Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey

Koen B. Pouwels; Thomas House; Emma Pritchard; Julie V. Robotham; Paul J. Birrell; Andrew Gelman; Karina Doris Vihta; Nikola Bowers; Ian Boreham; Heledd Thomas; James Lewis; Iain Bell; John I. Bell; John N. Newton; Jeremy Farrar; Ian Diamond; Pete Benton; Ann Sarah Walker; Koen B. Pouwels; A. Sarah Walker; Derrick Crook; Philippa C. Matthews; Tim Peto; Nicole Stoesser; Alison Howarth; George Doherty; James Kavanagh; Kevin K. Chau; Stephanie B. Hatch; Daniel Ebner; Lucas Martins Ferreira; Thomas Christott; Brian D. Marsden; Wanwisa Dejnirattisai; Juthathip Mongkolsapaya; Sarah Hoosdally; Richard Cornall; David I. Stuart; Gavin Screaton; David Eyre; John Bell; Stuart Cox; Kevin Paddon; Tim James; John N. Newton; Julie V. Robotham; Paul Birrell; Helena Jordan; Tim Sheppard; Graham Athey; Dan Moody; Leigh Curry; Pamela Brereton; Jodie Hay; Harper Vansteenhouse; Alex Lambert; Emma Rourke; Stacey Hawkes; Sarah Henry; James Scruton; Peter Stokes; Tina Thomas; John Allen; Russell Black; Heather Bovill; David Braunholtz; Dominic Brown; Sarah Collyer; Megan Crees; Colin Daglish; Byron Davies; Hannah Donnarumma; Julia Douglas-Mann; Antonio Felton; Hannah Finselbach; Eleanor Fordham; Alberta Ipser; Joe Jenkins; Joel Jones; Katherine Kent; Geeta Kerai; Lina Lloyd; Victoria Masding; Ellie Osborn; Alpi Patel; Elizabeth Pereira; Tristan Pett; Melissa Randall; Donna Reeve; Palvi Shah; Ruth Snook; Ruth Studley; Esther Sutherland; Eliza Swinn; Anna Tudor; Joshua Weston; Shayla Leib; James Tierney; Gabor Farkas; Raf Cobb

doi:10.1016/S2468-2667(20)30282-6

Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey

Koen B. Pouwels, Thomas House, Emma Pritchard, Julie V. Robotham, Paul J. Birrell, Andrew Gelman, Karina Doris Vihta, Nikola Bowers, Ian Boreham, Heledd Thomas, James Lewis, Iain Bell, John I. Bell, John N. Newton, Jeremy Farrar, Ian Diamond, Pete Benton, Ann Sarah Walker, Koen B. Pouwels, A. Sarah WalkerDerrick Crook, Philippa C. Matthews, Tim Peto, Nicole Stoesser, Alison Howarth, George Doherty, James Kavanagh, Kevin K. Chau, Stephanie B. Hatch, Daniel Ebner, Lucas Martins Ferreira, Thomas Christott, Brian D. Marsden, Wanwisa Dejnirattisai, Juthathip Mongkolsapaya, Sarah Hoosdally, Richard Cornall, David I. Stuart, Gavin Screaton, David Eyre, John Bell, Stuart Cox, Kevin Paddon, Tim James, John N. Newton, Julie V. Robotham, Paul Birrell, Helena Jordan, Tim Sheppard, Graham Athey, Dan Moody, Leigh Curry, Pamela Brereton, Jodie Hay, Harper Vansteenhouse, Alex Lambert, Emma Rourke, Stacey Hawkes, Sarah Henry, James Scruton, Peter Stokes, Tina Thomas, John Allen, Russell Black, Heather Bovill, David Braunholtz, Dominic Brown, Sarah Collyer, Megan Crees, Colin Daglish, Byron Davies, Hannah Donnarumma, Julia Douglas-Mann, Antonio Felton, Hannah Finselbach, Eleanor Fordham, Alberta Ipser, Joe Jenkins, Joel Jones, Katherine Kent, Geeta Kerai, Lina Lloyd, Victoria Masding, Ellie Osborn, Alpi Patel, Elizabeth Pereira, Tristan Pett, Melissa Randall, Donna Reeve, Palvi Shah, Ruth Snook, Ruth Studley, Esther Sutherland, Eliza Swinn, Anna Tudor, Joshua Weston, Shayla Leib, James Tierney, Gabor Farkas, Raf Cobb

