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

Healthcare workers have higher risk of coronavirus (COVID-19 disease) than other workers. 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 (including students and volunteers) with different job-roles and departments from several NHS Trusts within the West Midlands – 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.

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.

Co-Investigators:

Research Fellow & Project Co-ordinator

 PPI advisors:

 Database and administrative support:

 

Coronavirus disease 2019 (COVID-19) is a new infectious respiratory disease caused by the SARS-CoV-2 virus. Healthcare workers (HCW) have higher risk of COVID-19 than other workers. Occupation-related risk may arise from high viral exposures in healthcare settings (concentration of severely affected patients) and/or HCW’s tasks (eg exposure to body fluids through tasks such as intubation).

Risk levels in work settings are not uniform. Higher infection rates have been found among workers in housekeeping and acute/internal medicine than those in intensive care, emergency and surgery. These variations may relate to differences in occupational exposure to infection or differences in access/use of infection protection measures. Individual/organisational factors (e.g. PPE shortages) may have hindered uptake of protective measures. Alternatively, the differences may reflect non-work factors, including lifestyle, sociodemographic (e.g. ethnicity, household and transport factors) and clinical characteristics (e.g. diabetes).

Understanding the relative contribution of occupational and non-work exposures and their interplay is important for worker protection and maintaining the resilience of the NHS. HCW (including the asymptomatic) are themselves also an important source of nosocomial and community transmissions, especially during lockdown when the risk of community transmission drops because of drastic social distancing. Knowledge of the risk of workplace transmission and subsequent community transmissions is crucial.

Within COPE- West Midlands we will:

1. Determine the relative importance of occupational, sociodemographic, home environment, lifestyle and clinical characteristics associated with risk of SARS-CoV-2 infection

2. Determine the relative contribution of specific occupational exposures /characteristics associated with higher risk of SARS-CoV-2 infection and identify points of critical risk

3. Explore facilitators and barriers to uptake of infection prevention measures in and outside the workplace

4. Describe the changes in proportion with SARS-CoV-2 infection, exposures, risk and protective behaviours among HCW as the COVID-19 pandemic progresses

5. Assess the durability of antibodies against SARS-COV-2 and immunity to reinfection

6. Establish a large scale, multicentre occupational cohort for testing future interventions related to COVID-19, influenza and other pathogens

There are five sub-studies to answer the objectives as shown in the diagram above (figure 1):

1. Retrospective case-control study of HCW who received PCR or lateral flow tests for COVID-19 or had relevant symptoms in March or April 2020 (when testing was not widely available)
2. Prospective case-control study of symptomatic HCW receiving new PCR tests for COVID-19
3. Sub-study of asymptomatic HCW
4. Sub-study of household members of participants reporting positive tests
5. Qualitative interviews/focus groups with i) HCW selected from case-control studies, and ii) family members

Recruitment for COPE-West Midlands will commence from September 2020.

COPE study privacy notice

This study arose partly from concerns and feedback from UHB staff who want to understand how to avoid COVID-19. We convened a specific PPI panel of staff in the development of this work and assigned a PPI group lead (Dr Margaret O’Hara). Since, we have expanded the PPI panel, who will advise on the project through the lifetime of the study. Areas in which we expect staff PPI input to be crucial are: information and other study materials, recruitment, potential sensitivities around management and different staff groups, interpretation of results, dissemination and public engagement.

 

COPE WM November 19 2021 webinar transcript

 

COPE WM July 7 2022 webinar recording transcript

Household member sub-study 

Please find links to the participant information sheets for this below: 

If you are a healthcare worker participant considering taking part in the household member sub-study please view ‘Healthcare worker participant information sheet for the household member sub-study’ 

If you are a household member of a healthcare worker who has agreed for their household to be part of the household member sub-study please view ‘Household member participant information sheet for the COPE-WM household member sub-study’ 

If you are already a participant in the household member sub-study and are considering taking part in the HHM interview study please download the information sheet.

Main study

Any employee, student or volunteer working at one of the West Midlands NHS Trusts listed below who has had a PCR or lateral flow swab test for COVID-19 or had relevant symptoms in March or April 2020 (when testing was not widely available), was eligible to take part in COPE-WM. Recruitment to the main study closed on 16th August 2021. 

• Birmingham and Solihull Mental Health NHS Foundation Trust
• Birmingham Women's and Children's NHS Foundation Trust
• Herefordshire and Worcestershire Health and Care Trust
• Midlands Partnership NHS Foundation Trust
• North Staffordshire Combined Healthcare NHS Trust
• Sandwell and West Birmingham NHS Trust
• Shropshire Community Health NHS Trust
• The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust
• The Royal Orthopaedic NHS Hospital Foundation Trust
• University Hospital Birmingham NHS Foundation Trust
• West Midlands Ambulance Service NHS Foundation Trust
• Worcestershire Acute Hospitals NHS Trust
• Wye Valley Trust

For details on how we will use information about you and your choices about how your information is used please view the COPE study additional information for participants.

Part of the COPE-WM study?  View the instructions for the dried blood spot test.

View a video of the dried blood spot antibody test being completed below 

Interested in collaborating or finding out more about COPE-WM?

Contact the main Chief Investigator Professor Peymane Adab: p.adab@bham.ac.uk