Outcomes of COVID-19 Among Hospitalized Health Care Workers in North America

Effect of COVID‐19 on healthcare workers' morbidity and mortality compared to the general population in Kohgiluyeh and Boyer‐Ahmad Province, Iran

During the Covid‐19 pandemic, the adverse effects of recent coronaviruses on healthcare professionals cannot be ignored. This study compared the admission rates due to Covid‐19 and characteristics of hospitalized healthcare workers with the general population of Kohgiluyeh and Boyer‐Ahmad (K.B) province. 18546 hospitalized patients infected with Covid‐19 in hospitals in four cities of K.B province were enrolled in this study; of them, 236 (1.27%) patients were healthcare workers. Demographic and clinical data of hospitalized cases due to Covid‐19 infection were collected from August 2020 to September 2021. The underlying diseases were also considered in this study. According to our findings, 55.5% of the hospitalized healthcare workers were male, and 44.5% were female; their mean age was 41.41 years. However, in the general population, hospitalization rates were higher for women than for men (51.2% and 48.8%, respectively). Although the SARS‐CoV‐2 infectivity rate was higher in healthcare workers compared to the general population (68.6% vs. 56.1%), the mortality rate was significantly lower in them (1.7% vs. 3.8%). Fever, cough, Acute Respiratory Distress Syndrome, headache, and myalgia were the most prevalent symptoms in both groups. Among the cases examined in this study, inpatient ones aged 30–40 years and the general population aged over 60 seemed to be more likely to be hospitalized for Covid‐19. The hospitalization rate of healthcare workers during the pandemic follows the same pattern as the general population, but since the start of vaccination, this rate has decreased among healthcare workers compared to the general population of KB province.

In-hospital outcomes of SARS-CoV-2-infected health care workers in the COVID-19 pandemic first wave, Quebec, Canada

Background

Health care workers (HCW), particularly immigrants and ethnic minorities are at increased risk for SARS-CoV-2 infection. Outcomes during a COVID-19 associated hospitalization are not well described among HCW. We aimed to describe the characteristics of HCW admitted with COVID-19 including immigrant status and ethnicity and the associated risk factors for Intensive Care unit (ICU) admission and death.

Methods

Adults with laboratory-confirmed community-acquired COVID-19 hospitalized from March 1 to June 30, 2020, at four tertiary-care hospitals in Montréal, Canada were included. Demographics, comorbidities, occupation, immigration status, country of birth, ethnicity, workplace exposures, and hospital outcomes (ICU admission and death) were obtained through a chart review and phone survey. A Fine and Gray competing risk proportional hazards model was used to estimate the risk of ICU admission among HCW stratified by immigrant status and region of birth.

Results

Among 1104 included persons, 150 (14%) were HCW, with a phone survey participation rate of 68%. HCWs were younger (50 vs 64 years; p<0.001), more likely to be female (61% vs 41%; p<0.001), migrants (68% vs 55%; p<0.01), non-White (65% vs 41%; p<0.001) and healthier (mean Charlson Comorbidity Index of 0.3 vs 1.2; p<0.001) compared to non-HCW. They were as likely to be admitted to the ICU (28% vs 31%; p = 0.40) but were less likely to die (4% vs. 17%; p<0.001). Immigrant HCW accounted for 68% of all HCW cases and, compared to Canadian HCW, were more likely to be personal support workers (PSW) (54% vs. 33%, p<0.01), to be Black (58% vs 4%) and to work in a Residential Care Facility (RCF) (59% vs 33%; p = 0.05). Most HCW believed that they were exposed at work, 55% did not always have access to personal protective equipment (PPE) and 40% did not receive COVID-19-specific Infection Control (IPAC) training.

Conclusion

Immigrant HCW were particularly exposed to COVID-19 infection in the first wave of the pandemic in Quebec. Despite being young and healthy, one third of all HCW required ICU admission, highlighting the importance of preventing workplace transmission through strong infection prevention and control measures, including high COVID-19 vaccination coverage.

