Update Alert 5: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers
Authors: Roger Chou, Tracy Dana, David I. Buckley, Shelley Selph, Rongwei Fu, Annette M. Totten
Journal: Annals of Internal Medicine (2020)

Letters20 October 2020Update Alert 5: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care WorkersFREERoger Chou, MD, Tracy Dana, MLS, David I. Buckley, MD, MPH, Shelley Selph, MD, MPH, Rongwei Fu, PhD, and Annette M. Totten, PhDRoger Chou, MDPacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)Search for more papers by this author, Tracy Dana, MLSPacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)Search for more papers by this author, David I. Buckley, MD, MPHPacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University–Portland State University, Portland, Oregon (D.I.B., R.F.)Search for more papers by this author, Shelley Selph, MD, MPHPacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)Search for more papers by this author, Rongwei Fu, PhDPacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University–Portland State University, Portland, Oregon (D.I.B., R.F.)Search for more papers by this author, and Annette M. Totten, PhDPacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1227 SectionsSupplemental MaterialAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This is the fifth monthly update alert for a living rapid review on the epidemiology of and risk factors for coronavirus infection in health care workers (HCWs) (1). Searches were updated from 25 August to 24 September 2020 using the same search strategies as the original review. The updated searches identified 1987 citations. We applied the same inclusion criteria used for the prior update, with previously described protocol modifications to focus on higher-quality evidence (2). Ten studies (3–12) on the burden of and risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were added for this update.The original rapid review included 15 studies on the burden of SARS-CoV-2 infection (1); 52 studies were added in prior updates (2, 13–15) (Supplement Tables 1 and 2). For this update, 3 cohort studies (3, 4, 9) and 5 cross-sectional studies (5–7, 11, 12) were added. Studies were done in Belgium (11), Brazil (6), China (12), France (4), Italy (7), Qatar (3), the United Kingdom (9), and the United States (5).In the original review and prior updates, the incidence of SARS-CoV-2 infection (polymerase chain reaction positive) ranged from 0.4% to 49.6%, and the prevalence of SARS-CoV-2 seropositivity ranged from 1.6% to 31.6%; the wide ranges in estimates were likely related to differences in settings, exposures, rates of community transmission, symptom status, use of infection control measures, and other factors. Consistent with prior findings, estimates from new studies of SARS-CoV-2 infection in HCWs varied and were within previously reported ranges (Supplement Table 1). Five studies reported rates of SARS-CoV-2 infection based on polymerase chain reaction positivity that ranged from 1.7% to 43.4% (3–7, 9). One study reported a seropositivity rate of 6.4% (11), and 2 reported infection rates of 3.4% (12) and 3.5% (7) based on a combination of polymerase chain reaction, seropositivity, or computed tomography scan findings. Limitations of the studies included failure to provide information about the severity or clinical outcomes of SARS-CoV-2 infections in HCWs and, in some studies, small sample sizes or unclear participation rates.One new study done in China at the beginning of the SARS-CoV-2 outbreak was consistent with prior studies in finding that HCWs had higher levels of depression, anxiety, and insomnia relative to the general population (10). However, the study did not control for baseline symptoms.The original rapid review included 34 studies on risk factors for coronavirus infections (3 studies on risk factors for SARS-CoV-2 infection, 29 studies on SARS-CoV-1 infection, and 2 studies on Middle East respiratory syndrome–CoV infection) (1). A total of 36 studies (34 studies on SARS-CoV-2 and 2 studies on Middle East respiratory syndrome–CoV) were added in prior updates (2, 13, 15). For this update, 5 new studies (n = 5436) evaluated risk factors for SARS-CoV-2 infection in HCWs (Supplement Table 3) (6–9, 12). Limitations of the studies include limited measurement of exposures, potential recall bias, no control of confounders, and imprecise estimates. Four studies (7–9, 12) indicated no association between sex and risk for SARS-CoV-2 infection, and 2 (6, 7) reported inconsistent findings for the risk for SARS-CoV-2 infection in nurses versus physicians. One small case–control study that did not control for confounders found that providing direct patient care or performing an aerosol-generating procedure on a patient with unknown COVID-19 status was associated with an increased risk for HCW infection (8). Most estimates for personal protective equipment were imprecise, although use of a face shield or goggles was associated with reduced risk for SARS-CoV-2 infection. One study found that infection control education was associated with a decreased risk for SARS-CoV-2 infection (12), and 1 study reported a very imprecise estimate for infection control training (7). Overall, results for risk factors updated with these studies were judged to be consistent