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 DaviesJoan 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, Christine M. Albert, Gabriella Andreotti, Bijal Bala, Bijal A. Balasubramanian, Laura E. Beane-Freeman, John S. Brownstein, Fiona J. Bruinsma, Joe Coresh, Rui Costa, Annie N. Cowan, Anusila Deka, Sandra L. Deming-Halverson, Maria Elena Martinez, Michael E. Ernst, Jane C. Figueiredo, Pedro Fortuna, Paul W. Franks, Laura Beane Freeman, Christopher D. Gardner, Irene M. Ghobrial, Christopher A. Haiman, Janet E. Hall, Jae H. Kang, Brenda Kirpach, Karestan C. Koenen, Laura D. Kubzansky, James V. Lacey,, Loic Le Marchand, Xihong Lin, Pam Lutsey, Catherine R. Marinac, Maria Elena Martinez, Roger L. Milne, Anne M. Murray, Denis Nash, Julie R. Palmer, Alpa V. Patel, Eric Pierce, McKaylee M. Robertson, Lynn Rosenberg, Dale P. Sandler, Shepherd H. Schurman, Kara Sewalk, Shreela V. Sharma, Christopher J. Sidey-Gibbons, Liz Slevin, Jordan W. Smoller, Maarit I. Tiirikainen, Scott T. Weiss, Lynne R. Wilkens, Feng Zhang

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)e475-e483
JournalThe Lancet Public Health
Volume5
Issue number9
DOIs
StatePublished - Sep 2020

Bibliographical note

Funding Information:
LHN is supported by the American Gastroenterological Association Research Scholars Award. DAD is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K01DK120742). ATC is the Stuart and Suzanne Steele Massachusetts General Hospital (MGH) Research Scholar and a Stand Up to Cancer scientist. National Institutes of Health grants related to this project include UM1 CA186107 (to AHE and MJS), U01 CA176726 (to AHE and WCW), U01 CA167552 (to WCW and LAM), U01 HL145386 (to JEC), R24 ES028521 (to JEC), P30ES000002 (to JEH), and grant contract 200-2017-M-94186 (to JEC). The Massachusetts Consortium on Pathogen Readiness and Mark and Lisa Schwartz supported investigators from MGH. Investigators from King's College London were supported by the Wellcome Trust and Engineering and Physical Sciences Research Council (WT212904/Z/18/Z, WT203148/Z/16/Z, T213038/Z/18/Z), the National Institute for Health Research Guy's and St Thomas' NHS Foundation Trust and King's College London Biomedical Research Centre, the UK Medical Research Council and British Heart Foundation (MR/M016560/1), UK Research and Innovation London Medical Imaging and Artificial Intelligence Centre for Value Based Healthcare, and the Alzheimer's Society (AS-JF-17-011). We thank all individuals who downloaded the COVID Symptom Study smartphone application (app), including participants of cohort studies within the COronavirus Pandemic Epidemiology (COPE) Consortium ( appendix p 3 ). We thank investigators of cohort studies enrolled in the COPE Consortium for their assistance in disseminating the COVID Symptom Study smartphone app to their study participants, and the MGH Clinical and Translational Epidemiology Unit Clinical Research Coordination team. We thank Zoe Global for providing in-kind support for all aspects of building, running, and supporting the COVID-19 Symptom Study smartphone app and service to users worldwide. Finally, we thank Stand Up to Cancer for their assistance in media and social media outreach.

Funding Information:
LHN is supported by the American Gastroenterological Association Research Scholars Award. DAD is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (K01DK120742). ATC is the Stuart and Suzanne Steele Massachusetts General Hospital (MGH) Research Scholar and a Stand Up to Cancer scientist. National Institutes of Health grants related to this project include UM1 CA186107 (to AHE and MJS), U01 CA176726 (to AHE and WCW), U01 CA167552 (to WCW and LAM), U01 HL145386 (to JEC), R24 ES028521 (to JEC), P30ES000002 (to JEH), and grant contract 200-2017-M-94186 (to JEC). The Massachusetts Consortium on Pathogen Readiness and Mark and Lisa Schwartz supported investigators from MGH. Investigators from King's College London were supported by the Wellcome Trust and Engineering and Physical Sciences Research Council (WT212904/Z/18/Z, WT203148/Z/16/Z, T213038/Z/18/Z), the National Institute for Health Research Guy's and St Thomas' NHS Foundation Trust and King's College London Biomedical Research Centre, the UK Medical Research Council and British Heart Foundation (MR/M016560/1), UK Research and Innovation London Medical Imaging and Artificial Intelligence Centre for Value Based Healthcare, and the Alzheimer's Society (AS-JF-17-011). We thank all individuals who downloaded the COVID Symptom Study smartphone application (app), including participants of cohort studies within the COronavirus Pandemic Epidemiology (COPE) Consortium ( appendix p 3). We thank investigators of cohort studies enrolled in the COPE Consortium for their assistance in disseminating the COVID Symptom Study smartphone app to their study participants, and the MGH Clinical and Translational Epidemiology Unit Clinical Research Coordination team. We thank Zoe Global for providing in-kind support for all aspects of building, running, and supporting the COVID-19 Symptom Study smartphone app and service to users worldwide. Finally, we thank Stand Up to Cancer for their assistance in media and social media outreach. Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.

Publisher Copyright:
© 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

Fingerprint Dive into the research topics of 'Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study'. Together they form a unique fingerprint.

Cite this