Research output: Contribution to journal › Article › peer-review

Abstract

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Decisions about the continued need for control measures to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on accurate and up-to-date information about the number of people testing positive for SARS-CoV-2 and risk factors for testing positive. Existing surveillance systems are generally not based on population samples and are not longitudinal in design. Methods: Samples were collected from individuals aged 2 years and older living in private households in England that were randomly selected from address lists and previous Office for National Statistics surveys in repeated cross-sectional household surveys with additional serial sampling and longitudinal follow-up. Participants completed a questionnaire and did nose and throat self-swabs. The percentage of individuals testing positive for SARS-CoV-2 RNA was estimated over time by use of dynamic multilevel regression and poststratification, to account for potential residual non-representativeness. Potential changes in risk factors for testing positive over time were also assessed. The study is registered with the ISRCTN Registry, ISRCTN21086382. Findings: Between April 26 and Nov 1, 2020, results were available from 1 191 170 samples from 280 327 individuals; 5231 samples were positive overall, from 3923 individuals. The percentage of people testing positive for SARS-CoV-2 changed substantially over time, with an initial decrease between April 26 and June 28, 2020, from 0·40% (95% credible interval 0·29–0·54) to 0·06% (0·04–0·07), followed by low levels during July and August, 2020, before substantial increases at the end of August, 2020, with percentages testing positive above 1% from the end of October, 2020. Having a patient-facing role and working outside your home were important risk factors for testing positive for SARS-CoV-2 at the end of the first wave (April 26 to June 28, 2020), but not in the second wave (from the end of August to Nov 1, 2020). Age (young adults, particularly those aged 17–24 years) was an important initial driver of increased positivity rates in the second wave. For example, the estimated percentage of individuals testing positive was more than six times higher in those aged 17–24 years than in those aged 70 years or older at the end of September, 2020. A substantial proportion of infections were in individuals not reporting symptoms around their positive test (45–68%, dependent on calendar time. Interpretation: Important risk factors for testing positive for SARS-CoV-2 varied substantially between the part of the first wave that was captured by the study (April to June, 2020) and the first part of the second wave of increased positivity rates (end of August to Nov 1, 2020), and a substantial proportion of infections were in individuals not reporting symptoms, indicating that continued monitoring for SARS-CoV-2 in the community will be important for managing the COVID-19 pandemic moving forwards. Funding: Department of Health and Social Care.

Original language	English
Journal	The Lancet Public Health
Volume	6
Issue number	1
DOIs	https://doi.org/10.1016/S2468-2667(20)30282-6
State	Published - 1 Jan 2021

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Pouwels, K. B., House, T., Pritchard, E., Robotham, J. V., Birrell, P. J., Gelman, A., Vihta, K. D., Bowers, N., Boreham, I., Thomas, H., Lewis, J., Bell, I., Bell, J. I., Newton, J. N., Farrar, J., Diamond, I., Benton, P., Walker, A. S., Pouwels, K. B., ... Cobb, R. (2021). Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey. The Lancet Public Health, 6(1). https://doi.org/10.1016/S2468-2667(20)30282-6

