Healthcare Workers: an in depth virological analysis and behavioural study during the outbreak
Lead Research Organisation:
University College London
Department Name: UNLISTED
Abstract
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.
Technical Summary
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.
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.
Organisations
Publications
Ng KW
(2020)
Preexisting and de novo humoral immunity to SARS-CoV-2 in humans.
in Science (New York, N.Y.)
Aitken J
(2020)
Scalable and robust SARS-CoV-2 testing in an academic center.
in Nature biotechnology
Houlihan CF
(2020)
Pandemic peak SARS-CoV-2 infection and seroconversion rates in London frontline health-care workers.
in Lancet (London, England)
Rickman HM
(2021)
Nosocomial Transmission of Coronavirus Disease 2019: A Retrospective Study of 66 Hospital-acquired Cases in a London Teaching Hospital.
in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Faulkner N
(2021)
Reduced antibody cross-reactivity following infection with B.1.1.7 than with parental SARS-CoV-2 strains.
in eLife
Hellewell J
(2021)
Estimating the effectiveness of routine asymptomatic PCR testing at different frequencies for the detection of SARS-CoV-2 infections.
in BMC medicine
Rees-Spear C
(2021)
The effect of spike mutations on SARS-CoV-2 neutralization.
in Cell reports
Rosa A
(2021)
SARS-CoV-2 recruits a haem metabolite to evade antibody immunity.
in medRxiv : the preprint server for health sciences
Wilson-Aggarwal J
(2022)
Investigating healthcare worker mobility and patient contacts within a UK hospital during the COVID-19 pandemic
in Communications Medicine
Atti A
(2022)
Serological profile of first SARS-CoV-2 reinfection cases detected within the SIREN study.
in The Journal of infection
Wilson-Aggarwal JK
(2023)
Assessing spatiotemporal variability in SARS-CoV-2 infection risk for hospital workers using routinely-collected data.
in PloS one
Title | Logos/posters/masks |
Description | created above and a video for HCWs for SAFER and also explain ing immune responses to the virus and vaccination |
Type Of Art | Artwork |
Year Produced | 2021 |
Impact | Engagement with the study! |
Description | Asymptomatic screening |
Geographic Reach | National |
Policy Influence Type | Implementation circular/rapid advice/letter to e.g. Ministry of Health |
Impact | SAFER results on asymptomatic infection sand frequency of testing required are regularly communicated to NERVTAG and SAGE ; Influenced Initiation of national enhanced surveillance in HCWs |
Title | Protection from SARS-CoV-2 variants |
Description | Cross protection from cross-reacting antibodies to variants |
Type Of Material | Physiological assessment or outcome measure |
Year Produced | 2021 |
Provided To Others? | Yes |
Impact | Evidence on cross-protection; paper submitted to Nature Medicine |
Title | SARS-CoV-2 immune responses |
Description | Developed an array of serological methods for SAFER in order to detect immune response stolen natural SARS-CoV-2 infection and vaccination in HCWs |
Type Of Material | Antibody |
Year Produced | 2020 |
Provided To Others? | Yes |
Impact | An important finding on pre-existing cross-reacting antibodies published in Science |
Title | WGS for SARS-CoV-2 : outbreak analysis |
Description | Generated and used WGS data to investigate transmission within the hospital involving HCWs |
Type Of Material | Technology assay or reagent |
Year Produced | 2021 |
Provided To Others? | Yes |
Impact | manuscript submitted |
Title | Analysis of routinely available digital data of movement of HCWs |
Description | Digital data of movement from EHRS, eRoster , data fro card entry analysed using a novel statistical model and linkage with risk factors to infer on risk |
Type Of Material | Data analysis technique |
Year Produced | 2022 |
Provided To Others? | Yes |
Impact | Preprints will be available March 2022; we expect our approach will have a great impact in this area demonstrating the capabilities EHRS systems and data that are available and stored in these systems can be used in a clinically useful way to inform IC policies and flow within healthcare environments. |
Title | Behavioural analysis using the COM-B tool |
Description | Professor Michie developed the COM-B and the Behaviour Change Wheel framework to study behaviours and design interventions Utilising data from questionnaires from SAFER - the tool was utilised to aid interpretation of data |
Type Of Material | Data analysis technique |
Year Produced | 2022 |
Provided To Others? | Yes |
Impact | SAFER will be the first study where the tools will be used in HCW research and we expect a unique dataset that will inform further steps and research as well as inform policy |
Title | Digitisation of floors to aid spatial analysis and link with virological data |
Description | Utilising EHRS data all floors of UCLH have been digitised to aid spatial visualisation and analysis |
Type Of Material | Computer model/algorithm |
Year Produced | 2022 |
Provided To Others? | Yes |
Impact | Pre-prints by end of March 2022 |
Title | Modelling in SARS-CoV-2 asymptomatic infection |
Description | In collaboration with LSHTM developed modelling on frequency of PCR + in asymptomatic infection-guiding testing policies |
Type Of Material | Computer model/algorithm |
Year Produced | 2021 |
Provided To Others? | Yes |
Impact | Guided testing strategies; communicated to SAGE |
Description | Assessing infectivity and immune responses to breakthrough infections in HCWs |
Organisation | National Institute for Biological Standards and Control (NIBSC) |
Country | United Kingdom |
PI Contribution | Research questions and SAFER cohorts -all study design and implementation |
Collaborator Contribution | Lab support with cell culture and neutralisation |
Impact | Expected to report on these unique cohorts we followed up with breakthrough infections following vaccination. |
Start Year | 2021 |
Description | Developing sensitive flowcytometry , EIA and neutralisation to characterise immune responses of HCWs to SARS-CoV-2 |
Organisation | Francis Crick Institute |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Our team brought the virology expertise, the SAFER cohorts and provided the governance framework and all well characterised samples for the development |
Collaborator Contribution | State of the art infrastructure and basic scientists' time and input from senior PIs |
Impact | Important manuscripts in Nature Biotechnology, Science and the Lancet Informing policy via reports to NERVTAG and SAGE |
Start Year | 2020 |
Description | Expand movement study to incorporate dashboards including clinical data |
Organisation | University College London |
Department | i-Sense, UCL |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | SAFER study cohorts |
Collaborator Contribution | additional expertise in digital technologies |
Impact | engineers -medical- computing experts |
Start Year | 2021 |
Description | T-cell immune responses to SARS-CoV-2 in HCWs (SAFER study) |
Organisation | Imperial College London |
Department | Centre for Haematology |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Guiding the research questions around T-cell immunity in response to SARS CoV-2 in HCWs |
Collaborator Contribution | T-cell immunology expertise and lab set up |
Impact | All samples collected for analysis -hopefully to be completed in 2022 |
Start Year | 2021 |
Description | assessing risk of infection studying movement data |
Organisation | Alan Turing Institute |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | SAFER movement study |
Collaborator Contribution | collaboration on spatial analysis using machine learning |
Impact | expected outcomes in 2022 |
Start Year | 2021 |
Description | HCW NCL Group |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Other audiences |
Results and Impact | SAFER presentation in NCL BAME HCW Group |
Year(s) Of Engagement Activity | 2020 |
Description | SAFER workshop with HCWs on Risk Behaviours |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Study participants or study members |
Results and Impact | Workshop to discuss findings of Behavioural studies within SAFER. Audience ;UCLH HCWs |
Year(s) Of Engagement Activity | 2020 |