with the original review and prior updates (Supplement Tables 4 to 8).References1. Chou R, Dana T, Buckley DI, et al. Epidemiology of and risk factors for coronavirus infection in health care workers: a living rapid review. Ann Intern Med. 2020;173:120-136. doi:10.7326/M20-1632 LinkGoogle Scholar2. Chou R, Dana T, Buckley DI, et al. Update alert 2: epidemiology of and risk factors for coronavirus infection in health care workers [Letter]. Ann Intern Med. 2020;173:W77. doi:10.7326/M20-4806 LinkGoogle Scholar3. Alajmi J, Jeremijenko AM, Abraham JC, et al. COVID-19 infection among healthcare workers in a national healthcare system: the Qatar experience. Int J Infect Dis. 2020. [PMID: 32949777] doi:10.1016/j.ijid.2020.09.027 CrossrefMedlineGoogle Scholar4. Contejean A, Leporrier J, Canouï E, et al. Comparing dynamics and determinants of SARS-CoV-2 transmissions among health care workers of adult and pediatric settings in central Paris. Clin Infect Dis. 2020. [PMID: 32663849] doi:10.1093/cid/ciaa977 CrossrefGoogle Scholar5. Dora AV, Winnett A, Jatt LP, et al. Universal and serial laboratory testing for SARS-CoV-2 at a long-term care skilled nursing facility for veterans—Los Angeles, California, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:651-655. [PMID: 32463809] doi:10.15585/mmwr.mm6921e1 CrossrefMedlineGoogle Scholar6. Faíco-Filho KS, Carvalho JMA, Conte DD, et al. COVID-19 in health care workers in a university hospital during the quarantine in São Paulo city. Braz J Infect Dis. 2020. [PMID: 32931758] doi:10.1016/j.bjid.2020.08.003 CrossrefMedlineGoogle Scholar7. Fusco FM, Pisaturo M, Iodice V, et al. COVID-19 among healthcare workers in a specialist infectious diseases setting in Naples, Southern Italy: results of a cross-sectional surveillance study. J Hosp Infect. 2020;105:596-600. [PMID: 32565367] doi:10.1016/j.jhin.2020.06.021 CrossrefMedlineGoogle Scholar8. Khalil MM, Alam MM, Arefin MK, et al. Role of personal protective measures in prevention of COVID-19 spread among physicians in Bangladesh: a multicenter cross-sectional comparative study. SN Compr Clin Med. 2020:1-7. [PMID: 32904377] doi:10.1007/s42399-020-00471-1 CrossrefMedlineGoogle Scholar9. Leeds JS, Raviprakash V, Jacques T, et al. Risk factors for detection of SARS-CoV-2 in healthcare workers during April 2020 in a UK hospital testing programme. EClinicalMedicine. 2020;26:100513. [PMID: 32838245] doi:10.1016/j.eclinm.2020.100513 CrossrefMedlineGoogle Scholar10. Liang Y, Wu K, Zhou Y, et al. Mental health in frontline medical workers during the 2019 novel coronavirus disease epidemic in China: a comparison with the general population. Int J Environ Res Public Health. 2020;17. [PMID: 32916836] doi:10.3390/ijerph17186550 CrossrefMedlineGoogle Scholar11. Steensels D, Oris E, Coninx L, et al. Hospital-wide SARS-CoV-2 antibody screening in 3056 staff in a tertiary center in Belgium. JAMA. 2020;324:195-197. [PMID: 32539107] doi:10.1001/jama.2020.11160 CrossrefMedlineGoogle Scholar12. Zhou F, Li J, Lu M, et al. Tracing asymptomatic SARS-CoV-2 carriers among 3674 hospital staff: a cross-sectional survey. EClinicalMedicine. 2020;26:100510. [PMID: 32954232] doi:10.1016/j.eclinm.2020.100510 CrossrefMedlineGoogle Scholar13. Chou R, Dana T, Buckley DI, et al. Update alert: epidemiology of and risk factors for coronavirus infection in health care workers [Letter]. Ann Intern Med. 2020;173:W46-W47. doi:10.7326/L20-0768 LinkGoogle Scholar14. Chou R, Dana T, Buckley DI, et al. Update alert 3: epidemiology of and risk factors for coronavirus infection in health care workers [Letter]. Ann Intern Med. 2020;173:W123-W124. doi:10.7326/L20-1005 LinkGoogle Scholar15. Chou R, Dana T, Buckley DI, et al. Update alert 4: epidemiology of and risk factors for coronavirus infection in health care workers [Letter]. Ann Intern Med. 2020;173:W143-W144. doi:10.7326/L20-1134 LinkGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Roger Chou, MD; Tracy Dana, MLS; David I. Buckley, MD, MPH; Shelley Selph, MD, MPH; Rongwei Fu, PhD; Annette M. Totten, PhDAffiliations: Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon (R.C., T.D., S.S., A.M.T.)Pacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University–Portland State University, Portland, Oregon (D.I.B., R.F.)Disclaimer: The original review was funded by the World Health Organization. The World Health Organization staff developed the key questions and scope for the original review but did not have any role in the selection, assessment, or synthesis of evidence for this update.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1227.Corresponding Author: Roger Chou, MD, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code BICC, Portland, OR 97239; e-mail, chour@ohsu.edu.This article was published at Annals.org on 20 October 2020. 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Buckley, MD, MPH, Rongwei Fu, PhDSeroprevalence and Correlates of SARS-CoV-2 Antibodies in Health Care Workers in Chicago 1 December 2020Volume 173, Issue 11 Page: W154-W55 Keywords Cohort studies COVID-19 Disclosure Epidemiology Global health Health care providers Medical risk factors Polymerase chain reaction Risk management Upper respiratory tract infections ePublished: 20 October 2020 Issue Published: 1 December 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...