Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study.
Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study.
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DOI：
10.1101/2020.04.29.20084111
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发表时间：
2020-09-01
期刊：
影响因子：
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通讯作者：
Chan, Andrew T
中科院分区：
文献类型：
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作者：
Nguyen, Long H;Drew, David A;Chan, Andrew T
背景资料：一线医护人员（HCW）的数据和SARS-CoV-2感染的风险有限，个人防护设备（PPE）是否可以减轻这种风险尚不清楚。我们评估了一线医护人员与普通社区相比的COVID-19风险以及PPE的影响。方法：我们对普通社区进行了前瞻性队列研究，包括一线医护人员，他们从3月24日开始通过COVID症状研究智能手机应用程序报告信息（英国，英国）3月29日（美国）到2020年4月23日。我们使用考克斯比例风险模型来估计COVID-19检测阳性的多变量调整风险比（aHR）。结果：在2，035，395名社区个人和99，795名一线医务工作者中，我们记录了5，545起COVID-19检测阳性的事件报告，超过34，435，272人天。与一般社区相比，一线医务工作者报告阳性检测的aHR为11.6（95%CI：10.9至12.3）。使用逆概率加权考克斯模型调整接受检测的可能性，相应的aHR为3·40（95% CI：3·37至3·43）。一个基于神经网络的COVID-19预测分类器得出了类似的风险估计。与报告PPE充足的医务人员相比，报告PPE重复使用的医务人员报告阳性检测的aHR为1.46（95%CI：1.21至1.76），报告PPE不足的医务人员报告阳性检测的aHR为1.31（95%CI：1.10至1.56）。与报告有足够PPE但不护理COVID-19患者的医务人员相比，护理有记录的COVID-19患者的医务人员的aHR为4·83（95% CI：3.99至5.85）如果他们有足够的PPE，5.06（95% CI：3.90至6.57）对于重复使用的PPE，解释：一线医护人员感染COVID-19的风险显著增加，在重复使用PPE或无法充分获得PPE的医护人员中最高。然而，充足的个人防护设备供应并没有完全缓解高风险风险。Wellcome Trust，EPSRC，NIHR，UK Research and Innovation，Alzheimer's Society，NIH，NIOSH，马萨诸塞州病原体准备联盟背景：一线医护人员和COVID-19风险的数据有限。我们试图评估一线医护人员与一般社区相比感染COVID-19的风险，以及个人防护装备（PPE）对风险的影响。方法：我们在英国和美国的普通社区进行了一项前瞻性、观察性队列研究，包括一线卫生保健工作者，使用2020年3月24日（英国）和3月29日（美国）至4月23日的COVID症状研究智能手机应用程序（应用程序）的自我报告数据。参与者是该应用程序的自愿用户，首次使用时提供了有关人口统计学因素（包括年龄，性别，种族或民族背景，身高和体重以及职业）和病史的信息，随后报告了任何COVID-19症状。我们使用考克斯比例风险模型来估计我们的主要结局的多变量调整的风险比（HR），这是一个积极的COVID-19测试。COVID Symptom Study应用程序已在ClinicalTrials.gov注册，NCT 04331509。调查结果：在2 035 395名社区个人和99 795名一线卫生保健工作者中，我们在34 435 272人日内记录了5545起COVID-19阳性检测事件报告。 与一般社区相比，一线医护人员报告COVID-19检测阳性的风险增加（调整后HR 11.61，95%CI 10.93 - 12.33）。为了解释一线医护人员和普通社区之间检测频率的差异以及可能的选择偏倚，使用逆概率加权模型对接受COVID-19检测的可能性进行调整（调整后HR 3.40，95%CI 3.37 - 3.43）。次要和事后分析表明，PPE的充分性、临床环境和种族背景也是重要因素。解释：在英国和美国，一线医护人员报告COVID-19检测阳性的风险增加。卫生保健系统应确保个人防护设备的充足供应，并制定额外的战略，以保护卫生保健工作者免受COVID-19的影响，特别是那些来自黑人，亚洲和少数民族背景的人。基金：Zoe Global，Wellcome Trust，工程和物理科学研究理事会，国立卫生研究院，英国研究与创新，阿尔茨海默氏症协会，国立卫生研究院，国立职业安全与健康研究所和马萨诸塞州病原体准备联盟。
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.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.