Risk of hospital admission with coronavirus disease 2019 in healthcare workers and their households: nationwide linkage cohort study

  1. Anoop S V Shah
  2. Rachael Wood
  3. Ciara Gribben
  4. David Caldwell
  5. Jennifer Bishop
  6. Amanda Weir
  7. Sharon Kennedy
  8. Martin Reid
  9. Alison Smith-Palmer
  10. David Goldberg
  11. Jim McMenamin
  12. Colin Fischbacher
  13. Chris Robertson
  14. Sharon Hutchinson
  15. Paul McKeigue
  16. Helen Colhoun
  17. David A McAllister

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Abstract

Objective

To assess the risk of hospital admission for coronavirus disease 2019 (covid-19) among patient facing and non-patient facing healthcare workers and their household members.

Design

Nationwide linkage cohort study.

Setting

Scotland, UK, 1 March to 6 June 2020.

Participants

Healthcare workers aged 18-65 years, their households, and other members of the general population.

Main outcome measure

Admission to hospital with covid-19.

Results

The cohort comprised 158 445 healthcare workers, most of them (90 733; 57.3%) being patient facing, and 229 905 household members. Of all hospital admissions for covid-19 in the working age population (18-65 year olds), 17.2% (360/2097) were in healthcare workers or their households. After adjustment for age, sex, ethnicity, socioeconomic deprivation, and comorbidity, the risk of admission due to covid-19 in non-patient facing healthcare workers and their households was similar to the risk in the general population (hazard ratio 0.81 (95% confidence interval 0.52 to 1.26) and 0.86 (0.49 to 1.51), respectively). In models adjusting for the same covariates, however, patient facing healthcare workers, compared with non-patient facing healthcare workers, were at higher risk (hazard ratio 3.30, 2.13 to 5.13), as were household members of patient facing healthcare workers (1.79, 1.10 to 2.91). After sub-division of patient facing healthcare workers into those who worked in “front door,” intensive care, and non-intensive care aerosol generating settings and other, those in front door roles were at higher risk (hazard ratio 2.09, 1.49 to 2.94). For most patient facing healthcare workers and their households, the estimated absolute risk of hospital admission with covid-19 was less than 0.5%, but it was 1% and above in older men with comorbidity.

Conclusions

Healthcare workers and their households contributed a sixth of covid-19 cases admitted to hospital. Although the absolute risk of admission was low overall, patient facing healthcare workers and their household members had threefold and twofold increased risks of admission with covid-19.

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  1. ScreenIT

    SciScore for 10.1101/2020.08.03.20164897: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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:
    A further limitation of our study is that our cases were defined based on positive tests for SARS-CoV-2. Sensitivity of polymerase chain reaction tests for SARS-CoV-2 is 80%-90% depending on testing strategy.25 As such a proportion of true cases would have been misclassified. Finally, given that our healthcare worker population were predominantly white, our analysis lacked power to comment on the risk hospitalisation in ethnic minority groups.26 As the Northern Hemisphere enters winter and non-pharmacological measures on populations are relaxed, governments, healthcare managers and occupation health specialists need to consider how best to protect healthcare workers in the event of a resurgent pandemic. This is necessary to protect the healthcare worker and their families13 in addition to reducing onward transmission into the community.4 12 Our findings from the “first wave” in Scotland shows that healthcare workers in patient facing roles – especially those in “front-door” roles – are along with their households at particular risk. Crucially, those in non-patient facing roles had similar risks to that of the general population. These findings should inform decisions about the organisation of health services, the use of personal protective equipment and decisions about redeployment. Data sharing: Analysis code will be made available here – [WILL BE MADE PUBLIC PRIOR TO MANUSCRIPT PUBLICATION]. Since our analysis involved data on unconsented participants, we are unable to shar...

    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.

    About SciScore

    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 checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1136/bmj.m3582
  3. Version published to 10.1101/2020.08.03.20164897 on medRxiv