Longitudinal Assessment of Symptoms and Risk of SARS-CoV-2 Infection in Healthcare Workers Across 5 Hospitals to Understand Ethnic Differences in Infection Risk

Abstract

Objective: To understand ethnic differences in SARS-CoV-2 infection risk and symptoms in hospital healthcare workers (HCW).Methods: A Prospective longitudinal observational cohort study. 1364 HCW at five UK hospitals were studied with up to 16 weeks of symptom questionnaires and antibody testing (to both nucleocapsid and spike protein) during the first UK wave in five NHS hospitals. The main outcome measures were SARS-CoV-2 infection (seropositivity at any time-point) and symptoms.Results: 272 of 1364 HCW (mean age 40.7 years, 72% female, 74% white, ≥6 samples per participant) seroconverted, reporting predominantly mild or no symptoms. Seropositivity was lower in ITU workers (OR=0.43 95%CI 0.24, 0.76; p=0.0033). Seropositivity was higher in black (compared to white) participants, independent of age, sex, role and index of multiple deprivation (OR=2.61 95%CI 1.47-4.62 p=0.0009). No association was seen with other ethnic groups. Conclusions: In the UK first wave, black ethnicity (but not other ethnicities) more than doubled HCW infection risk, independent of age, sex, measured socio-economic factors and role.Trial Registration: NCT04318314Funding Statement: Funding for the PANTHER study was from the UKRI/MRC (Cov-0331 - MR/V027883/1 ), with additional institutional support from the Nottingham NIHR BRC. Funding for COVIDsortium was donated by individuals, charitable Trusts, and corporations including Goldman Sachs, Citadel and Citadel Securities, The Guy Foundation, GW Pharmaceuticals, Kusuma Trust, and Jagclif Charitable Trust, and enabled by Barts Charity with support from UCLH Charity. Wider support is acknowledged on the COVIDsortium website. Institutional support from Barts Health NHS Trust and Royal Free NHS Foundation Trust facilitated study processes, in partnership with University College London and Queen Mary University London. Serology tests (anti-S1 and anti-NP) were funded by Public Health England. JCM, CMa and TAT are directly and indirectly supported by the University College London Hospitals (UCLH) and Barts NIHR Biomedical Research Centres and through the British Heart Foundation (BHF) Accelerator Award (AA/18/6/34223). TAT is funded by a BHF Intermediate Research Fellowship (FS/19/35/34374). MN is supported by the Wellcome Trust (207511/Z/17/Z) and by NIHR Biomedical Research Funding to UCL and UCLH. None of the aforementioned funding bodies have contributed to the design, collection, or analysis of the data.Declaration of Interests: None to declare. Ethics Approval Statement: The study was approved by a UK Research Ethics Committee (South Central - Oxford A Research Ethics Committee, reference 20/SC/0149).