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1.
J Occup Environ Med ; 63(11): e807-e812, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1605104

ABSTRACT

OBJECTIVES: Despite having close contact with the general public, members of the San Francisco Fire Department (SFFD) reported relatively few cases of COVID-19 during the first half of 2020. Our objective was to explore evidence for prior undetected infections by conducting a seroprevalence survey, and to document both risk and protective factors for prior COVID-19 infection. METHODS: This cross-sectional study assessed workplace practices and exposures of SFFD personnel during the first 6 months of 2020 via questionnaire and documented prior COVID-19 infections by serologic antibody testing using an orthogonal testing protocol. RESULTS: Of 1231 participating emergency responders, three (0.25%) had confirmed positive COVID-19 antibody results. CONCLUSIONS: Safe workplace practices, community public health intervention, and low community infection rates appear to have been protective factors for emergency responders in San Francisco during our study period.


Subject(s)
COVID-19 , Firefighters , Allied Health Personnel , Cross-Sectional Studies , Humans , SARS-CoV-2 , San Francisco/epidemiology , Seroepidemiologic Studies
2.
Euro Surveill ; 26(41)2021 10.
Article in English | MEDLINE | ID: covidwho-1470739

ABSTRACT

We investigated a COVID-19 outbreak at a fire station in Marseille, France. Confirmed cases were defined as individuals with positive SARS-CoV-2 reverse transcription (RT)-PCR and/or neutralising antibodies. All 85 firefighters at work during the outbreak period were included after questioning and sampled for RT-PCR and viral neutralisation assay. Twenty-three firefighters were confirmed positive, 19 of them were symptomatic, and four asymptomatic cases were confirmed by virus neutralisation. A total of 22 firefighters had specific neutralising antibodies against SARS-CoV-2. Neutralising antibodies were found in four asymptomatic and 18 symptomatic cases. Eleven symptomatic cases had high titres (≥ 1:80). The earliest detection of neutralising antibodies was 7 days after symptom onset, and 80% had neutralising antibodies 15 days after onset. One viral culture was positive 13 days after onset. The attack rate was 27%. We identified two introductions of the virus in this outbreak, through a presymptomatic and a paucisymptomatic case. Asymptomatic cases were not the source of a third generation of cases, although they worked without wearing a mask, indicating that asymptomatic cases did not play a significant role in this outbreak. Management and strategy based on early research of clinical signs associated with self-quarantine was effective.


Subject(s)
COVID-19 , Firefighters , Disease Outbreaks , France/epidemiology , Humans , SARS-CoV-2
3.
Occup Environ Med ; 78(11): 789-792, 2021 11.
Article in English | MEDLINE | ID: covidwho-1373974

ABSTRACT

OBJECTIVES: We conducted serological SARS-CoV-2 antibody testing from October to November 2020 to estimate the SARS-CoV-2 seroprevalence among firefighters/paramedics in Orange County (OC), California. METHODS: OC firefighters employed at the time of the surveillance activity were invited to participate in a voluntary survey that collected demographic, occupational and previous COVID-19 testing data, and a SARS-CoV-2 immunoglobulin (Ig)G antibody blood test. We collected venous blood samples using mobile phlebotomy teams that travelled to individual fire stations, in coordination with an annual tuberculosis testing campaign for firefighters employed by OC Fire Authority (OCFA), and independently for firefighters employed by cities. We estimated seroprevalence and assessed several potential predictors of seropositivity. RESULTS: The seroprevalence was 5.3% among 923 OCFA personnel tested, with 92.2% participating. Among firefighters self-reporting a previous positive COVID-19 antibody or PCR test result, twenty-one (37%) did not have positive IgG tests in the current serosurvey. There were no statistically significant differences in demographic characteristics between cases and non-cases. Work city was a significant predictor of case status (p=0.015). Seroprevalence (4.8%) was similar when aggregated across seven city fire departments (42%-65% participation). In total, 1486°C fire personnel were tested. CONCLUSION: Using a strong serosurvey design and large firefighter cohort, we observed a SARS-CoV-2 IgG seroprevalence of 5.3%. The seroprevalence among OC firefighters in October 2020 was lower than the general county population estimated seroprevalence (11.5%) in August. The difference may be due in part to safety measures taken by OC fire departments at the start of the pandemic, as well as differences in antibody test methods and/or duration of antibody response.


