group (3,4). To assess community and close contact exposures associated with COVID-19, exposures reported by case-patients (154) were compared with exposures reported by control-participants (160). Case-patients were symptomatic adults (persons aged ≥18 years) with SARS-CoV-2 infection confirmed by reverse transcription-polymerase chain reaction (RT-PCR) testing. Control-participants were symptomatic outpatient adults from the same health care facilities who had negative SARS-CoV-2 test results. Close contact with a person with known COVID-19 was more commonly reported among case-patients (42%) than among control-participants (14%). Case-patients were more likely to have reported dining at a restaurant (any area designated by the restaurant, including indoor, patio, and outdoor seating) in the 2 weeks preceding illness onset than were control-participants (adjusted odds ratio [aOR] = 2.4; 95% confidence interval [CI] = 1.5-3.8). Restricting the analysis to participants without known close contact with a person with confirmed COVID-19, case-patients were more likely to report dining at a restaurant (aOR = 2.8, 95% CI = 1.9-4.3) or going to a bar/coffee shop (aOR = 3.9, 95% CI = 1.5-10.1) than were control-participants. Exposures and activities where mask use and social distancing are difficult to maintain, including going to places that offer on-site eating or drinking, might be important risk factors for acquiring COVID-19. As communities reopen, efforts to reduce possible exposures at locations that offer on-site eating and drinking options should be considered to protect customers, employees, and communities.