Pouwels, Koen B. ; House, Thomas ; Pritchard, Emma ; Robotham, Julie V. ; Birrell, Paul J. ; Gelman, Andrew ; Vihta, Karina Doris ; Bowers, Nikola ; Boreham, Ian ; Thomas, Heledd ; Lewis, James ; Bell, Iain ; Bell, John I. ; Newton, John N. ; Farrar, Jeremy ; Diamond, Ian ; Benton, Pete ; Walker, Ann Sarah ; Pouwels, Koen B. ; Walker, A. Sarah ; Crook, Derrick ; Matthews, Philippa C. ; Peto, Tim ; Stoesser, Nicole ; Howarth, Alison ; Doherty, George ; Kavanagh, James ; Chau, Kevin K. ; Hatch, Stephanie B. ; Ebner, Daniel ; Martins Ferreira, Lucas ; Christott, Thomas ; Marsden, Brian D. ; Dejnirattisai, Wanwisa ; Mongkolsapaya, Juthathip ; Hoosdally, Sarah ; Cornall, Richard ; Stuart, David I. ; Screaton, Gavin ; Eyre, David ; Bell, John ; Cox, Stuart ; Paddon, Kevin ; James, Tim ; Newton, John N. ; Robotham, Julie V. ; Birrell, Paul ; Jordan, Helena ; Sheppard, Tim ; Athey, Graham ; Moody, Dan ; Curry, Leigh ; Brereton, Pamela ; Hay, Jodie ; Vansteenhouse, Harper ; Lambert, Alex ; Rourke, Emma ; Hawkes, Stacey ; Henry, Sarah ; Scruton, James ; Stokes, Peter ; Thomas, Tina ; Allen, John ; Black, Russell ; Bovill, Heather ; Braunholtz, David ; Brown, Dominic ; Collyer, Sarah ; Crees, Megan ; Daglish, Colin ; Davies, Byron ; Donnarumma, Hannah ; Douglas-Mann, Julia ; Felton, Antonio ; Finselbach, Hannah ; Fordham, Eleanor ; Ipser, Alberta ; Jenkins, Joe ; Jones, Joel ; Kent, Katherine ; Kerai, Geeta ; Lloyd, Lina ; Masding, Victoria ; Osborn, Ellie ; Patel, Alpi ; Pereira, Elizabeth ; Pett, Tristan ; Randall, Melissa ; Reeve, Donna ; Shah, Palvi ; Snook, Ruth ; Studley, Ruth ; Sutherland, Esther ; Swinn, Eliza ; Tudor, Anna ; Weston, Joshua ; Leib, Shayla ; Tierney, James ; Farkas, Gabor ; Cobb, Raf. / Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey. In: The Lancet Public Health. 2021 ; Vol. 6, No. 1.

@article{5070f5b330d24591ad2bb9cce42f8a27,

title = "Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey",

abstract = "{\textcopyright} 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Decisions about the continued need for control measures to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on accurate and up-to-date information about the number of people testing positive for SARS-CoV-2 and risk factors for testing positive. Existing surveillance systems are generally not based on population samples and are not longitudinal in design. Methods: Samples were collected from individuals aged 2 years and older living in private households in England that were randomly selected from address lists and previous Office for National Statistics surveys in repeated cross-sectional household surveys with additional serial sampling and longitudinal follow-up. Participants completed a questionnaire and did nose and throat self-swabs. The percentage of individuals testing positive for SARS-CoV-2 RNA was estimated over time by use of dynamic multilevel regression and poststratification, to account for potential residual non-representativeness. Potential changes in risk factors for testing positive over time were also assessed. The study is registered with the ISRCTN Registry, ISRCTN21086382. Findings: Between April 26 and Nov 1, 2020, results were available from 1 191 170 samples from 280 327 individuals; 5231 samples were positive overall, from 3923 individuals. The percentage of people testing positive for SARS-CoV-2 changed substantially over time, with an initial decrease between April 26 and June 28, 2020, from 0·40% (95% credible interval 0·29–0·54) to 0·06% (0·04–0·07), followed by low levels during July and August, 2020, before substantial increases at the end of August, 2020, with percentages testing positive above 1% from the end of October, 2020. Having a patient-facing role and working outside your home were important risk factors for testing positive for SARS-CoV-2 at the end of the first wave (April 26 to June 28, 2020), but not in the second wave (from the end of August to Nov 1, 2020). Age (young adults, particularly those aged 17–24 years) was an important initial driver of increased positivity rates in the second wave. For example, the estimated percentage of individuals testing positive was more than six times higher in those aged 17–24 years than in those aged 70 years or older at the end of September, 2020. A substantial proportion of infections were in individuals not reporting symptoms around their positive test (45–68%, dependent on calendar time. Interpretation: Important risk factors for testing positive for SARS-CoV-2 varied substantially between the part of the first wave that was captured by the study (April to June, 2020) and the first part of the second wave of increased positivity rates (end of August to Nov 1, 2020), and a substantial proportion of infections were in individuals not reporting symptoms, indicating that continued monitoring for SARS-CoV-2 in the community will be important for managing the COVID-19 pandemic moving forwards. Funding: Department of Health and Social Care.",

