Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study.

Autor:	Nguyen LH; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Drew DA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA., Joshi AD; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA., Guo CG; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China., Ma W; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Mehta RS; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Sikavi DR; Department of Medicine, 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.; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Kwon S; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA., Song M; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Mucci LA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Stampfer MJ; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA., Willett WC; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Eliassen AH; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Hart JE; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA., Chavarro JE; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA., Rich-Edwards JW; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School. Boston, MA, U.S.A., Davies R; Zoe Global Limited. London, U.K., Capdevila J; Zoe Global Limited. London, U.K., Lee KA; Department of Twin Research and Genetic Epidemiology, King's College London, London, U.K., Lochlainn MN; Department of Twin Research and Genetic Epidemiology, King's College London, London, U.K., Varsavsky T; School of Biomedical Engineering & Imaging Sciences, King's College London. London, U.K., Graham MS; School of Biomedical Engineering & Imaging Sciences, King's College London. London, U.K., Sudre CH; School of Biomedical Engineering & Imaging Sciences, King's College London. London, U.K., Cardoso MJ; School of Biomedical Engineering & Imaging Sciences, King's College London. London, U.K., Wolf J; Zoe Global Limited. London, U.K., Ourselin S; School of Biomedical Engineering & Imaging Sciences, King's College London. London, U.K., Steves CJ; Department of Twin Research and Genetic Epidemiology, King's College London, London, U.K., Spector TD; Department of Twin Research and Genetic Epidemiology, King's College London, London, U.K., Chan AT; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School. Boston, MA, USA.; Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health. Boston, MA, USA.; Broad Institute of MIT and Harvard. Cambridge, MA, USA.; Massachusetts Consortium on Pathogen Readiness, Cambridge, MA, USA.
Jazyk:	angličtina
Zdroj:	MedRxiv : the preprint server for health sciences [medRxiv] 2020 May 25. Date of Electronic Publication: 2020 May 25.
DOI:	10.1101/2020.04.29.20084111
Abstrakt:	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. Competing Interests: Declaration of interests JW, RD, and JC are employees of Zoe Global Ltd. TDS is a consultant to Zoe Global Ltd. DAD and ATC previously served as investigators on a clinical trial of diet and lifestyle using a separate mobile application that was supported by Zoe Global Ltd. Other authors have no conflict of interest to declare.
Databáze:	MEDLINE
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