COVID-19 in Health Care Personnel

Abstract

Objective: To identify significant factors that help predict whether health care personnel (HCP) will test positive for severe acute respiratory coronavirus 2 (SARS-CoV-2). Patients and Methods: We conducted a prospective cohort study among 7015 symptomatic HCP from March 25, 2020, through November 11, 2020. We analyzed the associations between health care role, contact history, symptoms, and a positive nasopharyngeal swab SARS-CoV-2 polymerase chain reaction test results, using univariate and multivariable modelling. Results: Of the symptomatic HCP, 624 (8.9%) were positive over the study period. On multivariable analysis, having a health care role other than physician or advanced practice provider, contact with family or community member with known or suspected coronavirus disease 2019 (COVID-19), and seven individual symptoms (cough, anosmia, ageusia, fever, myalgia, chills, and headache) were significantly associated with higher adjusted odds ratios for testing positive for SARS-CoV-2. For each increase in symptom number, the odds of testing positive nearly doubled (odds ratio, 1.93; 95% CI, 1.82 to 2.07, P<.001). Conclusion: Symptomatic HCP have higher adjusted odds of testing positive for SARS-CoV-2 based on three distinct factors: (1) nonphysician/advanced practice provider role, (2) contact with a family or community member with suspected or known and (3) specific symptoms and symptom number. Differences among health care roles, which persisted after controlling for contacts, may reflect the influence of social determinants. Contacts with COVID-19epositive patients and/or HCP were not associated with higher odds of testing positive, supporting current infection control efforts. Targeted symptom and contact questionnaires may streamline symptomatic HCP testing for COVID-19.

Occupational Risk Factors for SARS-CoV-2 Seropositivity in Healthcare Workers

“…Interns exhibited the highest odds (OR, 4.22; 95% CI, 1.20–14.0), followed by resident physicians (OR, 3.14; 95% CI, 1.24–8.33), and clinical fellows and chief residents (OR, 1.19; 95% CI, 0.30–4.03) after multivariable adjustment. This result is consistent with prior research that disaggregated physicians-in-training from attending physicians 13,21–23 but is, to our knowledge, the first report of an inverse dose-response relationship between year of training and COVID-19 seroprevalence among physicians-in-training.…”

“…Interns exhibited the highest odds (OR, 4.22; 95% CI, 1.20-14.0), followed by resident physicians (OR, 3.14; 95% CI, 1.24-8.33), and clinical fellows and chief residents (OR, 1.19; 95% CI, 0.30-4.03) after multivariable adjustment. This result is consistent with prior research that disaggregated physicians-in-training from attending physicians 13,[21][22][23] but is, to our knowledge, the first report of an inverse dose-response relationship *All hazard and odds ratios have been adjusted for age, sex, race, ethnicity, community COVID incidence, high-risk COVID exposure outside of work, job position using house staff as a combined category, frequency of direct patient care, exposure to aerosol-generating procedures, and work with coworker who was known or suspected to be COVID+. Baseline odds ratios have also been adjusted for date of enrollment in the study.…”

“…In particular, the effect of job role has been inconsistent across studies, with early research showing physicians at higher risk and subsequent studies demonstrating elevated risk among nurses 19 . Although research on job role has many challenges—including missing data, 20 exposure misclassification, and heterogeneity of job roles 19 —point estimates for SARS-CoV-2 infection among physicians-in-training have been consistently observed to be higher than attending physicians in the United States 13,21–23 . Physicians-in-training may experience elevated occupational risk of SARS-CoV-2 infection due to their level of training as well as their close contact in caring for patients.…”

“…19 Although research on job role has many challenges-including missing data, 20 exposure misclassification, and heterogeneity of job roles 19 -point estimates for SARS-CoV-2 infection among physicians-in-training have been consistently observed to be higher than attending physicians in the United States. 13,[21][22][23] Physicians-in-training may experience elevated occupational risk of SARS-CoV-2 infection due to their level of training as well as their close contact in caring for patients. To address these gaps in the literature, we sought to provide a more granular analysis of HCW risk factors in a single metropolitan hospital system, including more detailed job classifications that account for physicians-in-training, and longitudinal follow-up to characterize both prevalent and incident infections.…”

Time Analysis of an Emergent Infection Spread Among Healthcare Workers: Lessons Learned from Early Wave of SARS-CoV-2

“…Some confirm our results and some claim that HCWs had the same infection rate as the population during that time. [5][6][7][20][21][22][23][24][25][26][27][28][29][30][31][32][33] These discrepancies can be attributed to multiple reasons. The first reason is the type of test used to confirm infection; our study is slightly superior as it uses RT-PCR testing instead of serology testing.…”