author = "Pouwels, {Koen B.} and Thomas House and Emma Pritchard and Robotham, {Julie V.} and Birrell, {Paul J.} and Andrew Gelman and Vihta, {Karina Doris} and Nikola Bowers and Ian Boreham and Heledd Thomas and James Lewis and Iain Bell and Bell, {John I.} and Newton, {John N.} and Jeremy Farrar and Ian Diamond and Pete Benton and Walker, {Ann Sarah} and Pouwels, {Koen B.} and Walker, {A. Sarah} and Derrick Crook and Matthews, {Philippa C.} and Tim Peto and Nicole Stoesser and Alison Howarth and George Doherty and James Kavanagh and Chau, {Kevin K.} and Hatch, {Stephanie B.} and Daniel Ebner and {Martins Ferreira}, Lucas and Thomas Christott and Marsden, {Brian D.} and Wanwisa Dejnirattisai and Juthathip Mongkolsapaya and Sarah Hoosdally and Richard Cornall and Stuart, {David I.} and Gavin Screaton and David Eyre and John Bell and Stuart Cox and Kevin Paddon and Tim James and Newton, {John N.} and Robotham, {Julie V.} and Paul Birrell and Helena Jordan and Tim Sheppard and Graham Athey and Dan Moody and Leigh Curry and Pamela Brereton and Jodie Hay and Harper Vansteenhouse and Alex Lambert and Emma Rourke and Stacey Hawkes and Sarah Henry and James Scruton and Peter Stokes and Tina Thomas and John Allen and Russell Black and Heather Bovill and David Braunholtz and Dominic Brown and Sarah Collyer and Megan Crees and Colin Daglish and Byron Davies and Hannah Donnarumma and Julia Douglas-Mann and Antonio Felton and Hannah Finselbach and Eleanor Fordham and Alberta Ipser and Joe Jenkins and Joel Jones and Katherine Kent and Geeta Kerai and Lina Lloyd and Victoria Masding and Ellie Osborn and Alpi Patel and Elizabeth Pereira and Tristan Pett and Melissa Randall and Donna Reeve and Palvi Shah and Ruth Snook and Ruth Studley and Esther Sutherland and Eliza Swinn and Anna Tudor and Joshua Weston and Shayla Leib and James Tierney and Gabor Farkas and Raf Cobb",

