First experience of COVID-19 screening of health-care workers in England

Hunter, Ewan; Price, David Ashley; Murphy, Elizabeth; Loeff, Ina Schim van der; Baker, Kenneth F.; Lendrem, Dennis; Lendrem, Clare; Schmid, Matthias; Pareja-Cebrian, Lucia; Welch, A. R.; Payne, Brendan; Duncan, Christopher

doi:10.1016/s0140-6736(20)30970-3

Cited by 294 publications

(347 citation statements)

References 3 publications

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“…Whilst the recent work by Hunter and colleagues (35) We hope our illustrative case series and recommendations can thus be applied to help manage these presentations of anosmia in the current climate until further evidence is available.…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

Anosmia as a presenting symptom of SARS-CoV-2 infection in healthcare workers – A systematic review of the literature, case series, and recommendations for clinical assessment and management

Lechner¹,

Chandrasekharan²,

Jumani³

et al. 2020

Rhin

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Background: Healthcare workers are at the forefront of the ongoing COVID-19 pandemic and are at high risk for both the contraction and subsequent spread of virus. Understanding the role of anosmia as an early symptom of infection may improve monitoring and management of SARS-CoV2 infection. Methodology:We conducted a systematic review of the literature of SARS-CoV2 infection/COVID-19 and anosmia to help inform management of anosmia in healthcare works. We report a case series of healthcare workers, who presented with a loss of sense of smell secondary to COVID-19 infection to demonstrate management principles. RT-PCR was used to confirm COVID-19 positivity and psychophysical testing of olfaction was performed using the British version of the University of Pennsylvania Smell Identification Test, UPSIT. Results:The systematic literature search returned 31 articles eligible for inclusion in the study and informed our recommendations for clinical assessment and management. All three healthcare professionals who presented with loss of sense of smell subsequently tested positive for SARS-CoV-2. Psychophysical testing of olfaction using the UPSIT confirmed mild and moderate microsmia in two, respectively, and normosmia at day 17 in one. Conclusions:Olfactory (± gustatory) dysfunction is indicative of COVID-19 infection and thus has important implications in the context of healthcare workers, or key workers in general, who work in close contact with others if not recognised as suffering from COVID. This leads to a potentially higher likelihood of spreading the virus. In conjunction with our literature review these findings have helped with creating recommendations on the assessment and management of olfactory dysfunction during the ongoing COVID-19 pandemic, both for healthcare workers and patients.

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Section: Discussion and Recommendationsmentioning

confidence: 99%

Anosmia as a presenting symptom of SARS-CoV-2 infection in healthcare workers – A systematic review of the literature, case series, and recommendations for clinical assessment and management

Lechner¹,

Chandrasekharan²,

Jumani³

et al. 2020

Rhin

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“…24,25 The overall proportion of COVID-19 positive tests in HCW was low and decreased during the study period corresponding with implementation of risk-mitigation measures in our health system such as the recommendations for universal masking and physical distancing but also followed the trend for non-HCW. Several of the previous studies of HCW risk for infection during the COVID-19 pandemic were limited by their sample sizes, [7][8][9] lack of generalizability for healthcare systems that have adequate access to PPE, 7-9 methodology relying on self-report, 12 limited ability to adjust for known risk factors of disease susceptibility and progression [7][8][9][10]12 and lacking data to investigate the relative effects of dual exposure of HCW to COVID-19 in the community versus the workplace. [7][8][9][10]12 The fact that HCW identi ed as patient-facing had a signi cantly higher odds for SARS-CoV-2 test positivity suggests an increased risk of COVID-19 infection with work exposure.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on healthcare workers risk of infection and outcomes in a large, integrated health system.

