National COVID-19 Hospital Admissions and Mortality Among Healthcare Workers in South Africa, 2020-2021

Abstract

Background: Healthcare workers (HCWs) in close contact with SARS-CoV-2-infected patients have an increased risk of infection compared to non-HCWs, but little is known about the clinical course and risks for mortality amongst HCWs in South Africa. In this study, we compared characteristics of hospitalised HCWs with non-HCWs with COVID-19 and assessed factors associated with COVID-19 mortality among HCWs. Methods: Data from 5 March 2020 to 30 April 2021 was obtained from DATCOV, the national surveillance programme monitoring COVID-19 admissions in private and public hospitals across South Africa. A logistic regression model was used to determine factors associated with COVID-19 HCW admissions and mortality.Results: There were a total 169,678 confirmed COVID-19 admissions reported on DATCOV, of which 6,364 (3.8%) were HCWs. Compared to non-HCWs, HCWs were less likely to be male [aOR 0.3, 95%CI (0.3-0.4)], and more likely to be younger, white or other race, have pre-existing obesity and asthma, and be admitted in the private sector, in Eastern Cape, Gauteng, Kwa-Zulu Natal, Limpopo, Northern Cape and North West provinces. Pre-wave 1 [aOR 3.0; 95%CI 2.4-3.7)], wave 1 [aOR 2.1; 95%CI (1.8-2.5)] and post-wave 1 [aOR 1.3; 95%CI (1.0-1.7)] were associated with increase in HCW admissions compared to wave 2. There was an increased risk for in-hospital mortality among HCWs in the older age group (40-49 [aOR 3.8; 95%CI (1.6-8.80)]; 50-59 [aOR 4.7; 95%CI (2.0-10.9)] and 60-65 years [aOR 9.8; 95%CI (4.2-23.0)] compared to HCWs less than 40 years, with comorbidities such as hypertension, diabetes, chronic kidney diseases, malignancy and TB. Mortality was decreased for HCWs who were coloured [aOR 0.5; 95%CI (0.3-0.8)], admitted in the public sector [aOR 0.7; 95%CI (0.5-0.9)] in pre-wave 1 [aOR 0.6; 95%CI (0.3-0.9)] compared to wave one period. Conclusion: In-hospital mortality in HCWs was associated with age, race, wave period, presence of comorbidites and sector. Policies should be put in place to remove older HCWs with comorbidities from direct patient care. Optimal management of comorbid conditions is advised and improvement of infection prevention and control measures in healthcare settings for those that come into direct contact with infected patients.

COVID-19 cases among medical laboratory services staff in South Africa, 2020–2021: A cohort study

“…A higher proportion of HCW cases is not unexpected, as the study by Gomez-Ochoa and colleagues showed a higher prevalence of SARS-CoV-2 infection among HCWs compared with the data from the general population [16]. Similar to reports on HCWs in South Africa, where more cases and increased COVID-19 hospital mortality were seen [9,17]. Compared to the epidemic curve among the population in SA, the epidemic curve comprising COVID-19 cases reported on OHASIS showed two waves (Fig 1).…”

“…A similar decrease in COVID-19 cases among medical laboratory services staff was seen in the second wave. This was thought to be due to reasons including improved safety protocols being implemented in health facilities, availability and appropriate use of PPE, better infection control measures being put into place, as well as improved handling of admitted patients [9]. In addition, previous exposure to COVID-19 has been shown to result in subsequently improved immunity against infections, which may also be the reason for a reduced number of cases in the second wave [18].…”

“…This data also compared age groups, where significant differences were observed with those 30 to 60 years at more risk than those under 30 years. Previous studies have alluded to a significant role of sex and age in COVID-19 related mortality [9]. In another study, it was found that men who worked in healthcare occupations in England and Wales had a statistically higher rate of death involving COVID-19 (44.9 deaths per 100,000 males; 190 deaths) when compared with the rate of COVID-19 among men of the same age in the population [21].…”

“…Several reports are available on COVID-19 in HCWs in South Africa, particularly those based in hospitals [9,10]. Nonetheless, there is a lack of reports focusing on the subcategories of health workers, such as medical laboratory workers, who may have a different education around exposure and type of interaction with the disease.…”

Strengthening Social Compact and Innovative Health Sector Collaborations in Addressing COVID-19 in South African Workplaces

“…Apart from studies among health workers (HWs) and reports among miners, there have been no studies on work-related COVID-19 in other groups of South African workers. [9][10][11][12][13][14]…”