Costs associated with COVID-19 in healthcare personnel in Greece: a cost-of-illness analysis

BACKGROUND

Healthcare personnel (HCP) are at increased risk of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the aetiological agent of coronavirus disease 2019 (COVID-19).

AIM

To estimate the costs related to SARS-CoV-2 exposure and infection among HCP in Greece.

METHODS

Data were retrieved from the national database of SARS-CoV-2 infections and from the database of HCP exposed to patients with COVID-19. A cost-of-illness analysis was performed to estimate total, direct and indirect costs.

RESULTS

In total, 254 HCP with COVID-19 and 3332 HCP exposed to patients with COVID-19 during the first epidemic wave were studied. Of the 254 HCP with COVID-19, 49 (19.3%) were hospitalized (mean length of hospitalization 11.6 days) and four were admitted to intensive care units (mean duration 10.8 days). Overall, 1332 (40%) exposed HCP had a mean duration of absenteeism of 7.5 days, and 252 (99.2%) HCP with COVID-19 had a mean duration of absenteeism of 25.8 days. The total costs for the management of the two groups were estimated at €1,735,830 (€772,890 Euros for HCP with COVID-19 and €962,940 for exposed HCP). Absenteeism accounted for a large proportion of the total costs (80.4% of all expenditures), followed by costs for reverse transcriptase polymerase chain reaction and hospitalization (10.2% and 6.5% of all expenditures, respectively).

CONCLUSION

COVID-19 is associated with increased rates and duration of absenteeism among HCP. Indirect costs, particularly absenteeism, are the major driver of total costs among exposed HCP and HCP with COVID-19. The estimated total costs are conservative. Studies are needed to explore the impact of COVID-19 vaccination of HCP on absenteeism and COVID-19-associated costs.

Hospital factors associated with SARS-CoV-2 infection among healthcare personnel in Greece

Healthcare workers (HCWs) have been recognized as a high-risk group for infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This study estimated their risk of infection based on hospital characteristics. Factors significantly associated with increased risk for SARS-CoV-2 infection were: working in a non-referral hospital compared with a coronavirus disease 2019 (COVID-19) referral hospital, working in a hospital with a high number of employees, and working in a hospital with an increased number of patients with COVID-19. This study revealed gaps in infection control in the non-referral hospitals. There is an urgent need for continuous training in infection control practices. Compliance of HCWs with the use of personal protective equipment should also be addressed.

Malaria knowledge, attitudes and practices among migrants from malaria-endemic countries in Evrotas, Laconia, Greece, 2013

Following re-emergence of malaria in Evrotas, Laconia, in 2009–12, a malaria-control programme was implemented in 2011–12 targeting migrants from malaria-endemic countries, including house-to-house active case detection, health education and distribution of mosquito protection items. In June 2013, we surveyed migrants in Evrotas to assess their malaria knowledge, attitudes and practices to guide prevention activities. We selected participants using simple random sampling and interviewed them, using structured questionnaires. We defined mosquito protection practices (MPPs) as the use of full-length clothes/topical repellent, mosquito screens, fans or air-conditioning, and insecticides. We calculated prevalence ratios (PRs) using Poisson regression and we allowed for clustering of participants in a residence. Of 654 migrants, we invited 132 and 130 participated (all men; 120 (92%) from Pakistan). Of the 130, 56 (43%) identified fever as a malaria symptom; those who were aware of this had higher level of education (PR: 3.2; 95% confidence interval (CI): 1.2–9.0). A total of 111 (85%) used insecticide-treated bednets and 95 (73%) used more than two MPPs. Poor housing conditions (warehouses/shacks: PR: 0.8; 95% CI: 0.6–0.9), were associated with use of up to two MPPs. Despite extensive interventions in Evrotas, the level of malaria awareness among migrants remained suboptimal and poor housing conditions hindered effective mosquito protection. We recommend culturally adapted health education and improvement of housing conditions to minimise the risk of new cases and re-establishment of malaria in Greece.

Autochthonous Plasmodium vivax malaria in Greece, 2011

Between May and September 2011, twenty cases of Plasmodium vivax infection were reported in Greek citizens without reported travel history. The vast majority of those cases were confined to a delimited agricultural area of Evrotas, Lakonia. Conditions favouring locally acquired transmission of malaria, including the presence of competent vectors and migrants from endemic countries exist in Greece, underscoring the need for the development of an integrated preparedness and response plan for malaria prevention.

Autochthonous Plasmodium vivax malaria in Greece, 2011

Between May and September 2011, twenty cases of Plasmodium vivax infection were reported in Greek citizens without reported travel history. The vast majority of those cases were confined to a delimited agricultural area of Evrotas, Lakonia. Conditions favouring locally acquired transmission of malaria, including the presence of competent vectors and migrants from endemic countries exist in Greece, underscoring the need for the development of an integrated preparedness and response plan for malaria prevention.