Demographic and professional risk factors of COVID-19 infections among physicians in low- and middle-income settings; findings from a representative survey in two Brazilian states

Abstract

Introduction. Health workers (HWs) are a key resource for health systems worldwide, and have been affected heavily by the COVID-19 pandemic. Evidence is consolidating on incidence and associated drivers of infections, predominantly in high-income settings. It is however still unclear what the risk factors may be for specific health professions, particularly in low- and middle-income countries (LMICs). Methods. We conducted a cross-sectional survey in a representative sample of 1,183 medical doctors registered with Brazil’s Federal Council of Medicine in one developed (São Paulo) and one disadvantaged state (Maranhão). Between February-June 2021, we administered a telephone questionnaire to collect data on physicians’ demographics, deployment to services, vaccination status, and self-reported COVID-19 infections. We performed descriptive, univariate, and multilevel clustered analysis to explore the association between physicians’ infection rates, and their sociodemographic and employment characteristics. A generalized linear mixed model with a binomial distribution was used to estimate the adjusted odds ratio. Results. We found that 35.8% of physicians in our sample were infected with COVID-19 in the first year of the pandemic. The infection rate in Maranhão (49.2%) [95% CI 45.0-53.4] was almost twice that in São Paulo (24.1%) [95% CI 20.8-27.5]. Being a physician in Maranhão [95% CI 2.08-3.57], younger than 50 years [95% CI 1.41-2.89], and having worked in a COVID-19 ward [95% CI 1.28-2.27], were positively associated with the probability of infections. Conversely, working with diagnostic services [95% CI 0.53-0.96], in administrative functions [95% CI 0.42-0.80], or in teaching and research [95% CI 0.48-0.91] was negatively associated. Conclusions. Based on data from Brazil, COVID-19 infections in LMICs may be more likely in those health systems with lower physician-to-patient ratios, and younger doctors working in COVID-19 wards may be infected more frequently. Such findings may be used to identify policies to mitigate COVID-19 effects on HWs in LMICs.

The Impact of the COVID-19 Pandemic on Physicians’ Working Hours and Earnings in São Paulo and Maranhão States, Brazil

“…For MA, our data show a general increase in working hours and earnings, mostly driven by public sector-only doctors. Although such a differential impact is consistent with what was witnessed in the two states during the pre-pandemic crisis [ 13 ], a recent study on risk factors suggests that the smaller number of physicians per capita in MA led to increased workloads, which increased physicians’ exposure to contracting the virus [ 37 ]. It will be important in the future to consider the fact that elements of health systems with fewer resources are affected unevenly by health emergencies, particularly as the increased workload (and associated working opportunities) is shared among a smaller pool of professionals.…”