Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19
- Cambridge University Hospitals NHS Trust, United Kingdom
- University of Cambridge, United Kingdom
- Public Health England (PHE), United Kingdom
- National Institutes for Health Research, United Kingdom
Abstract
Previously we showed that 31/1,032 (3%) asymptomatic healthcare workers (HCW) from a large teaching hospital in Cambridge UK tested positive for SARS-CoV-2 in April 2020. 26/169 (15%) HCWs with symptoms of coronavirus disease 2019 (COVID-19) also tested positive (Rivett et al., 2020). Here we show that the proportion of both asymptomatic and symptomatic HCWs testing positive rapidly declined to near-zero between 25th April and 24th May 2020, corresponding with a decline in patient admissions with COVID-19 during the ongoing UK 'lockdown'. These data demonstrate how infection prevention and control measures including staff testing may help prevent hospitals from becoming independent 'hubs' of SARS-CoV-2 transmission, and illustrate how, with appropriate precautions, organisations in other sectors may be able to resume on-site work safely.
Data availability
All data generated or analysed during this study are included in the manuscript and supporting files.
Article and author information
Author details
Nicholas J Matheson
Funding
Wellcome (108070/Z/15/Z)
- Michael P Weekes
Addenbrooke's Charitable Trust, Cambridge University Hospitals
- Paul J Lehner
Addenbrooke's Charitable Trust, Cambridge University Hospitals
- Ian G Goodfellow
NHS Blood and Transplant (WPA15-02)
- Nicholas J Matheson
National Institute for Health Research
- Gordon Dougan
National Institute for Health Research
- John R Bradley
National Institute for Health Research
- Afzal Chaudhry
Cancer Research UK (C38317/A24043)
- Jamie Young
Wellcome (215515/Z/19/Z)
- Stephen Baker
Wellcome (207498?Z/17/Z)
- Ian G Goodfellow
Wellcome (206298/B/17/Z)
- Ian G Goodfellow
Wellcome (210688/Z/18/Z)
- Paul J Lehner
Wellcome (200871/Z/16/Z)
- Kenneth G C Smith
Medical Research Council (MR/P008801/1)
- Nicholas J Matheson
Addenbrooke's Charitable Trust, Cambridge University Hospitals
- Michael P Weekes
Addenbrooke's Charitable Trust, Cambridge University Hospitals
- Stephen Baker
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Ethics
Human subjects: As a study of healthcare-associated infections, this investigation is exempt from requiring ethical approval under Section 251 of the NHS Act 2006 (see also the NHS Health Research Authority algorithm, available at http://www.hra-decisiontools.org.uk/research/, which concludes that no formal ethical approval is required). Our study was performed as a service evaluation of the Cambridge Universith Hospitals NHS Foundation Trust screening programme. The service provided was not changed in any way in order to undertake this evaluation.
Copyright
© 2020, Jones et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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Effective control of SARS-CoV-2 transmission between healthcare workers during a period of diminished community prevalence of COVID-19
eLife 9:e59391.
https://doi.org/10.7554/eLife.59391
Further reading
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- Epidemiology and Global Health
- Microbiology and Infectious Disease
The BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech) is being utilised internationally for mass COVID-19 vaccination. Evidence of single-dose protection against symptomatic disease has encouraged some countries to opt for delayed booster doses of BNT162b2, but the effect of this strategy on rates of asymptomatic SARS-CoV-2 infection remains unknown. We previously demonstrated frequent pauci- and asymptomatic SARS-CoV-2 infection amongst healthcare workers (HCWs) during the UK’s first wave of the COVID-19 pandemic, using a comprehensive PCR-based HCW screening programme (Rivett et al., 2020; Jones et al., 2020). Here, we evaluate the effect of first-dose BNT162b2 vaccination on test positivity rates and find a fourfold reduction in asymptomatic infection amongst HCWs ≥12 days post-vaccination. These data provide real-world evidence of short-term protection against asymptomatic SARS-CoV-2 infection following a single dose of BNT162b2 vaccine, suggesting that mass first-dose vaccination will reduce SARS-CoV-2 transmission, as well as the burden of COVID-19 disease.
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- Epidemiology and Global Health
- Medicine
Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3 week period (April 2020), 1032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19)>7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B∙1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff.
