INTRODUCTIONIn Mexico, a new COVID-19 case definition was released on 24 March 2020, this definition is no different from the one used for epidemiological surveillance of influenza-like illness since 2009. We aim to evaluate the effectiveness of the COVID-19 suspected case definition in identifying SARS-CoV-2 infection in Tijuana, a US-border city in Mexico. METHODS A cross-sectional database study was conducted, including entries from 11 March to 1 May 2020. COVID-19 case definition was compared to RT-PCR results using 2×2 tables to estimate sensitivity, specificity, PPV, NPV, accuracy and likelihood ratios (LR). Categorical variables were analyzed using χ 2 test. Stratification by gender, age group, history of chronic disease and severity of presentation was performed to control for confounding. RESULTS From a total of 10216 entries, 897 patients with results from RT-CPR for SARS-CoV-2 were included. There was no significant association between COVID-19 case definition and RT-PCR result (χ 2 =0.750, df=1, p=0.386). A sensitivity of 87.45%, specificity of 10.61%, PPV of 61.69%, and NPV of 33.96% were calculated, with an overall accuracy of 58.42%, LR+ was 0.98 and LR-was 1.18. Stratifying by age, homogeneity of OR=0.024 showed an association between case definition and test result particularly among those aged 16-39 years (p=0.014). Only 4 individual symptoms had a statistical association with RT-PCR result. These were dyspnea (p<0.001), odynophagia (p<0.001), rhinorrhea (p<0.001) and fever (p=0.008). CONCLUSIONS Satisfying criteria for COVID-19 case definition neither showed a significant association nor is it a powerful predictor for SARS-CoV-2 infection among the study population. However, this COVID-19 case definition better identifies those cases in those aged 16-39 years, suggesting a possible relation between the type of the clinical presentation and age.
Background: Healthcare workers (HCW) are a high-risk group for COVID-19. The aim of this study is to estimate the risk of acquiring COVID-19 among HCW from Mexican Institute of Social Security in Tijuana, Mexico. Methods: A cross-sectional study from Epidemiologic Surveillance Online Notification System database was conducted, including entries from Tijuana, starting March 11th until May 1st 2020. Multiple imputation was performed for the SARS-CoV-2 RT-PCR result variable where data was missing. Chi-squared statistic with Yates correction and OR were calculated to estimate the risk of HCW compared to the general population (GP). Results: From a total of 10,216 entries, only 6,256 patients were included for analysis. Being a HCW was significantly associated with a higher risk of acquiring COVID-19, OR=1.730 (CI 95% 1.459-2.050). Nurses had double the risk (OR=2.339; CI 95% 1.804-3.032) than the GP. The cluster of physicians only had an additional risk for COVID-19 of 2.8% (OR=1.828; CI 95% 0.766-1.380). Resident physicians doubled the risk of the GP (OR=2.166; CI 95% 0.933-5.025). Meanwhile, interns had a possible protecting factor (OR=0.253; CI 95% 0.085-0.758). Among medical specialties, emergency medicine has the highest risk (OR=4.071; CI 95% 1.090-15.208), followed by anesthesiologists (OR=2.806; CI 95% 0.544-14.466). Conclusion: HCW have up to 73% more risk of acquiring COVID-19 than the GP in Tijuana, Mexico. Nurses were the group at highest risk of all HCW, as a result of prolonged and close contact with patients. Emergency medicine and anesthesiology were the medical specialties most at risk because they frequently perform aerosol-generating procedures.
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