Epidemiology Characteristics of COVID-19 Infection Amongst Primary Health Care Workers in Qatar: March-October 2020

SARS-CoV-2 infection prevalence, risk factors, and outcomes among non-clinical-related service providers in a national healthcare system

Health care workers (HCWs) may be at a variable risk of SARS-CoV2 infection. Regardless of their involvement in providing direct clinical treatment, most of the prior research had included all HCWs. Understanding infection rates, risk factors and outcomes among different subgroups of HCWs is crucial. From February 28, 2020 to January 1, 2022, we conducted a retrospective analysis encompassing all full-time non-clinical staff (NCS) subcontracted with Hamad Medical Corporation (HMC) facilities. To determine current or previous SARS-CoV2 infection, all personnel underwent RT-PCR and/or serology testing. To identify the demographic factors linked to the risk of infection, we utilized Cox-Hazard regression analysis. Herein 3158/6231 (50.7%) subcontracted NCS tested positive for SARS-CoV-2 by RT-PCR or serology during the research period. The median age was 30 years (IQR 25,35), 69.8% of the population were males, 82.4% were from South Asia, 86.6% did not have any concomitant conditions. 6032 (96.8%) of the population lived in shared housing, while 4749 (76.2%) had low to median levels of education. While infection (PCR positive with or without seropositive results) was independently predicted by male gender, working in the catering, laundry, and security sectors and being intermediate (7-12 years of education), lower (0-6 years of education), higher (exposure to confirmed case), and having symptoms. Male gender, working in the security sectors and being intermediate (7-12 years of education) were independently associated with accidently detected cases (PCR negative and seropositive). 299 (4.8%) required hospitalization, of them 3 cases were severe pneumonia and one required ICU admission without mechanical ventilation, with no deaths reported. In conclusion Infection rates among NCS are high. The majority are asymptomatic and may contribute to ongoing illness spread in the public or in healthcare facilities. During a pandemic, routine screening of this population is crucial and may aid in containing the spread of infection.

Risk of SARS-CoV-2 infection in dental healthcare workers - a systematic review and meta-analysis

Background

Mounting evidence supports an association between the use of personal protective equipment (PPE) and the risk of infection from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in dental healthcare workers (DCW). However, the prevalence and incidence of SARS-CoV-2 infections in the setting of dental care remains poorly characterized.

Methods

A systematic review and meta-analysis of studies published prior to Mai 2023 providing epidemiological data for the occurrence of SARS-CoV-2 in DCW was performed. A random-effects model was used to calculate pooled estimates and odds ratios (ORs) with corresponding 95% confidence intervals (CIs). The associated factors were narratively evaluated. Risk of bias was assessed using the Joanna Briggs Institute tool for prevalence studies.

Results

Twenty-nine eligible studies were identified including a total of 85,274 DCW at risk; 27 studies met the criteria for the meta-analysis. Among the included DCW, the overall prevalence of SARS-CoV-2 was 11.8% (13,155/85,274; 95%CI, 7.5%-17%), whereby the degree of heterogeneity between the studies was considerable (I2=99.7%). The pooled prevalence rate for dentists and dental hygienists alone was 12.7% (1943/20,860; 95%CI, 8.0%-18.0%), showing significantly increased odds of contracting a SARS-CoV-2 infection compared to dental assistant personnel, the prevalence rate for which was less than half, at 5.2% (613/15,066; OR=2.42; 95% CI, 2.2-2.7). In the subgroup of 17 studies from countries with high income there was a significantly lower prevalence rate of 7.3% (95% CI, 5%-10%) in DCW compared to the prevalence rate in low- and middle-income countries, which came to 20.8% (95% CI, 14%-29%; p<0.001). In 19 out of the 29 studies (65.5%), specific information on the use of and adherence to PPE was absent while in the reports with concrete figures the wearing of N95 (or at least surgical masks) by DCW appeared to be associated with lower SARS-CoV-2 prevalence rates.

Conclusions

DCW were, depending in each case on their proximity to patients, at particular risk of SARS-CoV-2 infection during the COVID-19 pandemic. Until a significant level of vaccination protection against newer SARS-CoV-2 variants can be built up in the population, dental healthcare facilities should further maintain their focus on using PPE according to current guidelines.

