scholarly journals Development and presentation of an objective risk stratification tool for healthcare workers when dealing with the COVID-19 pandemic in the UK: risk modelling based on hospitalisation and mortality statistics compared with epidemiological data

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e042225
Author(s):  
W David Strain ◽  
Janusz Jankowski ◽  
Angharad P Davies ◽  
Peter English ◽  
Ellis Friedman ◽  
...  
Keyword(s):  
General Population ◽  
Risk Stratification ◽  
Healthcare Workers ◽  
Epidemiological Data ◽  
Assessment Process ◽  
White Female ◽  
Increased Risk ◽  
Objective Risk ◽  
Risk Stratification Tool ◽  
Line Manager

ObjectivesHealthcare workers have greater exposure to SARS-CoV-2 and an estimated 2.5-fold increased risk of contracting COVID-19 than the general population. We wished to explore the predictive role of basic demographics to establish a simple tool that could help risk stratify healthcare workers.SettingWe undertook a review of the published literature (including multiple search strategies in MEDLINE with PubMed interface) and critically assessed early reports on preprint servers. We explored the relative risk of mortality from readily available demographics to identify the population at the highest risk.ResultsThe published studies specifically assessing the risk of healthcare workers had limited demographics available; therefore, we explored the general population in the literature. Clinician demographics: Mortality increased with increasing age from 50 years onwards. Male sex at birth, and people of black and minority ethnicity groups had higher susceptibility to both hospitalisation and mortality. Comorbid disease. Vascular disease, renal disease, diabetes and chronic pulmonary disease further increased risk. Risk stratification tool: A risk stratification tool was compiled using a white female aged <50 years with no comorbidities as a reference. A point allocated to risk factors was associated with an approximate doubling in risk. This tool provides numerical support for healthcare workers when determining which team members should be allocated to patient facing clinical duties compared with remote supportive roles.ConclusionsWe generated a tool that provides a framework for objective risk stratification of doctors and healthcare professionals during the COVID-19 pandemic, without requiring disclosure of information that an individual may not wish to share with their direct line manager during the risk assessment process. This tool has been made freely available through the British Medical Association website and is widely used in the National Health Service and other external organisations.

scholarly journals Development of an Objective Risk Stratification Tool to facilitate workplace assessments of healthcare workers when dealing with the CoViD-19 pandemic

2020 ◽  
Author(s):  
W David Strain ◽  
Janusz Jankowski ◽  
Angharad Davies ◽  
Peter MB English ◽  
Ellis Friedman ◽  
...  
Keyword(s):  
Health Care ◽  
High Risk ◽  
Risk Stratification ◽  
Health Care Workers ◽  
Healthcare Workers ◽  
List Type ◽  
Care Workers ◽  
Increased Risk ◽  
Objective Risk ◽  
Risk Stratification Tool

SummaryHealthcare workers have a greater exposure to individuals with confirmed SARS-novel coronavirus 2, and thus a higher probability of contracting coronavirus disease (CoViD)-19, than the general population. Employers have a duty of care to minimise the risk for their employees. Several bodies including the Faculty of Occupational Medicine, NHS Employers, and Public Health England have published a requirement to perform risk assessments for all health care workers, however, with the absence of an objective risk stratification tool, comparing assessments between individuals is difficult if not impossible. Using published data, we explored the predictive role of basic demographics such as age, sex, ethnicity and comorbidities in order to establish an objective risk stratification tool that could help risk allocate duties to health care workers. We developed an objective risk stratification tool using a Caucasian female <50years of age with no comorbidities as a reference. Each point allocated to risk factors was associated with an approximate doubling in risk. This tool was then validated against the primary care-based analysis. This tool provides objective support for employers when determining which healthcare workers should be allocated to high-risk vs. lower risk patient facing clinical duties or to remote supportive roles.Strengths and limitations of this studyThere is an increased risk of mortality in the clinical workforce due to the effects of CoViD-19.This manuscript outlines a simple risk stratification tool that helps to quantify an individual’s biological riskThis will assist team leaders when allocating roles within clinical departments.This tool does not incorporate other external factors, such as high-risk household members or those at higher risk of mental health issues, that may require additional consideration when allocating clinical duties in an appropriate clinical domain.This population-based analysis did not explain for the very high risk observed in BAME healthcare workers suggesting there are other issues at play that require addressing. BAME healthcare workers suggesting there are other issues at play that require addressing.

