Study of COVID-19 levels in oncology staff suggests need for more extensive testing
A study of oncology staff carried out immediately after the spring peak of the COVID-19 pandemic in the UK indicates that many had been infected with the coronavirus as they tested positive for COVID-19 antibodies. This included staff who did not show any symptoms. 
The study also found that a substantial proportion of those with positive COVID-19 antibodies detected after the first peak had lost their positive antibody status after four weeks.
The research, presented at the NCRI Virtual Showcase, suggests that oncology staff should be routinely tested for signs of current or previous coronavirus infection as rates of COVID-19 begin to rise again.
A second study, also presented at the NCRI Virtual Showcase, reports the results of a survey of oncology staff on their management of patients, their wellbeing and whether they felt valued during the pandemic. 
Dr David Favara from Cambridge University Hospitals NHS Foundation Trust and the University of Cambridge, UK, led the Covid-19 Serology in Oncology Staff (CSOS) Study. He said: “We began work on this research in April 2020, when the UK was still under COVID-19 lockdown. At that time there was no widely available formal testing programme for NHS staff, symptomatic or asymptomatic, and I was concerned about the impact of transmission of the virus to our oncology patients. At that time, polymerase chain reaction testing was hampered by limited national testing capacity -- meaning that only individuals sick enough to be admitted to hospital with severe COVID-19 symptoms were being tested -- whilst antibody tests were not offered outside of the experimental setting.
“To the best of our knowledge, we believe this was the first study to specifically investigate exposure to the virus in patient-facing oncology staff who were at work during the peak of the COVID-19 pandemic in the UK between March and June 2020.”
The study included 434 nurses, doctors, radiographers and administrators who had been at work in patient-facing roles during the peak of the first wave in oncology departments at three large East of England NHS Trusts: The Cambridge University Hospitals NHS Foundation Trust, The North West Anglia NHS Foundation Trust and the Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust .
At the start of June, participating staff were given both an antigen test (a nasopharyngeal swab tested with polymerase chain reaction) for signs that the virus was present and two different antibody tests (a blood sample tested with both a laboratory assay and a rapid point-of-care assay) for signs of a previous infection with the virus.
No one tested positive for the antigen, meaning they were probably not infected at the time of testing. However, 18.4% of staff tested in June were positive for antibodies specific to the virus (according to the laboratory assay), suggesting previous infection.
The highest rates were among oncology nurses (21.3%), followed by doctors (17.4%), administrators (13.6%) and radiographers (8.9%). Only some of those who tested positive for the antibodies reported previous symptoms suggestive of COVID-19 (38%).
Four hundred of the staff were re-tested four weeks later in July and 13.3% tested positive for the antibodies. Of these, 92.5% were previously positive and 7.5% were newly positive. Of those who tested positive for antibodies in June, 32.5% had become antibody-negative when re-tested four weeks later.
Dr Favara said: “The UK has guidance from the UK Royal College of Radiologists on testing patients for the virus antigen prior to their radiotherapy treatments, and broad advice for testing staff.
“Considering our findings, we propose that there should be a focus on routinely testing oncology nursing staff for both the virus antigen and antibodies until an effective vaccine becomes available. Testing for signs of previous infection alongside testing for current infection on a large scale would also help us better understand changes in immunity over time.”
Dr Favara says he and his colleagues will continue collecting samples at intervals until a vaccine becomes widely available.
The second study, called COVID-NOW, was a survey conducted in June of 1038 doctors, nurses, pharmacists, administrators and allied health professionals (such dieticians and physiotherapists) working in oncology in the UK National Health Service (NHS).
The results show that 69% of oncology staff believe patients’ access to ‘standard of care treatment’ (meaning the standard NHS treatment available) has been compromised as a result of the COVID-19 pandemic and 94% of staff felt that ‘patient management’ (meaning treatments such as surgery and chemotherapy) had altered.
The study also found that while 66% felt able to do their job without compromising their personal safety, 42% of staff felt they were likely to be ‘at risk’ of poor wellbeing and 34% indicated signs of burnout. However, the majority said that they felt able to work well during this time and an average score of around 7 out of 10 was reported, where 10 indicates being able to work to their best.
The survey also uncovered the coping strategies staff use, with doctors tending to use planning and humour as strategies, whereas allied health professionals sought out emotional support and information from others. Staff were also asked how valued they felt by their organisation and by the public. Overall, 68% said they felt valued by the public and 66% said they felt valued in the workplace. On average, doctors felt the most valued by the UK public (79%) and their workplace (73%). Support services staff (such as research administration staff, health care assistants and phlebotomists) felt the least valued (47% felt valued by the public and 60% in the workplace).
The study will be presented at the NCRI Virtual Showcase by Dr Susana Banerjee, Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust and Reader in Women’s Cancers at The Institute of Cancer Research, London, UK. She said: “As a result of the COVID-19 pandemic, the entire oncology community has been facing rapid changes to help ensure the safety of our cancer patients while maintaining their cancer care.
“Increasing our understanding of oncology professionals’ experiences since COVID-19 is essential to making evidence-driven decisions on how best to help the oncology workforce and NHS organisations. The NHS and the global oncology community must work collaboratively to ensure that limited resources are used in the best way possible to support oncology staff and their patients.”
The COVID-NOW study continues with further surveys planned as well as in-depth interviews to learn more about the impact of COVID-19 and how best to support oncology staff.
Dr Iain Frame, Chief Executive of NCRI, said: “These studies give us some important insights into levels of infection among oncology staff during the spring peak of COVID-19 and how staff were managing during that time. As we see rates of the infection rise again around the world, it’s crucial that we learn lessons to protect oncology staff and cancer patients and ensure patients get the best treatment now and in the coming months.”
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