Update Alert 4: 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)

Letters11 September 2020Update Alert 4: 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/L20-1134 SectionsSupplemental MaterialAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This is the fourth 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 July to 24 August 2020 using the same search strategies as the original review. The updated searches identified 2494 citations. We applied the same inclusion criteria used for the prior update, with previously described protocol modifications to focus on higher-quality evidence (2). Seventeen studies (3–19) on 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); 42 studies were added in prior updates (2, 20, 21) (Supplement Tables 1 and 2). For this update, 10 cohort studies (4, 5, 7, 8, 11, 13, 15–18), 5 cross-sectional studies (3, 9, 10, 12, 14), and 1 case–control study (6) on the burden of SARS-CoV-2 infection were added. Of the new studies, 3 were done in the United States (9, 10, 13); 3 in Italy (3, 15, 16); 2 in the United Kingdom (7, 8); 2 in China (18, 19); and 1 each in Belgium (5), Germany (12), Spain (14), Turkey (6), and Egypt (11). The country was not reported in 1 study (4).As in the prior updates and review, estimates of SARS-CoV-2 infection in HCWs varied (Supplement Table 1). Among the new studies, 9 reported rates of SARS-CoV-2 seropositivity that ranged from 1.6% to 31.6% (3, 5, 7, 9, 10, 12–14, 16), 6 reported rates of SARS-CoV-2 infection (based on polymerase chain reaction positivity) of 0.4% to 23.5% (4, 14, 15, 17–19), and 2 reported rates of either SARS-CoV-2 seropositivity or infection (polymerase chain reaction positivity) of 12.2% and 43.5% (8, 11). Factors contributing to the variability in estimates likely include differences in locale, SARS-CoV-2 outbreak severity, presence and severity of HCW symptoms, and exposure extent. Limitations of the studies included variability in participation rates and failure to provide information about the severity or clinical outcomes of SARS-CoV-2 infections.The original rapid review included 31 studies on risk factors for SARS-CoV-2 infection (1); 19 studies were added in prior updates (2, 20). For this update, 15 new studies (n = 51 597) evaluated risk factors (Supplement Table 3) (3, 5–18). Study limitations include limited measurement and control of exposures, potential recall bias, and failure to address potential collinearity. Ten studies (3, 6, 8, 10–13, 15–17) indicated no association between sex and risk for SARS-CoV-2 infection, and 13 studies (3, 5, 6, 8–11, 13–18) reported inconsistent findings for differences in risk between nurses and physicians. One study found that mask use (FFP2, FFP3, or surgical mask) was associated with increased risk for SARS-CoV-2 infection versus no mask use. Although FFP2 and FFP3 mask use was associated with increased risk for SARS-CoV-2 infection versus surgical mask use, the analysis only adjusted for age (15). Another study found that improper use of personal protective equipment while caring for patients with suspected or confirmed coronavirus disease 2019 and break room exposure to another HCW without wearing a mask were associated with increased risk for HCW infection, after adjustment for other exposures (6). Results for risk factors updated with these studies were judged to be consistent with the original prior update (Supplement Tables 4 to 7).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. [PMID: 32369541]. 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. [PMID: 32663033]. doi:10.7326/M20-4806 LinkGoogle Scholar3. Amendola A, Tanzi E, Folgori L, et al. Low seroprevalence of SARS-CoV-2 infection among healthcare workers of the largest children hospital in Milan during the pandemic wave. Infect Control Hosp Epidemiol. 2020:1-6. [PMID: 32758311] doi:10.1017/ice.2020.401 CrossrefMedlineGoogle Scholar4. Blain H, Rolland Y, Tuaillon E, et al. Efficacy of a test–retest strategy in residents and health care personnel of a nursing home facing a COVID-19 outbreak. J Am Med Dir Assoc. 2020;21:933-936. [PMID: 32674822] doi:10.1016/j.jamda.2020.06.013 CrossrefMedlineGoogle Scholar5. Blairon L, Mokrane S, Wilmet A, et al. Large-scale, molecular and serological SARS-CoV-2 screening of healthcare workers in a 4-site public hospital in Belgium after COVID-19 outbreak. J Infect. 2020. [PMID: 32739485] doi:10.1016/j.jinf.2020.07.033 CrossrefMedlineGoogle Scholar6. Çelebi G, Pişkin N, Çelik Bekleviç A, et al. Specific risk factors for SARS-CoV-2 transmission among health care workers in a university hospital. Am J Infect Control. 