Differential occupational risks to healthcare workers from SARS-CoV-2 observed during a prospective observational study
- University of Oxford, United Kingdom
- Oxford University Hospitals, United Kingdom
- Nuffield Department of Medicine, University of Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, United Kingdom
- Oxford University, United Kingdom
- Target Discovery Institute, University of Oxford, United Kingdom
Abstract
We conducted voluntary Covid-19 testing programmes for symptomatic and asymptomatic staff at a UK teaching hospital using naso-/oro-pharyngeal PCR testing and immunoassays for IgG antibodies. 1128/10,034(11.2%) staff had evidence of Covid-19 at some time. Using questionnaire data provided on potential risk-factors, staff with a confirmed household contact were at greatest risk (adjusted odds ratio [aOR] 4.82 [95%CI 3.45-6.72]). Higher rates of Covid-19 were seen in staff working in Covid-19-facing areas (22.6% vs. 8.6% elsewhere) (aOR 2.47 [1.99-3.08]). Controlling for Covid-19-facing status, risks were heterogenous across the hospital, with higher rates in acute medicine (1.52 [1.07-2.16]) and sporadic outbreaks in areas with few or no Covid-19 patients. Covid-19 intensive care unit staff were relatively protected (0.44 [0.28-0.69]), likely by a bundle of PPE-related measures. Positive results were more likely in Black (1.66 [1.25-2.21]) and Asian (1.51 [1.28-1.77]) staff, independent of role or working location, and in porters and cleaners (2.06 [1.34-3.15]).
Data availability
The data studied are available from the Infections in Oxfordshire Research Database (https://oxfordbrc.nihr.ac.uk/research-themes-overview/antimicrobial-resistance-and-modernising-microbiology/infections-in-oxfordshire-research-database-iord/), subject to an application and research proposal meeting the ethical and governance requirements of the Database. For further details on how to apply for access to the data and for a research proposal template please email iord@ndm.ox.ac.uk.
Article and author information
Author details
Bernadette C Young
Philip George Drennan
Alexander J Mentzer
Funding
UK Government: Department of Health and Social Care
- David W Eyre
- Sheila F Lumley
- Denise O'Donnell
- Mark Campbell
- Elizabeth Sims
- Elaine Lawson
- Fiona Warren
- Tim James
- Stuart Cox
- Alison Howarth
- George Doherty
- Stephanie B Hatch
- James Kavanagh
- Kevin K Chau
- Philip W Fowler
- Jeremy Swann
- Denis Volk
- Fan Yang-Turner
- Nicole Stoesser
- Philippa C Matthews
- Maria Dudareva
- Timothy Davies
- Robert H Shaw
- Leon Peto
- Louise O Downs
- Alexander Vogt
- Ali Amini
- Bernadette C Young
- Philip George Drennan
- Alexander J Mentzer
- Donal T Skelly
- Fredrik Karpe
- Matt J Neville
- Monique Andersson
- Andrew J Brent
- Nicola Jones
- Lucas Martins Ferreira
- Thomas Christott
- Brian D Marsden
- Sarah Hoosdally
- Richard Cornall
- Derrick W Crook
- David I Stuart
- Gavin Screaton
- Timothy EA Peto
- Bruno Holthof
- Anne-Marie O'Donnell
- Daniel Ebner
- Christopher P Conlon
- Katie Jeffery
- Timothy M Walker
Wellcome Trust Clinical Research Training Fellow (216417/Z/19/Z)
- Ali Amini
NIHR Clinical Lecturer
- Bernadette C Young
Structural Genomics Consortium
- Lucas Martins Ferreira
- Thomas Christott
- Brian D Marsden
Kennedy Trust for Rheumatology Research
- Brian D Marsden
Wellcome Trust Senior Investigator
- Gavin Screaton
Schmidt Foundation
- Gavin Screaton
Wellcome Trust Career Development Fellow (214560/Z/18/Z)
- Timothy M Walker
National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance (HPRU-2012-10041)
- David W Eyre
- Sheila F Lumley
- Denise O'Donnell
- Mark Campbell
- Elizabeth Sims
- Elaine Lawson
- Fiona Warren
- Tim James
- Stuart Cox
- Alison Howarth
- George Doherty
- Stephanie B Hatch
- James Kavanagh
- Kevin K Chau
- Philip W Fowler
- Jeremy Swann
- Denis Volk
- Fan Yang-Turner
- Nicole Stoesser
- Philippa C Matthews
- Maria Dudareva
- Timothy Davies
- Robert H Shaw
- Leon Peto
- Louise O Downs
- Alexander Vogt
- Ali Amini
- Bernadette C Young
- Philip George Drennan
- Alexander J Mentzer
- Donal T Skelly
- Fredrik Karpe
- Matt J Neville
- Monique Andersson
- Andrew J Brent
- Nicola Jones
- Lucas Martins Ferreira
- Thomas Christott
- Brian D Marsden
- Sarah Hoosdally
- Richard Cornall
- Derrick W Crook
- David I Stuart
- Gavin Screaton
- Timothy EA Peto
- Bruno Holthof
- Anne-Marie O'Donnell
- Daniel Ebner
- Christopher P Conlon
- Katie Jeffery
- Timothy M Walker
Robertson Foundation
- David W Eyre
