Factors Associated with SARS-CoV-2 Infection in Physician Trainees in New York City during the First COVID-19 Wave

Abstract

Occupational and non-occupational risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported in healthcare workers (HCWs), but studies evaluating risk factors for infection among physician trainees are lacking. We aimed to identify sociodemographic, occupational, and community risk factors among physician trainees during the first wave of coronavirus disease 2019 (COVID-19) in New York City. In this retrospective study of 328 trainees at the Mount Sinai Health System in New York City, we administered a survey to assess risk factors for SARS-CoV-2 infection between 1 February and 30 June 2020. SARS-CoV-2 infection was determined by self-reported and laboratory-confirmed IgG antibody and reverse transcriptase-polymerase chain reaction test results. We used Bayesian generalized linear mixed effect regression to examine associations between hypothesized risk factors and infection odds. The cumulative incidence of infection was 20.1%. Assignment to medical-surgical units (OR, 2.51; 95% CI, 1.18–5.34), and training in emergency medicine, critical care, and anesthesiology (OR, 2.93; 95% CI, 1.24–6.92) were independently associated with infection. Caring for unfamiliar patient populations was protective (OR, 0.16; 95% CI, 0.03–0.73). Community factors were not statistically significantly associated with infection after adjustment for occupational factors. Our findings may inform tailored infection prevention strategies for physician trainees responding to the COVID-19 pandemic.

Transmission and Risk Factors of COVID-19 among Health Care Workers

“…Similarly, SARS-CoV-2 infection was less frequent among physician trainees who worked in ambulatory clinics and in telemedicine compared with those who reported never working in those settings. 20 Comparable results were reported in many studies in the postvaccination era. The highest risk of breakthrough infection was reported among nurse aides/auxiliary personnel (20.7-39%), nurses (35.5-41.5%), and physicians (13.5-15.9%).…”

“…Twelve studies assessed community and household exposures. [9][10][11][12][13][14][15][16][17][18][19][20] No explicit and/or consistent definition of community exposure was used among all reviewed studies. Also, in many studies, there was no clear distinction between community exposure and household exposure.…”

“…The high ORs of infection in the emergency department are probably due to the frequent overcrowding situations and fast-paced workflow in these settings. 10,12,15,16,20,23 Some exceptions were noted in the physician trainees' study, as the trainees may have been less familiar with their medical-surgical units and, importantly, with occupational infection control prevention protocols. 20 The higher frequency of SARS-CoV-2 infections in Emergency Medicine and Anesthesiology trainees may be attributed to performance of AGPs performed in those settings.…”

“…18 Similarly, SARS-CoV-2 infection was more likely among physician trainees who performed AGPs. 20 The prevalence of laboratory-confirmed COVID-19 was 1.9% for dentists and 0.8% for dental assistants. Interestingly, working in practice limited to endodontics was associated with decreased odds compared with practice limited to periodontology which showed increased odds of presenting a COVID-19-related clinical phenotype.…”

“…10,12,14,16,18,[22][23][24][25] In one study of physician trainees, the cumulative incidence of SARS-CoV-2 infection was 20.1%. 20 Nurses, nurse assistants, and hospital service/sanitation workers showed the highest seroprevalence rates. The highest seroprevalence among nurse assistants was 39%, and adjusted OR (aOR) ranged between 1.48 and 1.88.…”