Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission
- Cambridge University Hospitals NHS Trust, United Kingdom
- University of Cambridge, United Kingdom
- Public Health England (PHE), United Kingdom
- National Institutes for Health Research, United Kingdom
Abstract
Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3-week period (April 2020), 1,032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19) >7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B∙1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff.
Data availability
Sequencing data have been deposited in GSAID under accession codes EPI_ISL_433989-EPI_ISL_433992, EPI_ISL_434005, EPI_ISL_433489-EPI_ISL_433497
Article and author information
Author details
Nicholas J Matheson
Funding
Wellcome (108070/Z/15/Z)
- Michael P Weekes
Addenbrooke's Charitable Trust, Cambridge University Hospitals
- Paul J Lehner
Medical Research Council (MR/P008801/1)
- Nicholas J Matheson
NHS Blood and Transplant (WPA15-02)
- Nicholas J Matheson
National Institute for Health Research (Cambridge Biomedical Research Centre)
- John R Bradley
National Institute for Health Research (Cambridge Biomedical Research Centre)
- M Estee Torok
National Institute for Health Research (Cambridge Biomedical Research Centre)
- Afzal Chaudhry
National Institute for Health Research (Cambridge Biomedical Research Centre)
- Gordon Dougan
Academy of Medical Sciences (Clinician Scientist Fellowship)
- M Estee Torok
Engineering and Physical Sciences Research Council (EP/P031447/1)
- Richard J Samworth
Engineering and Physical Sciences Research Council (EP/N031938/1)
- Richard J Samworth
Wellcome (215515/Z/19/Z)
- Stephen Baker
Cancer Research UK (PRECISION Grand Challenge C38317/A24043)
- Jamie Young
Wellcome (207498?Z/17/Z)
- Ian G Goodfellow
Wellcome (206298/B/17/Z)
- Ian G Goodfellow
Wellcome (210688/Z/18/Z)
- Paul J Lehner
Wellcome (200871/Z/16/Z)
- Kenneth G C Smith
Addenbrooke's Charitable Trust, Cambridge University Hospitals
- Michael P Weekes
Addenbrooke's Charitable Trust, Cambridge University Hospitals
- Stephen Baker
Addenbrooke's Charitable Trust, Cambridge University Hospitals
- Ian G Goodfellow
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Ethics
Human subjects: As a study of healthcare-associated infections, this investigation is exempt from requiring ethical approval under Section 251 of the NHS Act 2006 (see also the NHS Health Research Authority algorithm, available at http://www.hra-decisiontools.org.uk/research/, which concludes that no formal ethical approval is required). Written consent was obtained from each HCW described in the anonymised case vignettes.
Copyright
© 2020, Rivett et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission
eLife 9:e58728.
https://doi.org/10.7554/eLife.58728
