Symptom and Age Homophilies in SARS-CoV-2 Transmission Networks during the Early Phase of the Pandemic in Japan

SIMPLE SUMMARY: In the early stages of the COVID-19 pandemic, Japan conducted contact tracing extensively and published detailed records of thousands of anonymized patients. We leveraged the registry data to perform an exponential random graph model (ERGM) network analysis to examine demographic and symptomological homophilies of SARS-CoV-2 transmission networks in Hokkaido and Kanagawa. Our analysis showed: (1) Age, symptom, and asymptomatic status homophilies in both prefectures; (2) Asymptomatic infections increased as the virus was passed from primary cases to secondary and tertiary ones; (3) Transmission was mostly seen at the primary and secondary levels, with none occurring beyond quaternary; (4) Transmission occurred primarily in healthcare settings, as well as in families. ABSTRACT: Kanagawa and Hokkaido were affected by COVID-19 in the early stage of the pandemic. Japan’s initial response included contact tracing and PCR analysis on anyone who was suspected of having been exposed to SARS-CoV-2. In this retrospective study, we analyzed publicly available COVID-19 registry data from Kanagawa and Hokkaido (n = 4392). Exponential random graph model (ERGM) network analysis was performed to examine demographic and symptomological homophilies. Age, symptomatic, and asymptomatic status homophilies were seen in both prefectures. Symptom homophilies suggest that nuanced genetic differences in the virus may affect its epithelial cell type range and can result in the diversity of symptoms seen in individuals infected by SARS-CoV-2. Environmental variables such as temperature and humidity may also play a role in the overall pathogenesis of the virus. A higher level of asymptomatic transmission was observed in Kanagawa. Moreover, patients who contracted the virus through secondary or tertiary contacts were shown to be asymptomatic more frequently than those who contracted it from primary cases. Additionally, most of the transmissions stopped at the primary and secondary levels. As expected, significant viral transmission was seen in healthcare settings.