Update Alert: 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)

This is the first monthly update alert for a living review on the epidemiology of and risk factors for coronavirus infections in health care workers (HCWs) (1).Searches were updated from 24 April 2020 to 24 May 2020, using the same search strategies as the original review, and we identified 1125 citations.Applying the same inclusion criteria, we identified 37 additional studies for this update (2-33-34 -38).All evaluated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, except for 2 studies, identified from reference lists, on Middle East Respiratory Syndrome coronavirus (MERS-CoV) infection (12,24).The original rapid review included 15 studies on the burden of SARS-CoV-2 infection (Supplement Tables 1 and2; all supplemental tables are available at Annals.org).Twenty-nine new studies (N = 573 352) were added: 11 cohort (2, 6, 8, 11, 14, 18, 21-23, 32, 35), 17 case-control (3, 5, 7, 13, 17, 19, 20, 25-31, 33, 36, 37), and 1 case series (15).Four studies were conducted in China, 4 in the United States, 18 in Europe, and 2 in Iran, and 1 study was conducted in both the United States and United Kingdom.Fourteen studies had not been peerreviewed (2, 6, 9, 16, 17, 21-23, 28 -30, 34, 35, 38).Other study limitations were inadequate information on clinical presentation or selection for testing; there was also variability in populations, clinical setting, and methods for diagnosing SARS-CoV-2 infection.In the new studies, the proportion of HCWs with coronavirus disease 2019 (COVID-19) ranged from 1.1% to 23.3% (7 studies) (2,3,8,14,(35)(36)(37); SARS-CoV-2 infection (not necessarily meeting COVID-19 criteria) ranged from 0.4% to 49.6% (19 studies) (5-7, 11, 15, 17-19, 21-23, 25-29, 31-33), and SARS-CoV-2 antibodies ranged from 1.6% to 24.4% (3 studies) (13,28,30).As in the original rapid review, SARS-CoV-2 infection seemed to be somewhat less severe in HCWs than in non-HCWs (5,6,15,16), with a case-fatality rate of 0% and 1.2% in 2 studies (15,16).One analysis of all cases in Italy estimated slightly higher mortality due to COVID-19 in physicians and dentists (0.046%) than in the general population (0.039%), due to increased infection incidence (20).Eight new studies were consistent with previous findings that HCWs in areas affected by COVID-19 report high levels of depression, anxiety, and psychological distress (Supplement Table 2) (4,9,10,16,26,34,36,38).Like prior studies, the new studies used a cross-sectional design, did not control for baseline symptoms, did not have a non-HCW control group, and did not control for work exposures.Ten new studies (N = 149 240) evaluated risk factors for SARS-CoV-2 infection in HCWs (Supplement Table 3) (2,6,13,14,17,22,28,33,35,37).All were susceptible to recall bias and did not adjust for confounders.The most frequently addressed risk factors were age, sex, hospital department, and HCW role or position.Results were consistent with the original rapid review (Supplement Tables 6 to 10).Two small studies (n = 40 and 9) identified through reference list review addressed MERS-CoV infections in HCWs (Supplement Tables 1 and5) (12,24).Results did not change the conclusions of the original rapid review.