Work-related SARS-CoV2 and Covid19

ObjectiveTo map the risk of work-related SARS-CoV-2 across occupations and pandemic waves and investigate its impact on morbidity and partner-risk.MethodsThe cohort includes 2,4 million employees aged 20–69 with follow-up from 2020 through 2021. During this period, 261,203 employees had a positive SARS-CoV-2 test and 4416 were admitted to hospital with Covid-19 (HA). At-risk occupations defined at the 4-digit DISCO-08 level were identified using a reference population of mainly office-workers defined a priory by a job-exposure matrix (JEM). Incidence rate ratios (IRR) and effect modification by pandemic wave were computed by Poisson regression. We adjusted for demographic, social and health characteristics including household size, completed Covid-19 vaccination and occupation-specific frequency of testing.ResultsIn addition to eight specific occupations in the healthcare sector, we found increased risk of Covid-19 related HA in bus drivers, kindergarten teachers, domestic helpers, and operators in food production (IRR from 1.5–3) and modestly increased risk of SARS-CoV-2 infection in numerous occupations outside the healthcare sector including police and security guards, supermarket attendants, receptionists, cooks, and waiters. After the first year of the pandemic, the risk fell to background levels among healthcare workers but not in other occupations. The risk of Covid-19 related HA was increased in spouses with partners in high-risk occupations (IRR 1.54, 95% CI 1.1–2.2). Employees born in low-income countries and male employees from Eastern Europe more often worked in at-risk occupations. Being foreign-born modified the risk of PCR test positivity, primarily because of higher risk among men born in Eastern Europe working in at-risk occupations (IRR 2.39, 95% CI 2.09–2.72 versus IRR 1.19 (95% CI 1.14–1.23) in native-born men).ConclusionSARS-Cov2 transmission at the workplace was common during the Covid-pandemic in spite of temporary lock-downs which emphasizes the need for improved safety measures during future epidemics.

Use of Personal Protective Equipment Among Healthcare Workers During the First and the Second Wave of the COVID-19 Pandemic.

INTRODUCTION: To treat and properly care for COVID-19 patients it is vital to have healthy healthcare workers to ensure the continued function of the healthcare system and to prevent transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to patients, co-workers, and the community. Personal protective equipment (PPE) can prevent healthcare workers from being infected with and transmitting SARS-CoV-2. Experience and training are pivotal to ensure optimal protection. This study aims to examine the use and failure of PPE and compliance with PPE guidelines during the first and the second wave of the COVID-19 pandemic among Danish healthcare workers. METHODS: Healthcare workers from the Central Denmark Region and the Capital Region of Denmark were invited to participate April-June 2020 during the first wave and November 2020-April 2021 during the second wave. Day-by-day, participants reported work procedures, use and failure of PPE, and compliance with PPE guidelines. Register-based information on sex, age, department, and profession was available for all participants. RESULTS: In total, 21 684 and 10 097 healthcare workers participated during the first and the second wave, respectively. During the first wave, 1.7% used filtering face piece-2 or -3 (FFP2 or FFP3) respirators and 8.2% used face masks [fluid resistant (type IIR) masks, masks with visor (typically type IIR), and other unspecified face masks] during physical contact with patients. During the second wave, the corresponding figures increased to 17.8% and 80.7%. During respiratory procedures, the use of FFP2 or FFP3 respirators increased from 5.6 to 24.3%, and the use of face masks from 14.7 to 77.8%. The no PPE use decreased from 21.3% during the first wave to 0.4% in the second wave, during respiratory procedures. Total PPE failures decreased from 0.7 to 0.4% from the first to second wave. The proportion not complying with PPE guidelines declined from 3.6 to 2.2% during physical contact with patients and from 6.5 to 4.6% during respiratory procedures. PPE failure and non-compliance varied by age, sex and type of department. Frequent reasons for non-compliance were forgetfulness and lack of time, and during the first but not during the second wave, limited availability of PPE. CONCLUSION: We found a substantial increase in the use of PPE and a substantial decrease in PPE failures from the first to the second wave of COVID-19 in Denmark. However, there is still a need for continuous focus on compliance in use of PPE among healthcare workers.

Healthcare workers' SARS-CoV-2 infection rates during the second wave of the pandemic: follow-up study.

