Highlights
- •Only 10.8% of healthcare providers (HCPs) who experienced work restriction were truly infected.
- •All infected HCPs restricted from working by symptom-based strategy.
- •There were no unexpectedly infected HCPs among those without work restriction.
- •Only 41.8% of HCPs with COVID-19-like symptoms restricted working.
- •Work restriction of HCPs with symptoms is the first step of infection prevention.
Abstract
Background
Methods
Results
Discussion
Conclusions
Key words
Introduction
World Health Organization. Timeline: WHO's COVID-19 response. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline. Accessed September 12, 2021.
Methods
COVID-19-like symptom-based work restriction strategy
Study setting and participants
Serological analysis of anti-SARS-CoV-2 antibodies
Questionnaire and medical record review of the study participants
Centers for Disease Control and Prevention. Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic. 2021. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. Accessed September 12, 2021.
RT-PCR for SARS-CoV-2
Statistical analysis
Ethical approval
Results
Study population
Study participants (n = 495) | All employees (n = 3,316) | % of study participants (study participants/all employees) | |
---|---|---|---|
Age, y (median, minimum to maximum) | 33, 20-69 | 35, 19-82 | - |
Sex (number of females, %) | 370, 74.7 | 2,470, 74.5 | - |
Profession (number, %) | |||
Physician | 56, 11.3 | 653, 19.7 | 4.8 |
Nurse and nurse assistant | 166, 32.9 | 1,174, 35.4 | 14.1 |
Pharmacist | 32, 6.5 | 63, 1.9 | 50.8 |
Medical technologist | 74, 15.0 | 150, 4.5 | 49.3 |
Radiology technologist | 35, 7.1 | 74, 2.2 | 47.3 |
Physical therapist | 21, 4.2 | 35, 1.1 | 60.0 |
Clinical engineer | 28, 5.7 | 36, 1.1 | 77.8 |
Administrative staff | 73, 14.8 | 734, 22.1 | 10.0 |
Other healthcare staff | 10, 2.0 | 397, 12.0 | 2.5 |
Identification of the infected participants by anti-SARS-CoV-2 antibody tests
Participant ID No. | Previous history of RT-PCR test | Test 1 result | Test 1 COI (positive: ≥1.0) | Test 2 result | Test 2 COI (positive: ≥1.4) | Test 3 (IgG) | Test 4 (IgG) | Definition |
---|---|---|---|---|---|---|---|---|
1 | Positive | Positive | 30.9 | Positive | 3.41 | Positive | Positive | Infected |
2 | Positive | Positive | 118.5 | Positive | 7.12 | Positive | Positive | Infected |
3 | Positive | Positive | 54.9 | Positive | 3.15 | Positive | Positive | Infected |
4 | Positive | Positive | 123.8 | Positive | 7.38 | Positive | Positive | Infected |
5 | Negative | Positive | 79.8 | Positive | 5.39 | Positive | Positive | Infected |
6 | Not performed | Positive | 1.61 | Negative | 0.03 | Negative | Negative | Uninfected |
Comparison of the infected and uninfected participants
Total (n = 495) | Infected (n = 5) | Uninfected (n = 490) | P | |
---|---|---|---|---|
Profession (n, %) | ||||
Physician | 56, 11.3 | 2, 40.0 | 54, 11.0 | - |
Nurse and nurse assistant | 166, 33.5 | 2, 40.0 | 164, 33.5 | - |
Pharmacist | 32, 6.5 | 0, 0 | 32, 6.5 | - |
Medical technologist | 74, 15.0 | 0, 0 | 74, 15.1 | - |
Radiology technologist | 35, 7.1 | 0, 0 | 35, 7.1 | - |
Physical therapist | 21, 4.3 | 0, 0 | 21, 4.3 | - |
Clinical engineer | 28, 5.7 | 0, 0 | 28, 5.7 | - |
Administrative staff | 73, 14.7 | 1, 20.0 | 72, 14.7 | - |
Other healthcare staff | 10, 2.0 | 0, 0 | 10, 2.0 | - |
Age, y (median, minimum-maximum) | 33, 20-69 | 39, 23-53 | 33, 20-69 | .57 |
Sex (number of females, %) | 370, 74.7 | 2, 40.0 | 368, 75.1 | .11 |
