Correspondence
First experience of 1654 staff. Overall, SARS-CoV-2 was roles, most staff were in group 1
detected in 240 (14%) tests. The (834 [81%] of 1029), with a minority
COVID-19 screening of mean age of those testing positive in groups 2 (86 [8%]) or 3 (109 [11%]). Published Online
health-care workers in (41·7 years [SD 12·1]) or negative We hypothesised that staff in patient- April 22, 2020
https://doi.org/10.1016/
England (40·6 years [11·5]) was similar (t test facing roles would experience a S0140-6736(20)30970-3
p=0·168). 12 staff were retested due higher rate of SARS-CoV-2 infection,
Since March 10, 2020, the Newcastle to recurrent symptoms (mean although comparison of positivity
upon Tyne Hospitals National Health interval 8 days, range 2–18). In one of rates by χ² test yielded no evidence of
Service (NHS) Foundation Trust these cases, repeat testing at 14 days a significant difference between these
has been screening symptomatic resulted in detection of SARS-CoV-2. groups (group 1: 128 [15%] of 834;
health-care workers for severe Initially, positivity rates were relatively group 2: 14 [16%] of 86; group 3:
acute respiratory syndrome (SARS) low, at two (5%) of 38 staff tested 20 [18%] of 109; group 1 vs group 2:
coronavirus 2 (SARS-CoV-2). Our on March 10–11, but rose steadily odds ratio 1·08, 95% CI 0·59–1·97;
decision was based on the following throughout the testing period, to group 1 vs group 3: 1·24, 0·74–2·09;
rationale: to maintain the health 29 (20%) of 146 staff tested on p=0·71), suggesting that nosocomial
and welfare of our staff; to enable March 30–31, the last 2 days before transmission from patients to staff
rapid identification and isolation of analysis. Inspection of the epidemic was not an important factor. This is
infected health-care workers so as curve suggested a period of expo consistent with observations in China,
to protect patients and the wider nential growth from March 10 until where staff testing was widespread.2
community, given that nosocomial around March 24, with a doubling These data provide several import
transmission has been recognised as time of 2·2 days (95% CI 2·0–2·4; ant insights into the COVID-19
an important amplifier in epidemics of appendix). From March 24 onwards, epidemic in England. Given that non- See Online for appendix
both SARS and Middle East respiratory the rate of increase appeared linear. clinical staff had similar positivity
syndrome; 1 and to enable more Consistent with these observations, rates to frontline staff, we conclude
rapid return to work of staff during we could fit an exponential line to that current isolation protocols and
this challenging period for the NHS. the data from March 10 to March 24 personal protective equipment appear
Importantly, we judged that we had (r²=0·99), whereas data after that date sufficient to prevent high levels of
sufficient capacity within our service conformed to a linear model (r²=0·99). nosocomial transmission to frontline
to absorb this additional testing. These data indicate a notable change staff in our setting. Rather, the data
We adapted a pathway previously in transmission dynamics occurring appear to reflect wider patterns of
implemented for community testing around March 24. Social distancing community transmission. Due to the
for SARS-CoV-2 during the so-called measures were implemented by the national testing strategy during the
containment phase of the UK response UK Government on March 20 (school analysis period, no data are available
to the coronavirus disease 2019 closures) and March 23 (widespread on community spread of SARS-CoV-2
(COVID-19) outbreak. In our model, closures or restrictions of businesses in non-hospitalised populations in
staff (mainly hospital employees and transport). England; thus, our dataset is highly
but also local general practitioners) To explore the occupational roles informative. We observed a shift
contact Occupa t ional Health by of staff that underwent testing, we in transmission dynamics around
email. An initial symptom screen cross-referenced virological data with a March 24, concurrent with steps
is done, and staff with compatible prospectively maintained Occupational taken by the UK Government to
symptoms (ie, new continuous cough Health database. Although data were implement social distancing: schools
or fever) are appointed to testing in a incomplete, we were able to identify were closed on March 20, with more
designated screening pod, staffed by staff roles for 1029 staff tested, widespread measures to close non-
trained nurses, within 24 h. Combined categorising them into three groups: essential shops, pubs, and restaurants
nose and throat swabs are taken for (1) directly patient facing (eg, nurses, and limit public transport following
SARS-CoV-2 RT-PCR (RdRp assay; doctors, allied health professionals, on March 23. Although it is not
Public Health England), and written porters, etc), (2) non-patient facing but possible to assign causality, it seems
advice about self-isolation is provided. potentially at higher risk of nosocomial plausible that these measures have
The results are conveyed within 24 h, exposure (eg, domestic and laboratory affected community transmission of
again via email. North East Ambulance staff), and (3) non-clinical (eg, clerical, SARS-CoV-2 in our region.
