Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study

Long H Nguyen, David A Drew, Amit D Joshi, Chuan-Guo Guo, Wenjie Ma, Raaj S Mehta, Daniel R Sikavi, Chun-Han Lo, Sohee Kwon, Mingyang Song, Lorelei A Mucci, Meir J Stampfer, Walter C Willett, A Heather Eliassen, Jaime E Hart, Jorge E Chavarro, Janet W Rich-Edwards, Richard Davies, Joan Capdevila, Karla A Lee, Mary Ni Lochlainn, Thomas Varsavsky, Mark S Graham, Carole H Sudre, M Jorge Cardoso, Jonathan Wolf, Sebastien Ourselin, Claire J Steves, Tim D Spector, Andrew T Chan, Long H Nguyen, David A Drew, Amit D Joshi, Chuan-Guo Guo, Wenjie Ma, Raaj S Mehta, Daniel R Sikavi, Chun-Han Lo, Sohee Kwon, Mingyang Song, Lorelei A Mucci, Meir J Stampfer, Walter C Willett, A Heather Eliassen, Jaime E Hart, Jorge E Chavarro, Janet W Rich-Edwards, Richard Davies, Joan Capdevila, Karla A Lee, Mary Ni Lochlainn, Thomas Varsavsky, Mark S Graham, Carole H Sudre, M Jorge Cardoso, Jonathan Wolf, Sebastien Ourselin, Claire J Steves, Tim D Spector, Andrew T Chan

Abstract

Background: Data for frontline healthcare workers (HCWs) and risk of SARS-CoV-2 infection are limited and whether personal protective equipment (PPE) mitigates this risk is unknown. We evaluated risk for COVID-19 among frontline HCWs compared to the general community and the influence of PPE.

Methods: We performed a prospective cohort study of the general community, including frontline HCWs, who reported information through the COVID Symptom Study smartphone application beginning on March 24 (United Kingdom, U.K.) and March 29 (United States, U.S.) through April 23, 2020. We used Cox proportional hazards modeling to estimate multivariate-adjusted hazard ratios (aHRs) of a positive COVID-19 test.

Findings: Among 2,035,395 community individuals and 99,795 frontline HCWs, we documented 5,545 incident reports of a positive COVID-19 test over 34,435,272 person-days. Compared with the general community, frontline HCWs had an aHR of 11·6 (95% CI: 10·9 to 12·3) for reporting a positive test. The corresponding aHR was 3·40 (95% CI: 3·37 to 3·43) using an inverse probability weighted Cox model adjusting for the likelihood of receiving a test. A symptom-based classifier of predicted COVID-19 yielded similar risk estimates. Compared with HCWs reporting adequate PPE, the aHRs for reporting a positive test were 1·46 (95% CI: 1·21 to 1·76) for those reporting PPE reuse and 1·31 (95% CI: 1·10 to 1·56) for reporting inadequate PPE. Compared with HCWs reporting adequate PPE who did not care for COVID-19 patients, HCWs caring for patients with documented COVID-19 had aHRs for a positive test of 4·83 (95% CI: 3·99 to 5·85) if they had adequate PPE, 5·06 (95% CI: 3·90 to 6·57) for reused PPE, and 5·91 (95% CI: 4·53 to 7·71) for inadequate PPE.

Interpretation: Frontline HCWs had a significantly increased risk of COVID-19 infection, highest among HCWs who reused PPE or had inadequate access to PPE. However, adequate supplies of PPE did not completely mitigate high-risk exposures.

Funding: Zoe Global Ltd., Wellcome Trust, EPSRC, NIHR, UK Research and Innovation, Alzheimer's Society, NIH, NIOSH, Massachusetts Consortium on Pathogen Readiness.

Conflict of interest statement

Declaration of interests JW, RD, and JC are employees of Zoe Global Ltd. TDS is a consultant to Zoe Global Ltd. DAD and ATC previously served as investigators on a clinical trial of diet and lifestyle using a separate mobile application that was supported by Zoe Global Ltd. Other authors have no conflict of interest to declare.

Figures

Figure 1.. The risk of testing positive…
Figure 1.. The risk of testing positive for COVID-19 among frontline healthcare workers (HCW).
A. Between March 24, 2020 and April 23, 2020, considerable disparities in prevalence of a positive COVID-19 test among frontline HCW risk compared to the general community were observed in both the United Kingdom and the United States. B. Prevalence of a positive COVID-19 test reported by frontline HCWs in the United States and the United Kingdom. Regions in gray did not offer sufficient data.

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Source: PubMed

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