RT-PCR, performed (n, %) | 37, 7.5 | 5, 100.0 | 32, 6.53 | <.0001 |
RT-PCR, positive (n, %) | 4, 0.81 | 4, 80.0 | 0, 0 | <.0001 |
Contact with confirmed COVID-19 patients in their work (n, %) | 257, 51.9 | 3, 60.0 | 254, 51.8 | 1.00 |
Clinic visits for symptoms (n, %) | 67, 13.5 | 5, 100.0 | 62, 12.7 | <.0001 |
Restricted from working (n, %) | 46, 9.3 | 5, 100.0 | 41, 8.4 | <.0001 |
History of travel overseas in 2020 (n, %) | 46, 9.3 | 1, 20.0 | 45, 9.18 | .39 |
History of use of karaoke, gym, live music venue (n, %) | 77, 15.6 | 0, 0 | 77, 15.7 | 1.00 |
History of cedar pollinosis (n, %) | 231, 46.7 | 3, 60.0 | 228, 46.5 | .67 |
Symptom (n, %) | ||||
Any | 110, 22.2 | 5, 100.0 | 105, 21.4 | .0005 |
Malaise | 25, 5.05 | 3, 60.0 | 22, 4.5 | .0011 |
Shivering | 19, 3.8 | 3, 60.0 | 16, 3.3 | .0005 |
Fever | 48, 9.7 | 4, 80.0 | 44, 9.0 | .0004 |
Headache | 37, 7.5 | 4, 80.0 | 33, 6.7 | <.0001 |
Eye symptoms | 6, 1.2 | 1, 20.0 | 5, 1.0 | .06 |
Nasal symptoms | 36, 7.3 | 2, 40.0 | 34, 6.9 | .0450 |
Taste disturbance | 4, 0.8 | 0, 0 | 4, 0.8 | 1.00 |
Smell disturbance | 3, 0.6 | 1, 20.0 | 2, 0.4 | .0300 |
Sore throat | 56, 11.3 | 3, 60.0 | 53, 10.8 | .0120 |
Cough | 43, 8.7 | 2, 40.0 | 41, 8.4 | .06 |
Myalgia | 6, 1.2 | 3, 60.0 | 3, 0.61 | <.0001 |
Rhinitis + (n = 231) | Rhinitis - (n = 264) | P | |
---|---|---|---|
Antibody, positive (n, %) | 3, 1.3 | 2, 0.76 | .67 |
Symptom, positive (n, %) | 63, 27.3 | 47, 17.8 | .013 |
Clinic visits for symptoms (n, %) | 45, 19.5 | 22, 8.3 | .0003 |
Restriction from working (n, %) | 28, 12.1 | 18, 6.8 | .045 |
Detailed comparison of the participants with previous history of SARS-CoV-2 RT-PCR test
Total (n = 37) | Infected (n = 5) | Uninfected (n = 32) | P | |
---|---|---|---|---|
Profession (n, %) | ||||
Physician | 6, 16.2 | 2, 40.0 | 4, 12.5 | - |
Nurse and nurse assistant | 16, 43.2 | 2, 40.0 | 14, 43.8 | - |
Pharmacist | 0 | 0 | 0 | - |
Medical technologist | 0 | 0 | 0 | - |
Radiology technologist | 1, 2.7 | 0 | 1, 3.1 | - |
Physical therapist | 0 | 0 | 0 | - |
Clinical engineer | 1, 2.7 | 0 | 1, 3.1 | - |
Administrative staff | 11, 29.3 | 1, 20 | 10, 31.3 | - |
Other healthcare staff | 2, 5.4 | 0 | 2, 6.25 | - |
Age, y (median, minimum-maximum) | 34, 22-54 | 39, 23-53 | 33, 22-54 | .46 |
Sex (number of females, %) | 31, 83.8 | 2, 40.0 | 29, 90.6 | .022 |
RT-PCR, positive (n, %) | 4, 10.8 | 4, 80.0 | 0, 0 | <.0001 |
Contact with confirmed COVID-19 patients in their work (n, %) | 17, 45.9 | 3, 60.0 | 14, 43.8 | .64 |
Duration of restriction from working (median, minimum-maximum) | 7, 2-33 | 14, 12-33 | 7, 2-14 | .0006 |
History of travel overseas in 2020 (n, %) | 1, 2.7 | 1, 20.0 | 0, 0 | .14 |
History of use of karaoke, gym, live music venue (n, %) | 3, 8.1 | 0, 0 | 3, 9.4 | 1 |
History of cedar pollinosis (n, %) | 21, 56.8 | 3, 60.0 | 18, 56.3 | 1 |
Symptom (n, %) | ||||
Malaise | 13, 35.1 | 3, 60.0 | 10, 31.3 | .32 |
Shivering | 11, 29.7 | 3, 60.0 | 8, 25.0 | .14 |
Fever | 25, 67.6 | 4, 80.0 | 21, 65.6 | 1 |
Headache | 16, 43.2 | 4, 80.0 | 12, 37.5 | .14 |
Eye symptoms | 1, 2.7 | 1, 20 | 0, 0 | .14 |
Nasal symptoms | 10, 27.0 | 2, 40.0 | 8, 25.0 | .6 |
Taste disturbance | 2, 5.4 | 0, 0 | 2, 6.25 | 1 |
Smell disturbance | 2, 5.4 | 1, 20 | 1, 3.13 | .26 |
Sore throat | 20, 54.1 | 3, 60.0 | 17, 53.1 | 1 |
Cough | 14, 37.8 | 2, 40.0 | 12, 37.5 | 1 |
Myalgia | 4, 10.8 | 3, 60.0 | 1, 3.13 | .0049 |
