COVID-19 Screening of Health Care Workers in England

Quick Takes

  • Current isolation protocols and PPE appear sufficient to prevent high levels of nosocomial transmission to frontline staff in England.
  • These data also suggest that testing might have positive effects on health behavior, by providing health care workers with the confidence that they can self-isolate with mild symptoms, knowing that a rapid negative result will enable them to return to work in a timely manner.
  • Testing might lessen the desire of staff with mild symptoms to soldier on, in fear of abandoning colleagues for 7–14 days, thereby inadvertently contributing to nosocomial transmission.

Study Questions:

What is the experience of COVID-19 screening of health care workers in England?

Methods:

The investigators adapted a pathway previously implemented for community testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the so-called containment phase of the United Kingdom (UK) response to the coronavirus disease 2019 (COVID-19) outbreak. In this model, staff (mainly hospital employees but also local general practitioners) contact Occupational Health by email. An initial symptom screen is done, and staff with compatible symptoms (i.e., new continuous cough or fever) are appointed to testing in a designated screening pod, staffed by trained nurses, within 24 hours. Combined nose and throat swabs are taken for SARS-CoV-2 RT-PCR (RdRp assay; Public Health England), and written advice about self-isolation is provided. The results are conveyed within 24 hours, again via email. Since March 10, 2020, the Newcastle upon Tyne Hospitals National Health Service Foundation Trust has been screening symptomatic health care workers for SARS-CoV-2. North East Ambulance Service staff are also tested and were included in this analysis.

Results:

Between March 10 and 31, 2020, the investigators did 1,666 SARS-CoV-2 tests in 1,654 staff. Overall, SARS-CoV-2 was detected in 240 (14%) tests. The mean age of those testing positive (41.7 [standard deviation, 12.1] years) or negative (40.6 [11.5] years) was similar (t-test, p = 0.168). Twelve staff were retested due to recurrent symptoms (mean interval, 8 days; range, 2-18). In one of these cases, repeat testing at 14 days resulted in detection of SARS-CoV-2. Initially, positivity rates were relatively low, as 2 (5%) of 38 staff tested on March 10–11, but rose steadily throughout the testing period, to 29 (20%) of 146 staff tested on March 30–31, the last 2 days before analysis.

Conclusions:

The authors concluded that current isolation protocols and personal protective equipment (PPE) appear sufficient to prevent high levels of nosocomial transmission to frontline staff.

Perspective:

These data provide several important insights into the COVID-19 epidemic in England. Given that nonclinical staff had similar positivity rates to frontline staff, it appears that current isolation protocols and PPE appear sufficient to prevent high levels of nosocomial transmission to frontline staff in their setting. The investigators observed a shift in transmission dynamics around March 24, concurrent with steps taken by the UK Government to implement social distancing: Schools were closed on March 20, with more widespread measures to close nonessential shops, pubs, and restaurants and limit public transport following on March 23. Although it is not possible to assign causality, it seems that these social distancing measures affected community transmission of SARS-CoV-2 in England.

Clinical Topics: Prevention

Keywords: Coronavirus, Cough, COVID-19, Electronic Mail, Fever, General Practitioners, Nurses, Occupational Health, Personal Protective Equipment, Primary Prevention, Public Health, RNA Replicase, SARS Virus


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