year = "2021",

month = jan,

day = "1",

doi = "10.1016/S2468-2667(20)30282-6",

language = "English",

volume = "6",

journal = "The Lancet Public Health",

number = "1",

}

Pouwels, KB, House, T, Pritchard, E, Robotham, JV, Birrell, PJ, Gelman, A, Vihta, KD, Bowers, N, Boreham, I, Thomas, H, Lewis, J, Bell, I, Bell, JI, Newton, JN, Farrar, J, Diamond, I, Benton, P, Walker, AS, Pouwels, KB, Walker, AS, Crook, D, Matthews, PC, Peto, T, Stoesser, N, Howarth, A, Doherty, G, Kavanagh, J, Chau, KK, Hatch, SB, Ebner, D, Martins Ferreira, L, Christott, T, Marsden, BD, Dejnirattisai, W, Mongkolsapaya, J, Hoosdally, S, Cornall, R, Stuart, DI, Screaton, G, Eyre, D, Bell, J, Cox, S, Paddon, K, James, T, Newton, JN, Robotham, JV, Birrell, P, Jordan, H, Sheppard, T, Athey, G, Moody, D, Curry, L, Brereton, P, Hay, J, Vansteenhouse, H, Lambert, A, Rourke, E, Hawkes, S, Henry, S, Scruton, J, Stokes, P, Thomas, T, Allen, J, Black, R, Bovill, H, Braunholtz, D, Brown, D, Collyer, S, Crees, M, Daglish, C, Davies, B, Donnarumma, H, Douglas-Mann, J, Felton, A, Finselbach, H, Fordham, E, Ipser, A, Jenkins, J, Jones, J, Kent, K, Kerai, G, Lloyd, L, Masding, V, Osborn, E, Patel, A, Pereira, E, Pett, T, Randall, M, Reeve, D, Shah, P, Snook, R, Studley, R, Sutherland, E, Swinn, E, Tudor, A, Weston, J, Leib, S, Tierney, J, Farkas, G & Cobb, R 2021, 'Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey', The Lancet Public Health, vol. 6, no. 1. https://doi.org/10.1016/S2468-2667(20)30282-6

Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey. / Pouwels, Koen B.; House, Thomas; Pritchard, Emma; Robotham, Julie V.; Birrell, Paul J.; Gelman, Andrew; Vihta, Karina Doris; Bowers, Nikola; Boreham, Ian; Thomas, Heledd; Lewis, James; Bell, Iain; Bell, John I.; Newton, John N.; Farrar, Jeremy; Diamond, Ian; Benton, Pete; Walker, Ann Sarah; Pouwels, Koen B.; Walker, A. Sarah; Crook, Derrick; Matthews, Philippa C.; Peto, Tim; Stoesser, Nicole; Howarth, Alison; Doherty, George; Kavanagh, James; Chau, Kevin K.; Hatch, Stephanie B.; Ebner, Daniel; Martins Ferreira, Lucas; Christott, Thomas; Marsden, Brian D.; Dejnirattisai, Wanwisa; Mongkolsapaya, Juthathip; Hoosdally, Sarah; Cornall, Richard; Stuart, David I.; Screaton, Gavin; Eyre, David; Bell, John; Cox, Stuart; Paddon, Kevin; James, Tim; Newton, John N.; Robotham, Julie V.; Birrell, Paul; Jordan, Helena; Sheppard, Tim; Athey, Graham; Moody, Dan; Curry, Leigh; Brereton, Pamela; Hay, Jodie; Vansteenhouse, Harper; Lambert, Alex; Rourke, Emma; Hawkes, Stacey; Henry, Sarah; Scruton, James; Stokes, Peter; Thomas, Tina; Allen, John; Black, Russell; Bovill, Heather; Braunholtz, David; Brown, Dominic; Collyer, Sarah; Crees, Megan; Daglish, Colin; Davies, Byron; Donnarumma, Hannah; Douglas-Mann, Julia; Felton, Antonio; Finselbach, Hannah; Fordham, Eleanor; Ipser, Alberta; Jenkins, Joe; Jones, Joel; Kent, Katherine; Kerai, Geeta; Lloyd, Lina; Masding, Victoria; Osborn, Ellie; Patel, Alpi; Pereira, Elizabeth; Pett, Tristan; Randall, Melissa; Reeve, Donna; Shah, Palvi; Snook, Ruth; Studley, Ruth; Sutherland, Esther; Swinn, Eliza; Tudor, Anna; Weston, Joshua; Leib, Shayla; Tierney, James; Farkas, Gabor; Cobb, Raf.

In: The Lancet Public Health, Vol. 6, No. 1, 01.01.2021.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Community prevalence of SARS-CoV-2 in England from April to November, 2020: results from the ONS Coronavirus Infection Survey

AU - Pouwels, Koen B.