[Risk management system to reduce COVID-19 infection in health personnelSistema de gestão de riscos para reduzir o contágio de COVID-19 em profissionais de saúde]

Objective

To assess the occupational factors associated with the occurrence of COVID-19 in health personnel who were exposed to different magnitudes of risk and who followed the United Nations crisis management policy for COVID-19.

Methods

Cross-sectional survey conducted between April and May 2021. The low-risk group (LRG) were considered to be those who had minimal contact with patients; the medium-risk group (MRG) had contact with non-COVID-19 patients and did not perform instrumental airway intervention; and the high-risk group (HRG) were those who cared for COVID-19 patients and performed instrumental intervention with aerosol generation. Diagnosed COVID-19 disease and the presence of positive IgG antibodies for SARS-CoV-2 measured with Elecsys® anti-SARS-CoV-2 were considered as outcomes.

Results

Outcome recorded in 43.8% of the LRG, versus 46.7% in the MRG (odds ratio [OR]: 1.125; 95% confidence interval [CI 95% ]: 0.896-1.414; p = 0.311), and 48.6% in the HRG (OR: 1,214; CI 95%: 0.964-1.530; p= 0.10).

Conclusion

Belonging to the high-risk group and the medium-risk group, based on the degree of exposure to confirmed COVID-19 patients in the work area, was not associated with a higher occurrence of disease or seroconversion.

Impact of DHCWs' Safety Perception on Vaccine Acceptance and Adoption of Risk Mitigation Strategies

OBJECTIVES

To estimate the association between safety perception on vaccine acceptance and adoptions of risk mitigation strategies among dental health care workers (DHCWs).

METHODS

A survey was emailed to DHCWs in the New Jersey area from December 2020 to January 2021. Perceived safety from regular SARS-CoV-2 testing of self, coworkers, and patients and its association with vaccine hesitancy and risk mitigation were ascertained. Risk Mitigation Strategy (RiMS) scores were computed from groupings of office measures: 1) physical distancing (reduced occupancy, traffic flow, donning of masks, minimal room crowding), 2) personal protective equipment (fitted for N95; donning N95 masks; use of face shields; coverings for head, body, and feet), and 3) environmental disinfection (suction, air filtration, ultraviolet, surface wiping).

RESULTS

SARS-CoV-2 testing of dental professionals, coworkers, and patients were perceived to provide safety at 49%, 55%, and 68%, respectively. While dentists were least likely to feel safe with regular self-testing for SARS-CoV-2 (P < 0.001) as compared with hygienists and assistants, they were more willing than hygienists (P = 0.004; odds ratio, 1.79 [95% CI, 1.21 to 2.66]) and assistants (P < 0.001; odds ratio, 3.32 [95% CI, 1.93 to 5.71]) to receive the vaccine. RiMS scores ranged from 0 to 19 for 467 participants (mean [SD], 10.9 [2.9]). RiMS scores did not significantly differ among groups of DHCWs; however, mean RiMS scores were higher among those who received or planned to receive the COVID-19 vaccine than those with who did not (P = 0.004). DHCWs who felt safer with regular testing had greater RiMS scores than those who did not (11.0 vs. 10.3, P = 0.01).

CONCLUSIONS

Understanding DHCWs' perception of risk and safety is crucial, as it likely influences attitudes toward testing and implementation of office risk mitigation policies. Clinical studies that correlate risk perception and RiMS with SARS-CoV-2 testing are needed to demonstrate the effectiveness of RiMS in dental care settings.

KNOWLEDGE TRANSFER STATEMENT

Educators, clinicians, and policy makers can use the results of this study when improving attitudes toward testing and implementation of risk mitigation policies within dental offices, for current and future pandemics.

Occupational Prevention of COVID-19 Among Healthcare Workers in Primary Healthcare Settings: Compliance and Perceived Effectiveness of Personal Protective Equipment

OBJECTIVES

It is crucial for healthcare workers (HCWs) to comply with infection prevention and control precautions such as the appropriate use of personal protective equipment (PPE) for their safety and the safety of patients. In this study, we aimed to assess HCWs' compliance with the appropriate use of PPE in primary healthcare settings in Qatar along with its associated factors and explore their perceived effectiveness of different PPE items in protecting against COVID-19 infection.