Practical prediction model for the risk of 2-year mortality of individuals in the general population

2016 ◽  
Vol 64 (4) ◽  
pp. 848-853 ◽  
Author(s):  
Alexander Goldfarb-Rumyantzev ◽  
Shiva Gautam ◽  
Robert S Brown
Keyword(s):  
General Population ◽  
Risk Stratification ◽  
Prediction Model ◽  
Mortality Rates ◽  
Risk Indicator ◽  
Intermediate Risk ◽  
Data Set ◽  
Health And Nutrition ◽  
Risk Stratification Tool ◽  
Potential Use

This study proposed to validate a prediction model and risk-stratification tool of 2-year mortality rates of individuals in the general population suitable for office practice use. A risk indicator (R) derived from data in the literature was based on only 6 variables: to calculate R for an individual, starting with 0, for each year of age above 60, add 0.14; for a male, add 0.9; for diabetes mellitus, add 0.7; for albuminuria >30 mg/g of creatinine, add 0.7; for stage ≥3 chronic kidney disease (CKD), add 0.9; for cardiovascular disease (CVD), add 1.4; or for both CKD and CVD, add 1.7. We developed a univariate logistic regression model predicting 2-year individual mortality rates. The National Health and Nutrition Examination Survey (NHANES) data set (1999–2004 with deaths through 2006) was used as the target for validation. These 12,515 subjects had a mean age of 48.9±18.1 years, 48% males, 9.5% diabetes, 11.7% albuminuria, 6.8% CVD, 5.4% CKD, and 2.8% both CKD and CVD. Using the risk indicator R alone to predict mortality demonstrated good performance with area under the receiver operating characteristic (ROC) curve of 0.84. Dividing subjects into low-risk (R=0–1.0), low intermediate risk (R>1.0–3.0), high intermediate risk (R>3.0–5.0) or high-risk (R>5.0) categories predicted 2-year mortality rates of 0.52%, 1.44%, 5.19% and 15.24%, respectively, by the prediction model compared with actual mortality rates of 0.29%, 2.48%, 5.13% and 13.40%, respectively. We have validated a model of risk stratification using easily identified clinical characteristics to predict 2-year mortality rates of individuals in the general population. The model demonstrated performance adequate for its potential use for clinical practice and research decisions.

scholarly journals Protection offered by COVID-19 vaccines in reducing SARS-CoV-2 infection frequency; severity and mortality, among Indian Healthcare Workers: Multicenter, pan-Fortis study

2021 ◽  
Author(s):  
Subrat Acharya ◽  
Gaurav Mahindra ◽  
Purushottam Nirala ◽  
Sulabh Tripathi ◽  
Bishnu Panigrahi ◽  
...  
Keyword(s):  
General Population ◽  
Healthcare Workers ◽  
Case Fatality Rate ◽  
Population Control ◽  
Real Life ◽  
Case Fatality ◽  
Infection Frequency ◽  
Fatality Rate ◽  
Indian States ◽  
Increased Risk

Abstract During COVID-19 pandemic, Healthcare Workers (HCWs) were at increased risk for exposure to SARS-CoV-2 virus and prioritized for early administration of COVID-19 vaccines in India. Real-life scenario information among vaccinated HCWs acquiring COVID-19 infection, is scarce. We retrospectively analyzed COVID-19 infection frequency, severity, and associated mortality among healthcare workers, immunized with either Covishield or Covaxin vaccines at 27 Fortis Hospitals across 11 Indian states. Positive cases were identified based on RT-PCR or rapid antigen tests for SARS-CoV-2 between 16th January 2021 till 15th May 2021. 20034 HCWs received vaccination. 3971 received 1 dose, 16063 received 2 doses. Post-vaccination, 1139 HCWs acquired COVID-19 infection, 180 (4.53%) and 959 (5.97%) among partially and fully vaccinated category, respectively. Breakthrough infection occurred among 913 (5.68%) HCWs. Concurrently, Case Positivity Rate was 11.9%, among general population (control). Among 1139 positive cases, mild, moderate, and severe infections were 1059 (93%), 71 (6.2%) and 9 (0.8%), respectively with Case Fatality Rate of 0.18%, compared to 0.92% among general population (p=0.0043). The Case Fatality Rate in vaccinated HCWs was found to be 80% less than that in general population (control). Hence, COVID-19 vaccines available in India seem to be effective against SARS-CoV-2 virus.

