Household transmission and incidence of positive SARS-CoV-2 RT-PCR in symptomatic healthcare workers, clinical course and outcome: a French hospital experience

Abstract

ObjectivesAlthough healthcare workers (HCWs) have been particularly affected by SARS-CoV-2, detailed data remain scarce. In this study, we investigated infection rates, clinical characteristics, occupational exposure and household transmission among all symptomatic HCWs screened by SARS-CoV-2 RT-PCR between 17 March (French lockdown) and 20 April.MethodsSARS-CoV-2 RT-PCR was proposed to symptomatic (new cough or dyspnoea) HCWs at Creteil Hospital in one of the Parisian suburbs most severely affected by COVID-19. Data on occupational profile, living situation and household, together with self–isolation and mask use at home were collected, as well as the number of cases in the household.ResultsThe incidence rate of symptomatic SARS-CoV-2 was estimated to be 5% (110/2188). A total of 110 (35%) of the 314 HCWs tested positive and 9 (8%) were hospitalised. On multivariate analysis, factors independently associated with positive RT-PCR were occupational profile with direct patient facing (OR 3.1, 95% CI 1.1 to 8.8), p<0.03), and presence of anosmia (OR 5.7, 95% CI 3.1 to 10.6), p<0.0001). Being a current smoker was associated with negative RT-PCR (OR 0.3, 95% CI 0.1 to 0.7), p=0.005). Transmission from HCWs to household members was reported in 9 (14%) cases, and 2 deaths occurred. Overall, self-isolation was possible in 52% of cases, but only 31% of HCWs were able to wear a mask at home.ConclusionThis is the first study to report infection rates among HCWs during the peak of the SARS-CoV-2 epidemic in France and the lockdown period, highlighting the risk related to occupational profile and household transmission.

Incidence of Reported Flu-Like Syndrome Cases in Brazilian Health Care Workers in 2020 (March to June)

“…This strategy produced proportions [ 13 ] instead of crude rates. The results confirm the relevance of HCWs’ exposure to infection risk [ 1 , 2 , 3 , 4 , 6 , 11 , 30 , 35 , 37 , 41 ]. We avoided producing localized results by studying a state in each region of the country.…”

“…A relevant result to highlight is that professionals performing tasks that, in theory, do not require dealing directly with patients occupied the second position in the number of affected. In France, the incidence rate of symptomatic COVID-19 infection also varied when comparing occupational subgroups [ 35 ]. However, some controversies are observed in the literature.…”

Epidemiological characterization of symptomatic and asymptomatic COVID-19 cases and positivity in subsequent RT-PCR tests in the United Arab Emirates

“…Re-exposure to more COVID-19 carriers or contaminated physical services [ 17 ] may have contributed to an increased level of the contracted viral load, which may have expedited the symptomatic state. Nevertheless, this observation does not undermine the role of household transmission among retired or unemployed people [ 18 – 20 ].…”

Update Alert 7: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers

“…The original rapid review included 34 studies on risk factors for coronavirus infections (3 studies on SARS-CoV-2 infection, 29 studies on SARS-CoV-1 infection, and 2 studies on Middle East respiratory syndrome–CoV infection) ( 1 ); 46 studies (44 studies on SARS-CoV-2 infection, 0 studies on SARS-CoV-1 infection, and 2 studies on Middle East respiratory syndrome–CoV infection) were added in prior updates ( 2 , 21–25 ). For this update, 12 cohort studies ( 3–9 , 11 , 14 , 15 , 18 , 19 ) and 6 cross-sectional studies ( 10 , 12 , 13 , 16 , 17 , 20 ) were added ( Supplement Table 1 ). Four studies were done in the United States ( 4 , 7 , 18 , 20 ), 10 in Europe (Spain [ 5 , 11 , 14 ], Italy [ 8 , 9 ], the United Kingdom [ 12 , 17 ], France [ 13 ], Sweden [ 15 ], and the Netherlands [ 15 ]), 2 in India ( 6 , 10 ), and 1 each in China ( 19 ) and Egypt ( 3 ).…”

“…Nine new studies reported inconsistent associations between direct patient contact or contact with patients with COVID-19 and risk for SARS-CoV-2 infection or seropositivity primarily based on unadjusted risk estimates ( 3–5 , 7 , 8 , 10 , 14 , 18 , 19 ). In 2 studies that controlled for potential confounders, direct contact with patients with COVID-19 was associated with increased risk for infection versus no contact (adjusted OR, 1.69 [CI, 1.28 to 2.24]) ( 14 ) and versus a nonclinical health care worker role (adjusted OR, 3.08 [CI, 1.09 to 8.78]) ( 13 ).…”