Community and Close Contact Exposures Associated with COVID-19 Among Symptomatic Adults ≥18 Years in 11 Outpatient Health Care Facilities — United States, July 2020
Authors: Kiva A. Fisher, Mark W. Tenforde, Leora R. Feldstein, Christopher J. Lindsell, Nathan I. Shapiro, D. Clark Files, Kevin W. Gibbs, Heidi L. Erickson, Matthew E. Prekker, Jay S. Steingrub, Matthew C. Exline, Daniel J. Henning, Jennifer G. Wilson, Samuel M. Brown, Ithan D. Peltan, Todd W. Rice, David N. Hager, Adit A. Ginde, H. Keipp Talbot, Jonathan D. Casey, Carlos G. Grijalva, Brendan Flannery, Manish M. Patel, Wesley H. Self, Kimberly W. Hart, Robert McClellan, Hsi-nien Tan, Adrienne Baughman, Nora A. Hennesy, Brittany Grear, Michael Wu, Kristin Mlynarczyk, Luc Marzano, Zuwena Plata, Alexis Caplan, Samantha M. Olson, Constance E. Ogokeh, Emily R. Smith, Sara S. Kim, Eric P. Griggs, Bridget Richards, Sonya Robinson, Kaylee Kim, Ahmed M. Kassem, Courtney N. Sciarratta, Paula L. Marcet
Journal: MMWR Morbidity and Mortality Weekly Report (2020)

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.