METHODS

A Web-based survey was conducted between November 2020 and January 2021 targeting all clinical HCWs under the umbrella of Primary Health Care Corporation.

RESULTS

A total of 757 HCWs completed the survey, and most were between 30 and 39 years of age (50.2%), females (62.7%), and nurses (35.3%). Eighty eight percent of participants believed that PPE could provide high or very high protection against COVID-19. About one-half (53%) were found to be fully compliant with PPE use during patient interactions with suspected or confirmed COVID-19 cases, whereas three-quarters (76.3%) were fully compliant while performing aerosol-generating procedures. Healthcare workers' age, nationality, health center region, area of work, clinical experience, frequency of interaction with suspected or confirmed COVID-19 cases, and the perceived effectiveness of PPE were significant predictors of full compliance with PPE. Shortage of PPE was the commonest reported barrier to appropriate use.

CONCLUSIONS

Despite HCWs' high perceived effectiveness for PPE in protecting against COVID-19 infection, their full compliance rate with using PPE was moderate and needs further improvement.

Impact of COVID-19 on environmental services workers in healthcare settings: a scoping review

BACKGROUND

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, demand for deep cleaning and environmental services workers grew exponentially. Although there is extant literature examining the impact of the COVID-19 pandemic on healthcare workers, less emphasis has been placed on environmental services workers, who play an equally important front-line role.

AIM

To examine the impact of the COVID-19 pandemic on environmental services workers employed in healthcare settings.

METHODS

Scoping review methodology. A search strategy was developed, in consultation with a medical information specialist, employing various combinations of the keywords [(environmental services worker OR health attendant OR housekeeping) AND (COVID OR coronavirus OR pandemic OR epidemic)]. Four bibliographical databases were searched from inception to 5th July 2022: OVID Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Database.

RESULTS

In total, 24 studies were included in this review. The studies were generally cross-sectional in design. Seroprevalence studies highlighted significantly higher rates of COVID-19 among environmental services workers (housekeeping, cleaning and janitorial staff) compared with other clinical and non-clinical staff in the same institutions. In addition, based on qualitative interviews, environmental services workers experienced greater psychological stress working during the pandemic.

CONCLUSIONS

Environmental services workers were particularly vulnerable to increased work stress and COVID-19 during the pandemic. Health systems need to do more to support these workers. Further research could investigate specific policy and procedural changes to benefit this under-recognized group in the greater healthcare workforce.

Incidence, Prevalence, and Sources of COVID-19 Infection among Healthcare Workers in Hospitals in Malaysia

The COVID-19 pandemic introduced significant novel risks for healthcare workers and healthcare services. This study aimed to determine the prevalence, trends, characteristics, and sources of COVID-19 infection among healthcare workers during the early COVID-19 pandemic in Malaysian hospitals. A cross-sectional study used secondary data collected from a COVID-19 surveillance system for healthcare workers between January and December 2020. Two surges in COVID-19 cases among healthcare workers in Malaysia were epidemiologically correlated to a similarly intense COVID-19 pattern of transmission in the community. The period prevalence of COVID-19 infection and the mortality rate among healthcare workers in Malaysia were 1.03% and 0.0019%, respectively. The majority of infections originated from the workplace (53.3%); a total of 36.3% occurred among staff; a total of 17.0% occurred between patients and staff; and 43.2% originated from the community. Healthcare workers had a 2.9 times higher incidence risk ratio for the acquisition of COVID-19 infection than the general population. Nursing professionals were the most highly infected occupational group (40.5%), followed by medical doctors and specialists (24.1%), and healthcare assistants (9.7%). The top three departments registering COVID-19 infections were the medical department (23.3%), the emergency department (17.7%), and hospital administration and governance (9.1%). Occupational safety and health units need to be vigilant for the early detection of a disease outbreak to prevent the avoidable spread of disease in high-risk settings. The transformation of some tertiary hospitals to dedicated COVID-19 care, the monitoring of new procedures for the management of COVID-19 patients, and appropriate resource allocation are key to successful risk mitigation strategies.

