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

doi:10.1101/2020.04.29.20084111

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[Preprint]. 2020 May 25:2020.04.29.20084111.

doi: 10.1101/2020.04.29.20084111.

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

Long H Nguyen^{1

2

3}, David A Drew^{1

2}, Amit D Joshi^{1

2}, Chuan-Guo Guo^{1

2

4}, Wenjie Ma^{1

2

3}, Raaj S Mehta^{1

2

3}, Daniel R Sikavi⁵, Chun-Han Lo^{1

2

6}, Sohee Kwon^{1

2}, Mingyang Song^{1

2

6

7}, Lorelei A Mucci⁶, Meir J Stampfer^{6

8}, Walter C Willett^{6

7}, A Heather Eliassen⁶, Jaime E Hart^{8

9}, Jorge E Chavarro^{6

7

8}, Janet W Rich-Edwards^{6

10}, Richard Davies¹¹, Joan Capdevila¹¹, Karla A Lee¹², Mary Ni Lochlainn¹², Thomas Varsavsky¹³, Mark S Graham¹³, Carole H Sudre¹³, M Jorge Cardoso¹³, Jonathan Wolf¹¹, Sebastien Ourselin¹³, Claire J Steves¹², Tim D Spector¹², Andrew T Chan^{1

2

14

15

16}

Affiliations

¹ Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
² Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
³ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁴ Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
⁵ Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁸ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁹ Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁰ Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School. Boston, MA, U.S.A.
¹¹ Zoe Global Limited. London, U.K.
¹² Department of Twin Research and Genetic Epidemiology, King's College London, London, U.K.
¹³ School of Biomedical Engineering & Imaging Sciences, King's College London. London, U.K.
¹⁴ Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health. Boston, MA, USA.
¹⁵ Broad Institute of MIT and Harvard. Cambridge, MA, USA.
¹⁶ Massachusetts Consortium on Pathogen Readiness, Cambridge, MA, USA.

PMID: 32511531
PMCID: PMC7273299
DOI: 10.1101/2020.04.29.20084111

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

Long H Nguyen et al. medRxiv. 2020.

[Preprint]. 2020 May 25:2020.04.29.20084111.

doi: 10.1101/2020.04.29.20084111.

Authors

Affiliations

¹ Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
² Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
³ Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁴ Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
⁵ Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁷ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁸ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁹ Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁰ Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School. Boston, MA, U.S.A.
¹¹ Zoe Global Limited. London, U.K.
¹² Department of Twin Research and Genetic Epidemiology, King's College London, London, U.K.
¹³ School of Biomedical Engineering & Imaging Sciences, King's College London. London, U.K.
¹⁴ Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health. Boston, MA, USA.
¹⁵ Broad Institute of MIT and Harvard. Cambridge, MA, USA.
¹⁶ Massachusetts Consortium on Pathogen Readiness, Cambridge, MA, USA.

PMID: 32511531
PMCID: PMC7273299
DOI: 10.1101/2020.04.29.20084111

Update in

Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study.
Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo CG, Ma W, Mehta RS, Warner ET, Sikavi DR, Lo CH, Kwon S, Song M, Mucci LA, Stampfer MJ, Willett WC, Eliassen AH, Hart JE, Chavarro JE, Rich-Edwards JW, Davies R, Capdevila J, Lee KA, Lochlainn MN, Varsavsky T, Sudre CH, Cardoso MJ, Wolf J, Spector TD, Ourselin S, Steves CJ, Chan AT; COronavirus Pandemic Epidemiology Consortium. Nguyen LH, et al. Lancet Public Health. 2020 Sep;5(9):e475-e483. doi: 10.1016/S2468-2667(20)30164-X. Epub 2020 Jul 31. Lancet Public Health. 2020. PMID: 32745512 Free PMC article.

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.

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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 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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References

1. Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD. How will country-based mitigation measures influence the course of the COVID-19 epidemic? Lancet (London, England) 2020; 395(10228): 931–4. - PMC - PubMed
1. Johns Hopkins University of Medicine Coronavirus Resource Center. 2020. https://coronavirus.jhu.edu/us-map (accessed 5/6/2020 2020).
1. The L. COVID-19: protecting health-care workers. Lancet (London, England) 2020; 395(10228): 922. - PMC - PubMed
1. Black JRM, Bailey C, Przewrocka J, Dijkstra KK, Swanton C. COVID-19: the case for health-care worker screening to prevent hospital transmission. Lancet (London, England) 2020; 395(10234): 1418–20. - PMC - PubMed
1. California Department of Public Health Latest Covid-19 Facts. 2020. https://www.cdph.ca.gov/Programs/OPA/Pages/NR20-065.aspx (accessed May 1, 2020 2020).

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[1] Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD. How will country-based mitigation measures influence the course of the COVID-19 epidemic? Lancet (London, England) 2020; 395(10228): 931–4. - PMC - PubMed

[2] Anderson RM, Heesterbeek H, Klinkenberg D, Hollingsworth TD. How will country-based mitigation measures influence the course of the COVID-19 epidemic? Lancet (London, England) 2020; 395(10228): 931–4. - PMC - PubMed

[3] Johns Hopkins University of Medicine Coronavirus Resource Center. 2020. https://coronavirus.jhu.edu/us-map (accessed 5/6/2020 2020).

[4] Johns Hopkins University of Medicine Coronavirus Resource Center. 2020. https://coronavirus.jhu.edu/us-map (accessed 5/6/2020 2020).

[5] The L. COVID-19: protecting health-care workers. Lancet (London, England) 2020; 395(10228): 922. - PMC - PubMed

[6] The L. COVID-19: protecting health-care workers. Lancet (London, England) 2020; 395(10228): 922. - PMC - PubMed

[7] Black JRM, Bailey C, Przewrocka J, Dijkstra KK, Swanton C. COVID-19: the case for health-care worker screening to prevent hospital transmission. Lancet (London, England) 2020; 395(10234): 1418–20. - PMC - PubMed

[8] Black JRM, Bailey C, Przewrocka J, Dijkstra KK, Swanton C. COVID-19: the case for health-care worker screening to prevent hospital transmission. Lancet (London, England) 2020; 395(10234): 1418–20. - PMC - PubMed

[9] California Department of Public Health Latest Covid-19 Facts. 2020. https://www.cdph.ca.gov/Programs/OPA/Pages/NR20-065.aspx (accessed May 1, 2020 2020).

[10] California Department of Public Health Latest Covid-19 Facts. 2020. https://www.cdph.ca.gov/Programs/OPA/Pages/NR20-065.aspx (accessed May 1, 2020 2020).

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This is a preprint.

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

Affiliations

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

Authors

Affiliations

Update in

Abstract

Conflict of interest statement

Figures

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