Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission

Rivett, L.; Sridhar, S.; Sparkes, D.; Routledge, M.; Jones, N. K.; Forrest, S.; Young, J.; Pereira-Dias, J.; Hamilton, W. L.; Ferris, M.; Torok, M. E.; Meredith, L.; Curran, M. D.; Fuller, S.; Chaudhry, A.; Shaw, A.; Samworth, R. J.; Bradley, J. R.; Dougan, G.; Smith, K. G. C.; Lehner, P. J.; Matheson, N. J.; Wright, G.; Goodfellow, I. G.; Baker, S.; Weekes, M. P.; Lyons, P. A.; Toshner, M.; Warne, B.; Scott, J. B.; Cormie, C.; Gill, H.; Kean, I.; Maes, M.; Reynolds, N.; Wantoch, M.; Caddy, S.; Caller, L.; Feltwell, T.; Hall, G.; Hosmillo, M.; Houldcroft, C.; Jahun, A.; Khokhar, F.; Yakovleva, A.; Butcher, H.; Caputo, D.; Clapham-Riley, D.; Dolling, H.; Furlong, A.; Graves, B.; Gresley, E. L.; Kingston, N.; Papadia, S.; Stark, H.; Stirrups, K. E.; Webster, J.; Calder, J.; Harris, J.; Hewitt, S.; Kennet, J.; Meadows, A.; Rastall, R.; Brien, C. O.; Price, J.; Publico, C.; Rowlands, J.; Ruffolo, V.; Tordesillas, H.; Brookes, K.; Canna, L.; Cruz, I.; Dempsey, K.; Elmer, A.; Escoffery, N.; Jones, H.; Ribeiro, C.; Saunders, C.; Wright, A.; Nyagumbo, R.; Roberts, A.; Bucke, A.; Hargreaves, S.; Johnson, D.; Narcorda, A.; Read, D.; Sparke, C.; Warboys, L.; Lagadu, K.; Mactavous, L.; Gould, T.; Raine, T.; Mather, C.; Ramenatte, N.; Vallier, A. -L.; Kasanicki, M.; Eames, P. -J.; Mcnicholas, C.; Thake, L.; Bartholomew, N.; Brown, N.; Parmar, S.; Zhang, H.; Bowring, A.; Martell, G.; Quinnell, N.; Wright, J.; Murphy, H.; Dunmore, B. J.; Legchenko, E.; Graf, S.; Huang, C.; Hodgson, J.; Hunter, K.; Martin, J.; Mescia, F.; O'Donnell, C.; Pointon, L.; Shih, J.; Sutcliffe, R.; Tilly, T.; Tong, Z.; Treacy, C.; Wood, J.; Bergamaschi, L.; Betancourt, A.; Bowyer, G.; A. D., Sa; Epping, M.; Hinch, A.; Huhn, O.; Jarvis, I.; Lewis, D.; Marsden, J.; Mccallum, S.; Nice, F.

doi:10.7554/eLife.58728

Significant differences exist in the availability of healthcare worker (HCW) SARS-CoV-2 testing between countries, and existing programmes focus on screening symptomatic rather than asymptomatic staff. Over a 3-week period (April 2020), 1,032 asymptomatic HCWs were screened for SARS-CoV-2 in a large UK teaching hospital. Symptomatic staff and symptomatic household contacts were additionally tested. Real-time RT-PCR was used to detect viral RNA from a throat+nose self-swab. 3% of HCWs in the asymptomatic screening group tested positive for SARS-CoV-2. 17/30 (57%) were truly asymptomatic/pauci-symptomatic. 12/30 (40%) had experienced symptoms compatible with coronavirus disease 2019 (COVID-19) >7 days prior to testing, most self-isolating, returning well. Clusters of HCW infection were discovered on two independent wards. Viral genome sequencing showed that the majority of HCWs had the dominant lineage B·1. Our data demonstrates the utility of comprehensive screening of HCWs with minimal or no symptoms. This approach will be critical for protecting patients and hospital staff.