Evidence map›Paper›PMID 32745512›Full record

Observational studyThe Lancet. Public health2020

Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study.

Long H Nguyen, David A Drew, Mark S Graham, Amit D Joshi, Chuan-Guo Guo, Wenjie Ma, Raaj S Mehta, Erica T Warner, Daniel R Sikavi, Chun-Han Lo and 22 more

3 registry-linked trialsOpen access · goldAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in The Lancet. Public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 1,167 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1,167citing papers in PubMed, 6 pooled it
175.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04331509 active not recruitingnot on this map

COVID-19 Symptom Tracker

TypeobservationalSponsorKing's College LondonRan2020 to 2026Enrolled10,000,000ConditionsCOVID-19ArmsNo Intervention
NCT04632537 phase3withdrawnnot on this map

Novel Use of an Existing Vaccine (BCG) Alliance: The NUEVA Trial

TypeinterventionalSponsorHenry M. Jackson Foundation for the Advancement of Military MedicineRan2020 to 2021Enrolled0ConditionsCOVID-19ArmsTice® BCG (for intravesical use) BCG LIVE strain of the BCG (Merck) vaccine, Preservative-free saline
NCT04937257 nacompletednot on this map

Comparison of a Virtual Reality Versus an E-Module on Efficacy of Donning and Doffing PPE: A Randomized Control Trial

TypeinterventionalSponsorMontefiore Medical CenterRan2020 to 2021Enrolled54ConditionsMedical TrainingArmsVirtual Reality, E-module
3 · Its place in the literature

Who cites it

1,167 citing papers in PubMed, 6 syntheses or guidelines pooled it, 2,283 citations in OpenAlex.

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1,107 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

32 authors at 6 institutions in 3 countries.

Long H NguyenDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA.
David A DrewDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Mark S GrahamSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
Amit D JoshiDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Chuan-Guo GuoDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China.
Wenjie MaDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA.
Raaj S MehtaDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA.
Erica T WarnerClinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Center on Genomics, Vulnerable Populations, and Health Disparities, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Daniel R SikaviDepartment of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Chun-Han LoDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
Sohee KwonDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Mingyang SongDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA.
Lorelei A MucciDepartment of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
Meir J StampferDepartment of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Walter C WillettDepartment of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA.
A Heather EliassenDepartment of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Jaime E HartDepartment of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Jorge E ChavarroDepartment of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Janet W Rich-EdwardsDepartment of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Richard DaviesZoe Global, London, UK.
Joan CapdevilaZoe Global, London, UK.
Karla A LeeDepartment of Twin Research and Genetic Epidemiology, King's College London, London, UK.
Mary Ni LochlainnDepartment of Twin Research and Genetic Epidemiology, King's College London, London, UK.
Thomas VarsavskySchool of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
Carole H SudreSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
M Jorge CardosoSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
Jonathan WolfZoe Global, London, UK.
Tim D SpectorDepartment of Twin Research and Genetic Epidemiology, King's College London, London, UK.
Sebastien OurselinSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
Claire J StevesDepartment of Twin Research and Genetic Epidemiology, King's College London, London, UK.
Andrew T ChanDivision of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Immunology and Infectious Disease, Harvard T H Chan School of Public Health, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA; Massachusetts Consortium on Pathogen Readiness, Cambridge, MA, USA. Electronic address: achan@mgh.harvard.edu.
COronavirus Pandemic Epidemiology Consortium
Harvard University · USKing's College London · GBMassachusetts General Hospital · USZOE (United Kingdom) · GBBrigham and Women's Hospital · USConcord Consortium · US

