COPE-Birmingham: The contribution of occupational exposures to risk of COVID-19 and approaches to control among healthcare workers

Healthcare workers have higher risk of getting coronavirus (COVID-19 disease). Contact with infected patients, the type of work and measures such as use of masks affect their risk. However, factors outside the workplace are also important. For example, being older, from minority ethnic groups, some health conditions and home circumstances increase risk. We don't know how these aspects compare with workplace risks, or which work exposures are most risky.

We will invite about 5000 staff with different job-roles and departments from three large West Midlands NHS Trusts (University Hospitals Birmingham, Birmingham Women's and Children's and The West Midlands Ambulance Trust) to join our study. These will include workers who had a COVID-19 test because of symptoms. We will also invite some workers with no symptoms. Participants will be asked to complete a questionnaire covering:
- type and nature of work
- extent and nature of contact with COVID-19 patients (direct, cleaning, transport etc)
- ability to comply with recommended infection control procedures
- home/family circumstances
- travel patterns
- personal data and health conditions

We will compare workplace exposures and other characteristics amongst those who had positive with those who had negative tests.

Our findings will help us to better understand the risk of infection among healthcare workers and to develop guidelines to reduce risk.

Occupational exposures may contribute to higher risk of COVID-19 disease among healthcare workers (HCW). Using two linked case control studies, we aim to estimate the relative importance of occupational exposures and non-workplace related factors in risk of infection. Additional longitudinal follow-up of the participants will allow us to examine risks among asymptomatic carriers, determine antibody durability and track the pandemic evolution in HCW.

We will recruit 5000 HCW from diverse backgrounds and job-roles within three large NHS Trusts in West Midlands. Participants will include HCW with COVID-19 symptoms and have had PCR tests, as well as 1000 of those without symptoms. Cases are HCW with positive PCR results and controls will be a matched sample of those tested negative. We will collect data on personal and health characteristics, type/nature of work, extent and type of interaction with COVID-19 patients, and ability to use recommended infection control procedures. Those with positive tests will be asked about symptoms in household members and the symptomatic ones will be tested for SARS-CoV-2. We will compare occupational and other characteristics by PCR status to examine the relative contribution of occupational and non-workplace risk factors. Participants will be followed up, with blood tests for SARS-CoV-2 antibodies at 3-months and repeated at 6 months.

Using interviews with up to 30 purposively selected staff and 20 managers, we will explore access to and use of infection control procedures, to understand any barriers or facilitators.

The findings will inform future workplace policies and resource allocation decisions.