Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19
- 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
Previously we showed that 31/1,032 (3%) asymptomatic healthcare workers (HCW) from a large teaching hospital in Cambridge UK tested positive for SARS-CoV-2 in April 2020. 26/169 (15%) HCWs with symptoms of coronavirus disease 2019 (COVID-19) also tested positive (Rivett et al., 2020). Here we show that the proportion of both asymptomatic and symptomatic HCWs testing positive rapidly declined to near-zero between 25th April and 24th May 2020, corresponding with a decline in patient admissions with COVID-19 during the ongoing UK 'lockdown'. These data demonstrate how infection prevention and control measures including staff testing may help prevent hospitals from becoming independent 'hubs' of SARS-CoV-2 transmission, and illustrate how, with appropriate precautions, organisations in other sectors may be able to resume on-site work safely.
Data availability
All data generated or analysed during this study are included in the manuscript and supporting files.
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
Addenbrooke's Charitable Trust, Cambridge University Hospitals
- Ian G Goodfellow
NHS Blood and Transplant (WPA15-02)
- Nicholas J Matheson
National Institute for Health Research
- Gordon Dougan
National Institute for Health Research
- John R Bradley
National Institute for Health Research
- Afzal Chaudhry
Cancer Research UK (C38317/A24043)
- Jamie Young
Wellcome (215515/Z/19/Z)
- Stephen Baker
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
Medical Research Council (MR/P008801/1)
- Nicholas J Matheson
Addenbrooke's Charitable Trust, Cambridge University Hospitals
- Michael P Weekes
Addenbrooke's Charitable Trust, Cambridge University Hospitals
- Stephen Baker
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Reviewing Editor
- Jos WM van der Meer, Radboud University Medical Centre, Netherlands
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). Our study was performed as a service evaluation of the Cambridge Universith Hospitals NHS Foundation Trust screening programme. The service provided was not changed in any way in order to undertake this evaluation.
Version history
- Received: May 28, 2020
- Accepted: June 19, 2020
- Accepted Manuscript published: June 19, 2020 (version 1)
- Version of Record published: June 30, 2020 (version 2)
- Version of Record updated: September 21, 2020 (version 3)
Copyright
© 2020, Jones 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.
Metrics
-
- 3,694
- Page views
-
- 510
- Downloads
-
- 40
- Citations
Article citation count generated by polling the highest count across the following sources: Scopus, Crossref, PubMed Central.
Download links
A two-part list of links to download the article, or parts of the article, in various formats.
Downloads (link to download the article as PDF)
Open citations (links to open the citations from this article in various online reference manager services)
Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)
Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19
eLife 9:e59391.
https://doi.org/10.7554/eLife.59391
Further reading
-
- Epidemiology and Global Health
- Microbiology and Infectious Disease
The BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) is being utilised internationally for mass COVID-19 vaccination. Evidence of single-dose protection against symptomatic disease has encouraged some countries to opt for delayed booster doses of BNT162b2, but the effect of this strategy on rates of asymptomatic SARS-CoV-2 infection remains unknown. We previously demonstrated frequent pauci- and asymptomatic SARS-CoV-2 infection amongst healthcare workers (HCWs) during the UK’s first wave of the COVID-19 pandemic, using a comprehensive PCR-based HCW screening programme (Rivett et al., 2020; Jones et al., 2020). Here, we evaluate the effect of first-dose BNT162b2 vaccination on test positivity rates and find a fourfold reduction in asymptomatic infection amongst HCWs ≥12 days post-vaccination. These data provide real-world evidence of short-term protection against asymptomatic SARS-CoV-2 infection following a single dose of BNT162b2 vaccine, suggesting that mass first-dose vaccination will reduce SARS-CoV-2 transmission, as well as the burden of COVID-19 disease.
-
- Epidemiology and Global Health
- Medicine
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), 1032 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.