Funding

Translational Research Support CoreP30ES000002 · NIEHS · HARVARD UNIVERSITY (SCH OF PUBLIC HLTH) · PI Marc G Weisskopf · 1985 to 2026
$44.6M
Environmental and Genetic Risk Factors For Breast Cancer: The Sister StudyZIAES044005 · NIEHS · NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES · PI SANDLER, DALE P · 2009 to 2025
$22.7M
Life Course Cancer Epidemiology Cohort in WomenU01CA176726 · NCI · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · PI ELIASSEN, A. HEATHER, WILLETT, WALTER C. · 2018 to 2025
$22.4M
Long Term Multidisciplinary Study of Cancer in Women: The Nurses Health StudyUM1CA186107 · NCI · BRIGHAM AND WOMEN'S HOSPITAL · PI ELIASSEN, A. HEATHER, STAMPFER, MEIR · 2014 to 2023
$22.3M
Integrating lifecourse approaches, biologic and digital phenotypes in support of heart and lung disease epidemiologic researchU01HL145386 · NHLBI · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · PI CHAVARRO, JORGE EDUARDO, MANSON, JOANN ELISABETH · 2019 to 2025
$17.8M
Cancer Epidemiology Cohort in Male Health ProfessionalsU01CA167552 · NCI · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · PI Lorelei Mucci, Walter C. Willett · 2017 to 2026
$17.0M
Personalized Environment and Genes Study (PEGS)ZICES103354 · NIEHS · NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES · PI HALL, JANET · 2020 to 2024
$7.0M
Nurses Health Study 3: A multiple exposure environmental epidemiology cohort of young adultsR24ES028521 · NIEHS · HARVARD SCHOOL OF PUBLIC HEALTH · PI CHAVARRO, JORGE EDUARDO, LADEN, FRANCINE · 2018 to 2022
$2.1M
Impact of Aspirin on the Gut Microbiome and Mucosal MicroenvironmentK01DK120742 · NIDDK · MASSACHUSETTS GENERAL HOSPITAL · PI DREW, DAVID A · 2020 to 2024
$793k
British Heart Foundation SP/14/8/31352Department of Health NIHR300159EPA EP-W-17-011Medical Research Council MR/M016560/1NCI NIH HHS U01 CA167552NCI NIH HHS U01 CA176726NCI NIH HHS UM1 CA186107NHLBI NIH HHS U01 HL145386NIDDK NIH HHS K01 DK120742NIEHS NIH HHS P30 ES000002NIEHS NIH HHS R24 ES028521Wellcome TrustWellcome Trust T213038/Z/18/ZWellcome Trust WT203148/Z/16/ZWellcome Trust WT212904/Z/18/Z
6 · The paper itself

Abstract

backgroundData for front-line health-care workers and risk of COVID-19 are limited. We sought to assess risk of COVID-19 among front-line health-care workers compared with the general community and the effect of personal protective equipment (PPE) on risk.

methodsWe did a prospective, observational cohort study in the UK and the USA of the general community, including front-line health-care workers, using self-reported data from the COVID Symptom Study smartphone application (app) from March 24 (UK) and March 29 (USA) to April 23, 2020. Participants were voluntary users of the app and at first use provided information on demographic factors (including age, sex, race or ethnic background, height and weight, and occupation) and medical history, and subsequently reported any COVID-19 symptoms. We used Cox proportional hazards modelling to estimate multivariate-adjusted hazard ratios (HRs) of our primary outcome, which was a positive COVID-19 test. The COVID Symptom Study app is registered with ClinicalTrials.gov, NCT04331509.

findingsAmong 2 035 395 community individuals and 99 795 front-line health-care workers, we recorded 5545 incident reports of a positive COVID-19 test over 34 435 272 person-days. Compared with the general community, front-line health-care workers were at increased risk for reporting a positive COVID-19 test (adjusted HR 11·61, 95% CI 10·93-12·33). To account for differences in testing frequency between front-line health-care workers and the general community and possible selection bias, an inverse probability-weighted model was used to adjust for the likelihood of receiving a COVID-19 test (adjusted HR 3·40, 95% CI 3·37-3·43). Secondary and post-hoc analyses suggested adequacy of PPE, clinical setting, and ethnic background were also important factors.

interpretationIn the UK and the USA, risk of reporting a positive test for COVID-19 was increased among front-line health-care workers. Health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds. Additional follow-up of these observational findings is needed.

fundingZoe Global, Wellcome Trust, Engineering and Physical Sciences Research Council, National Institutes of Health Research, UK Research and Innovation, Alzheimer's Society, National Institutes of Health, National Institute for Occupational Safety and Health, and Massachusetts Consortium on Pathogen Readiness.

Indexed as

AdultClinical Laboratory TechniquesCoronavirus InfectionsCOVID-19COVID-19 TestingFemaleHealth PersonnelHumansInfectious Disease Transmission, Patient-to-ProfessionalMaleMiddle AgedMobile ApplicationsPandemicsPersonal Protective EquipmentPneumonia, ViralProspective Studies

Identifiers

PMID32745512
PMCPMC7491202
OpenAlexW3046400528

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.