Reply to Dowd et al.: Dangerous to overemphasize the importance of specific {COVID}-19 risk factors based on (unadjusted) macro-level analyses

Dowd et al. (1) state that it is “dangerous to claim ‘no clear association’ between intergenerational relationships and COVID-19.” We agree. However, our paper’s title (2) already specifies “from macro-level analyses.” The main criticism in ref. 1 originates in a misunderstanding of our macro-level analyses as a denial of risks inherent to intergenerational relationships (IR). It is valuable to have the opportunity to clarify this point. We aim to warn against simplistic interpretations of macro-level correlations and clearly state that physical contacts, whether intergenerational or not, favor virus transmission. In the last months, in academia and on (social) media, IR were claimed to be crucial in explaining the high spread and lethality of COVID-19 in countries like Italy (“intergenerational contacts hypothesis”), drawing on anecdotal evidence or very simple (simplistic, we would argue) country-level analyses. We showed that similarly simple analyses do not support such a macro-level hypothesis. As our paper was not meant to be a direct reply to Dowd et al.’s early study (3), it did not test their interaction effect. We used analyses similar to ref. 4, the only study by then to have empirically examined the relationship between IR and COVID-19.