Monitoring populations at increased risk for SARS-CoV-2 infection in the community using population-level demographic and behavioural surveillance

COVID-19 Infection Survey Team, Emma Pritchard*, Joel Jones, Karina Doris Vihta, Nicole Stoesser, Prof Philippa C. Matthews, David W. Eyre, Thomas House, John I. Bell, Prof John N. Newton, Jeremy Farrar, Prof Derrick Crook, Susan Hopkins, Duncan Cook, Emma Rourke, Ruth Studley, Prof Ian Diamond, Prof Tim Peto, Koen B. Pouwels, Prof A.Sarah Walker

*Corresponding author for this work

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Background: The COVID-19 pandemic is rapidly evolving, with emerging variants and fluctuating control policies. Real-time population screening and identification of groups in whom positivity is highest could help monitor spread and inform public health messaging and strategy. 

Methods: To develop a real-time screening process, we included results from nose and throat swabs and questionnaires taken 19 July 2020-17 July 2021 in the UK's national COVID-19 Infection Survey. Fortnightly, associations between SARS-CoV-2 positivity and 60 demographic and behavioural characteristics were estimated using logistic regression models adjusted for potential confounders, considering multiple testing, collinearity, and reverse causality. 

Findings: Of 4,091,537 RT-PCR results from 482,677 individuals, 29,903 (0·73%) were positive. As positivity rose September-November 2020, rates were independently higher in younger ages, and those living in Northern England, major urban conurbations, more deprived areas, and larger households. Rates were also higher in those returning from abroad, and working in healthcare or outside of home. When positivity peaked December 2020-January 2021 (Alpha), high positivity shifted to southern geographical regions. With national vaccine roll-out from December 2020, positivity reduced in vaccinated individuals. Associations attenuated as rates decreased between February-May 2021. Rising positivity rates in June-July 2021 (Delta) were independently higher in younger, male, and unvaccinated groups. Few factors were consistently associated with positivity. 25/45 (56%) confirmed associations would have been detected later using 28-day rather than 14-day periods. 

Interpretation: Population-level demographic and behavioural surveillance can be a valuable tool in identifying the varying characteristics driving current SARS-CoV-2 positivity, allowing monitoring to inform public health policy. 

Funding: Department of Health and Social Care (UK), Welsh Government, Department of Health (on behalf of the Northern Ireland Government), Scottish Government, National Institute for Health Research.

Original languageEnglish
Article number100282
JournalThe Lancet Regional Health - Europe
Early online date11 Dec 2021
Publication statusPublished - 1 Feb 2022

Bibliographical note

Funding Information: This study is funded by the Department of Health and Social Care with in-kind support from the Welsh Government, the Department of Health on behalf of the Northern Ireland Government and the Scottish Government. K-DV, KBP, ASW, TEAP, NS, DE are supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford in partnership with Public Health England (PHE) (NIHR200915). ASW and TEAP are also supported by the NIHR Oxford Biomedical Research Centre. KBP is also supported by the Huo Family Foundation. ASW is also supported by core support from the Medical Research Council UK to the MRC Clinical Trials Unit [MC_UU_12023/22] and is an NIHR Senior Investigator. PCM is funded by Wellcome (intermediate fellowship, grant ref 110110/Z/15/Z) and holds an NIHR Oxford BRC Senior Fellowship award. DWE is supported by a Robertson Fellowship and an NIHR Oxford BRC Senior Fellowship. NS is an Oxford Martin Fellow and an NIHR Oxford BRC Senior Fellow. The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR, Department of Health, or PHE. The funder/sponsor did not have any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. All authors had full access to all data analysis outputs (reports and tables) and take responsibility for their integrity and accuracy. PCM received funding from the Wellcome Trust [110110/Z/15/Z]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors had access to all data reported in the study and accept responsibility for the decision to submit for publication.

Open Access: This is an open access article under the CC BY license

Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd.

Citation: Pritchard, Emma, et al. "Monitoring populations at increased risk for SARS-CoV-2 infection in the community using population-level demographic and behavioural surveillance." The Lancet Regional Health-Europe 13 (2022): 100282.



  • SARS-CoV-2
  • community
  • monitoring


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