Subject(s)
Antibodies, Viral/immunology , COVID-19/epidemiology , Firefighters/statistics & numerical data , SARS-CoV-2/immunology , Adult , COVID-19/immunology , California/epidemiology , Female , Humans , Immunoglobulin G/immunology , Male , Middle Aged , Occupational Exposure/statistics & numerical data , Seroepidemiologic Studies , Young Adult
4.
Int J Environ Res Public Health ; 18(15)2021 08 01.
Article in English | MEDLINE | ID: covidwho-1335078

ABSTRACT

The new coronavirus has been affecting health worldwide and essential service workers are continually exposed to this infectious agent, increasing the chance of infection and the development of the disease. Thus, this study aimed to estimate the frequency of infection and seroprevalence for SARS-CoV-2 in military firefighters in a city in Northeastern Brazil in January 2021. An observational cross-sectional study was carried out with 123 firefighters who answered a brief questionnaire to collect socio-epidemiological data and underwent RT-PCR and immunofluorescence test (IgM and IgG). The results found reveal a positive seroprevalence, with a high rate of infection in this class of workers, since they are essential service professionals who are exposed to risk due to their working hours, in addition to sharing some spaces and work materials. Besides, there were significant associations between positivity for IgG and IgM, as well as for positive RT-PCR prior to the study and the presence of IgG, with odd ratios of 3.04 and 4.9, respectively. These findings reinforce the need for immunization in this category, whose line of service hinders the adoption of distancing measures, since in many situations physical contact is inevitable.


Subject(s)
COVID-19 , Firefighters , Antibodies, Viral/blood , Brazil/epidemiology , COVID-19/epidemiology , Cross-Sectional Studies , Health Personnel , Humans , SARS-CoV-2 , Seroepidemiologic Studies
5.
BMJ Open ; 11(6): e045537, 2021 06 16.
Article in English | MEDLINE | ID: covidwho-1276958

ABSTRACT

INTRODUCTION: Career firefighters experience chronic circadian rhythm disruption, increasing their risk of cardiometabolic disease. The recent discovery that eating patterns regulate circadian rhythmicity in metabolic organs has raised the hypothesis that maintaining a consistent daily cycle of eating and fasting can support circadian rhythms and reduce disease risks. Preclinical animal studies and preliminary clinical trials have shown promising effects of time-restricted eating (TRE) to reduce disease risk without compromising physical performance. However, there is a lack of research on TRE in shift workers including firefighters. This study aims to investigate the feasibility and efficacy of 10-hour TRE on health parameters that contribute to cardiometabolic disease risks among career firefighters who work on a 24-hour shift schedule. METHODS AND ANALYSES: The Healthy Heroes Study is a randomised controlled parallel open-label clinical trial with 150 firefighters over 1 year. Firefighters are randomised with a 1:1 ratio to either the control or intervention group. The control group receives Mediterranean diet nutritional counselling (standard of care, 'SOC'). The intervention group receives the same SOC and a self-selected 10-hour TRE window. After the 2-week baseline, participants enter a 3-month monitored intervention, followed by a 9-month self-guided period with follow-up assessments. The impact of TRE on blood glucose, body weight, body composition, biomarkers (neuroendocrine, inflammatory and metabolic), sleep and mood is evaluated. These assessments occur at baseline, at the end of intervention and at 6, 9 and 12-month follow-ups. Temporal calorie intake is monitored with the smartphone application myCircadianClock throughout the study. Continuous glucose monitors, wrist-worn actigraphy device and questionnaires are used to monitor glucose levels, activity, sleep and light exposure. ETHICS AND DISSEMINATION: The study was approved by the Institutional Review Boards of the University of California San Diego and the Salk Institute for Biological Studies. Results will be disseminated through peer-reviewed manuscripts, reports and presentations. TRIAL REGISTRATION NUMBER: NCT03533023; Pre result.