2020. [PMID: 32771498] doi:10.1016/j.ajic.2020.07.039 CrossrefMedlineGoogle Scholar7. Grant JJ, Wilmore SMS, McCann NS, et al. Seroprevalence of SARS-CoV-2 antibodies in healthcare workers at a London NHS Trust. Infect Control Hosp Epidemiol. 2020. [PMID: 32746953] doi:10.1017/ice.2020.402 CrossrefMedlineGoogle Scholar8. Houlihan CF, Vora N, Byrne T, et al. Pandemic peak SARS-CoV-2 infection and seroconversion rates in London frontline health-care workers. Lancet. 2020;396:e6-e7. [PMID: 32653078] doi:10.1016/S0140-6736(20)31484-7 CrossrefMedlineGoogle Scholar9. Hunter BR, Dbeibo L, Weaver CS, et al. Seroprevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies among healthcare workers with differing levels of coronavirus disease 2019 (COVID-19) patient exposure. Infect Control Hosp Epidemiol. 2020. [PMID: 32741406] doi:10.1017/ice.2020.390 CrossrefMedlineGoogle Scholar10. Jeremias A, Nguyen J, Levine J, et al. Prevalence of SARS-CoV-2 infection among health care workers in a tertiary community hospital. JAMA Intern Med. 2020. [PMID: 32780100] doi:10.1001/jamainternmed.2020.4214 CrossrefMedlineGoogle Scholar11. Kassem AM, Talaat H, Shawky S, et al. SARS-CoV-2 infection among healthcare workers of a gastroenterological service in a tertiary care facility. Arab J Gastroenterol. 2020. [PMID: 32732168] doi:10.1016/j.ajg.2020.07.005 CrossrefMedlineGoogle Scholar12. Lackermair K, William F, Grzanna N, et al. Infection with SARS-CoV-2 in primary care health care workers assessed by antibody testing. Fam Pract. 2020. [PMID: 32766704] doi:10.1093/fampra/cmaa078 CrossrefMedlineGoogle Scholar13. Moscola J, Sembajwe G, Jarrett M, et al. Prevalence of SARS-CoV-2 antibodies in health care personnel in the New York City area. JAMA. 2020;324:893-895. [PMID: 32780804] doi:10.1001/jama.2020.14765 CrossrefMedlineGoogle Scholar14. Olalla J, Correa AM, Martín-Escalante MD, et al. Search for asymptomatic carriers of SARS-CoV-2 in healthcare workers during the pandemic: a Spanish experience. QJM. 2020. [PMID: 32777050] doi:10.1093/qjmed/hcaa238 CrossrefMedlineGoogle Scholar15. Piapan L, De Michieli P, Ronchese F, et al. COVID-19 outbreak in healthcare workers in Trieste hospitals (North–Eastern Italy). J Hosp Infect. 2020. [PMID: 32805309] doi:10.1016/j.jhin.2020.08.012 CrossrefMedlineGoogle Scholar16. Sotgiu G, Barassi A, Miozzo M, et al. SARS-CoV-2 specific serological pattern in healthcare workers of an Italian COVID-19 forefront hospital. BMC Pulm Med. 2020;20:203. [PMID: 32727446] doi:10.1186/s12890-020-01237-0 CrossrefMedlineGoogle Scholar17. Villanueva AMG, Lazaro J, Sayo AR, et al. COVID-19 screening for healthcare workers in a tertiary infectious diseases referral hospital in Manila, the Philippines. Am J Trop Med Hyg. 2020;103:1211-1214. [PMID: 32729461] doi:10.4269/ajtmh.20-0715 CrossrefMedlineGoogle Scholar18. Zhang GQ, Pan HQ, Hu XX, et al. The role of isolation rooms, facemasks and intensified hand hygiene in the prevention of nosocomial COVID-19 transmission in a pulmonary clinical setting. Infect Dis Poverty. 2020;9:104. [PMID: 32703281] doi:10.1186/s40249-020-00725-z CrossrefMedlineGoogle Scholar19. Zhao D, Wang M, Wang M, et al. Asymptomatic infection by SARS-CoV-2 in healthcare workers: a study in a large teaching hospital in Wuhan, China. Int J Infect Dis. 2020;99:219-225. [PMID: 32758693] doi:10.1016/j.ijid.2020.07.082 CrossrefMedlineGoogle Scholar20. Chou R, Dana T, Buckley DI, et al. Update alert: epidemiology of and risk factors for coronavirus infection in health care workers. Ann Intern Med. 2020;173:W46-W47. [PMID: 32515983]. doi:10.7326/L20-0768 LinkGoogle Scholar21. Chou R, Dana T, Buckley DI, et al. Update alert 3: epidemiology of and risk factors for coronavirus infection in health care workers. Ann Intern Med. 2020;173:W123-W124. [PMID: 32744870]. doi:10.7326/L20-1005 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=L20-1134.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 11 September 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEpidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers Roger Chou , Tracy Dana , David I. Buckley , Shelley Selph , Rongwei Fu , and Annette M. Totten Update Alert: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers Roger Chou , Tracy Dana , David I. Buckley , Shelley Selph , Rongwei Fu , and Annette M. 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Totten, PhD 20 October 2020Volume 173, Issue 8 Page: 143-144 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: 11 September 2020 Issue Published: 20 October 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...