1. Front line health care workers in Wuhan had a lower rate of COVID-19 infection when compared to non-front line health care workers.
2. The risk of infection was higher during the initial stages of the COVID-19 outbreak.
Evidence Rating Level: 2 (Good)
Study Rundown: Risk of infection with COVID-19 among healthcare workers remains unclear. This study examined rates of infection among healthcare workers working in low-contagion areas in Wuhan, China, and aimed to characterize those who tested positive. The study found that most healthcare worker related infections occurred during the early stages of the outbreak, and that non front-line healthcare workers had higher rates of infection than front-line workers. Contact with infected patients and colleagues as well as community-related exposures were the main routes of infection exposure. The study is limited by recall bias that may have occurred during the administration of the questionnaire used to collect epidemiological and exposure related information from healthcare workers.
Relevant Reading: Coronavirus infections—more than just the common cold
In-Depth [case series]: This study was conducted in Wuhan, China from January 1 to February 9, 2020, involving healthcare workers in Tongji Hospital. A brief questionnaire consisting of exposure, epidemiologic, and demographic information was administered, and clinical, laboratory and radiographic information was collected by retrospective review. A total of 9684 health care workers were sampled, of which 110 (1.1%) tested positive for SARS-CoV-2 infection. While 0.5% of first-line workers were infected, 1.4% of non-first line workers were the same. Subclinical infection rate of 0.74% in asymptomatic health care workers compared to 1.0% in non-first-line staff. Among those with COVID-19, 71.8% were found to be women ranging from 30-47 years of age. The majority (84.5%) of these health care workers had non-severe COVID-19; one (0.9%) patient died. The most common modes of exposure were contact with SARS-CoV-2 infected patients (59.2%), followed by contact with infected colleagues (10.9%) and community acquisition (12.7%); interestingly, despite transmission considered to be via droplet and contact spread, no environmental surfaces tested positive. The common symptoms reported were fever, myalgia or fatigue, cough, sore-throat and muscle ache. Overall, study findings suggested that healthcare worker related infections occurred earlier in the disease outbreak, were generally associated with non-severe disease, were largely associated with an infected patient exposure, and affected non-first line healthcare workers more than first-line workers.
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