Service staff are also tested in our Trust administrative, information technol Our testing protocol has enabled Submissions should be
made via our electronic
and were included in this analysis. ogy, secretarial, etc). 1414 health-care workers to return submission system at
Between March 10 and 31, 2020, As the screening criteria initially more rapidly to NHS service in the past http://ees.elsevier.com/
we did 1666 SARS-CoV-2 tests in prioritised those in patient-facing 3 weeks, the vast majority returning thelancet/
www.thelancet.com Published online April 22, 2020 https://doi.org/10.1016/S0140-6736(20)30970-3 1
Correspondence
to direct patient care. Beyond this Ewan Hunter, David A Price,
obvious benefit, we speculate that Elizabeth Murphy,
testing might have additional positive Ina Schim van der Loeff,
effects on health behaviour, by Kenneth F Baker, Dennis Lendrem,
providing health-care workers with the Clare Lendrem, Matthias L Schmid,
confidence that they can self-isolate Lucia Pareja-Cebrian, Andrew Welch,
with mild symptoms, knowing that a Brendan A I Payne,
rapid negative result will enable them *Christopher J A Duncan
to return to work in a timely manner. christopher.duncan@newcastle.ac.uk
This might lessen the desire of staff with Department of Infection and Tropical Medicine
(EH, DAP, MLS, BAIP, CJAD), Occupational Health
mild symptoms to soldier on, in fear of Department (EM), Microbiology and Virology
abandoning colleagues for 7–14 days, Services (LP-C, BAIP), and Department of Ear Nose
thereby inadvertently contributing to and Throat Surgery (AW), Newcastle upon Tyne
Hospitals NHS Foundation Trust, Newcastle upon
nosocomial transmission. Tyne, UK; and Immunity and Inflammation Theme
Several limitations to these data (ISvdL, KFB, CJAD), National Institute of Health
should be acknowledged. We were Research (NIHR) Biomedical Research Centre (DL),
NIHR In Vitro Diagnostics Cooperative (CL),
unable to identify staff roles for and Mitochondrial and Neuromuscular Diseases
more than a third of those tested. Theme (BAIP), Newcastle University,
Furthermore, no data on symptoms Newcastle upon Tyne NE2 4HH, UK
or outcomes are available. Ongoing 1 Chowell G, Abdirizak F, Lee S, et al.
Transmission characteristics of MERS and
prospective data collection will aim SARS in the healthcare setting: a comparative
to capture both of these elements in study. BMC Med 2015; 13: 210.
due course. The small number of non- 2 Wu Z, McGoogan JM. Characteristics of and
important lessons from the coronavirus
clinical staff tested meant that it was disease 2019 (COVID-19) outbreak in China:
not possible to meaningfully compare summary of a report of 72314 cases from the
Chinese Center for Disease Control and
transmission dynamics between these Prevention. JAMA 2020; published online
groups, where more complex patterns Feb 24. DOI:10.1001/jama.2020.2648.
might exist. Finally, we acknowledge 3 Chan JF, Yip CC, To KK, et al. Improved
molecular diagnosis of COVID-19 by the novel,
possible insensitivity of the SARS-CoV-2 highly sensitive and specific COVID-19-RdRp/
RdRp assay,3 which might provide Hel real-time reverse transcription-polymerase
chain reaction assay validated in vitro and with
unwarranted reassurance in some clinical specimens. J Clin Microbiol 2020;
cases. Nevertheless, we view this as a published online Mar 4. DOI:10.1128/
risk reduction rather than elimination JCM.00310-20.
strategy, and continue to stress that
staff with a negative test should not
return to work until their symptoms
have substantially improved. National
guidance is anticipated on this issue.
CJAD reports grants from the Wellcome Trust
during the conduct of the study reported in this
Correspondence. All other authors declare no
competing interests. We are grateful to S Graziadio
(NIHR Newcastle) for helpful advice regarding
statistical analysis. We acknowledge the assistance
of many staff involved in establishing and
supporting the screening pod. CJAD is funded by
the Wellcome Trust (211153/Z/18/Z). KFB is funded
by a National Institute for Health Research (NIHR)
Clinical Lectureship (CL-2017-01-004). The views
expressed are those of the authors and not
necessarily those of the NHS, the NIHR or the
Department of Health and Social Care. The funders
had no role in study design, data collection,
or decision to publish this Correspondence.
The corresponding author had full access to all
data and had final responsibility for the decision to
submit for publication. CJAD and BAIP contributed
equally to this work.
2 www.thelancet.com Published online April 22, 2020 https://doi.org/10.1016/S0140-6736(20)30970-3
