Microbial, immune, metabolic perturbations by antibiotics (MIME study)

As SARS-CoV-2 is sweeping through the USA, healthcare workers (HCW) are our first line ofdefense. But they too are susceptible to becoming infected, resulting in physical illness, loss ofproductivity, and potential for disease transmission to patients. Our long-term goal is to protectHCW taking care of SARS-CoV-2-infected patients as well as their families, communities, andthe general population. Our specific objective is to rapidly establish a prospective cohort tocharacterize the factors related to viral transmission and disease severity in a large healthcaresystem in both healthcare settings and workers' households. Our central hypothesis is thatHCW are at higher risk of acquiring and transmitting SARS-CoV-2 and COVID-19 comparedwith non-healthcare workers (NCHW). We propose to address this hypothesis by recruiting andfollowing 500 HCW and 250 age- and sex-matched NHCW within a large academic healthsystem, Rutgers Biomedical and Health Sciences (RBHS). By intensively following participantsover a six-month period and collecting serial biospecimens (nasopharyngeal swabs and blood)and questionnaire data at nine time points, we will be uniquely situated to characterize SARS-CoV-2 transmission and risk factors for COVID-19 among HCW and their families. Our specificaims are: (i), to assess the baseline prevalence of SARS-CoV-2 and COVID-19 in the studypopulation; (ii), to characterize the natural history of SARS-CoV-2 infection in a diverse USworkforce, including the incidence of asymptomatic infections and critical illness; (iii), todetermine the incidence of SARS-CoV-2 and COVID-19 in healthcare workers compared withnon-healthcare workers; (iv), to identify the risk factors for acquiring SARS-CoV-2 anddeveloping COVID-19; (v), to determine the duration and extent of SARS-CoV-2 shedding; and(vi), to determine the rate and direction of transmission of SARS-CoV-2 within households. Ourmultidisciplinary team has the opportunity, population, resources, and motivation to immediatelytackle these crucial questions and to mobilize in the early stages of this public health crisisbefore overwhelming infection occurs in the US. The proposed cohort study will produceimmediate, actionable, and translatable knowledge about protecting the healthcare workforce.The established cohort and repository of ~15,000 biospecimens will also serve as a foundationfor future mechanistic studies. The coordinated activities of our team working within a largehealthcare system will advance efforts to control, treat, and prevent COVID-19, with focus onthe safety of HCW and the staffing of hospitals during this continuing epidemic.