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.
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.
Lancet Public Health. 2020 Sep;5(9):e475-e483. doi: 10.1016/S2468-2667(20)30164-X. Epub 2020 Jul 31.
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.
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.
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.
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.
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.
关于一线医护人员感染 COVID-19 的数据有限。我们旨在评估一线医护人员与普通人群相比感染 COVID-19 的风险，并评估个人防护设备（PPE）对风险的影响。
我们在英国和美国进行了一项针对普通人群（包括一线医护人员）的前瞻性观察队列研究，使用 COVID 症状研究智能手机应用程序（app）自 2020 年 3 月 24 日（英国）和 3 月 29 日（美国）至 4 月 23 日期间的自我报告数据。参与者自愿使用该应用程序，首次使用时提供了人口统计学因素（包括年龄、性别、种族或民族背景、身高和体重以及职业）和病史信息，随后报告了任何 COVID-19 症状。我们使用 Cox 比例风险模型来估计我们主要结局的多变量调整风险比（HR），主要结局是 COVID-19 检测阳性。COVID 症状研究应用程序已在 ClinicalTrials.gov 注册，编号为 NCT04331509。
在 2035395 名社区个体和 99795 名一线医护人员中，我们记录了 5545 例 COVID-19 检测阳性的发病报告，涉及 34435272 人日。与普通人群相比，一线医护人员报告 COVID-19 检测阳性的风险增加（调整后的 HR 11.61，95%CI 10.93-12.33）。为了考虑一线医护人员和普通人群之间检测频率的差异和可能的选择偏倚，我们使用逆概率加权模型来调整 COVID-19 检测的可能性（调整后的 HR 3.40，95%CI 3.37-3.43）。二级和事后分析表明，PPE 的充足性、临床环境和族裔背景也是重要因素。
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。医疗保健系统应确保 PPE 的充分供应，并制定额外的策略来保护医护人员免受 COVID-19 的侵害，特别是来自黑人和少数族裔背景的医护人员。需要对这些观察结果进行进一步随访。
Zoe 环球、惠康信托基金、工程和物理科学研究理事会、英国研究与创新署、阿尔茨海默病协会、美国国立卫生研究院、美国国立职业安全与健康研究所、马萨诸塞州病原体准备联盟。
