On May 12, 2020 (day 0), a hair stylist at salon A in Springfield, Missouri (stylist A), developed respiratory symptoms and continued working with clients until day 8, when the stylist received a positive test result for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). A second hair stylist (stylist B), who had been exposed to stylist A, developed respiratory symptoms on May 15, 2020 (day 3), and worked with clients at salon A until day 8 before seeking testing for SARS-CoV-2, which returned a positive result on day 10. A total of 139 clients were directly serviced by stylists A and B from the time they developed symptoms until they took leave from work. Stylists A and B and the 139 clients followed the City of Springfield ordinance* and salon A policy recommending the use of face coverings (i.e., surgical masks, N95 respirators,† or cloth face coverings) for both stylists and clients during their interactions. Other stylists at salon A who worked closely with stylists A and B were identified, quarantined, and monitored daily for 14 days after their last exposure to stylists A or B. None of these stylists reported COVID-19 symptoms. After stylist B received a positive test result on day 10, salon A closed for 3 days to disinfect frequently touched and contaminated areas. After public health contact tracings and 2 weeks of follow-up, no COVID-19 symptoms were identified among the 139 exposed clients or their secondary contacts. The citywide ordinance and company policy might have played a role in preventing spread of SARS-CoV-2 during these exposures. These findings support the role of source control in preventing transmission and can inform the development of public health policy during the COVID-19 pandemic. As stay-at-home orders are lifted, professional and social interactions in the community will present more opportunities for spread of SARS-CoV-2. Broader implementation of masking policies could mitigate the spread of infection in the general population.
Stylist A worked from day 0 to day 8 with COVID-19 symptoms before receiving a diagnosis of COVID-19 by polymerase chain reaction (PCR) testing. Although self-isolation was recommended after testing on day 6, stylist A continued to work until the test returned a positive result, at which time stylist A was excluded from work by salon A. On day 3, after working with stylist A, stylist B developed respiratory symptoms. During Stylist A’s symptomatic period, the two stylists interacted while neither was masked during intervals between clients. Stylist B worked from day 3 to day 8 while symptomatic before self-isolating and seeking PCR testing, which returned a positive result for SARS-CoV-2 on day 10. Stylist A worked with clients for 8 days while symptomatic, as did stylist B for 5 days. During all interactions with clients at salon A, stylist A wore a double-layered cotton face covering, and stylist B wore a double-layered cotton face covering or a surgical mask.
The Greene County Health Department (Missouri) conducted contact tracing for all 139 exposed clients back to the dates that stylists A and B first developed symptoms. The 139 clients were monitored after their last exposure at salon A. Clients were asked to self-quarantine for 14 days and were called or sent daily text messages to inquire about any symptoms; none reported signs or symptoms of COVID-19. Testing was offered to all clients 5 days after exposure, or as soon as possible for those exposed >5 days before contact tracing began. Overall, 67 (48.2%) clients volunteered to be tested, and 72 (51.8%) refused; all 67 nasopharyngeal swab specimens tested negative for SARS-CoV-2 by PCR. Telephone interviews were attempted 1 month after initial contact tracings to collect supplementary information. Among the 139 exposed clients, the Greene County Health Department interviewed 104 (74.8%) persons.
Among the 139 clients, the mean age was 52 years (range = 21–93 years); 79 clients (56.8%) were male (Table 1). Salon appointments ranged from 15 to 45 minutes in length (median = 15 minutes; mean = 19.5 minutes). Among the 104 interviewed clients, 102 (98.1%) reported wearing face coverings for their entire appointment, and two (1.9%) reported wearing face coverings part of the time (Table 2). Types of face covering used by clients varied; 49 (47.1%) wore cloth face coverings, 48 (46.1%) wore surgical masks, five (4.8%) wore N95 respirators, and two (1.9%) did not know what kind of face covering they wore. Overall, 101 (97.1%) interviewed clients reported that their stylist wore a face covering for the entire appointment; three did not know. When asked about the type of face coverings worn by the stylists, 64 (61.5%) reported that their stylist wore a cloth face covering (39; 37.5%) or surgical mask (25; 24.0%); 40 (38.5%) clients did not know or remember the type of face covering worn by stylists. When asked whether they had experienced respiratory symptoms in the 90 days preceding their appointment, 87 (83.7%) clients reported that they had not. Of those who did report previous symptoms, none reported testing for or diagnosis of COVID-19.
Six close contacts of stylists A and B outside of salon A were identified: four of stylist A and two of stylist B. All four of stylist A’s contacts later developed symptoms and had positive PCR test results for SARS-CoV-2. These contacts were stylist A’s cohabitating husband and her daughter, son-in-law, and their roommate, all of whom lived together in another household. None of stylist B’s contacts became symptomatic.
