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Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study.
Nguyen, Long H; Drew, David A; Joshi, Amit D; Guo, Chuan-Guo; Ma, Wenjie; Mehta, Raaj S; 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; Graham, Mark S; Sudre, Carole H; Cardoso, M Jorge; Wolf, Jonathan; Ourselin, Sebastien; Steves, Claire J; Spector, Tim D; Chan, Andrew T.
  • Nguyen LH; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Drew DA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Joshi AD; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Guo CG; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Ma W; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Mehta RS; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Sikavi DR; Clinical and Translational Epidemiology Unit, 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.
  • Kwon S; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Song M; Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.
  • Mucci LA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Stampfer MJ; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Willett WC; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Eliassen AH; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Hart JE; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Chavarro JE; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Rich-Edwards JW; Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
  • Davies R; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Capdevila J; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Lee KA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Lochlainn MN; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Varsavsky T; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Graham MS; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Sudre CH; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.
  • Cardoso MJ; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Wolf J; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Ourselin S; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Steves CJ; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  • Spector TD; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Chan AT; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
medRxiv ; 2020 May 25.
Article in English | MEDLINE | ID: covidwho-829263
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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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Year: 2020 Document Type: Article Affiliation country: 2020.04.29.20084111

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Language: English Year: 2020 Document Type: Article Affiliation country: 2020.04.29.20084111