Intimate Physical Contact between People from Different Households During the COVID-19 Pandemic: A Mixed-Methods Study from a Large, Quasi-Representative Survey (Natsal-Covid)

Background: Physical distancing aims to reduce interactions between people to prevent SARS-CoV-2 transmission. Intimate physical contact outside the household (IPCOH) may expand transmission networks by connecting households. We explored whether intimacy needs impacted adherence to physical distancing following lockdown in Britain in March 2020. Methods: The Natsal-COVID web-panel survey (July-August 2020) used quota-sampling and weighting to achieve a quasi-representative population sample. We estimated IPCOH with a romantic/sexual partner in the four weeks prior to interview and identified associated factors. Qualitative interviews (n=18) were conducted to understand the context, reasons, and decision-making around IPCOH. Findings: Of 6,654 participants aged 18-59 years, 9.9% (95%CI:9.1-10.6%) reported IPCOH. IPCOH was highest in those aged 18-24 (17.7%), identifying as gay or lesbian (19.5%), and in steady non-cohabiting relationships (56.3%). IPCOH was associated with reporting risk behaviours (e.g., condomless sex, higher alcohol consumption). IPCOH was less likely among those reporting bad/very bad health (aOR 0.54;0.32-0.93) but more likely among those with COVID-19 symptoms and/or diagnosis (aOR 1.34;1.10-1.65). Two-thirds (64.4%) of IPCOH was reported as being within a support bubble. Qualitative interviews found that people reporting IPCOH deliberated over, and made efforts to mitigate, the risks. Interpretation: Given 90% of people did not report IPCOH, this contact may not be a large additional contributor to SARS-CoV-2 transmission, although heterogeneity exists within the population. Public health messages need to recognise how single people and partners living apart balance sexual intimacy and relationship needs with adherence to control measures. Funding Information: Natsal (Wellcome/ESRC/NIHR), MRC/CSO, and UCL COVID-19 Rapid Response Fund. Declaration of Interests: The other authors declare that they have no conflicts of interest. Ethics Approval Statement: Ethical approval was obtained from the University of Glasgow MVLS College (reference 20019174) and LSHTM research ethics committees (reference 22565). An anonymised dataset will be deposited with the UK Data Archive.