Prognosis of COVID-19 in the middle eastern population, knowns and unknowns

Since its emergence in China in 2019, the SARS-CoV-2 virus has affected all countries worldwide. The virus is easily transmitted from one person to another via infected aerosols or contaminated surfaces. Unlike its counterparts, the prognosis of COVID-19 ranges from asymptomatic to critical disease or death. Several factors play a role in determining the severity of the disease in infected patients. Among others, is the pre-existence of an underlying medical condition such as diabetes, cancer, and others. Furthermore, although children are less prone to the severe form of the COVID-19 disease, they require attention due to the report of many atypical presentations of the infection, post-asymptomatic exposure. In the Middle East, little is known about the prognosis of the SARS-CoV-2 infection in high-risk categories, notably patients with diabetes, cancer, and pregnant women. The aim of this review is to summarize the current knowledge about this group of population in the middle eastern region as well as to highlight the gap in the literature. We have found that the majority of the papers were from the Gulf countries. Although, few studies were conducted; high-risk patients appear to have an increased risk of morbidity and mortality from COVID-19 compared to their counterparts. Higher levels of inflammatory markers, C-reactive protein, erythrocyte sedimentation rate, D-dimer, and ferritin levels were also observed. Children are often asymptomatic or present with atypical presentations. More studies should be conducted to determine the clinical biomarkers of COVID-19 in high-risk categories to help in patient risk stratification and management in the middle eastern population.

SARS-CoV-2 Exposures of Healthcare Workers from Primary Care, Long-Term Care Facilities and Hospitals: A Nationwide Matched Case-Control Study

OBJECTIVES

This study assessed the roles of various exposures and personal protective equipment (PPE) use on healthcare workers'risk (HCWs) of COVID-19 working in primary care, long-term-care facilities or hospitals.

METHODS

We conducted a matched case-control (1:1) study (10 April-9 July 2021). Cases (HCWs with confirmed COVID-19) and controls (HCWs without any COVID-19-positive test or symptoms) were invited by email to complete an online questionnaire on their exposures and PPE use over the 10-day period preceding inclusion. Risk factors were analyzed using multivariable conditional logistic regression.

RESULTS

A total of 2076 cases and 2076 matched controls were included. The analysis retained exposure to an infected person outside work (adjusted odd ratio, 19.9 [95% confidence intervaI, 12.4-31.9]), an infected colleague (2.26 [1.53-3.33]) or COVID-19 patients (2.37 [1.66-3.40]), as independent predictors of COVID-19 in HCWs, while partial (0.30 [0.22-0.40]) or complete (0.19 [0.14-0.27]) immunization was protective. Eye protection (0.57 [0.37-0.87]) and wearing a gown (0.58 [0.34-0.97]) for COVID-19 patient care were protective, while wearing an apron slightly increased the risk of infection (1.47 [1.00-2.18]). Protection of N95 respirators and surgical facemasks did not differ. Compared to medical professions, being a nurse (3.79 [2.50-5.76]) or a nurse's aide (9.08 [5.30-15.5]) was associated with COVID-19. Results were consistent across all healthcare settings.

CONCLUSIONS

HCWs were more likely to get COVID-19 in their personal sphere than during occupational activities. Our results suggest that eye protection for HCWs during patient care should be actively promoted.

Mitigating SARS-CoV-2 Transmission in Hospitals: A Systematic Literature Review

Objectives: Hospital outbreaks of SARS-CoV-2 infection are dreaded but preventable catastrophes. We review the literature to examine the pattern of SARS-CoV-2 transmission in hospitals and identify potential vulnerabilities to mitigate the risk of infection.

Methods: Three electronic databases (PubMed, Embase and Scopus) were searched from inception to July 27, 2021 for publications reporting SARS-CoV-2 outbreaks in hospital. Relevant articles and grey literature reports were hand-searched.

