Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19

Abstract

Background & objectives: Healthcare workers (HCWs) are at an elevated risk of contracting COVID-19. While intense occupational exposure associated with aerosol-generating procedures underlines the necessity of using personal protective equipment (PPE) by HCWs, high-transmission efficiency of the causative agent [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] could also lead to infections beyond such settings. Hydroxychloroquine (HCQ), a repurposed antimalarial drug, was empirically recommended as prophylaxis by the National COVID-19 Task Force in India to cover such added risk. Against this background, the current investigation was carried out to identify the factors associated with SARS-CoV-2 infection among HCWs in the country. Methods: A case-control design was adopted and participants were randomly drawn from the countrywide COVID-19 testing data portal maintained by the ICMR. The test results and contact details of HCWs, diagnosed as positive (cases) or negative (controls) for SARS-CoV-2 using real-time reverse transcription-polymerase chain reaction (qRT-PCR), were available from this database. A 20-item brief-questionnaire elicited information on place of work, procedures conducted and use of PPE. Results: Compared to controls, cases were slightly older (34.7 vs. 33.5 yr) and had more males (58 vs. 50%). In multivariate analyses, HCWs performing endotracheal intubation had higher odds of being SARS-CoV-2 infected [adjusted odds ratio (AOR): 4.33, 95% confidence interval (CI): 1.16-16.07]. Consumption of four or more maintenance doses of HCQ was associated with a significant decline in the odds of getting infected (AOR: 0.44; 95% CI: 0.22-0.88); a dose-response relationship existed between frequency of exposure to HCQ and such reductions (χ 2 for trend=48.88; P <0.001). In addition, the use of PPE was independently associated with the reduction in odds of getting infected with SARS-CoV-2. Interpretations & conclusions: Until results of clinical trials for HCQ prophylaxis become available, this study provides actionable information for policymakers to protect HCWs at the forefront of COVID-19 response. The public health message of sustained intake of HCQ prophylaxis as well as appropriate PPE use need to be considered in conjunction with risk homoeostasis operating at individual levels.

Pre exposure Hydroxychloroquine Prophylaxis for COVID-19 in healthcare workers: a retrospective cohort

“…CQ/ HCQ can prevent viral entry has been demonstrated by Wang et al 30 through their time-of-addition studies. Based on these encouraging preclinical trials and supported further by preliminary internal observational studies, 31 prior to exposure. It was also observed that among HCQ takers 32 were exposed to a symptomatic contact out of which only 3 (9.38%) were positive whereas in the control group 33 were exposed to a symptomatic contact out of which 18 (54.55%) tested to be positive.…”

Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future

“…A number of recent studies have endorsed these concerns including the UK Recovery Trial (171,(176)(177)(178), resulting in the WHO and the National Institute of Health (NIH) in the US halting the use of hydroxychloroquine in their studies (161,167,177,179,180). However, hydroxychloroquine is still recommended for prophylaxis in India with Chatterjee et al (181) demonstrating that hydroxychloroquine was associated with a significant reduction in the chances of healthcare workers getting COVID-19 (21,181,182). The Government and others in Malaysia also initially endorsed hydroxychloroquine helped by additional supplies from India (183), with continued endorsement at lower doses in early June (8,184,185), with the Government in Pakistan banning exports for fear of shortages (186), although later reversed (187).…”

Hydroxychloroquine for prophylaxis of COVID‐19 physicians survey: Despite lack of evidence, many would take or give to dear ones, and despite the perceived necessity of an RCT, few would participate

“…6 A total of 22 studies including HCWs were registered on clinicaltrials.gov, and 6 of them were already recruiting subjects. 7 On May 31st, Chatterjee et al published a case-control study, in which they found an association between HCQ administration and a lower risk of disease 8 ; this study was the first one to suggest the prophylactic efficacy of HCQ among HCWs. On the other hand, continuous treatment with HCQ did not prevent SARS-CoV-2 infection in a large database analysis.…”