Subject(s)
Cardiovascular Diseases , Firefighters , Shift Work Schedule , Cardiovascular Diseases/prevention & control , Circadian Rhythm , Feasibility Studies , Humans , Randomized Controlled Trials as Topic
8.
J Public Health Manag Pract ; 27(3): 322-324, 2021.
Article in English | MEDLINE | ID: covidwho-1234188
9.
J Occup Environ Med ; 63(5): 369-373, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1072455

ABSTRACT

OBJECTIVES: Estimate the point prevalence of COVID-19 vaccine acceptability among US firefighters and Emergency Medical Services (EMS) workers. METHODS: A cross-sectional study design was used to administer an anonymous online survey to a national non-probabilistic sample of firefighter and EMS workers. RESULTS: Among the 3169 respondents, 48.2% expressed high acceptability of the COVID-19 vaccine when it becomes available, while 24.2% were unsure and 27.6% reported low acceptability. Using the "high COVID-19 vaccine acceptability" group as the reference category, the groups with greater odds of reporting low acceptability included those: 30 to 39 years of age (odds ratio = 3.62 [95% confidence interval = 2.00 to 6.55]), Black race (3.60 [1.12 to 11.53]), Hispanic/Latinx ethnicity (2.39 [1.45 to 3.92]), with some college education (2.06 [1.29 to 3.27]), married (1.65 [1.03 to 2.65]), of current rank firefighter/EMS (2.21 [1.60 to 3.08]). CONCLUSIONS: Over half of US firefighters and EMS workers were uncertain or reported low acceptability of the COVID-19 vaccine when it becomes available.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Emergency Medical Technicians/psychology , Firefighters/psychology , Patient Acceptance of Health Care , Adult , Cross-Sectional Studies , Emergency Medical Technicians/statistics & numerical data , Female , Firefighters/statistics & numerical data , Humans , Male , Middle Aged , Odds Ratio , Prevalence , SARS-CoV-2 , Surveys and Questionnaires , United States/epidemiology
10.
Sci Total Environ ; 760: 144296, 2021 Mar 15.
Article in English | MEDLINE | ID: covidwho-989205

ABSTRACT

Throughout the United States, wildland firefighters respond to wildfires, performing arduous work in remote locations. Wildfire incidents can be an ideal environment for the transmission of infectious diseases, particularly for wildland firefighters who congregate in work and living settings. In this review, we examine how exposure to wildfire smoke can contribute to an increased likelihood of SARS-CoV-2 infection and severity of coronavirus disease (COVID-19). Human exposure to particulate matter (PM), a component of wildfire smoke, has been associated with oxidative stress and inflammatory responses; increasing the likelihood for adverse respiratory symptomology and pathology. In multiple epidemiological studies, wildfire smoke exposure has been associated with acute lower respiratory infections, such as bronchitis and pneumonia. Co-occurrence of SARS-CoV-2 infection and wildfire smoke inhalation may present an increased risk for COVID-19 illness in wildland firefighters due to PM based transport of SARS CoV-2 virus and up-regulation of angiotensin-converting enzyme II (ACE-2) (i.e. ACE-2 functions as a trans-membrane receptor, allowing the SARS-CoV-2 virus to gain entry into the epithelial cell). Wildfire smoke exposure may also increase risk for more severe COVID-19 illness such as cytokine release syndrome, hypotension, and acute respiratory distress syndrome (ARDS). Current infection control measures, including social distancing, wearing cloth masks, frequent cleaning and disinfecting of surfaces, frequent hand washing, and daily screening for COVID-19 symptoms are very important measures to reduce infections and severe health outcomes. Exposure to wildfire smoke may introduce additive or even multiplicative risk for SARS-CoV-2 infection and severity of disease in wildland firefighters. Thus, additional mitigative measures may be needed to prevent the co-occurrence of wildfire smoke exposure and SARS-CoV-2 infection.


Subject(s)
COVID-19 , Coronavirus , Firefighters , Humans , SARS-CoV-2 , Smoke/adverse effects
11.
Anaesthesist ; 70(5): 420-431, 2021 05.
Article in German | MEDLINE | ID: covidwho-950263

