Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

Long H Nguyen; David A Drew; Mark S Graham; Amit D Joshi; Chuan-Guo Guo; Wenjie Ma; Raaj S Mehta; Erica T Warner; Daniel R Sikavi; Chun-Han Lo; Sohee Kwon; Mingyang Song; Lorelei A Mucci; Meir J Stampfer; Walter C Willett; A Heather Eliassen; Jaime E Hart; Jorge E Chavarro; Janet W Rich-Edwards; Richard Davies; Joan Capdevila; Karla A Lee; Mary Ni Lochlainn; Thomas Varsavsky; Carole H Sudre; M Jorge Cardoso; Jonathan Wolf; Tim D Spector; Sebastien Ourselin; Claire J Steves; Andrew T Chan; COronavirus Pandemic Epidemiology Consortium

doi:10.1016/S2468-2667(20)30164-X

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Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

Journal article

Open access

Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study

Long H Nguyen, David A Drew, Mark S Graham, Amit D Joshi, Chuan-Guo Guo, Wenjie Ma, Raaj S Mehta, Erica T Warner, Daniel R Sikavi, Chun-Han Lo, …

The Lancet. Public health, Vol.5(9), pp.e475-e483

09/2020

DOI: 10.1016/S2468-2667(20)30164-X

PMCID: PMC7491202

PMID: 32745512

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Abstract

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. 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. 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. 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. 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.

Adult

Clinical Laboratory Techniques - statistics & numerical data

Coronavirus Infections - diagnosis

Coronavirus Infections - epidemiology

Coronavirus Infections - prevention & control

Coronavirus Infections - transmission

COVID-19

COVID-19 Testing

Female

Health Personnel - statistics & numerical data

Humans

Infectious Disease Transmission, Patient-to-Professional - prevention & control

Male

Middle Aged

Mobile Applications

Pandemics - prevention & control

Personal Protective Equipment - statistics & numerical data

Pneumonia, Viral - epidemiology

Pneumonia, Viral - prevention & control

Pneumonia, Viral - transmission

Prospective Studies

Risk Assessment

Self Report

United Kingdom - epidemiology

United States - epidemiology

Young Adult

Details

Title: Subtitle: Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study
Creators: Long H Nguyen - Harvard University
David A Drew - Harvard University
Mark S Graham - King's College London
Amit D Joshi - Harvard University
Chuan-Guo Guo - Harvard University
Wenjie Ma - Harvard University
Raaj S Mehta - Harvard University
Erica T Warner - Harvard University
Daniel R Sikavi - Harvard University
Chun-Han Lo - Harvard University
Sohee Kwon - Harvard University
Mingyang Song - Harvard University
Lorelei A Mucci - Harvard University
Meir J Stampfer - Harvard University
Walter C Willett - Harvard University
A Heather Eliassen - Harvard University
Jaime E Hart - Harvard University
Jorge E Chavarro - Harvard University
Janet W Rich-Edwards - Harvard University
Richard Davies - ZOE (United Kingdom)
Joan Capdevila - ZOE (United Kingdom)
Karla A Lee - King's College London
Mary Ni Lochlainn - King's College London
Thomas Varsavsky - King's College London
Carole H Sudre - King's College London
M Jorge Cardoso - King's College London
Jonathan Wolf - ZOE (United Kingdom)
Tim D Spector - King's College London
Sebastien Ourselin - King's College London
Claire J Steves - King's College London
Andrew T Chan
COronavirus Pandemic Epidemiology Consortium
Contributors: Michael E Ernst (Contributor) - University of Iowa, Pharmacy Practice and Science
Resource Type: Journal article
Publication Details: The Lancet. Public health, Vol.5(9), pp.e475-e483
DOI: 10.1016/S2468-2667(20)30164-X
PMID: 32745512
PMCID: PMC7491202
NLM abbreviation: Lancet Public Health
ISSN: 2468-2667
eISSN: 2468-2667
Grant note: U01 CA167552 / NCI NIH HHS Wellcome Trust EP-W-17-011 / EPA MR/M016560/1 / Medical Research Council T213038/Z/18/Z / Wellcome Trust SP/14/8/31352 / British Heart Foundation U01 CA164974 / NCI NIH HHS P30 ES000002 / NIEHS NIH HHS WT203148/Z/16/Z / Wellcome Trust UM1 CA186107 / NCI NIH HHS U01 HL145386 / NHLBI NIH HHS NIHR300159 / Department of Health K01 DK120742 / NIDDK NIH HHS U01 CA176726 / NCI NIH HHS R24 ES028521 / NIEHS NIH HHS WT212904/Z/18/Z / Wellcome Trust
Language: English
Date published: 09/2020
Academic Unit: Family and Community Medicine; Pharmacy Practice and Science
Record Identifier: 9984297451502771

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