Positive findings on chest CT (n, %) | 9 (n = 35), 25.7 | 4, 80.0 | 5, 16.7 | .011 |
Discussion
Centers for Disease Control and Prevention. Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic. 2021. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. Accessed September 12, 2021.
Centers for Disease Control and Prevention. COVID-19 Exposure in Healthcare Settings. 2021. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/exposure-in-healthcare.html. Accessed September 12, 2021.
Centers for Disease Control and Prevention. Return to Work Criteria for Healthcare Personnel with SARS-CoV-2 Infection (Interim Guidance). 2021. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html. Accessed September 12, 2021.
Centers for Disease Control and Prevention. Strategies to Mitigate Healthcare Personnel Staffing Shortages. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/mitigating-staff-shortages.html. Accessed September 12, 2021.
American Collage of Radiology. ACR Recommendations for the use of Chest Radiography and Computed Tomography (CT) for Suspected COVID-19 Infection. 2020. Available at:https://www.acr.org/Advocacy-and-Economics/ACR-Position-Statements/Recommendations-for-Chest-Radiography-and-CT-for-Suspected-COVID19-Infection. Accessed November 19, 2021.
Centers for Disease Control and Prevention. Similarities and Differences between Flu and COVID-19. 2021. Available at: https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm. Accessed September 12, 2021.
Mayo Clinic. COVID-19, cold, allergies and the flu: What are the differences? 2021. Available at: https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/covid-19-cold-flu-and-allergies-differences/art-20503981. Accessed September 12, 2021.
Centers for Disease Control and Prevention. Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination. 2021. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-after-vaccination.html. Accessed September 12, 2021.
World Health Organization. Prevention, identification and management of health worker infection in the context of COVID-19 Interim guidance. 2020. Available at: https://apps.who.int/iris/bitstream/handle/10665/336265/WHO-2019-nCoV-HW_infection-2020.1-eng.pdf?sequence=1&isAllowed=y. Accessed November 19, 2021.
Conclusions
Acknowledgments
Appendix. SUPPLEMENTARY MATERIALS
Figure S1 Experience of symptoms, self-report of symptoms, work restriction and anti-SARS-CoV-2 antibody results of the study participants. Among 495 study participants, 110 (22.2%) experienced suspicious symptoms of COVID-19. Of those, 46 (41.8%) reported their symptoms and restricted themselves from working. All 5 antibody-positive infected HCPs (1.0% of the study participants, 10.9% of study participants with work restriction) experienced symptoms and restricted themselves from working.
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Article Info
Publication History
Footnotes
Funding/support: This work was supported by a donation for research projects about COVID-19 from an anonymous patient of St. Luke's International Hospital. The authors acknowledge the generous help for our research. The benefactor had no involvement in conducting this study.
Conflicts of Interest: None of the authors have any commercial or financial involvements in connection with this study that represent or appear to represent any conflicts of interest. All authors report no conflict of interest relevant to this article.
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