scholarly journals RISK OF HOSPITALISATION WITH COVID-19 AMONG TEACHERS COMPARED TO HEALTHCARE WORKERS AND OTHER WORKING-AGE ADULTS. A NATIONWIDE CASE-CONTROL STUDY

2021 ◽  
Author(s):  
Fenton Lynda ◽  
Gribben Ciara ◽  
Caldwell David ◽  
Colville Sam ◽  
Bishop Jen ◽  
...  
Keyword(s):  
General Practice ◽  
General Population ◽  
Healthcare Workers ◽  
Case Control Study ◽  
Case Control ◽  
Positive Test ◽  
Increased Risk ◽  
Working Age ◽  
Household Members ◽  
Control Study

AbstractObjectiveTo determine the risk of hospitalisation with COVID-19 and severe COVID-19 among teachers and their household members, overall and compared to healthcare workers and the general working-age population.DesignPopulation-based nested case-control study.SettingsScotland, March 2020 to January 2021. Before and after schools re-opened in early August 2020.ParticipantsAll cases of COVID-19 in Scotland in adults ages 21 to 65 (n = 83,817) and a random sample of controls matched on age, sex and general practice (n = 841,708).ExposureIndividuals identified as actively teaching in a Scottish school by the General Teaching Council for Scotland, and household members of such individuals identified via the Unique Property Reference Number.ComparatorIndividuals identified as healthcare workers in Scotland, their household members, and the remaining “general population” of working-age adults.Main outcomesThe primary outcome was hospitalisation with COVID-19 defined in anyone testing positive with COVID-19 in hospital, admitted to hospital within 28 days of a positive test, and/or diagnosed with COVID-19 on discharge from hospital. Severe COVID-19 was defined as individuals admitted to intensive care or dying within 28 days of a positive test or assigned COVID-19 as a cause of death.ResultsMost teachers were young (mean age 42), female (80%) and had no underlying conditions (84%). The cumulative incidence (risk) of hospitalisation with COVID-19 was below 1% for all of the working age adults. In the period after school re-opening, compared to the general population, in conditional logistic regression models adjusting for age, sex, general practice, deprivation, underlying conditions and number of adults in the household, the relative risk in teachers (among 18,479 cases and controls) for hospitalisation was rate ratio (RR) 0.97 (95%CI 0.72-1.29) and for severe COVID-19 was RR 0.27 (95%CI 0.09-0.77). Equivalent rate ratios for household members of teachers were 0.97 (95%CI 0.74-1.27) and 0.67 (95%CI 0.36-1.24), and for healthcare workers were 1.82 (95%CI 1.55-2.14) and 1.76 (95%CI 1.22-2.56), respectively.ConclusionCompared to working-age adults who are otherwise similar, teachers and their household members are not at increased risk of hospitalisation with COVID-19 and are at lower risk of severe COVID-19. These findings are broadly reassuring for adults engaged in face to face teaching.

scholarly journals Protection offered by COVID-19 vaccines in reducing SARS-CoV-2 infection frequency; severity and mortality, among Indian Healthcare Workers: Multicenter, pan-Fortis study

2021 ◽  
Author(s):  
Subrat Acharya ◽  
Gaurav Mahindra
Keyword(s):  
General Population ◽  
Healthcare Workers ◽  
Case Fatality Rate ◽  
Population Control ◽  
Real Life ◽  
Case Fatality ◽  
Infection Frequency ◽  
Fatality Rate ◽  
Indian States ◽  
Increased Risk

Abstract During COVID-19 pandemic, Healthcare Workers (HCWs) were at increased risk for exposure to SARS-CoV-2 virus and prioritized for early administration of COVID-19 vaccines in India. Real-life scenario information among vaccinated HCWs acquiring COVID-19 infection, is scarce. We retrospectively analyzed COVID-19 infection frequency, severity, and associated mortality among healthcare workers, immunized with either Covishield or Covaxin vaccines at 27 Fortis Hospitals across 11 Indian states. Positive cases were identified based on RT-PCR or rapid antigen tests for SARS-CoV-2 between 16th January 2021 till 15th May 2021. 20034 HCWs received vaccination. 3971 received 1 dose, 16063 received 2 doses. Post-vaccination, 1139 HCWs acquired COVID-19 infection, 180 (4.53%) and 959 (5.97%) among partially and fully vaccinated category, respectively. Breakthrough infection occurred among 913 (5.68%) HCWs. Concurrently, Case Positivity Rate was 11.9%, among general population (control). Among 1139 positive cases, mild, moderate, and severe infections were 1059 (93%), 71 (6.2%) and 9 (0.8%), respectively with Case Fatality Rate of 0.18%, compared to 0.92% among general population (p=0.0043). The Case Fatality Rate in vaccinated HCWs was found to be 80% less than that in general population (control). Hence, COVID-19 vaccines available in India seem to be effective against SARS-CoV-2 virus.

