1. Healthcare workers in patient facing roles have a 3 times greater risk of being admitted for COVID-19, compared to the general population, and their household contacts have a 2 times greater risk.
2. When examining healthcare workers in all settings, the risk between healthcare workers and the general population is comparable.
Evidence Rating Level: 2 (Good)
Study Rundown: While workplaces around the world have begun limiting face-to-face contact during the COVID-19 pandemic, healthcare workers and their close contacts could be at increased risk of contracting SARS-CoV-2. Previous studies examining the risk of transmission in healthcare workers has been limited by sample size (single centre studies) and bias in reporting. The current retrospective cohort study used record linkage to collect data from all healthcare workers in Scotland, comparing hospital admission risk with COVID-19 for patient-facing versus non-patient facing roles, and across various healthcare settings. Overall, the study found that 1/6 of all COVID-19 hospital admissions were from healthcare workers and their household contacts. In particular, the risk in patient facing healthcare workers and their household contacts were 3 and 2 times greater respectively, compared to the general population, although the absolute risk was still low (0.5%). Limitations of this study include not being able to estimate COVID-19 mortality risk, (due to low mortality rates in this cohort), not separating out workers who had repeated contacted with COVID-19 patients, and the sample not being completely representative of ethnic minorities. Overall however, this study demonstrates that healthcare workers in patient facing roles, and their household contacts, are at elevated risk for COVID-19 hospital admissions, which has implications for public health interventions targeted toward this population.
In-depth [retrospective cohort study]: The study population consisted of 158,445 healthcare workers (78.7% female, 96.6% white) and 229,905 household members (38.4% female, 95.7% white). Each participant was categorized as patient facing (57.3%), non-patient facing (20.6%), or undetermined (22.2%). Furthermore, patient facing individuals were sorted into “front door” workers (e.g. paramedics and acute receiving), intensive care, non-intensive care with aerosol generation, and other. The primary outcome was the risk of a COVID-19 related hospital admission, defined as testing positive for SARS-CoV-2 during an admission or within 28 days prior to the admission. The risk from healthcare workers was compared to general population data from a previous Scottish case-control study: REACT-COVID-19. The current study found that overall, the risk between healthcare workers/household members and the general population was comparable (hazard ratio 0.81, 95% CI 0.52-1.26 and HR 0.86, 95% CI 0.49-1.51 respectively). However, patient facing workers and their household contacts were at higher risk (HR 3.30, 95% CI 2.13-5.13 and HR 1.79, 95% CI 1.10-2.91 respectively). Within this category, the most at risk were front door workers (HR 2.09, 95% CI 1.49-2.94).
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