NIHR Oxford BRC Senior Fellow
- David W Eyre
- Philippa C Matthews
Wellcome Trust Clinical Research Fellow
- Sheila F Lumley
Medical Research Council (MR/N00065X/1)
- David I Stuart
Wellcome Trust Intermediate Fellowship (110110/Z/15/Z)
- Philippa C Matthews
NIHR Doctoral Research Fellow
- Maria Dudareva
Medical Research Foundation (MRF-145-004-TPG-AVISO)
- Kevin K Chau
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Reviewing Editor
- Marc Lipsitch, Harvard TH Chan School of Public Health, United States
Ethics
Human subjects: All asymptomatic staff data collection and testing were part of enhanced hospital infection prevention and control measures instituted by the UK Department of Health and Social Care (DHSC). Deidentified data from staff testing and patients were obtained from the Infections in Oxfordshire Research Database (IORD) which has generic Research Ethics Committee, Health Research Authority and Confidentiality Advisory Group approvals (19/SC/0403, ECC5-017(A)/2009). De-identified patient data extracted included admission and discharge dates, ward location and positive Covid-19 test results.
Version history
- Received: July 2, 2020
- Accepted: August 18, 2020
- Accepted Manuscript published: August 21, 2020 (version 1)
- Version of Record published: September 11, 2020 (version 2)
Copyright
© 2020, Eyre 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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Differential occupational risks to healthcare workers from SARS-CoV-2 observed during a prospective observational study
eLife 9:e60675.
https://doi.org/10.7554/eLife.60675
Further reading
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- Epidemiology and Global Health
Paxlovid, a SARS-CoV-2 antiviral, not only prevents severe illness but also curtails viral shedding, lowering transmission risks from treated patients. By fitting a mathematical model of within-host Omicron viral dynamics to electronic health records data from 208 hospitalized patients in Hong Kong, we estimate that Paxlovid can inhibit over 90% of viral replication. However, its effectiveness critically depends on the timing of treatment. If treatment is initiated three days after symptoms first appear, we estimate a 17% chance of a post-treatment viral rebound and a 12% (95% CI: 0%-16%) reduction in overall infectiousness for non-rebound cases. Earlier treatment significantly elevates the risk of rebound without further reducing infectiousness, whereas starting beyond five days reduces its efficacy in curbing peak viral shedding. Among the 104 patients who received Paxlovid, 62% began treatment within an optimal three-to-five-day day window after symptoms appeared. Our findings indicate that broader global access to Paxlovid, coupled with appropriately timed treatment, can mitigate the severity and transmission of SARS-Cov-2.
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- Epidemiology and Global Health
Background:
Circulating omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) have been associated with various chronic diseases and mortality, but results are conflicting. Few studies examined the role of omega-6/omega-3 ratio in mortality.
Methods:
We investigated plasma omega-3 and omega-6 PUFAs and their ratio in relation to all-cause and cause-specific mortality in a large prospective cohort, the UK Biobank. Of 85,425 participants who had complete information on circulating PUFAs, 6461 died during follow-up, including 2794 from cancer and 1668 from cardiovascular disease (CVD). Associations were estimated by multivariable Cox proportional hazards regression with adjustment for relevant risk factors.
Results:
Risk for all three mortality outcomes increased as the ratio of omega-6/omega-3 PUFAs increased (all Ptrend <0.05). Comparing the highest to the lowest quintiles, individuals had 26% (95% CI, 15–38%) higher total mortality, 14% (95% CI, 0–31%) higher cancer mortality, and 31% (95% CI, 10–55%) higher CVD mortality. Moreover, omega-3 and omega-6 PUFAs in plasma were all inversely associated with all-cause, cancer, and CVD mortality, with omega-3 showing stronger effects.
Conclusions:
Using a population-based cohort in UK Biobank, our study revealed a strong association between the ratio of circulating omega-6/omega-3 PUFAs and the risk of all-cause, cancer, and CVD mortality.
Funding:
Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institute of Health under the award number R35GM143060 (KY). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