OBJECTIVES: This study aimed to assess if, during the second wave of the COVID-19 pandemic, healthcare workers had increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates, following close contact with patients, co-workers and persons outside work with COVID-19. METHODS: A follow-up study of 5985 healthcare workers from Denmark was conducted between November 2020 and April 2021 and provided day-to-day information on COVID-19 contacts. SARS-CoV-2 infection was defined by the first positive polymerase chain reaction (PCR) test ever. Data was analyzed in multivariable Poisson regression models. RESULTS: The SARS-CoV-2 infection rates following close contact 3-7 days earlier with patients, co-workers and persons outside work with COVID-19 were 153.7, 240.8, and 728.1 per 100 000 person-days, respectively. This corresponded with age, sex, month, number of PCR tests and mutually adjusted incidence rate ratios of 3.17 [40 cases, 95% confidence interval (CI) 2.15-4.66], 2.54 (10 cases, 95% CI 1.30-4.96) and 17.79 (35 cases, 95% CI 12.05-26.28). The risk of SARS-CoV-2 infection was thus lower, but the absolute numbers affected was higher following COVID-19 contact at work than COVID-19 contact off work. CONCLUSIONS: Despite strong focus on preventive measures during the second wave of the pandemic, healthcare workers were still at increased risk of SARS-CoV-2 infection when in close contact with patients or co-workers with COVID-19. There is a need for increased focus on infection control measures in order to secure healthcare workers' health and reduce transmission into the community during ongoing and future waves of SARS-CoV-2 and other infections.

Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence Survey Among 17 971 Healthcare and Administrative Personnel at Hospitals, Prehospital Services, and Specialist Practitioners in the Central Denmark Region.

BACKGROUND: The objective of this study was to perform a seroprevalence survey on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among Danish healthcare workers to identify high-risk groups. METHODS: All healthcare workers and administrative personnel at the 7 hospitals, prehospital services, and specialist practitioner clinics in the Central Denmark Region were invited to be tested by a commercial SARS-CoV-2 total antibody enzyme-linked immunosorbent assay (Wantai Biological Pharmacy Enterprise Co, Ltd, Beijing, China). RESULTS: A total of 25 950 participants were invited. Of these, 17 971 had samples available for SARS-CoV-2 antibody testing. After adjustment for assay sensitivity and specificity, the overall seroprevalence was 3.4% (95% confidence interval [CI], 2.5%-3.8%). The seroprevalence was higher in the western part of the region than in the eastern part (11.9% vs 1.2%; difference: 10.7 percentage points [95% CI, 9.5-12.2]). In the high-prevalence area, the emergency departments had the highest seroprevalence (29.7%), whereas departments without patients or with limited patient contact had the lowest seroprevalence (2.2%). Among the total 668 seropositive participants, 433 (64.8%) had previously been tested for SARS-CoV-2 RNA, and 50.0% had a positive reverse-transcription polymerase chain reaction (PCR) result. CONCLUSIONS: We found large differences in the prevalence of SARS-CoV-2 antibodies in staff working in the healthcare sector within a small geographical area of Denmark. Half of all seropositive staff had been tested positive by PCR prior to this survey. This study raises awareness of precautions that should be taken to avoid in-hospital transmission. Regular testing of healthcare workers for SARS-CoV-2 should be considered to identify areas with increased transmission.

Risk of exposure to a SARS-CoV-2 infection at work: development of a Job Exposure Matrix (COVID-19-JEM) for Denmark, the Netherlands and the United Kingdom

IntroductionAs workplaces may be one of the key settings in the spread of SARS-COV-2 infections, among both essential and non-essential workers, it is important to assess the occupations at increased risk of exposure to SARS-COV-2 in large study populations.ObjectivesThis study aimed to construct a job-exposure matrix (JEM) for the risk of becoming infected with SARS-COV-2 in an occupational setting.MethodsExperts in occupational epidemiology from three European countries (Denmark, the Netherlands and United Kingdom) defined relevant exposure and workplace characteristics with regard to possible exposure to SARS-COV-2. Within an iterative qualitative process, experts rated the different dimensions of the COVID-19-JEM for each job title within the International Standard Classification of Occupations 2008 (ISCO-08). The agreement scores including confidence intervals, weighted kappas, and explained variances were estimated.ResultsThe COVID-19-JEM contains four determinants of transmission risk (number of people, type of contacts, indirect contact and location), two mitigation measures (social distancing and face covering), and two social factors (income insecurity and migrant workers). Agreement scores ranged from 0.58 (95%CI 0.55;0.61) for ‘number of people’ to 0.76 (95%CI 0.74;0.78) for ‘type of contacts’. Agreement scores ranged from 0.58 (95%CI 0.55;0.61) for ‘number of people’ to 0.76 (95%CI 0.74;0.78) for ‘type of contacts. Weighted kappas ranged from 0.60 for ‘face covering’ to 0.80 for ‘indirect contact’. Due to some between-country differences, COVID-19-JEMs are separately presented for Denmark, the Netherlands and the United Kingdom.ConclusionsThe COVID-19-JEM provides risk estimates at population level of the eight dimensions related to a SARS-COV-2 infection at the workplace, and is a valuable tool for epidemiological studies. Additionally, the eight dimensions of the COVID-19-JEM could also be used for other communicable diseases at worksites.

