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Magnitude of SARS-CoV-2 virus exposure may contribute to symptom severity. In a sample of seropositive adults (n=1101), we found that individuals who lived with a known COVID-19 case exhibited greater symptom severity and IgG concentrations compared to individuals who were seropositive but did not live with a known case (P<0.0001).
Notably, working in close proximity to others, which has received substantial attention as a risk factor for COVID-19,20 did not exhibit statistically significant associations with symptom severity or IgG antibody concentrations. Our results suggest that high virus exposure levels, which may often occur when exposed to a cohabitant with COVID-19, contribute to greater disease severity and stronger antibody responses. Regardless of which individual in the household was exposed first, our results suggest that preventing transmission within households should be a critical area of focus for public health efforts designed to reduce rates of symptomatic COVID-19. Policies and interventions that apply only to public places (e.g., mask mandates, business capacity limits) may be insufficient unless they are combined with measures that also reduce transmission within households (e.g., intensive testing, contact tracing, and isolation programs).
Preprint available in merRxiv (March 12, 2021):
