Differential occupational risks to healthcare workers from SARS-CoV-2: A prospective observational study
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Abstract
Background
Personal protective equipment (PPE) and social distancing are designed to mitigate risk of occupational SARS-CoV-2 infection in hospitals. Why healthcare workers nevertheless remain at increased risk is uncertain.
Methods
We conducted voluntary Covid-19 testing programmes for symptomatic and asymptomatic staff at a UK teaching hospital using nasopharyngeal PCR testing and immunoassays for IgG antibodies. A positive result by either modality determined a composite outcome. Risk-factors for Covid-19 were investigated using multivariable logistic regression.
Results
1083/9809(11.0%) staff had evidence of Covid-19 at some time and provided data on potential risk-factors. Staff with a confirmed household contact were at greatest risk (adjusted odds ratio [aOR] 4.63 [95%CI 3.30-6.50]). Higher rates of Covid-19 were seen in staff working in Covid-19-facing areas (21.2% vs. 8.2% elsewhere) (aOR 2.49 [2.00-3.12]). Controlling for Covid-19-facing status, risks were heterogenous across the hospital, with higher rates in acute medicine (1.50 [1.05-2.15]) and sporadic outbreaks in areas with few or no Covid-19 patients. Covid-19 intensive care unit (ICU) staff were relatively protected (0.46 [0.29-0.72]). Positive results were more likely in Black (1.61 [1.20-2.16]) and Asian (1.58 [1.34-1.86]) staff, independent of role or working location, and in porters and cleaners (1.93 [1.25-2.97]). Contact tracing around asymptomatic staff did not lead to enhanced case identification. 24% of staff/patients remained PCR-positive at ≥6 weeks post-diagnosis.
Conclusions
Increased Covid-19 risk was seen in acute medicine, among Black and Asian staff, and porters and cleaners. A bundle of PPE-related interventions protected staff in ICU.
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SciScore for 10.1101/2020.06.24.20135038: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Deidentified data from staff testing and patients were obtained from the Infections in Oxfordshire Research Database (IORD) which has generic Research Ethics Committee, Health Research Authority and Confidentiality Advisory Group approvals (19/SC/0403, ECC5-017(A)/2009). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Serology for SARS-CoV-2 IgG to nucleocapsid and trimeric spike were performed using the Abbott Architect i2000 chemiluminescent microparticle immunoassay (CMIA) and an enzyme-linked immunosorbent assay (ELISA) … SciScore for 10.1101/2020.06.24.20135038: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Deidentified data from staff testing and patients were obtained from the Infections in Oxfordshire Research Database (IORD) which has generic Research Ethics Committee, Health Research Authority and Confidentiality Advisory Group approvals (19/SC/0403, ECC5-017(A)/2009). Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Serology for SARS-CoV-2 IgG to nucleocapsid and trimeric spike were performed using the Abbott Architect i2000 chemiluminescent microparticle immunoassay (CMIA) and an enzyme-linked immunosorbent assay (ELISA) developed at the University of Oxford (Supplement). Abbott Architectsuggested: (Abbott ARCHITECT i1000sr System, RRID:SCR_019328)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations of our study include its cross-sectional nature and that data gathered on particular exposures may be subject to recall bias. It is unknown what proportion of staff were infected who either mounted no detectable antibody response or in whom it had waned by the time of testing. Our data are also from a single setting and findings may vary by practice, geography and population-wide Covid-19 incidence.(5,6) Our study suggests that an earlier move to universal level-1 PPE may have prevented some infections, and that a consistent bundle of level-2 PPE provision and use, training, and supervision and space for donning and doffing protected staff working in high-risk areas. Wider deployment of this bundle should be considered where staff are at increased risk. Our study provides data to inform risk assessments for staff, to ensure those staff most at risk are deployed appropriately. Given likely staff-to-staff transmission where COVID-19 patient pressure was low, there is a need to protect all staff regardless of role. This includes reinforcement of measures to support social distancing and raises questions about the role of social inequality in Covid-19 transmission. If some staff are already immune the impact of any future Covid-19 surge may be less marked for staff, although differential deployment or use of PPE based on immune status would require evidence it was safe and socially acceptable. Our testing programme has been highly popular with staff, ensured enhanced ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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SciScore for 10.1101/2020.06.24.20135038: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Deidentified data from staff testing and patients were obtained from the Infections in Oxfordshire Research Database ( IORD ) which has generic Research Ethics Committee , Health Research Authority and Confidentiality Advisory Group approvals ( 19/SC/0403 , ECC5-017 ( A)/2009) . Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable There was limited evidence that male staff were more at risk of infection than female staff ( 301/2506 [ 12.0 % ] positive vs. 779/7284 [ 10.7 % ] , p=0.07 ) and risk decreased with age ( univariable odds ratio [ OR] , per 10 years , 0.95 [ 95 % CI 0.90-1.00 , p=0.05] , … SciScore for 10.1101/2020.06.24.20135038: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Deidentified data from staff testing and patients were obtained from the Infections in Oxfordshire Research Database ( IORD ) which has generic Research Ethics Committee , Health Research Authority and Confidentiality Advisory Group approvals ( 19/SC/0403 , ECC5-017 ( A)/2009) . Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable There was limited evidence that male staff were more at risk of infection than female staff ( 301/2506 [ 12.0 % ] positive vs. 779/7284 [ 10.7 % ] , p=0.07 ) and risk decreased with age ( univariable odds ratio [ OR] , per 10 years , 0.95 [ 95 % CI 0.90-1.00 , p=0.05] , Figure S4) . Table 2: Resources
Software and Algorithms Sentences Resources Serology for SARS-CoV-2 IgG to nucleocapsid and trimeric spike were performed using the Abbott Architect i2000 chemiluminescent microparticle immunoassay ( CMIA ) and an enzyme-linked immunosorbent assay ( ELISA ) developed at the University of Oxford ( Supplement) . Abbott Architectsuggested: (Abbott ARCHITECT i1000sr System, SCR_018371)This work was supported by the National Institute for Health Research Health Protection Research Unit ( NIHR HPRU ) in Healthcare Associated Infections and Antimicrobial Resistance at Oxford University in partnership with Public Health England ( PHE ) [ grant HPRU-2012-10041 ] and the NIHR Biomedical Research Centre , Oxford. NIHR Biomedical Research Centresuggested: NoneBCY is an NIHR Clinical Lecturer . LMF , TC and BDM are supported by the SGC , a registered charity ( number 1097737 ) that receives funds from AbbVie , Bayer Pharma AG , Boehringer Ingelheim , Canada Foundation for Innovation , Eshelman Institute for Innovation , Genome Canada through Ontario Genomics Institute [ OGI-055] AbbViesuggested: (AbbVie, SCR_010484)Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.
Results from OddPub: We did not find a statement about open data. We also did not find a statement about open code. Researchers are encouraged to share open data when possible (see Nature blog).
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SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.
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