Are healthcare workers using personal protective equipment during the COVID-19 pandemic?

IntroductionPersonal protective equipment (PPE) can prevent transmission of COVID-19;however, proper use requires time, experience, training and sufficient supplies of PPE.ObjectiveThe aim of the overall study is to investigate the risk of COVID-19 among Danish healthcare workers. Here, the availability and use of PPE among the Danish healthcare workers during the pandemic is investigated.MethodsHealthcare workers employed at the Central Denmark Region (32,413) and the Capital Region of Denmark (38,807) on April 1, 2020 were invited to respond to daily questionnaires from April 24, 2020, until June 30, 2020 that addressed work tasks, contact with COVID-19 patients, use of PPE and breach of PPE. On November 17, 2020, 26,092 healthcare workers from the Central Denmark Region and on December 15, 2020, 9,664 from the Capitol Region of Denmark were invited to a second round of daily questionnaires, and were followed until April and March 30, 2021, respectively.ResultsIn total, 12,328 (38.0%) and 9,664 (24.4%) healthcare workers participated in the first round of the study, respectively in the Central Denmark Region and the Capital Region of Denmark. One fifth (20.3% and 20.6% respectively), reported that they did not use the recommended PPE at least once during the study. Forgetfulness (26.1% and 27.3%, respectively) and time constrains (23.1% and 21.1%, respectively) were the primary causes for not using the recommended PPE. At the time of the conference, data from the second round of questionnaires (response rates of 26.1% and 41.6%, respectively, corresponding to 6,816 and 3,959 participants respectively) will also be available for presentation.ConclusionOne fifth of Danish healthcare workers have been in a situation where PPE was recommended but not used. Time constrains and forgetfulness are important reasons for this. Healthcare workers not wearing the recommended PPE increases the risk of the healthcare workers becoming infected with COVID-19, and is harmful to the performance of the healthcare system.

Day-by-day symptoms following positive and negative PCR tests for SARS-CoV-2 in non-hospitalized healthcare workers: A 90-day follow-up study.

OBJECTIVE: Our study aimed to compare symptoms day by day for non-hospitalized individuals testing positive and negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: In total, 210 positive-test and 630 negative-test healthcare workers in the Central Denmark Region were followed for up to 90 days after testing, between April and June, 2020. Their daily reported COVID-19-related symptoms were compared graphically and by logistic regression. RESULTS: Thirty per cent of the positive-test and close to 0% of the negative-test participants reported a reduced sense of taste and smell during all 90 days (adjusted odds ratio [aOR] 86.07, 95% CI 22.86-323). Dyspnea was reported by an initial 20% of positive-test participants, declining to 5% after 30 days, without ever reaching the level of the negative-test participants (aOR 6.88, 95% CI 2.41-19.63). Cough, headache, sore throat, muscle pain, and fever were temporarily more prevalent among the positive-test participants; after 30 days, no increases were seen. Women and older participants were more susceptible to long-lasting COVID-19 symptoms. CONCLUSION: The prevalence of long-lasting reduced sense of taste and smell is highly increased in mild COVID-19 patients. This pattern is also seen for dyspnea at a low level, but not for cough, sore throat, headache, muscle pain, or fever.

Symptoms reported by SARS-CoV-2 seropositive and seronegative healthcare and administrative employees in Denmark from May to August 2020.

BACKGROUND: The distribution and nature of symptoms among SARS-CoV-2 infected individuals need to be clarified. METHODS: Between May and August 2020, 11 138 healthcare and administrative personnel from Central Denmark Region were tested for SARS-CoV-2 antibodies and subsequently completed a questionnaire. Symptom prevalence and overall duration for symptoms persisting for more than 30 days were calculated. Logistic regression models were used to estimate adjusted odds ratios (ORs) with 95% CIs. RESULTS: In total, 447 (4%) of the participants were SARS-CoV-2-seropositive. Loss of sense of smell and taste was reported by 50% of seropositives compared with 3% of seronegatives. Additionally, seropositives more frequently reported fever, dyspnoea, muscle or joint ache, fatigue, cough, headache and sore throat, and they were more likely to report symptoms persisting for more than 30 days. In adjusted models, they had a higher risk of reporting symptoms, with the strongest association observed for loss of sense of taste and smell (OR = 35.6; 95% CI: 28.6-44.3). CONCLUSION: In this large study, SARS-CoV-2-seropositive participants reported COVID-19-associated symptoms more frequently than those who were seronegative, especially loss of sense of taste and smell. Overall, their symptoms were also more likely to persist for more than 30 days.