ABSTRACT

BACKGROUND: The COVID-19 pandemic represents an unprecedented severe test for emergency medicine in Germany. In addition to in-hospital emergency medicine, prehospital emergency medicine has the decisive task of fully guaranteeing emergency medical healthcare. In this article the Berlin Fire Brigade shows new ways for emergency medical services to fulfil these increased responsibilities during the pandemic in prehospital emergency medicine in the State of Berlin. METHODS: A systematic presentation of the challenges and conceptional responses of preclinical emergency medicine to the COVID-19 pandemic was carried out using the example of the emergency medical services in the State of Berlin. RESULTS: The Berlin Fire Brigade has a dispatch center that coordinates all requests for assistance in the State of Berlin over the emergency telephone number 112. On average a total of 2565 emergency calls are received every 24 h, from which 1271 missions are generated. During the pandemic there was a striking increase in missions to patients with acute respiratory diseases (ARD). Of the missions 11% were carried out to patients with the suspicion of COVID-19. The duration of the emergency calls was extended on average by 1:36 min due to the additional questions in the pandemic protocol and the duration of the mission by an average of 17 min with the additional alarm keyword acute respiratory disease (ARD). CONCLUSION: The continuing pandemic reveals that tasks and responsibilities of public services in emergency rescue go far beyond the immediate medical prevention of danger to life and limb. In addition to the controller and triage functions in the integrated dispatch center of the Berlin Fire Brigade (112), the emergency and healthcare measures could be ensured. This was accomplished by comprehensive measures for situation control, situation reports and mastering situations despite the lack of alternative outpatient care options, especially in the areas of general practitioner, public health care and medical specialist practices.


Subject(s)
COVID-19/diagnosis , Emergency Medical Services/methods , Exercise Test/methods , Berlin , COVID-19/physiopathology , COVID-19/therapy , Emergency Responders , Emergency Service, Hospital , Firefighters , Humans , Pandemics , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Triage
12.
Am J Ind Med ; 64(1): 39-47, 2021 01.
Article in English | MEDLINE | ID: covidwho-932412

ABSTRACT

BACKGROUND: The disease burden of coronavirus disease 2019 (COVID-19) is not uniform across occupations. Although healthcare workers are well-known to be at increased risk, data for other occupations are lacking. In lieu of this, models have been used to forecast occupational risk using various predictors, but no model heretofore has used data from actual case numbers. This study assesses the differential risk of COVID-19 by occupation using predictors from the Occupational Information Network (O*NET) database and correlating them with case counts published by the Washington State Department of Health to identify workers in individual occupations at highest risk of COVID-19 infection. METHODS: The O*NET database was screened for potential predictors of differential COVID-19 risk by occupation. Case counts delineated by occupational group were obtained from public sources. Prevalence by occupation was estimated and correlated with O*NET data to build a regression model to predict individual occupations at greatest risk. RESULTS: Two variables correlate with case prevalence: disease exposure (r = 0.66; p = 0.001) and physical proximity (r = 0.64; p = 0.002), and predict 47.5% of prevalence variance (p = 0.003) on multiple linear regression analysis. The highest risk occupations are in healthcare, particularly dental, but many nonhealthcare occupations are also vulnerable. CONCLUSIONS: Models can be used to identify workers vulnerable to COVID-19, but predictions are tempered by methodological limitations. Comprehensive data across many states must be collected to adequately guide implementation of occupation-specific interventions in the battle against COVID-19.


Subject(s)
COVID-19/epidemiology , Occupational Exposure/statistics & numerical data , Physical Distancing , Aviation , Barbering , Firefighters/statistics & numerical data , Health Personnel/statistics & numerical data , Humans , Law Enforcement , Mortuary Practice , Occupational Health , Prevalence , Risk Factors , School Teachers/statistics & numerical data , Time Factors , Transportation , Washington/epidemiology , Workplace
13.
BMJ ; 371: m4262, 2020 11 11.
Article in English | MEDLINE | ID: covidwho-919183

