Secondary attack rate of COVID-19 among contacts and risk factors, Tamil Nadu, March-May 2020: a retrospective cohort study.

OBJECTIVE: To describe the characteristics of contacts of patients with COVID-19 case in terms of time, place and person, to calculate the secondary attack rate (SAR) and factors associated with COVID-19 infection among contacts. DESIGN: A retrospective cohort study SETTING AND PARTICIPANTS: Contacts of cases identified by the health department from 14 March 2020to 30 May 2020, in 9 of 38 administrative districts of Tamil Nadu. Significant proportion of cases attended a religious congregation. OUTCOME MEASURE: Attack rate among the contacts and factors associated with COVID-19 positivity. RESULTS: We listed 15 702 contacts of 931 primary cases. Of the contacts, 89% (n: 14 002) were tested for COVID-19. The overall SAR was 4% (599/14 002), with higher among the household contacts (13%) than the community contacts (1%). SAR among the contacts of primary cases with congregation exposure were 5 times higher than the contacts of non-congregation primary cases (10% vs 2%). Being a household contact of a primary case with congregation exposure had a fourfold increased risk of getting COVID-19 (relative risk (RR): 16.4; 95% CI: 13 to 20) than contact of primary case without congregation exposure. Among the symptomatic primary cases, household contacts of congregation primaries had higher RR than household contacts of other cases ((RR: 25.3; 95% CI: 10.2 to 63) vs (RR: 14.6; 95% CI: 5.7 to 37.7)). Among asymptomatic primary case, RR was increased among household contacts (RR: 16.5; 95% CI: 13.2 to 20.7) of congregation primaries compared with others. CONCLUSION: Our study showed an increase in disease transmission among household contacts than community contacts. Also, symptomatic primary cases and primary cases with exposure to the congregation had more secondary cases than others.

Sodium ion transport in the intestinal wall: a mathematical model.

A theoretical approach to study the uptake of sodium ions across the gastrointestinal mucosa and the concentrations at which they are taken up into the underlying blood capillaries has been attempted. A two-phase model of the mucosa is considered, consisting of an extracellular phase and a cellular phase. The model takes into account two important modes of transport: diffusion under concentration gradient and potential gradient (electrodiffusion) and active transport which is ATPase enzyme mediated. Appropriate partial differential equations for the two mechanisms of transport are derived and are solved by iterative methods. An approximate distance from the lumen where the capillaries lie is somewhere between 10 and 15% of the total wall length. The mean concentration of sodium ions made available for absorption at the capillaries is studied with time. A functional form for the variation of potential with respect to distance is proposed, and by comparing model solutions with experimental data it is calculated explicitly.