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. 2025 Sep 30;20(9):e0332819.
doi: 10.1371/journal.pone.0332819. eCollection 2025.

Associations of SARS-CoV-2 PCR positivity with clinical symptoms and race/ethnicity: The household transmission study

Sara H Goodman  1 , Jonathan Altamirano  2 , Julianne Burns  1 , Clea S Sarnquist  1 , Jennifer S Read  1 , Yvonne Maldonado  1   2
Affiliations

Associations of SARS-CoV-2 PCR positivity with clinical symptoms and race/ethnicity: The household transmission study

Sara H Goodman et al. PLoS One. .

Abstract

Objective: The objective of this study was to identify demographic and clinical factors associated with SARS-CoV-2 infection among household contacts (HCs) following exposure to a confirmed case.

Methods: We analyzed an existing case-ascertained prospective cohort study of 43 HCs of SARS-CoV-2-positive index cases recruited from Stanford Health Care between March 2020 and June 2022. Participants self-collected nasal swabs daily for up to 21 days for reverse transcription polymerase chain reaction (RT-PCR) testing and reported symptoms in daily diaries. Using Cox proportional hazards models, we assessed associations between participant characteristics over time to first positive PCR result.

Results: We found that symptomatology and race/ethnicity were independently associated with increased infection risk. In multivariable analysis, participants with systemic symptoms had a higher likelihood of testing positive (adjusted hazard ratio [aHR]=2.62; 95% confidence interval [CI]: 1.38-6.55). Additionally, identifying as a racial/ethnic minority had a greater risk of a positive test (aHR = 2.55 for systemic symptoms, 2.43 for any respiratory symptoms, and 2.40 for upper respiratory symptoms) compared to white patients.

Conclusion: These findings underscore the importance of symptom-based surveillance and highlight ongoing racial and ethnic disparities in SARS-CoV-2 transmission risk. This study also demonstrates the feasibility of longitudinal, self-administered testing and offers a scalable model for investigating transmission dynamics of respiratory viruses in community settings.

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Conflict of interest statement

Dr. Maldonado reported receiving grants from Pfizer outside the submitted work. No other disclosures were reported. The other authors have no conflicts of interest to report.

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