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Hospitalised shift workers more likely to test COVID-19 positive

Tuesday April 27th 2021

Shift workers are more likely to test positive for COVID-19 in hospital compared to those who work in the daytime, according to new research.

Writing in Thorax, the researchers say shift working could be just as important a risk factor as already known high-risk features such as ethnicity and living in poorer areas and should be considered in future public health measures aiming to reduce COVID-19 infections.

Previous studies have found adverse health effects of shift work, which could be explained by sleep deprivation, poor diet and disruption of the body’s natural circadian cycle.

Researchers from the Universities of Manchester and Oxford in the UK and the University of the West Indies investigated if shift work could be causing “circadian misalignment” and increasing a person’s susceptibility to COVID-19 infection.

For this observational study, they used data on more than 280,000 individuals aged 40 to 69 who were enrolled in the UK Biobank study (2006-10), with data from other resources such as Hospital Episode Statistics and GP records. They excluded participants who had COVID-19 testing outside of secondary care.

To find out if shift work was associated with an in-hospital COVID-19 positive test, the researchers compared workers who never worked shifts with participants who worked irregular or permanent shifts.

More than half a million people were enrolled in the UK Biobank, of whom 6,442 were tested for COVID-19 in hospital. This resulted in 498 positive tests between March and August 2020.

In those who tested positive, 316 did not work shifts, 98 worked irregular shifts and 84 worked permanent shifts, totalling 182. The shift workers were 2.5 to three times more likely to be positive with COVID-19 than non-shift workers in those that were hospitalised.

Analysis was also conducted on a subset of UK Biobank participants whose occupational shift work status was updated in 2017.

In the subset, 43,878 participants were used to analyse the effect of shift work with 72 participants being hospitalised for COVID-19. From this analysis shift workers were an even greater 4.5 times more likely to be positive for COVID-19.

Day and night shift workers were more likely to have a positive COVID-19 test compared to those who did not work shifts.

Those doing irregular night shifts were three times more likely to test positive for the virus in hospitals and these higher risks were largely unchanged after taking account of factors such as sleep duration, BMI, alcohol and smoking.

They also found that shift work in all sectors – essential and non-essential work – was still significantly associated with COVID-19, which suggested that shift work was associated with higher odds for having COVID-19.

Although this is an observational study that does not establish cause, the researchers suggest their findings may be due to increased occupancy of workspaces over 24 hours for shift workers, reduced time for cleaning between shifts, and tiredness resulting in less awareness of health and safety measures.

Author Dr John Blaikley, from the University of Manchester, said: “This study shows quite a strong association between shift working and being hospitalised for COVID-19, even after controlling for existing COVID-19 risk factors.

“It’s hard to explain the exact cause of this association though we think workplaces should be made aware of these risks so they can take appropriate precautions for their staff.”

Co-author Dr Hannah Durrington, at the University of Manchester, added: “We do believe it should be possible to substantially mitigate these risks through good handwashing, use of face protection, appropriate spacing and vaccination.”

Maidstone R, Anderson SG, Ray DW et al. Shift work is associated with positive COVID-19 status in hospitalised patients. Thorax 27 April 2021; doi:10.1136/thoraxjnl-2020-216651


Tags: A&E | Flu & Viruses | Respiratory | South America | UK News

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