NHS cleaners twice as likely to be infected with Covid-19 than frontline doctors

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Hospital cleaners are more than twice as likely to be infected by Covid than frontline NHS doctors and nurses, reveals new research.

Intensive care staff were the least likely hospital workers to contract the virus, according to the shock findings of a study conducted in the West Midlands at the height of the pandemic.

Researchers say the disparities could be down to the type of personal protective equipment (PPE) worn.

Their findings, published in the BMJ journal Thorax, could be particularly relevant for any second coronavirus surge or seasonal flu this winter.

Infection risk was highest among cleaners, acute and general medicine clinicians, and those of Black, Asian and Minority Ethnic (BAME) backgrounds at University Hospitals Birmingham NHS Foundation Trust (UHBFT).

The findings prompted the researchers to suggest that the type of PPE worn may be ‘key’ to the differences.

UHBFT is one of the biggest hospital trusts in Britain with more than 20,000 employees caring for 2.2 million people every year.

Study lead author Professor Alex Richter explained that, at the height of the pandemic, five patients with serious Covid-19 infection were being admitted every hour.

She said that, at the time, there was no national NHS staff testing capacity, so no way of knowing who was infected, and therefore at risk of passing the virus on to patients, or who had already had the infection.

Dr Richter said: “You’ve got to remember that we are all key workers, so travelling on public transport, and out and about.”

To find out, she offered to test staff with no COVID-19 symptoms for both current – throat and nose swabs to detect antigen – and previous – blood test to detect antibodies – infection.

Dr Richter said: “I’ve never recruited to a study so fast in my life. We recruited 545 staff in 20 hours.”

All the staff were at work over the course of 24 hours between Friday 24 and Saturday 25 of April, around a month after Britain went into lockdown.

They were asked to report any illnesses consistent with Covid-19 that they had had in the previous four months. Information on ethnicity and department of work was also collected.

Nearly one in 40 staff (2.3 per cent) with no symptoms tested positive for SARS-CoV-2, the virus responsible for Covid-19 infection. Of these, 38 per cent subsequently developed Covid-19 symptoms.

Just over a quarter of the 516 for whom serum samples were available said they had previously had symptoms consistent with Covid-19 infection.

Staff with previous symptoms were ‘significantly more likely’ to have antibodies (37 per cent) than those who hadn’t had symptoms (17 per cent). And they had higher levels of antibodies.

The overall prevalence of antibody positivity (seroprevalence) was 24 per cent, compared with six per cent generally in the Midlands at the time.

When the researchers looked at the figures by staff area, ‘striking’ differences in antibody positivity emerged.

Cleaners had the highest seroprevalence (34.5 per cent), followed by clinicians working in acute medicine (33 per cent) or general internal medicine (30 per cent).

The lowest seroprevalence was found among staff working in intensive care medicine (15 per cent), emergency medicine (13 per cent) and general surgery (also 13 per cent).

There was also an ethnic divide, according to the findings, with workers of BAME backgrounds nearly twice as likely to have already had the infection as their white colleagues.

Prof Richter, of the Clinical Immunology Service at University of Birmingham College of Medical and Dental Sciences, said: “We presumed intensive care workers would be at highest risk.

“But workers in ITU are relatively well protected compared with other areas.

“The reasons underlying this are likely to be multifactorial: in accordance with national guidelines, intensive care units were designated high-risk environments and the use of enhanced PPE including filtered face piece (class 3) respirators mandated.

“In contrast, fluid-resistant surgical masks were recommended in other clinical areas.”

Prof Richter said it was an observational study, and not all participants provided all the information requested. Nor is it known whether symptomless infection among staff puts hospital patients at risk.

However, she added: “Our data would support the assessment of widespread healthcare worker testing, including track and trace, on viral transmission during future waves of a pandemic.

“All these factors are important for considering what’s going to happen this winter.

“Cases are on the rise. Are we going to have another surge? If there is one, how do we protect healthcare workers this winter?

“And let’s think not just about SARS-CoV-2 and the lessons we can learn for other pandemics, but seasonal infection. Influenza has a massive impact on the NHS every winter.”

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