ABSTRACT

OBJECTIVE: To assess the accuracy of the AbC-19 Rapid Test lateral flow immunoassay for the detection of previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN: Test accuracy study. SETTING: Laboratory based evaluation. PARTICIPANTS: 2847 key workers (healthcare staff, fire and rescue officers, and police officers) in England in June 2020 (268 with a previous polymerase chain reaction (PCR) positive result (median 63 days previously), 2579 with unknown previous infection status); and 1995 pre-pandemic blood donors. MAIN OUTCOME MEASURES: AbC-19 sensitivity and specificity, estimated using known negative (pre-pandemic) and known positive (PCR confirmed) samples as reference standards and secondly using the Roche Elecsys anti-nucleoprotein assay, a highly sensitive laboratory immunoassay, as a reference standard in samples from key workers. RESULTS: Test result bands were often weak, with positive/negative discordance by three trained laboratory staff for 3.9% of devices. Using consensus readings, for known positive and negative samples sensitivity was 92.5% (95% confidence interval 88.8% to 95.1%) and specificity was 97.9% (97.2% to 98.4%). Using an immunoassay reference standard, sensitivity was 94.2% (90.7% to 96.5%) among PCR confirmed cases but 84.7% (80.6% to 88.1%) among other people with antibodies. This is consistent with AbC-19 being more sensitive when antibody concentrations are higher, as people with PCR confirmation tended to have more severe disease whereas only 62% (218/354) of seropositive participants had had symptoms. If 1 million key workers were tested with AbC-19 and 10% had actually been previously infected, 84 700 true positive and 18 900 false positive results would be projected. The probability that a positive result was correct would be 81.7% (76.8% to 85.8%). CONCLUSIONS: AbC-19 sensitivity was lower among unselected populations than among PCR confirmed cases of SARS-CoV-2, highlighting the scope for overestimation of assay performance in studies involving only PCR confirmed cases, owing to "spectrum bias." Assuming that 10% of the tested population have had SARS-CoV-2 infection, around one in five key workers testing positive with AbC-19 would be false positives. STUDY REGISTRATION: ISRCTN 56609224.


Subject(s)
Clinical Laboratory Techniques/standards , Coronavirus Infections/diagnosis , Immunoassay/standards , Pneumonia, Viral/diagnosis , Betacoronavirus , COVID-19 , COVID-19 Testing , Female , Firefighters , Health Personnel , Humans , Male , Pandemics , Police , Predictive Value of Tests , Reagent Kits, Diagnostic/standards , SARS-CoV-2 , Sensitivity and Specificity , United Kingdom
15.
Occup Environ Med ; 77(12): 857-861, 2020 12.
Article in English | MEDLINE | ID: covidwho-695387

ABSTRACT

OBJECTIVES: We estimate the point seroprevalence of SARS-CoV-2 antibodies in the frontline firefighter/paramedic workforce of a South Florida fire department located in the epicentre of a State outbreak. METHODS: A cross-sectional study design was used to estimate the point seroprevalence of SARS-CoV-2 antibodies using a rapid immunoglobulin (Ig)M-IgG combined point-of-care lateral flow immunoassay among frontline firefighters/paramedics collected over a 2-day period, 16-17 April 2020. Fire department personnel were emailed a survey link assessing COVID-19 symptoms and work exposures the day prior to the scheduled drive-through antibody testing at a designated fire station. Off-duty and on-duty firefighter/paramedic personnel drove through the fire station/training facility in their personal vehicles or on-duty engine/rescue trucks for SARS-CoV-2 antibody testing. RESULTS: Among the 203 firefighters/paramedics that make up the fire department workforce, 18 firefighters/paramedics (8.9%) tested positive for SARS-CoV-2 antibodies, of which 8 firefighters/paramedics (3.9%) were IgG positive only, 8 (3.9%) were IgM positive only and 2 (0.1%) were IgG/IgM positive. The positive predictive value (PPV) of the serological test is estimated to be 33.2% and the negative predictive value is 99.3%. The average number of COVID-19 case contacts (ie, within 6 feet of an infected person (laboratory-confirmed or probable COVID-19 patient) for ≥15 min) experienced by firefighters/paramedics was higher for those with positive serology compared with those with negative (13.3 cases vs 7.31 cases; p=0.022). None of the antibody positive firefighters/paramedics reported receipt of the annual influenza vaccine compared with firefighters/paramedics who tested negative for SARS-CoV-2 antibodies (0.0% vs 21.0%; p=0.027). CONCLUSION: Rapid SARS-CoV-2 IgM-IgG antibody testing documented early-stage and late-stage infection in a firefighter workforce providing insight to a broader medical surveillance project on return to work for firefighters/paramedics. Given the relatively low PPV of the serological test used in this study back in April 2020, caution should be used in interpreting test results.


Subject(s)
Allied Health Personnel , Betacoronavirus/immunology , Coronavirus Infections/epidemiology , Firefighters , Immunoglobulin G/blood , Immunoglobulin M/blood , Occupational Exposure , Pneumonia, Viral/epidemiology , Adult , Antibodies, Viral/blood , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Cross-Sectional Studies , Disease Outbreaks , Female , Florida/epidemiology , Humans , Influenza Vaccines , Male , Middle Aged , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Population Surveillance , Prevalence , Risk Factors , SARS-CoV-2 , Seroepidemiologic Studies , Workplace , Young Adult
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