Abstract
BACKGROUND: Understanding how non-household activities contributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections under different levels of national health restrictions is vital. METHODS: Among adult Virus Watch participants in England and Wales, we used multivariable logistic regressions and adjusted-weighted population attributable fractions (aPAF) assessing the contribution of work, public transport, shopping, and hospitality and leisure activities to infections. RESULTS: Under restrictions, among 17,256 participants (502 infections), work [adjusted odds ratio (aOR) 2.01 (1.65-2.44), (aPAF) 30% (22-38%)] and transport [(aOR 1.15 (0.94-1.40), aPAF 5% (-3-12%)], were risk factors for SARS-CoV-2 but shopping, hospitality and leisure were not. Following the lifting of restrictions, among 11,413 participants (493 infections), work [(aOR 1.35 (1.11-1.64), aPAF 17% (6-26%)] and transport [(aOR 1.27 (1.04-1.57), aPAF 12% (2-22%)] contributed most, with indoor hospitality [(aOR 1.21 (0.98-1.48), aPAF 7% (-1-15%)] and leisure [(aOR 1.24 (1.02-1.51), aPAF 10% (1-18%)] increasing. During the Omicron variant, with individuals more socially engaged, among 11,964 participants (2335 infections), work [(aOR 1.28 (1.16-1.41), aPAF (11% (7-15%)] and transport [(aOR 1.16 (1.04-1.28), aPAF 6% (2-9%)] remained important but indoor hospitality [(aOR 1.43 (1.26-1.62), aPAF 20% (13-26%)] and leisure [(aOR 1.35 (1.22-1.48), aPAF 10% (7-14%)] dominated. CONCLUSIONS: Work and public transport were important to transmissions throughout the pandemic with hospitality and leisure's contribution increasing as restrictions were lifted, highlighting the importance of restricting leisure and hospitality alongside advising working from home, when facing a highly infectious and virulent respiratory infection.