Results: Twenty-seven articles that described 35 SARS-CoV-2 outbreaks were included. Despite epidemiological investigations, the primary case could not be identified in 37% of outbreaks. Healthcare workers accounted for 40% of primary cases (doctors 17%, followed by ancillary staff 11%). Mortality among infected patients was approximately 15%. By contrast, none of the infected HCWs died. Several concerning patterns were identified, including infections involving ancillary staff and healthcare worker infections from the community and household contacts.

Conclusion: Continuous efforts to train-retrain and enforce correct personal protective equipment use and regular routine screening tests (especially among ancillary staff) are necessary to stem future hospital outbreaks of SARS-CoV-2.

[Health worker safety as an essential condition for patient safety]

El mayor activo de cualquier sistema sanitario son sus profesionales, y estos deben ser cuidados para poder cuidar. Es necesario resaltar que son clave para la resiliencia de nuestros sistemas de salud. Esto es particularmente importante en momentos de crisis, y especialmente trascendente para la atención primaria de salud.

Durante la pandemia de la COVID-19, las condiciones de trabajo han sido el principal factor latente común para los incidentes de seguridad del paciente. Los profesionales de atención primaria han trabajado en condiciones laborales inseguras, con escasez de medios de protección, gran incertidumbre, falta de conocimiento científico y protocolos de trabajo rápidamente cambiantes para el abordaje de los casos y contactos de infección por la COVID-19, con una alta presión asistencial, largas jornadas de trabajo, suspensión de permisos y vacaciones, e incluso cambios de sus puestos de trabajo. Todo ello ha contribuido a que se conviertan, no solo en primeras víctimas de la pandemia, sino también en segundas víctimas de los eventos adversos sucedidos durante la misma.

Por ello, en este artículo analizamos los principales riesgos y daños sufridos por los profesionales en atención primaria y aportamos claves para contribuir a su protección en futuras situaciones parecidas.

Investigating Adherence to COVID-19 Vaccination and Serum Antibody Concentration among Hospital Workers-The Experience of an Italian Private Hospital

SARS-CoV-2 transmission has been high, especially among healthcare workers worldwide during the first wave. Vaccination is recognized as the most effective approach to combat the pandemic, but hesitation to get vaccinated represents an obstacle. Another important issue is the duration of protection after administration of the full vaccination cycle. Based on these premises, we conducted a study to evaluate vaccination adherence and the anti-S antibodies levels among hospital workers, from January to March, 2021. To assess adherence, an anonymous questionnaire was used. Anti-S antibody levels were obtained from the monitoring serological sample database. In total, 56.2% of the unvaccinated people did not report a previous infection from COVID-19. Among those who have not been vaccinated, 12.5% showed distrust against the vaccine, 8.3% stated to have received contraindications to the vaccination, and 6.3% did not report any choice. Analyzing anti-S antibody levels, only one person was found to have a value below the lower cut-off, two weeks, and three months after receiving their second dose. One was below the cut-off after two weeks, and then above the same cut-off after three months. The results of our survey should be seen as a stimulus to further sensitize hospital staff to the importance of vaccination and pay attention to anti-S antibody levels monitoring.

Pre-symptomatic and asymptomatic transmission of COVID-19: Implications for control measures in Qatar

Public health control measures for communicable diseases are often based on the identification of symptomatic cases. However, emerging epidemiological evidence demonstrates the role of pre-symptomatic and asymptomatic transmissions of coronavirus disease 2019 (COVID-19). Understanding high-risk settings where transmissions can occur from infected individuals without symptoms has become critical for improving the response to the pandemic. In this review, we discussed the evidence on the transmission of severe acute respiratory syndrome coronavirus-2, its effect on control strategies, and lessons that can be applied in Qatar. Although Qatar has a small population, it has a distinct setting for COVID-19 control. It has a largely young population and is mostly composed of expatriates particularly from the Middle East and Asia that reside in Qatar for work. Further key considerations for Qatar and travel include population movement during extended religious holiday periods, screening and tracing of visitors and residents at entry points into the country, and expatriates living and working in high-density settings. We also consider how its international airport serves as a major transit destination for the region, as Qatar is expected to experience a rapid expansion of visitors while preparing to host the FIFA World Cup in 2022.