Misra‐Hebert

Jehi

et al. 2020

Preprint

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Background: Understanding the impact of the COVID-19 pandemic on healthcare workers (HCW) is crucial.Objective: Utilizing a health system COVID-19 research registry, we assessed HCW risk for COVID-19 infection, hospitalization and intensive care unit (ICU) admission.Design: Retrospective cohort study with overlap propensity score weighting.Participants: Individuals tested for SARS-CoV-2 infection in a large academic healthcare system (N=72,909) from March 8-June 9 2020 stratified by HCW and patient-facing status. Main Measures: SARS-CoV-2 test result, hospitalization, and ICU admission for COVID-19 infection. Key Results: Of 72,909 individuals tested, 9.0% (551) of 6,145 HCW tested positive for SARS-CoV-2 compared to 6.5% (4353) of 66,764 non-HCW. The HCW were younger than non-HCW (median age 39.7 vs. 57.5, p<0.001) with more females (proportion of males 21.5 vs. 44.9%, p<0.001), higher reporting of COVID-19 exposure (72 vs. 17 %, p<0.001) and fewer comorbidities. However, the overlap propensity score weighted proportions were 8.9 vs. 7.7 for HCW vs. non-HCW having a positive test with weighted odds ratio (OR) 1.17, 95% confidence interval (CI) 0.99-1.38. Among those testing positive, weighted proportions for hospitalization were 7.4 vs.15.9 for HCW vs. non-HCW with OR of 0.42 (CI 0.26-0.66) and for ICU admission: 2.2 vs.4.5 for HCW vs. non-HCW with OR of 0.48 (CI 0.20 -1.04). Those HCW identified as patient-facing compared to not had increased odds of a positive SARS-CoV-2 test (OR 1.60, CI 1.08-2.39, proportions 8.6 vs. 5.5), but no statistically significant increase in hospitalization (OR 0.88, CI 0.20-3.66, proportions 10.2 vs. 11.4) and ICU admission (OR 0.34, CI 0.01-3.97, proportions 1.8 vs. 5.2).Conclusions: In a large healthcare system, HCW had similar odds for testing SARS-CoV-2 positive, but lower odds of hospitalization compared to non-HCW. Patient-facing HCW had higher odds of a positive test. These results are key to understanding HCW risk mitigation during the COVID-19 pandemic.

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“…This approach has been exemplified by recent studies of symptomatic HCWs. 3,4 The 94 role of nosocomial transmission of SARS-CoV-2 is becoming increasingly recognised, accounting for 12-95 29% of cases in some reports. 5 Importantly, data suggest that the severity and mortality risk of nosocomial 96 transmission may be greater than for community-acquired COVID-19.…”

Section: Introduction 90mentioning

confidence: 99%

“…9 Screening also allows earlier return to work when individuals or their family 02 members test negative. 3,4 Another major consideration is the protection of vulnerable patients from a 03 potentially infectious workforce 6 , particularly as social distancing is not possible whilst caring for patients. 04…”

Section: Introduction 90mentioning

confidence: 99%

Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission

Rivett

Sridhar

Sparkes

et al. 2020

eLife

484

394

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75Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between 76 countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 77 3-week period (April 2020), 1,032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK 78 teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-79 time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the 80 asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly 81 asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus 82 disease 2019 (COVID-19) >7 days prior to testing, most self-isolating, returning well. Clusters of HCW 83 infection were discovered on two independent wards. Viral genome sequencing showed that the majority of 84HCWs had the dominant lineage B•1. Our data demonstrates the utility of comprehensive screening of 85HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital 86 staff. 87 88

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First experience of COVID-19 screening of health-care workers in England

Cited by 294 publications

References 3 publications

Anosmia as a presenting symptom of SARS-CoV-2 infection in healthcare workers – A systematic review of the literature, case series, and recommendations for clinical assessment and management

Anosmia as a presenting symptom of SARS-CoV-2 infection in healthcare workers – A systematic review of the literature, case series, and recommendations for clinical assessment and management

Impact of the COVID-19 pandemic on healthcare workers risk of infection and outcomes in a large, integrated health system.

Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission

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