AU - House, Thomas

AU - Pritchard, Emma

AU - Robotham, Julie V.

AU - Birrell, Paul J.

AU - Gelman, Andrew

AU - Vihta, Karina Doris

AU - Bowers, Nikola

AU - Boreham, Ian

AU - Thomas, Heledd

AU - Lewis, James

AU - Bell, Iain

AU - Bell, John I.

AU - Newton, John N.

AU - Farrar, Jeremy

AU - Diamond, Ian

AU - Benton, Pete

AU - Walker, Ann Sarah

AU - Pouwels, Koen B.

AU - Walker, A. Sarah

AU - Crook, Derrick

AU - Matthews, Philippa C.

AU - Peto, Tim

AU - Stoesser, Nicole

AU - Howarth, Alison

AU - Doherty, George

AU - Kavanagh, James

AU - Chau, Kevin K.

AU - Hatch, Stephanie B.

AU - Ebner, Daniel

AU - Martins Ferreira, Lucas

AU - Christott, Thomas

AU - Marsden, Brian D.

AU - Dejnirattisai, Wanwisa

AU - Mongkolsapaya, Juthathip

AU - Hoosdally, Sarah

AU - Cornall, Richard

AU - Stuart, David I.

AU - Screaton, Gavin

AU - Eyre, David

AU - Bell, John

AU - Cox, Stuart

AU - Paddon, Kevin

AU - James, Tim

AU - Newton, John N.

AU - Robotham, Julie V.

