High prevalence of SARS-CoV-2 infection among symptomatic healthcare workers in a large university tertiary hospital in São Paulo, Brazil

Abstract

Background: Brazil became the epicenter of the COVID-19 pandemic in Latin America since May 2020, reporting the highest number of cases and deaths in the region. Healthcare workers (HCWs) are at increased risk of SARS-CoV-2 infection, experiencing a significant burden from COVID-19. Identifying and understanding the clinical characteristics and risk factors associated with infection are of paramount importance to inform screening strategies and infection control practices in this scenario. The aims of this study were to investigate the prevalence and clinical characteristics of HCWs with COVID-19 symptoms. Methods: Between March 21st and May 22nd, 2020 a cross-sectional study was performed in a tertiary university hospital in São Paulo. Prevalence of SARS-CoV-2 infection among HCWs with COVID-19 symptoms was determined by RT-PCR testing on nasopharyngeal and oropharyngeal samples. Participants were asked to complete an electronic structured questionnaire including clinical and demographic data. Results: Overall, 125 (42.37%) of 295 symptomatic HCWs tested positive for SARS-CoV-2. Over the 10-week study period, positivity rates varied from 22.2% (95% CI 15.9% - 60.3%) in the second week to 55.9% (95% CI 43.2% - 68.6%) in the sixth week, reaching a plateau (38% - 46%) thereafter. Median (SD) age was 34.2 ( 9.9) years and 205 (69.5%) were female. We did not find significant differences in the prevalence of the most commonly reported underlying medical condition among healthcare workers that tested positive or negative for SARS-CoV-2 infection. After multivariable analysis, using logistic regression, anosmia (adjusted OR 4.4 95% CI 2.21 - 8.74) and ocular pain (adjusted OR 1.95 95% CI 1.14 - 3.33) were the only symptoms independently associated with positivity for SARS-CoV-2 infection. Follow-up information on clinical outcomes showed that 9 (7.2%) HCWs were hospitalized (seven were male) and 2 (1.6%) died. Conclusions: The findings of this study confirmed the high burden of SARS-CoV-2 infection among healthcare workers in the hardest hit city by the pandemic in Latin America. Anosmia and ocular pain were symptoms independently associated with COVID-19 diagnosis. In low and middle-income countries, where limited availability of tests is frequent, these findings may contribute to optimize a targeted symptom-oriented screening strategy.

The Predictors of COVID-19 Disease Outcomes in Health Care Workers

“…These results are in agreement with another study that shows no correlation between them (11). However, some studies reported that general practitioners have higher mortality among doctors (7,13) because they spend prolonged periods of time with COVID-19 patients, have more shift timing, and get more exposure to higher distress, which put them in the high-risk group (13).…”

“…In terms of gender, the mortality in infected females and males was 1.3% and 7.4%, which is a statistically signi cant difference like that found in other studies (7,11,13).…”

“…The current investigation demonstrated that the use of PPE (a combination of N95 face mask, gloves, gown, and eye shield) was associated with less mortality in HCWs, but constant exposure to COVID-19 increases the risk and severity of infection in HCWs (13), while another study showed that the risk of exposure to COVID-19 at work is negligible. For optimal risk reduction in HCWs, more preventive care is recommended (14).…”

COVID-19 in Health Care Personnel

“…A number of other publications found similar associations between symptoms and SARS-CoV-2 testing for symptomatic HCP. [7][8][9][10][11] Most demonstrated the presence of fever, cough, ageusia, or anosmia are associated with a higher odds of testing positive; few have similarly shown gastrointestinal symptoms and pharyngitis may be associated with significantly lower odds. However, prior results have been hampered by: (1) limited Symptoms included cough, chills, fever, anosmia, ageusia, headache, and myalgia.…”

“…Data on prevalence of, and risk factors for, COVID-19 in HCP exist [2][3][4][5][6] ; however, there is little information on the relationship between (1) health care role, (2) contact history, and (3) symptoms with subsequent SARS-CoV-2 polymerase chain reaction (PCR) testing results for symptomatic HCP. [7][8][9][10][11] We performed a prospective cohort study of symptomatic HCP at a large, tertiary care center to determine these associations.…”