Risks of COVID-19 by occupation in NHS workers in England.

OBJECTIVE: To quantify occupational risks of COVID-19 among healthcare staff during the first wave (9 March 2020-31 July 2020) of the pandemic in England. METHODS: We used pseudonymised data on 902 813 individuals employed by 191 National Health Service trusts to explore demographic and occupational risk factors for sickness absence ascribed to COVID-19 (n=92 880). We estimated ORs by multivariable logistic regression. RESULTS: With adjustment for employing trust, demographic characteristics and previous frequency of sickness absence, risk relative to administrative/clerical occupations was highest in 'additional clinical services' (care assistants and other occupations directly supporting those in clinical roles) (OR 2.31 (2.25 to 2.37)), registered nursing and midwifery professionals (OR 2.28 (2.23 to 2.34)) and allied health professionals (OR 1.94 (1.88 to 2.01)) and intermediate in doctors and dentists (OR 1.55 (1.50 to 1.61)). Differences in risk were higher after the employing trust had started to care for documented patients with COVID-19, and were reduced, but not eliminated, following additional adjustment for exposure to infected patients or materials, assessed by a job-exposure matrix. For prolonged COVID-19 sickness absence (episodes lasting >14 days), the variation in risk by staff group was somewhat greater. CONCLUSIONS: After allowance for possible bias and confounding by non-occupational exposures, we estimated that relative risks for COVID-19 among most patient-facing occupations were between 1.5 and 2.5. The highest risks were in those working in additional clinical services, nursing and midwifery and in allied health professions. Better protective measures for these staff groups should be a priority. COVID-19 may meet criteria for compensation as an occupational disease in some healthcare occupations. TRIAL REGISTRATION NUMBER: ISRCTN36352994.

Ethnic differences in risk of severe Covid-19: To what extent are they driven by exposure?

BACKGROUND: This study quantifies the risk of Covid-19 among ethnic groups of healthcare staff during the first pandemic wave in England. METHODS: We analysed data on 959 356 employees employed by 191 National Health Service trusts during 1 January 2019 to 31 July 2020, comparing rates of Covid-19 sickness absence in different ethnic groups. RESULTS: In comparison with White ethnic groups, the risk of short-duration Covid-19 sickness absence was modestly elevated in South Asian but not Black groups. However, all Black and ethnic minority groups were at higher risk of prolonged Covid-19 sickness absence. Odds ratios (ORs) relative to White ethnicity were more than doubled in South Asian groups (Indian OR 2.49, 95% confidence interval (CI) 2.36-2.63; Pakistani OR 2.38, 2.15-2.64; Bangladeshi OR 2.38, 1.98-2.86), while that for Black African ethnicity was 1.82 (1.71-1.93). In nursing/midwifery staff, the association of ethnicity with prolonged Covid-19 sickness absence was strong; the odds of South Asian nurses/midwives having a prolonged episode of Covid-19 sickness absence were increased 3-fold (OR 3.05, 2.82-3.30). CONCLUSIONS: Residual differences in risk of short term Covid-19 sickness absences among ethnic groups may reflect differences in non-occupational exposure to SARS-CoV-2. Our results indicate ethnic differences in vulnerability to Covid-19, which may be only partly explained by medical comorbidities.

Changing patterns of sickness absence among healthcare workers in England during the COVID-19 pandemic.

BACKGROUND: Patterns of sickness absence shed useful light on disease occurrence and illness-related behaviours in working populations. METHODS: We analysed prospectively collected, pseudonymized data on 959 356 employees who were continuously employed by National Health Service trusts in England from 1 January 2019 to 31 July 2020, comparing the frequency of new sickness absence in 2020 with that at corresponding times in 2019. RESULTS: After exclusion of episodes directly related to COVID-19, the overall incidence of sickness absence during the initial 10 weeks of the pandemic (March-May 2020) was more than 20% lower than in corresponding weeks of 2019. Trends for specific categories of illness varied substantially, with a fall by 24% for cancer, but an increase for mental illness. A doubling of new absences for pregnancy-related disorders during May-July of 2020 was limited to women with earlier COVID-19 sickness absence. CONCLUSIONS: Various factors will have contributed to the large and divergent changes that were observed. The findings reinforce concerns regarding delays in diagnosis and treatment of cancers and support a need to plan for a large backlog of treatment for many other diseases. Further research should explore the rise in absence for pregnancy-related disorders among women with earlier COVID-19 sickness absence.

Impact of COVID-19 pandemic on sickness absence for mental ill health in National Health Service staff.

OBJECTIVE: To explore the patterns of sickness absence in National Health Service (NHS) staff attributable to mental ill health during the first wave of the COVID-19 epidemic in March-July 2020. DESIGN: Case-referent analysis of a secondary dataset. SETTING: NHS Trusts in England. PARTICIPANTS: Pseudonymised data on 959 356 employees who were continuously employed by NHS trusts during 1 January 2019 to 31 July 2020. MAIN OUTCOME MEASURES: Trends in the burden of sickness absence due to mental ill health from 2019 to 2020 according to demographic, regional and occupational characteristics. RESULTS: Over the study period, 164 202 new sickness absence episodes for mental ill health were recorded in 12.5% (119 525) of the study sample. There was a spike of sickness absence for mental ill health in March-April 2020 (899 730 days lost) compared with 519 807 days in March-April 2019; the surge was driven by an increase in new episodes of long-term absence and had diminished by May/June 2020. The increase was greatest in those aged >60 years (227%) and among employees of Asian and Black ethnic origin (109%-136%). Among doctors and dentists, the number of days absent declined by 12.7%. The biggest increase was in London (122%) and the smallest in the East Midlands (43.7%); the variation between regions reflected the rates of COVID-19 sickness absence during the same period. CONCLUSION: Although the COVID-19 epidemic led to an increase in sickness absence attributed to mental ill health in NHS staff, this had substantially declined by May/June 2020, corresponding with the decrease in pressures at work as the first wave of the epidemic subsided.