Risk of hospital admission with covid-19 among teachers compared with healthcare workers and other adults of working age in Scotland, March 2020 to July 2021: population based case-control study

Abstract

Objective To determine the risk of hospital admission with covid-19 and severe covid-19 among teachers and their household members, overall and compared with healthcare workers and adults of working age in the general population. Design Population based nested case-control study. Setting Scotland, March 2020 to July 2021, during defined periods of school closures and full openings in response to covid-19. Participants All cases of covid-19 in adults aged 21 to 65 (n=132 420) and a random sample of controls matched on age, sex, and general practice (n=1 306 566). Adults were identified as actively teaching in a Scottish school by the General Teaching Council for Scotland, and their household members were identified through the unique property reference number. The comparator groups were adults identified as healthcare workers in Scotland, their household members, and the remaining general population of working age. Main outcome measures The primary outcome was hospital admission with covid-19, defined as having a positive test result for SARS-CoV-2 during hospital admission, being admitted to hospital within 28 days of a positive test result, or receiving a diagnosis of covid-19 on discharge from hospital. Severe covid-19 was defined as being admitted to intensive care or dying within 28 days of a positive test result or assigned covid-19 as a cause of death. Results Most teachers were young (mean age 42), were women (80%), and had no comorbidities (84%). The risk (cumulative incidence) of hospital admission with covid-19 was <1% for all adults of working age in the general population. Over the study period, in conditional logistic regression models adjusted for age, sex, general practice, race/ethnicity, deprivation, number of comorbidities, and number of adults in the household, teachers showed a lower risk of hospital admission with covid-19 (rate ratio 0.77, 95% confidence interval 0.64 to 0.92) and of severe covid-19 (0.56, 0.33 to 0.97) than the general population. In the first period when schools in Scotland reopened, in autumn 2020, the rate ratio for hospital admission in teachers was 1.20 (0.89 to 1.61) and for severe covid-19 was 0.45 (0.13 to 1.55). The corresponding findings for household members of teachers were 0.91 (0.67 to 1.23) and 0.73 (0.37 to 1.44), and for patient facing healthcare workers were 2.08 (1.73 to 2.50) and 2.26 (1.43 to 3.59). Similar risks were seen for teachers in the second period, when schools reopened in summer 2021. These values were higher than those seen in spring/summer 2020, when schools were mostly closed. Conclusion Compared with adults of working age who are otherwise similar, teachers and their household members were not found to be at increased risk of hospital admission with covid-19 and were found to be at lower risk of severe covid-19. These findings should reassure those who are engaged in face-to-face teaching.

Was the risk of death among the population of teachers and other school workers in England and Wales due to COVID-19 and all causes higher than other occupations during the pandemic in 2020? An ecological study using routinely collected data on deaths from the Office for National Statistics

“…The data we examined from ONS are consistent with the Public Health Scotland study 2 and with the Swedish study 7 which both showed similar or lower risk of hospitalisations due to COVID-19 among teachers compared with other occupations, but our findings are also compatible with a slightly higher risk of COVID-19 mortality among secondary school teachers. Mutambudzi and colleagues 17 investigated the risk of hospitalisation or death by occupation after testing positive for COVID-19 among 120 075 working participants (aged 49–64 years) in the UK Biobank study; they found weak evidence of more hospitalisations or deaths with COVID-19 among education workers compared with non-essential workers up to July 2020 (OR 1.59, 95% CI 0.87 to 2.91) after adjusting for potential confounders.…”

“…Whether or not teachers and others working in schools are at higher risk of COVID-19 as a result of schools being open is central to decisions on school closures, but until recently there has not been good data on this. Record linkage studies carried out in Scotland 2 and Finland 3 show that teachers had a greater risk of being diagnosed as a COVID-19 case compared with the general population when schools were open; there was a 40% higher risk of COVID-19 among teachers in the Scottish study, and between 50% and 70% higher risk in the Finnish study. A study in Sweden found that teachers delivering in-person teaching had a twofold higher risk of COVID-19 infection compared with those who were teaching remotely.…”

“…Analyses of more robust outcomes such as hospitalisation from COVID-19 are less susceptible to detection bias and may be more reliable. The Scottish study 2 found teachers and their household members were at a lower risk of being hospitalised with COVID-19 compared with adults of working age in the general population after matched on age, sex and general practice registration and adjusted for ethnicity, deprivation, comorbidity counts and sharing a household with a healthcare worker. Sweden has been an outlier in the COVID-19 pandemic in that schools have remained open for children up to 16 years of age.…”

Reinfection with SARS-CoV-2: outcome, risk factors and vaccine efficacy in a Scottish cohort

“…Using the Common Healthcare Identifier (CHI) held on all Scottish health records these individuals were linked to the population register, the national vaccination database, registers of teachers and health care workers, the list of those designated as clinically extremely vulnerable (eligible for shielding), the ECOSS database of test results, a database of hospitalisations (RAPID) that is updated daily, dispensed prescriptions in primary care and death registrations as described elsewhere [4][5][6][7]. As described elsewhere individuals were clasified into three categories of clinical risk: no risk condition, designated moderate risk condition, and clinically extremely vulnerable [6].…”

Education Attainment, Intelligence and COVID-19: A Mendelian Randomization Study

“…Alternatively, if intelligence affects the risk of COVID-19 outcomes independently of education attainment, or intelligence mediates the education-COVID-19 association, provision of adequate training to improve the cognitive functions might be more effective in combating COVID-19. Meanwhile, a very recent population-based case-control study in Scotland showed that teachers were subjected to a reduced risk of COVID-19 related hospital admission and severe COVID-19 when compared to the general population [ 15 ]. We hypothesize that their higher education attainment or intelligence may be the causes for much lower risk.…”