Healthcare workers may be at higher risk of getting infected with the coronavirus disease 2019 (Covid-19) when not on the job, a study published Wednesday by JAMA Network Open found.

Conversely, neither working in the emergency room nor providing care for patients with Covid-19 increased the odds of infection.

“Despite multiple challenges that healthcare providers faced during the early stages of the Covid-19 pandemic, these data suggest that the processes based on infection prevention, including personal protective equipment likes masks, were effective in keeping our healthcare teams safe while providing essential care to patients,” study co-author Dr. Jesse Jacob said.

“At work we are thinking about infection prevention all the time, but outside work may be the more likely place for anyone, including healthcare workers, to get Covid-19,” said Jacob, an infectious disease specialist at Emory University in Atlanta.

More than 200,000 healthcare workers were infected with coronavirus in the United States in 2020 alone, according to figures from the Centers for Disease Control and Prevention.

An investigation by the Guardian and Kaiser Health Network indicates that more than 3,500 have died as a result, mostly due to exposure to infected patients without proper personal protective equipment, or PPE.

For this study, Jacob and his colleagues analyzed data on nearly 25,000 healthcare workers at four large health systems in three states who were tested for Covid-19 antibodies.

Among the study participants, 4.4 percent tested positive for antibodies, which are cells produced by the immune system to fight off viruses and other pathogens, meaning they had been infected recently.

Just over 50 percent of the study participants reported direct contact with an infected patient at work, and 81 percent indicated that they had no contact with confirmed cases of COVID-19 outside of work.

Still, healthcare workers exposed to people with the virus in the community were 3.5 times as likely to have antibodies against it compared to those who were not.

Those who had direct contact with infected patients while at work were not found to be at increased risk, they said.

“I’m not surprised that we did not identify any patient-facing activities in healthcare that was associated with having antibodies to the virus, but did find that association with exposures in the community,” Jacob said.

“Our infection prevention measures appear to be effective in preventing healthcare personnel from acquiring Covid-19 from patients,” he said.