Psychological Responses of Health Care Workers Are Strongly Associated With Pandemic Management

Background

Globally, governments adopted protective measures to stabilize the worsening COVID-19 pandemic situation. These measures had a large impact on health care workers (HCWs) and could make the work environment more stressful for them. Therefore, we explored the associations of the psychological responses of HCWs and pandemic management among Slovak health care workers during the second wave of the pandemic.

Materials and Methods

We obtained data about psychological responses, COVID-19 experiences, information overload, non-adherence of the public, work stress and barriers and facilitators of health care provision from HCWs at the COVID-19-related departments of one hospital that mainly covered eastern Slovakia (215 health care professionals, 77.7% females, M/SD = 44.4). Data were analyzed using logistic regression models adjusted for gender.

Results

Pandemic management was most strongly associated with psychological responses, such as irritability, sadness, anxiety, dizziness, and back pain, in health care workers. The non-adherence of the public had the strongest associated psychological impact on HCWs, mostly affecting anxiety and irritability (odds ratios, ORs varying from 3.9 to 7.0). From the barriers and facilitators of health care provision, the use of personal protective equipment had the most impact psychologically, whereas efficient department management was most protective, with ORs around 0.3.

Conclusion

Pandemic management has a large impact on health care workers, and promoting resilience may seriously decrease job-related stress and associated psychological responses of HCWs.

Infection, reinfection, and postvaccination incidence of SARS-CoV-2 and associated risks in healthcare workers in Tamil Nadu: A retrospective cohort study

BACKGROUND

The study was conducted in response to the need to understand the incidence of SARS-CoV2 infection and its determinants in healthcare workers (HCWs) and describe the epidemiology and presentation of reinfection cases. Also, we intended to determine the incidence of post-vaccination infections among health care workers as well as the contributing factors.

MATERIALS AND METHODS

Retrospective cohort design was used to quantify the coronavirus disease (COVID-19) infection among HCWs. The study cohort was all healthcare personnel working during the month of June 2021 in a tertiary care medical college hospital. Individuals diagnosed with laboratory-confirmed positive real-time polymerase chain reaction tests for SARS-CoV-2 infection between March 20, 2020, and May 31, 2021, were included. Univariate and multivariate analysis with Cox regression model elicited potential risk factors for all infections in HCWs.

RESULTS

A total of 2420 HCWs constituted the cohort, in which the majority were primary healthcare providers (67.1%) and others. The mean age of the cohort was 30.27 years ± 10.53 standard deviation. The cumulative incidence of infection, reinfection, and postvaccination infection was 144.6 cases, 11.4 individuals, and 66.5 per 1000 HCWs respectively. Chronic illness was significantly associated with all infections. However, males and primary-care providers had higher risk of infection, whereas among the postvaccinated participants, partial vaccination status was one of the determinants.

CONCLUSION

Based on the findings, we endorse stringent testing and encourage HCWs to mandatorily follow COVID-appropriate behavior even if they are completely vaccinated and after recovery from previous infection.

Coronavirus Disease 2019 as Cause of Viral Sepsis: A Systematic Review and Meta-Analysis

OBJECTIVE

Coronavirus disease 2019 is a heterogeneous disease most frequently causing respiratory tract infection, which can induce respiratory failure and multiple organ dysfunction syndrome in its severe forms. The prevalence of coronavirus disease 2019-related sepsis is still unclear; we aimed to describe this in a systematic review.

DATA SOURCES

MEDLINE (PubMed), Cochrane, and Google Scholar databases were searched based on a prespecified protocol (International Prospective Register for Systematic Reviews: CRD42020202018).

STUDY SELECTION

Studies reporting on patients with confirmed coronavirus disease 2019 diagnosed with sepsis according to sepsis-3 or according to the presence of infection-related organ dysfunctions necessitating organ support/replacement were included in the analysis. The primary end point was prevalence of coronavirus disease 2019-related sepsis among adults hospitalized in the ICU and the general ward. Among secondary end points were the need for ICU admission among patients initially hospitalized in the general ward and the prevalence of new onset of organ dysfunction in the ICU. Outcomes were expressed as proportions with respective 95% CI.

