Study: Healthcare Workers May Be More Likely to Contract COVID-19 Outside of Work

Nancy Grover

Sarasota, FL ( – Safety protocols put in place to protect healthcare workers from the coronavirus appear to be working, at least at four major institutions. However, the findings in a new study also suggest that of these workers who did contract the virus, they were more likely to have been exposed in the community, meaning it was not work-related.

“The aim of the study was to assess infection control in the hospital workplace,” explained John Howard, MD, director of the National Institute for Occupational Safety and Health. ‘The study found that an ‘HCP (healthcare personnel) who reported having contact with a person known to have or suspected of having COVID-19 IN THE COMMUNITY had substantially increased odds of seropositivity compared with HCP with no known COVID-19 contacts outside of work …”

The Study

The study, published in the Journal of the American Medical Association calls into question whether healthcare workers should be presumed to have contracted the virus at work. A number of states have adopted presumptions that require the employer to prove a worker did not contract the illness at work, or pay workers’ compensation benefits.

The researchers did a cross-sectional study of 24 healthcare personnel in three states, involving several large healthcare systems, including:

  • Emory Healthcare in Atlanta
  • Johns Hopkins Medicine in Baltimore
  • University of Maryland Medical System in Baltimore
  • Rush University System in Chicago.

“The systems were primarily based in metropolitan areas and predominantly acute care hospitals, but they included more than 100 affiliated regional ambulatory locations, administrative locations, rehabilitation facilities, and skilled nursing facilities,” the researchers explained. “In this cross-sectional study … contact with an individual with known coronavirus disease 2019 (COVID-19) exposure outside the workplace was the strongest risk factor associated with SARS-CoV-2 seropositivity, along with living in a zip code with higher COVID-19 incidence. None of the assessed workplace factors were associated with seropositivity.”

The researchers found an association between cumulative incidence of COVID-19 in a healthcare worker’s residential zip code and seropositivity across a diverse geographic area.

“We found that the higher the cumulative incidence of COVID-19 until the week prior to the antibody test, the higher the risk of the health care personnel being antibody positive,” the authors wrote. “This finding aligns well with the observed association that health care personnel who had contact with a person with COVID-19 in the community were more likely to be antibody positive. Together, these findings suggest that exposures outside of the workplace, rather than exposures to patients with COVID-19, may be major drivers for SARS-CoV-2 infection among health care personnel in the United States.”

The researchers said their study does not eliminate the possibility that workplace exposure increases the risk of contracting the virus, but it shows that community exposure may be higher than patient exposures.

“Importantly, these findings suggest that current infection control measures are effective for preventing SARS-CoV-2 transmission when working with patients, and health care personnel risk of infection may be driven by community and nonpatient care occupational exposures,” the study says. “Prioritizing efforts to practice optimal infection prevention in all health care facilities remains critical to keeping health care personnel and patients safe and may need to include assessments comparing transmission from patient-to-health care personnel and between health care personnel.”

John Howard’s Insights

While the study does not suggest that a healthcare worker can never be infected with the virus at work, its size makes it important. “It adds information to the question of how ‘work-related’ is COVID-19 infection (or in this paper seropositivity) using a large cohort of healthcare workers (who would have the highest level of SARS-CoV-2 exposure among all occupations),” Howard said.

Howard says future research that focuses on a detailed examination of individual healthcare worker infections could provide more insight. For example, tracing the person’s activities in the 10-day period before they are infected. For those who had contact with an infected person in the community, research could delve into the nature of the contact, whether they were masked or not, and whether the other person was a family member.

“Teasing out the relative contributions of work and community exposure in determining infection causation is fraught with many methodological difficulties, which the workers’ compensation community knows well,” Howard said. “Sorting out how much exposure to attribute to the community versus work has many methodological challenges. That may be why historically infectious diseases prevalent in the community are not usually covered by workers’ compensation.”

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