AU - Birrell, Paul

AU - Jordan, Helena

AU - Sheppard, Tim

AU - Athey, Graham

AU - Moody, Dan

AU - Curry, Leigh

AU - Brereton, Pamela

AU - Hay, Jodie

AU - Vansteenhouse, Harper

AU - Lambert, Alex

AU - Rourke, Emma

AU - Hawkes, Stacey

AU - Henry, Sarah

AU - Scruton, James

AU - Stokes, Peter

AU - Thomas, Tina

AU - Allen, John

AU - Black, Russell

AU - Bovill, Heather

AU - Braunholtz, David

AU - Brown, Dominic

AU - Collyer, Sarah

AU - Crees, Megan

AU - Daglish, Colin

AU - Davies, Byron

AU - Donnarumma, Hannah

AU - Douglas-Mann, Julia

AU - Felton, Antonio

AU - Finselbach, Hannah

AU - Fordham, Eleanor

AU - Ipser, Alberta

AU - Jenkins, Joe

AU - Jones, Joel

AU - Kent, Katherine

AU - Kerai, Geeta

AU - Lloyd, Lina

AU - Masding, Victoria

AU - Osborn, Ellie

AU - Patel, Alpi

AU - Pereira, Elizabeth

AU - Pett, Tristan

AU - Randall, Melissa

AU - Reeve, Donna

AU - Shah, Palvi

AU - Snook, Ruth

AU - Studley, Ruth

AU - Sutherland, Esther

AU - Swinn, Eliza

AU - Tudor, Anna

AU - Weston, Joshua

AU - Leib, Shayla

AU - Tierney, James

AU - Farkas, Gabor

AU - Cobb, Raf

PY - 2021/1/1

Y1 - 2021/1/1

N2 - © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Decisions about the continued need for control measures to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on accurate and up-to-date information about the number of people testing positive for SARS-CoV-2 and risk factors for testing positive. Existing surveillance systems are generally not based on population samples and are not longitudinal in design. Methods: Samples were collected from individuals aged 2 years and older living in private households in England that were randomly selected from address lists and previous Office for National Statistics surveys in repeated cross-sectional household surveys with additional serial sampling and longitudinal follow-up. Participants completed a questionnaire and did nose and throat self-swabs. The percentage of individuals testing positive for SARS-CoV-2 RNA was estimated over time by use of dynamic multilevel regression and poststratification, to account for potential residual non-representativeness. Potential changes in risk factors for testing positive over time were also assessed. The study is registered with the ISRCTN Registry, ISRCTN21086382. Findings: Between April 26 and Nov 1, 2020, results were available from 1 191 170 samples from 280 327 individuals; 5231 samples were positive overall, from 3923 individuals. The percentage of people testing positive for SARS-CoV-2 changed substantially over time, with an initial decrease between April 26 and June 28, 2020, from 0·40% (95% credible interval 0·29–0·54) to 0·06% (0·04–0·07), followed by low levels during July and August, 2020, before substantial increases at the end of August, 2020, with percentages testing positive above 1% from the end of October, 2020. Having a patient-facing role and working outside your home were important risk factors for testing positive for SARS-CoV-2 at the end of the first wave (April 26 to June 28, 2020), but not in the second wave (from the end of August to Nov 1, 2020). Age (young adults, particularly those aged 17–24 years) was an important initial driver of increased positivity rates in the second wave. For example, the estimated percentage of individuals testing positive was more than six times higher in those aged 17–24 years than in those aged 70 years or older at the end of September, 2020. A substantial proportion of infections were in individuals not reporting symptoms around their positive test (45–68%, dependent on calendar time. Interpretation: Important risk factors for testing positive for SARS-CoV-2 varied substantially between the part of the first wave that was captured by the study (April to June, 2020) and the first part of the second wave of increased positivity rates (end of August to Nov 1, 2020), and a substantial proportion of infections were in individuals not reporting symptoms, indicating that continued monitoring for SARS-CoV-2 in the community will be important for managing the COVID-19 pandemic moving forwards. Funding: Department of Health and Social Care.

AB - © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Decisions about the continued need for control measures to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rely on accurate and up-to-date information about the number of people testing positive for SARS-CoV-2 and risk factors for testing positive. Existing surveillance systems are generally not based on population samples and are not longitudinal in design. Methods: Samples were collected from individuals aged 2 years and older living in private households in England that were randomly selected from address lists and previous Office for National Statistics surveys in repeated cross-sectional household surveys with additional serial sampling and longitudinal follow-up. Participants completed a questionnaire and did nose and throat self-swabs. The percentage of individuals testing positive for SARS-CoV-2 RNA was estimated over time by use of dynamic multilevel regression and poststratification, to account for potential residual non-representativeness. Potential changes in risk factors for testing positive over time were also assessed. The study is registered with the ISRCTN Registry, ISRCTN21086382. Findings: Between April 26 and Nov 1, 2020, results were available from 1 191 170 samples from 280 327 individuals; 5231 samples were positive overall, from 3923 individuals. The percentage of people testing positive for SARS-CoV-2 changed substantially over time, with an initial decrease between April 26 and June 28, 2020, from 0·40% (95% credible interval 0·29–0·54) to 0·06% (0·04–0·07), followed by low levels during July and August, 2020, before substantial increases at the end of August, 2020, with percentages testing positive above 1% from the end of October, 2020. Having a patient-facing role and working outside your home were important risk factors for testing positive for SARS-CoV-2 at the end of the first wave (April 26 to June 28, 2020), but not in the second wave (from the end of August to Nov 1, 2020). Age (young adults, particularly those aged 17–24 years) was an important initial driver of increased positivity rates in the second wave. For example, the estimated percentage of individuals testing positive was more than six times higher in those aged 17–24 years than in those aged 70 years or older at the end of September, 2020. A substantial proportion of infections were in individuals not reporting symptoms around their positive test (45–68%, dependent on calendar time. Interpretation: Important risk factors for testing positive for SARS-CoV-2 varied substantially between the part of the first wave that was captured by the study (April to June, 2020) and the first part of the second wave of increased positivity rates (end of August to Nov 1, 2020), and a substantial proportion of infections were in individuals not reporting symptoms, indicating that continued monitoring for SARS-CoV-2 in the community will be important for managing the COVID-19 pandemic moving forwards. Funding: Department of Health and Social Care.

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DO - 10.1016/S2468-2667(20)30282-6

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JO - The Lancet Public Health

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