Update Alert 6: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers
Authors: Roger Chou, Tracy Dana, Shelley Selph, Annette M. Totten, David I. Buckley, Rongwei Fu
Journal: Annals of Internal Medicine (2020)

Letters24 November 2020Update Alert 6: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care WorkersFREERoger Chou, MD, Tracy Dana, MLS, Shelley Selph, MD, MPH, Annette M. Totten, PhD, David I. Buckley, MD, MPH, Rongwei Fu, PhDRoger Chou, MDPacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, OregonSearch for more papers by this author, Tracy Dana, MLSPacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, OregonSearch for more papers by this author, Shelley Selph, MD, MPHPacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, OregonSearch for more papers by this author, Annette M. Totten, PhDPacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, OregonSearch 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, OregonSearch 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, OregonSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1323 SectionsSupplemental MaterialAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This is the sixth 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 September to 24 October 2020 using the same search strategies as the original review. The updated searches identified 1552 citations. We applied the same inclusion criteria used for the prior update, with previously described protocol modifications (2) to focus on higher-quality evidence. Eight studies (3–10) 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); 62 studies were added in prior updates (2, 11–14) (Supplement Tables 1 and 2). For this update, 8 cross-sectional studies (3–10) were added. Two studies were done in Asia (7, 9), 5 were done in Europe (4–6, 8, 10), and 1 was done in Oman (3).On the basis of 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% (2, 11–14). The wide ranges in estimates were likely related to differences in settings, exposures, community transmission rates, symptom status, use of infection control measures, and other factors. Rates of SARS-CoV-2 infection based on polymerase chain reaction positivity, reported in 4 new studies, ranged from 0% to 9.9% (3, 4, 9, 10). Severe acute respiratory syndrome coronavirus 2 seropositivity, reported in 5 new studies, ranged from 3.2% to 13.2% (4–6, 8, 10). Among HCWs with SARS-CoV-2 infection, 3 studies reported hospitalization rates of 0% to 14.4% (3, 9, 10), and 2 studies reported that 0.7% and 10.2% had severe disease (7, 9). In 2 studies, mortality among HCWs with SARS-CoV-2 infection was 0% and 0.7% (7, 9). Limitations of the studies included failure to adequately report demographic characteristics of HCWs, small sample sizes, unclear participation rates, and lack of information on clinical outcomes of SARS-CoV-2 infections.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); 41 studies (39 studies on SARS-CoV-2) were added in prior updates (2, 11–14). For this update, 5 new studies evaluated risk factors for SARS-CoV-2 infection in HCWs (Supplement Table 3) (3–5, 8, 10). As in prior studies, 3 new studies found no association between sex and risk for SARS-CoV-2 infection (3, 8, 10), and 4 studies found no association between nurse or physician health worker role and risk for SARS-CoV-2 infection (3–5, 10). There was no new evidence for masks, other personal protective equipment, or other risk factors, including infection control training and education (Supplement Tables 4 to 8). Because the conclusions of the review have been stable during the past 6 monthly updates, the frequency of these update alerts will be changed to every other month.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;173:120-36. [PMID: 32369541] doi:10.7326/M20-1632 Google 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 Google Scholar3. Al Maskari Z, Al Blushi A, Khamis F, et al. Characteristic of healthcare workers infected with COVID-19, a cross-sectional observational study. Int J Infect Dis. 2020. [PMID: 33039607] doi:10.1016/j.ijid.2020.10.009 Google Scholar4. Dacosta-Urbieta A, Rivero-Calle I, Pardo-Seco J, et al. Seroprevalence of SARS-CoV-2 among pediatric healthcare workers in Spain. Front Pediatr. 2020;8:547. [PMID: 33042908] doi:10.3389/fped.2020.00547 Google Scholar5. Dalla Volta A, Valcamonico F, Pedersini R, et al. The spread of SARS-CoV-2 infection among the medical oncology staff of ASST Spedali Civili of Brescia: efficacy of preventive measures. Front Oncol. 2020;10:1574. [PMID: 33014806] doi:10.3389/fonc.2020.01574 Google Scholar6. Dimeglio C, Herin F, Miedougé M, et al. Screening for SARS-CoV-2 antibodies among healthcare workers in a university hospital in southern France [Letter]. J Infect. 2020. [PMID: 33010259] doi:10.1016/j.jinf.2020.09.035 Google Scholar7. Gong H, Feng H, Yu L, et al. Coronavirus disease 2019 infection among medical staff in Wuhan: a retrospective study from a single center. Chest. 2020;158:1409-12. [PMID: 32473172] doi:10.1016/j.chest.2020.05.529 Google Scholar8. Jespersen S, Mikkelsen S, Greve T, et al. SARS-CoV-2 seroprevalence survey among 17,971 healthcare and administrative personnel at hospitals, pre-hospital services, and specialist practitioners in the Central Denmark Region. Clin Infect Dis. 2020. [PMID: 33011792] doi:10.1093/cid/ciaa1471 Google Scholar9. Malik FT, Ishraquzzaman M, Kalimuddin M, et al. Clinical presentation, management and in-hospital outcome of healthcare personnel with COVID-19 disease. Cureus. 2020;12:e10004. [PMID: 32983701] doi:10.7759/cureus.10004 Google Scholar10. Martin C, Montesinos I, Dauby N, et al. Dynamics of SARS-CoV-2 RT-PCR positivity and seroprevalence among high-risk healthcare workers and hospital staff. J Hosp Infect. 2020;106:102-106. [PMID: 32593608] doi:10.1016/j.jhin.2020.06.028 Google Scholar11. 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. [PMID: 32515983] doi:10.7326/L20-0768 Google Scholar12. 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. [PMID: 32744870] doi:10.7326/L20-1005 Google Scholar13. 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. [PMID: 32915642] doi:10.7326/L20-1134 Google Scholar14. Chou R, Dana T, Buckley DI, et al. Update alert 5: epidemiology of and risk factors for coronavirus infection in health care workers [Letter]. Ann Intern Med. 2020;173:W154-W155. [PMID: 33076695] doi:10.7326/L20-1227 Google Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Roger Chou, MD; Tracy Dana, MLS; Shelley Selph, MD, MPH; Annette M. Totten, PhD; David I. Buckley, MD, MPH; Rongwei Fu, PhDAffiliations: Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, OregonPacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University–Portland State University, Portland, OregonDisclaimer: 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=L20-1323.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 24 November 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoKeeping Up With Emerging Evidence in (Almost) Real Time Christine Laine , Darren B. Taichman , Eliseo Guallar , and Cynthia D. Mulrow 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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