Changes in social contacts in England during the COVID-19 pandemic between March 2020 and March 2021 as measured by the CoMix survey: A repeated cross-sectional study

Abstract

BackgroundDuring the Coronavirus Disease 2019 (COVID-19) pandemic, the United Kingdom government imposed public health policies in England to reduce social contacts in hopes of curbing virus transmission. We conducted a repeated cross-sectional study to measure contact patterns weekly from March 2020 to March 2021 to estimate the impact of these policies, covering 3 national lockdowns interspersed by periods of less restrictive policies. Methods and findingsThe repeated cross-sectional survey data were collected using online surveys of representative samples of the UK population by age and gender. Survey participants were recruited by the online market research company Ipsos MORI through internet-based banner and social media ads and email campaigns. The participant data used for this analysis are restricted to those who reported living in England. We calculated the mean daily contacts reported using a (clustered) bootstrap and fitted a censored negative binomial model to estimate age-stratified contact matrices and estimate proportional changes to the basic reproduction number under controlled conditions using the change in contacts as a scaling factor. To put the findings in perspective, we discuss contact rates recorded throughout the year in terms of previously recorded rates from the POLYMOD study social contact study.The survey recorded 101,350 observations from 19,914 participants who reported 466,710 contacts over 53 weeks. We observed changes in social contact patterns in England over time and by participants' age, personal risk factors, and perception of risk. The mean reported contacts for adults 18 to 59 years old ranged between 2.39 (95% confidence interval [CI] 2.20 to 2.60) contacts and 4.93 (95% CI 4.65 to 5.19) contacts during the study period. The mean contacts for school-age children (5 to 17 years old) ranged from 3.07 (95% CI 2.89 to 3.27) to 15.11 (95% CI 13.87 to 16.41). This demonstrates a sustained decrease in social contacts compared to a mean of 11.08 (95% CI 10.54 to 11.57) contacts per participant in all age groups combined as measured by the POLYMOD social contact study in 2005 to 2006. Contacts measured during periods of lockdowns were lower than in periods of eased social restrictions. The use of face coverings outside the home has remained high since the government mandated use in some settings in July 2020. The main limitations of this analysis are the potential for selection bias, as participants are recruited through internet-based campaigns, and recall bias, in which participants may under- or overreport the number of contacts they have made. ConclusionsIn this study, we observed that recorded contacts reduced dramatically compared to prepandemic levels (as measured in the POLYMOD study), with changes in reported contacts correlated with government interventions throughout the pandemic. Despite easing of restrictions in the summer of 2020, the mean number of reported contacts only returned to about half of that observed prepandemic at its highest recorded level. The CoMix survey provides a unique repeated cross-sectional data set for a full year in England, from the first day of the first lockdown, for use in statistical analyses and mathematical modelling of COVID-19 and other diseases. Author summary Why was this study done? Mathematical models can be used to better understand the transmission dynamics of Coronavirus Disease 2019 (COVID-19) and could be strengthened by empirical evidence of the number of social contacts made under pandemic conditions.We identified a need for real-time social contact data to inform outbreak models, as we expected social contact behaviour to change due to perceived risk and in response to government policies restricting social contact over the course of the pandemic.We launched the CoMix social contact and behavioural study on March 24, 2020 to capture the changes in social contacts, risk perception, and other behaviours, such as hand hygiene and the use of face coverings. What did the researchers do and find? During the most stringent lockdown in the UK, we found that the mean number of reported contacts in England was about 75% less than prepandemic measures for adults over the age of 17.Throughout the year, the mean number of contacts remained low-only reaching about 50% of the prepandemic levels, even during periods of relatively few policies remaining to restrict social activity.During each lockdown, contacts returned to similar levels as the first lockdown for adults, while the mean number of contacts for children depends on whether or not schools were open for in-person learning. What do these findings mean? Throughout the year, the UK government, which governs England, used the CoMix social contact data to monitor social contacts and as an early indication of changes to the basic reproduction number.While these data have been put to use in real time, both researchers and policymakers need to take into account some limitations of the CoMix study results, including the self-reporting of social contacts, which could lead to bias as a result of inaccurate memory or due to social pressure to report more or fewer contacts.These data will continue to be used by researchers and policymakers to monitor changes in social behaviour, to model transmission of COVID-19 and other diseases, and to make important policy decisions.