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Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study.
Nguyen, Long H; Drew, David A; Graham, Mark S; Joshi, Amit D; Guo, Chuan-Guo; Ma, Wenjie; Mehta, Raaj S; Warner, Erica T; Sikavi, Daniel R; Lo, Chun-Han; Kwon, Sohee; Song, Mingyang; Mucci, Lorelei A; Stampfer, Meir J; Willett, Walter C; Eliassen, A Heather; Hart, Jaime E; Chavarro, Jorge E; Rich-Edwards, Janet W; Davies, Richard; Capdevila, Joan; Lee, Karla A; Lochlainn, Mary Ni; Varsavsky, Thomas; Sudre, Carole H; Cardoso, M Jorge; Wolf, Jonathan; Spector, Tim D; Ourselin, Sebastien; Steves, Claire J; Chan, Andrew T.
  • Nguyen LH; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, B
  • Drew DA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
  • Graham MS; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
  • Joshi AD; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
  • Guo CG; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Medicine, Li Ka Shing Faculty of Medicine, University of H
  • Ma W; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, B
  • Mehta RS; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, B
  • Warner ET; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
  • Sikavi DR; Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
  • Lo CH; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Bo
  • Kwon S; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
  • Song M; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Bo
  • Mucci LA; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
  • Stampfer MJ; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Willett WC; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA.
  • Eliassen AH; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Hart JE; Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Chavarro JE; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, M
  • Rich-Edwards JW; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Davies R; Zoe Global, London, UK.
  • Capdevila J; Zoe Global, London, UK.
  • Lee KA; Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
  • Lochlainn MN; Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
  • Varsavsky T; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
  • Sudre CH; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
  • Cardoso MJ; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
  • Wolf J; Zoe Global, London, UK.
  • Spector TD; Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
  • Ourselin S; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
  • Steves CJ; Department of Twin Research and Genetic Epidemiology, King's College London, London, UK.
  • Chan AT; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Immunology and Infectious Disease, Harvard T H Chan School
Lancet Public Health ; 5(9): e475-e483, 2020 09.
Article in English | MEDLINE | ID: covidwho-706478
ABSTRACT

BACKGROUND:

Data for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk.

METHODS:

We did a prospective, observational cohort study in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. The COVID Symptom Study app is registered with ClinicalTrials.gov, NCT04331509.

FINDINGS:

Among 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11·61, 95% CI 10·93-12·33). To account for differences in testing frequency between front-line health-care workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3·40, 95% CI 3·37-3·43). Secondary and post-hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors.

INTERPRETATION:

In the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these observational findings is needed.

FUNDING:

Zoe Global, Wellcome Trust, Engineering and Physical Sciences Research Council, National Institutes of Health Research, UK Research and Innovation, Alzheimer's Society, National Institutes of Health, National Institute for Occupational Safety and Health, and Massachusetts Consortium on Pathogen Readiness.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Health Personnel / Infectious Disease Transmission, Patient-to-Professional / Coronavirus Infections / Personal Protective Equipment Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adult / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: North America / Europa Language: English Journal: Lancet Public Health Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Health Personnel / Infectious Disease Transmission, Patient-to-Professional / Coronavirus Infections / Personal Protective Equipment Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adult / Female / Humans / Male / Middle aged / Young adult Country/Region as subject: North America / Europa Language: English Journal: Lancet Public Health Year: 2020 Document Type: Article