DATA EXTRACTION

Two reviewers independently screened and reviewed existing literature and assessed study quality with the Newcastle-Ottawa Scale and the Methodological index for nonrandomized studies.

DATA SYNTHESIS

Of 3,825 articles, 151 were analyzed, only five of which directly reported sepsis prevalence. Noting the high heterogeneity observed, coronavirus disease 2019-related sepsis prevalence was 77.9% (95% CI, 75.9-79.8; I2 = 91%; 57 studies) in the ICU, and 33.3% (95% CI, 30.3-36.4; I2 = 99%; 86 studies) in the general ward. ICU admission was required for 17.7% (95% CI, 12.9-23.6; I2 = 100%) of ward patients. Acute respiratory distress syndrome was the most common organ dysfunction in the ICU (87.5%; 95% CI, 83.3-90.7; I2 = 98%).

CONCLUSIONS

The majority of coronavirus disease 2019 patients hospitalized in the ICU meet Sepsis-3 criteria and present infection-associated organ dysfunction. The medical and scientific community should be aware and systematically report viral sepsis for prognostic and treatment implications.

Long-Term Effects of COVID-19 on Health Care Workers 1-Year Post-Discharge in Wuhan

Introduction

To assess the long-term consequences of coronavirus disease (COVID-19) among health care workers (HCWs) in China (hereafter surviving HCWs).

Methods

A total of 303 surviving HCWs were included. Lung (pulmonary function test, 6-min walk test [6MWT], chest CT), physical (St. George’s Respiratory Questionnaire [SGRQ], Modified Medical Research Council dyspnea scale [mMRC], and Borg scale), and psychiatric functions (Essen Trauma Inventory) were evaluated during the 1-year follow-up.

Results

Surviving HCWs had an abnormal diffusion capacity 1 year post-discharge. Participants with a reduced carbon monoxide diffusing capacity (DLCO) comprised 43.48%. The proportion of HCWs with a median 6MWT distance below the lower limit of the normal was 19.4%. An abnormal CT pattern was observed in 37.5% of the HCWs. The SGRQ, mMRC, and Borg scores of surviving HCWs, especially those with critical/severe disease, were significantly higher than those in the normal population. Probable post-traumatic stress disorder (PTSD) was reported in 21.9% of the surviving HCWs. Diffusion capacity impairment was associated with women. Critical/severe illness and nurses were associated with impaired physical function.

Conclusions

Most surviving HCWs, especially female HCWs, still had an abnormal diffusion capacity at 1 year. The physical and psychiatric functions of surviving HCWs were significantly worse than those of the healthy population. Long-term follow-up of pulmonary, physical, and psychiatric functions for surviving HCWs is required.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40121-021-00553-0.

Healthcare Workers Infection Rate in the Era of Coronavirus Disease 2019 - in Tertiary Teaching Hospital

BACKGROUND: Healthcare workers (HCWs) are at the frontline defense against coronavirus disease 2019 (COVID-19) pandemic. AIM: The study aimed to describe the characteristics and appraise potential risk factors of COVID-19 transmission among HCWs who tested positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in one of Cairo University Hospitals. METHOD: Cross-sectional descriptive analysis of confirmed polymerase chain reaction (PCR) positive versus negative cases for COVID-19. RESULTS: Through March–June 2020, (145/846; 17%) suspected HCWs were tested for COVID-19 by PCR; out of them (70/145; 48.3%) were confirmed as positive, these positive cases represented (70/846; 8.3%) of all HCWs of the hospital. About 33% of confirmed COVID-19 positive HCWs acquired the infection from the healthcare while only (13/70; 19%) from community settings, and no clear exposure data were identified in (34/70; 48%) of cases. Most of symptomatic cases showed a positive PCR test for SARS-CoV-2 versus asymptomatic cases, p < 0.001. There was no statistical significance regarding gender, age, presence of comorbidity, workload or the type of acquisition. CONCLUSION: HCWs are at an increased risk of COVID-19 infection at the workplace. Strict implementation of infection control measures is of crucial role in preventing transmission of COVID-19 infection in health-care settings.