scholarly journals Seroprevalence of SARS-COV-2 Antibodies in Scottish Healthcare Workers

2020 ◽  
Author(s):  
Hani Abo-Leyah ◽  
Stephanie Gallant ◽  
Diane Cassidy ◽  
Yan Hui Giam ◽  
Justin Killick ◽  
...  
Keyword(s):  
General Population ◽  
Healthcare Workers ◽  
Social Care ◽  
Clinical Information ◽  
Antibody Test ◽  
Care Workers ◽  
Increased Risk ◽  
Health And Social Care ◽  
Seroprevalence Data ◽  
Predominantly Female

AbstractIntroductionHealthcare workers are believed to be at increased risk of SARS-CoV-2 infection. The extent of that increased risk compared to the general population and the groups most at risk have not been extensively studied.MethodsA prospective observational study of health and social care workers in NHS Tayside (Scotland, UK) from May to September 2020. The Siemens SARS-CoV-2 total antibody assay was used to establish seroprevalence in this cohort. Patients provided clinical information including demographics and workplace information. Controls, matched for age and sex to the general Tayside population, were studied for comparison.ResultsA total of 2062 health and social care workers were recruited for this study. The participants were predominantly female (81.7%) and 95.2% were white. 299 healthcare workers had a positive antibody test (14.5%). 11 out of 231 control sera tested positive (4.8%). Healthcare workers therefore had an increased likelihood of a positive test (odds ratio 3.4 95% CI 1.85-6.16, p<0.0001). Dentists, healthcare assistants and porters were the job roles most likely to test positive. Those working in front-line roles with COVID-19 patients were more likely to test positive (17.4% vs. 13.4%, p=0.02). 97.1% of patients who had previously tested positive for SARS-CoV-2 by RT-PCR had positive antibodies, compared to 11.8% of individuals with a symptomatic illness who had tested negative. Anosmia was the symptom most associated with the presence of detectable antibodies.ConclusionIn this study, healthcare workers were three times more likely to test positive for SARS-CoV-2 than the general population. The seroprevalence data in different populations identified in this study will be useful to protect healthcare staff during future waves of the pandemic.

Risk stratification for sudden cardiac death in the general population

ESC CardioMed ◽  
2018 ◽  
pp. 2305-2308
Author(s):  
Efstathios K. Iliodromitis ◽  
Dimitrios Farmakis
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Sudden Cardiac Death ◽  
General Population ◽  
Risk Stratification ◽  
Cardiac Death ◽  
Increased Risk ◽  
Artery Disease

There are three main groups in the general population as far as sudden cardiac death (SCD) is concerned: individuals without a known history or predisposing factors for heart disease; individuals with known risk factors for heart disease or SCD; and patients with diagnosed ischaemic, structural, or electrical cardiac conditions, acquired or genetic, that are associated with an increased risk for SCD. Although SCD literature focuses mainly on patients with known heart disease, approximately 50% of SCD cases occur in individuals belonging to the first two groups. The annual incidence of SCD in the general population ranges between 0.6 and greater than 1.4 per 1000 individuals. SCD occurs more commonly in men than in women and with an incidence that increases with age due to the increase in coronary artery disease. The commonest aetiologies for SCD in the general population are coronary artery disease and cardiomyopathy, accounting for 80% and 10–15% of cases, respectively. A number of factors have been related to an increased risk for SCD in the general population including genetic predisposition, risk factors for atherosclerosis, strenuous physical activity and sports, electrocardiographic abnormalities, elevated levels of biomarkers, and abnormalities in imaging and other diagnostic techniques. However, large-scale prospective studies that confirm the feasibility, clinical efficacy, and cost-effectiveness of using these factors for broad mass screening for SCD are generally lacking and therefore risk stratification for SCD in the general population remains challenging.

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