Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers: A Living Rapid Review
Main result
I key issue: What is the involvement of health care workers with SARS-CoV, MERS-CoV, and SARS-CoV-2 infections, and how is it related to age, gender, and the presence of co-morbidities?
SARS-CoV-2: analysis of 1 cohort study, 9 cross-sectional studies, and 5 case series. Of the studies reporting the incidence of infection in healthcare workers (many of which are not peer-reviewed), the results suggest an incidence of 6.4% (86 out of 1,353, Dutch study), 38.9% (out of 72 patients, small Chinese study) and 3.8% (1,716 out of 44,672 PCR-confirmed cases in China as of February 11, 2020). A Chinese study on 25,961 people estimated that the incidence among healthcare workers (5.1%, 1316 out of 25,961) was higher than for the overall population as of February 18, 2020 (144.7 vs. 41.7 out of 10^6 people). Seven cross-sectional studies reported that both female gender and direct contact with COVID-19 patients were associated with altered psychological status.
SARS-CoV: analysis of 14 cohort studies, 1 cross-sectional study, and 1 case series. The prevalence of seropositivity among exposed healthcare workers ranged from 0.3% to 40% in 6 studies and the incidence of SARS-CoV infection ranged from 1.2% to 29.4% in 14 studies. The incidence of infection among healthcare workers is about 21% (1,706 cases out of 8,096) according to the WHO.
MERS-CoV: analysis of 7 cohort studies, 4 case-series cases, and 1 cross-sectional study. In three studies involving at least 500 health workers, the incidence of infection ranged from 1.12% to 2.0%. The incidence among all cases reported by the WHO was estimated to be about 5.8% (24 out of 415).
II Key issue: What are the risk factors for health workers related to SARS-CoV, MERS-CoV, and SARS-CoV-2?
SARS-CoV-2: A retrospective cohort study examined a total of 72 health care workers. The risk factors that were identified included: working in high-risk services (RR 2.13, CI: 1.45-3.95), suboptimal hand washing (RR 3.10, CI: 1.43-6.73), incorrect use of PPE (RR 2.82, CI: 1.11-7.18).
SARS-CoV: analysis of 17 cohort studies, 11 case-control series, and 1 cross-sectional study. 6 studies found no association between the risk of infection and gender. 12 studies found no significant difference between nurses and physicians. 6 studies reported an increased risk with certain procedures such as endotracheal intubation, contact with mucous membranes, and body fluids of infected patients, while there was no correlation with duration of exposure. Numerous studies have shown that the use of PPE reduces the risk of infection.
III Key issue: What are the main risk factors for transmission in the household environment of healthcare workers?
No studies have been conducted on this subject.
Takeaways
The study shows that healthcare workers experience a higher incidence of infection than the rest of the population, but have milder symptoms (which may be related to their younger age and reduced co-morbidities).
Experiences of depression, generalized anxiety and psychological stress are frequent among health care workers in contact with patients with COVID-19, as previously reported for SARS-CoV.
Evidence has been documented linking the correct use of PPE to a reduction in the incidence of infection and the association between exposure to body fluids of infected patients/endotracheal intubation and increased risk of infection.
Strength of evidence Moderate
Intermediate:
1) Non-systematic review of the literature
2) Methodological limitations
3) Uncertainty as to whether SARS-CoV and MERS-CoV data can be generalized to SARS-CoV-2
4) Most of the information relevant to China must be examined in different contexts.
Objectives
Method
Non-systematic literature review
Articles retrieved from PubMed, MEDLINE, Elsevier Embase, WHO database on SARS-CoV-2, and medRxiv preprint server between 2003 and 24 April 2020.
Given the scarcity of information for SARS-CoV-2, articles for SARS-CoV and MERS-CoV were also considered.
The review was conducted with a fast-track process: only 25% of the abstracts were evaluated by the two reviewers, no explicit tools for critical assessment were used, only one reviewer assessed the limitations of the articles, abstracts, and data, a second reviewer examined the first evaluation.
64 articles were included in the review: 43 for the study of health care workers involved with the infections (15 on SARS-CoV-2), and 34 studies for the risk factors (3 specific to SARS-CoV-2).
Articles were selected to address three main issues:
I key issue: the involvement of health care workers by SARS-CoV-2, SARS-CoV, and MERS-CoV, and the relationship with factors such as age, gender, and co-morbidity.
II key issue: the risk factors for SARS-CoV-2, SARS-CoV, and MERS-CoV infection for health care workers.
III key issue: risk factors for transmission of SARS-CoV-2, SARS-CoV, and MERS-CoV in the domestic environment of health workers.
bibliovid.org and its content are bibliovid property.