COPE Study

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. The team aimed to invite about 5000 staff (including students and volunteers) with different job-roles and departments from several NHS Trusts within the West Midlands to join the study. These included workers who had a COVID-19 test because of symptoms. The team also invited some workers with no symptoms.

The team then compared workplace exposures and other characteristics amongst those who had positive with those who had negative tests. The aim was for the findings to help better understand the risk of infection among healthcare workers and to develop guidelines to reduce risk.

Co-investigators

• Professor Rachel Jordan
• Professor KK Cheng
• Dr Kiran Rai
• Dr Ruth Riley
• Professor Alice Sitch
• Professor Steven Sadhra
• Dr Neeraj Bhala
• Dr Raoul Reulen
• Dr Mark Garvey

Research Fellow and Project Co-ordinator

• Dr Emma Lancashire

Database and administrative support

• David Alexander
• Karen Jones
• Anne Walker

Coronavirus disease 2019 (COVID-19) is an 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 the team looked at:

1. Determining the relative importance of occupational, sociodemographic, home environment, lifestyle and clinical characteristics associated with risk of SARS-CoV-2 infection
2. Determining the relative contribution of specific occupational exposures /characteristics associated with higher risk of SARS-CoV-2 infection and identifying points of critical risk
3. Exploring facilitators and barriers to uptake of infection prevention measures in and outside the workplace
4. Describing the changes in proportion with SARS-CoV-2 infection, exposures, risk and protective behaviours among HCW as the COVID-19 pandemic progresses
5. Assessing the durability of antibodies against SARS-COV-2 and immunity to reinfection
6. Establishing a large scale, multicentre occupational cohort for testing future interventions related to COVID-19, influenza and other pathogens.

There were five sub-studies to answer the objectives:

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 commenced in September 2020.

Read the COPE study's 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.

Watch the COPE-WM November 2021 webinar recording

Watch the COPE-WM July 2022 webinar recording

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

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

Telephone: +44(0)121 414 3151

Email: cope-wm@contacts.bham.ac.uk

Twitter: @CopeWestMids