Comparing dynamics and determinants of SARS-CoV-2 transmissions among health care workers of adult and pediatric settings in central Paris

Abstract

Background: From the start of the pandemic, health-care workers (HCW) have paid a heavy toll to the coronavirus disease-19 (COVID-19) outbreak. Objectives: To describe the dynamics and determinants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in HCW. Design: Prospective observational study conducted from February 24th until April 10th, 2020. Setting: Comparison of a 1,500-bed adult and a 600-bed pediatric setting of a tertiary-care university hospital located in central Paris. Participants: All symptomatic HCW screened for SARS-CoV-2 on a nasopharyngeal swab. Measurements: HCW screened positive were prospectively questioned on their profession, symptoms, occupational and non-occupational exposures to SARS-CoV-2. Results: Among 1344 symptomatic HCW tested, 373 were positive (28%) and 336 (90%) corresponding questionnaires were completed. Three hospitalizations and no death were reported. Most HCW (70%) had patient-facing occupational activities (22% in COVID-19 dedicated units). The total number of HCW cases peaked on March 23rd, then decreased slowly, concomitantly with a continuous increase of compliance to preventive measures (including universal medical masking and personal protective equipment (PPE) for direct care to COVID-19 patients). Attack rates were of 3.2% and 2.3% in the adult and pediatric setting, respectively (p=0.0022). In the adult setting, HCW more frequently reported exposure to COVID-19 patients without PPE (25% versus 15%, p=0.046). Report of contacts with children attending out-of-home care facilities dramatically decreased over the study period. Limitations: Lack of COVID-19 negative controls and recall bias. Conclusion: Universal masking, reinforcement of hand hygiene, and PPE with medical masks for patients' care allowed protection of HCW and containment of the outbreak. Residual transmissions were related to persistent exposures with undiagnosed patients or colleagues and not to contacts with children attending out-of-home care facilities.

Transmission routes of SARS-CoV-2 among healthcare workers of a French university hospital in Paris, France: a case-control study

“…As suggested in our first report[1] and here confirmed by the case-control study, HCW who reported to have children kept outside the family home did not have a higher risk of COVID-19 infection. However, childcare facilities that remained open for HCW’s children during the national lockdown gathered a limited number of children simultaneously (<10).…”

Risk factors and frequency of COVID-19 among healthcare workers at a tertiary care centre in India: a case–control study

“…It was also apparent that implementation of control measures such as universal masking and PPE and physical distancing between workers led to a reduction of infection among HCWs, even in COVID-19 areas. 20 …”

High-risk exposure without personal protective equipment and infection with SARS-CoV-2 in healthcare workers: results of the CoV-CONTACT prospective cohort

“…The HCWs included in our analysis reflected the diversity of the hospital workers, [17] offering an ideal perspective to analyze the risks of infections encountered in a hospital. Following universal masking for HCWs on March, 18 th in our hospital, high-risk exposure to SARS-CoV-2-positive patients dropped from 68.2% to 11.8%, and high-risk exposure to SARS-CoV-2-positive colleagues became predominant, increasing from 31.8% to 88.2% and making colleagues-to-colleagues transmission a potentially major route of infection [7]. The profession of the contact subject was associated with infection, but we did not find any association with the type of activities of the HCWs.…”