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Dear editor: Healthcare workers (HCW) have been the first-line defense against pandemic SARS-CoV-2 infection, for this reason, they are highly exposed and possibly have the greatest risk of contagion.1
We present results from a transversal study of healthcare personnel working at a Covid-19 hospital in Mexico, Hospital Civil de Guadalajara Dr. Juan I. Menchaca, who were exposed to SARS-CoV-2 from March 2020 to February 2021. Symptomatic HCW underwent RT-PCR (DeCoV19 Triplex kit) to identify SARS-CoV-2 viral load and their symptoms and medical history were registered.
We performed 3 024 RT-PCR tests, mean age at testing was 38 ±11 years, with a range from 18 to 67 years. Test results were positive in 1 128 (37.3%) samples; 704 were in female and 424 in male. HCW were more prone to respiratory affections in June and July, nevertheless, results were more often positive in November, December, and January (19 vs. 97%). Reinfections occurred in 30%.
Clinical presentation and medical history association with a positive test are detailed in table I. Symptoms related to a positive test were fever, headache, and cough. Obesity was the only condition positively associated with SARS-CoV-2 infection [OR= 2.4 (IC95% 2.01,3.03)], [aOR= 2.4 (IC95% 2.01,3.05)]. Five HCW (four female and one male) underwent assisted mechanical ventilation and amines. All were obese, two had hypertension, and one had diabetes. Two women died, a 64 year obese with pulmonary hypertension, and a 54 year obese with diabetes.
Table 1 SARS-CoV-2 test and symptoms/medical history in healthcare workers at Hospital Civil de Guadalajara. Mexico, March 2020-February 2021
|
Feature |
SARS-CoV2 positive/negative (n=3 024) |
Crude OR (95%CI) |
Adjusted* OR (95%CI) |
p‡ |
|
Symptoms |
||||
|
Fever |
514/91 |
16.6(13.04-21.12) |
3.07(2.26-4.17) |
0.0001 |
|
Headache |
802/216 |
19.1(15.8-23.17) |
2.54(1.87-3.43) |
0.0001 |
|
Cough |
698/147 |
19.3(15.7-32.75) |
2.46(1.81-3.35) |
0.0001 |
|
Odynophagia |
650/152 |
15.6(12.72-19.12) |
1.8(1.34-2.43) |
0.0001 |
|
Rhinorrhea |
650/127 |
18.9(15.27-23.49) |
2.6(1.94-3.54) |
0.01 |
|
Conjunctivitis |
375/56 |
16.3(12.2-21.94) |
1.64(1.14-2.36) |
0.007 |
|
Chest pain |
299/49 |
13.5(9.94-18.59) |
1.39(0.93-2.10) |
0.1 |
|
Dyspnea |
111/33 |
6.16(4.14-9.15) |
0.56(0.33-0.97) |
0.03 |
|
Tachypnea |
102/23 |
8.0(5.11-12.8) |
0.7(0.41-1.35) |
0.3 |
|
Diarrhea |
310/81 |
8.49(6.56-10.99) |
1.18(0.84-1.65) |
0.33 |
|
Medical history | ||||
|
Diabetes |
70/87 |
1.37(0.99-1.90) |
1.18(0.83-1.66) |
0.34 |
|
Hypertension |
109/135 |
1.3(1.07-1.81) |
1.15(0.87-1.52) |
0.31 |
|
Asthma |
91/125 |
1.2(0.93-1.64) |
1.26(0.94-1.68) |
0.11 |
|
COPD |
5/18 |
0.46(0.17-1.25) |
0.32(0.11-0.90) |
0.31 |
|
Obesity |
249/195 |
2.4(2.01-3.03) |
2.4(2.01-3.05) |
0.0001 |
|
Smoking |
141/282 |
0.8(0.65-1.01) |
0.77(0.62-0.96) |
0.02 |
OR: odds ratio; 95%CI: 95% confidence interval; COPD: chronic obstructive pulmonary disease.
* OR was adjusted for symptoms and medical history.
‡ Xi2 test for adjusted OR, p<0.05.
Our findings are in agreement with studies that described similar infection rates among HCW and the general population; possibly because protective personal equipment (PPE) provides an additional barrier.1,2 HCW in our study had SARS-CoV-2 infection rates similar to European facilities.1,2 This result is impressive considering Mexico is the country with the most infections in HCW and also with the highest death rates.3 This outcome could be associated with an early March 2020 PPE distribution and training at our institution in comparison with the rest of the country (May 2020).4
We concluded that more relaxed social distancing measures and lack or inadequate use of PPE were contagion determinants among HCW. Also, we found the clinical presentation and medical history related to SARS-CoV-2 infection in HCW similar to those observed in the general population; obesity is the single most important factor to determine both, a positive test, and a serious outcome.
