Healthcare Workers: an in depth virological analysis and behavioural study during the outbreak

Coronaviruses transmit easily, the disease is highly infectious and can lead to serious illness and death. Healthcare workers becoming ill in large numbers would have a huge impact on health care provision. Bed shortages in over-stretched hospitals are common and the additional burden from coronavirus could bring staff to breaking point. We had a unique opportunity in 2017/8 to investigate healthcare workers at University College London Hospitals (UCLH) infected with influenza compared to those who were well. There is lack of evidence around the risk of coronavirus so we now propose a study that will examine the rates at which healthcare workers become infected with coronavirus in three wards and A/E at UCLH, using the same methods as before. We will also interview healthcare workers to find out their challenges in preventing infection spreading to themselves, other staff and patients, while working during a novel pathogen outbreak. We will use antigen tests to rapidly screen them to see if they are infected with coronavirus, and complement these with antibody tests. This information will add significantly to the understanding of staff health and safety, hospital infection prevention and control, and will improve the evidence-base for the protection of patients and staff.

This COVID-19 Rapid Response award is jointly funded (50:50) between the Medical Research Council and the National Institute for Health Research. The figure displayed is the total award amount of the two funders combined, with each partner contributing equally towards the project.

The further spread of the novel coronavirus SARS-CoV-2 outside China, causing coronavirus disease (COVID-19) globally has led to an outbreak that WHO announced 12 March 2020 as a pandemic. The role of Healthcare Workers (HCWs) in managing the outbreak is critical, while working in a setting where they may be inadvertently exposed to SARS-CoV-2, and WHO has prioritised research on how best to protect them from infection and disease. The similar “Public Health Emergencies of International Concern” caused by Zika and Ebola highlighted another important aspect: the need to integrate social sciences research into the outbreak response and to address ethical questions around studies and data sharing, in this context involving HCWs. With our proposal, we aim to integrate three key priorities in a unique way. We will leverage existing funding and our experience within the ICONIC study, funded by the Wellcome Trust/DoH (2014-18). We propose an in-depth analysis of risk of infection with SARS-CoV-2 in HCWs including longitudinal sampling, tracking of movement and studies of behaviours and influences on them (capability, opportunity and motivation). We will perform a virological analysis of infected patients with serial samples to construct a detailed analysis of transmission clusters. The latter will provide valuable clinical data on virus shedding. Finally, we propose to address the ethical questions around the use of apps and wearables, data sharing and conducting studies during an outbreak to produce a set of definitive recommendations for policy makers.