Age groups that sustain resurging COVID-19 epidemics in the United States

INTRODUCTION: After initial declines, in mid-2020, a sustained resurgence in the transmission of novel coronavirus disease (COVID-19) occurred in the United States. Throughout the US epidemic, considerable heterogeneity existed among states, both in terms of overall mortality and infection, but also in the types and stringency of nonpharmaceutical interventions. Despite these stark differences among states, little is known about the relationship between interventions, contact patterns, and infections, or how this varies by age and demographics. A useful tool for studying these dynamics is individual, age-specific mobility data. In this study, we use detailed mobile-phone data from more than 10 million individuals and establish a mechanistic relationship between individual contact patterns and COVID-19 mortality data. RATIONALE: As the pandemic progresses, disease control responses are becoming increasingly nuanced and targeted. Understanding fine-scale patterns of how individuals interact with each other is essential to mounting an efficient public health control program. For example, the choice of closing workplaces, closing schools, limiting hospitality sectors, or prioritizing vaccination to certain population groups should be informed by the demographics currently driving and sustaining transmission. To develop the tools to answer such questions, we introduce a new framework that links mobility to mortality through age-specific contact patterns and then use this rich relationship to reconstruct accurate transmission dynamics (see figure panel A). RESULTS: We find that as of 29 October 2020, adults aged 20 to 34 and 35 to 49 are the only age groups that have sustained SARS-CoV-2 transmission with reproduction numbers (transmission rates) consistently above one. The high reproduction numbers from adults are linked both to rebounding mobility over the summer and elevated transmission risks per venue visit among adults aged 20 to 49. Before school reopening, we estimate that 75 of 100 COVID-19 infections originated from adults aged 20 to 49, and the share of young adults aged 20 to 34 among COVID-19 infections was highly variable geographically. After school reopening, we reconstruct relatively modest shifts in the age-specific sources of resurgent COVID-19 toward younger individuals, with less than 5% of SARS-CoV-2 transmissions attributable to children aged 0 to 9 and less than 10% attributable to early adolescents and teenagers aged 10 to 19. Thus, adults aged 20 to 49 continue to be the only age groups that contribute disproportionately to COVID-19 spread relative to their size in the population (see figure panel B). However, because children and teenagers seed infections among adults who are more transmission efficient, we estimate that overall, school opening is indirectly associated with a 26% increase in SARS-CoV-2 transmission. CONCLUSION: We show that considering transmission through the lens of contact patterns is fundamental to understanding which population groups are driving disease transmission. Over time, the share of age groups among reported deaths has been markedly constant, and the data provide no evidence that transmission shifted to younger age groups before school reopening, and no evidence that young adults aged 20 to 34 were the primary source of resurgent epidemics since the summer of 2020. Our key conclusion is that in locations where novel, highly transmissible SARS-CoV-2 lineages have not yet become established, additional interventions among adults aged 20 to 49, such as mass vaccination with transmission-blocking vaccines, could bring resurgent COVID-19 epidemics under control and avert deaths.