Update Alert 2: 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)

Letters14 July 2020Update Alert 2: 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/M20-4806 SectionsSupplemental MaterialAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This is the second 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 24 May 2020 to 24 June 2020, using the same search strategies as the original review. The update searches identified 2087 citations. Due to the high volume of literature and to focus on higher-quality evidence, we modified selection criteria for this and future updates by restricting inclusion to peer-reviewed studies, studies on incidence or outcomes of HCW infections with clearly defined inception cohorts, and studies on mental health or quality of life that controlled for baseline symptoms. Other inclusion criteria were unchanged. Four studies, all on SARS-CoV-2 infection, were added for this update (2–5).The original rapid review included 15 studies on the burden of SARS-CoV-2 infection; 29 studies were added for the first monthly update (Supplement Tables 1 and 2). Four cohort studies were added for this update (2–5). Of the new studies, 1 was conducted in the United States (2), 1 in Austria (3), 1 in China (5), and 1 was multinational (4). There was also variability across studies in SARS-CoV-2 exposures and criteria for diagnosing HCW infections; 2 studies (2, 3) did not provide demographic or clinical information. In the new studies, the proportion of HCWs with COVID-19 was 3.1% and 6.8% in 2 studies (2, 4) and the proportion with SARS-CoV-2 infection (not necessarily meeting criteria for COVID-19) was 19.2% in 1 study (3); these estimates were within previously described ranges. One new prospective study found that measures of mood, anxiety, and depression worsened in HCWs in China after compared with before the pandemic (5). This builds on prior studies that found that HCWs in areas affected by COVID-19 report high levels of depression, anxiety, and psychological distress, but the studies did not control for baseline symptoms. Like prior studies, the new study did not have a non-HCW control group or control for work exposures. No new study reported the severity of SARS-CoV-2 infections in HCWs.Two new studies (n = 1744) evaluated risk factors for SARS-CoV-2 infection in HCWs (Supplement Table 3) (3, 4). One new study evaluated HCWs involved in tracheal intubation of patients who were enrolled in a registry (4). An important limitation of this study was that infections included patients with laboratory-confirmed COVID-19 infection, as well as those with symptoms but no laboratory diagnosis. The other new study reported a very imprecise estimate of risk for SARS-CoV-2 infection in nurses versus physicians and did not adjust for confounders (3). Results for risk factors updated with these studies were judged to be consistent with the original rapid review and prior update (Supplement Tables 6 to 10).References1. Chou R, Dana T, Buckley DI, et al. Epidemiology of and risk factors for coronavirus infection in health care workers. Ann Intern Med. 2020. [PMID: 32369541]. doi:10.7326/M20-1632 LinkGoogle Scholar2. Baker MA, Rhee C, Fiumara K, et al. COVID-19 infections among HCWs exposed to a patient with a delayed diagnosis of COVID-19. Infect Control Hosp Epidemiol. 2020:1-2. [PMID: 32456720] doi:10.1017/ice.2020.256 CrossrefMedlineGoogle Scholar3. Buchtele N, Rabitsch W, Knaus HA, et al. Containment of a traceable COVID-19 outbreak among healthcare workers at a hematopoietic stem cell transplantation unit [Letter]. Bone Marrow Transplant. 2020;55:1491-1492. [PMID: 32483288] doi:10.1038/s41409-020-0958-6 CrossrefMedlineGoogle Scholar4. El-Boghdadly K, Wong DJN, Owen R, et al. Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study. Anaesthesia. 2020. [PMID: 32516833] doi:10.1111/anae.15170 CrossrefMedlineGoogle Scholar5. Li W, Frank E, Zhao Z, et al. Mental health of young physicians in China during the novel coronavirus disease 2019 outbreak. JAMA Netw Open. 2020;3:e2010705. [PMID: 32478846] doi:10.1001/jamanetworkopen.2020.10705 CrossrefMedlineGoogle 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 WHO. WHO 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=M20-4806.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 14 July 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, PhDRelevance and paucity of evidence: a dental perspective on personal protective equipment during the COVID-19 pandemic 18 August 2020Volume 173, Issue 4 Page: W77 Keywords Anxiety Cohort studies COVID-19 Disclosure Epidemiology Health care providers Medical risk factors Quality of life Research laboratories Risk management ePublished: 14 July 2020 Issue Published: 18 August 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...