Incidence and Source of COVID‑19 Infection Among Health Care Workers in a Tertiary Hospital in South India—A Prospective Cohort Study

Yogesh Mohan, B. Charumathi, V. M. Anantha Eashwar, Timsi Jain, V. K. Abiramasundari

Abstract


Background: Data for COVID‑19 incidence and the source of infection among health care workers (HCWs) in Indian population are limited. The main objective of the study was to assess the incidence of COVID‑19 infection and identify the source of infection among the HCWs in a tertiary teaching hospital.

Methods: A prospective cohort study was conducted among the 2134 HCWs recruited by purposive sampling from a tertiary teaching hospital from May to August 2020 (4‑month period—123 days). Over the 4‑month period, all the HCWs who had symptoms or those were close contacts of COVID positive patients were traced and tested using validated COVID diagnostic test (reverse transcription–polymerase chain reaction [RT–PCR] test). A semi‑structured questionnaire was used to interview each positive HCW to identify the source of exposure of the infection.

Results: Incidence proportion was 9.3% among HCWs and was two times higher among males compared to females. Hazard ratio was found to be higher among males and HCWs working in the non‑COVID areas. Test positivity rate was found to highest (around 57.8%) among those aged less than 30 years. The most common source of infection was infected HCW colleagues (40.9%) followed by exposure to patients in non‑COVID areas (27.3%). Only 5.1% of total infection was found in HCWs who had worked in COVID zones.

Conclusions: People working in non‑COVID areas, those using shared workplace, dining halls, and staff hostels, must follow strict COVID protocols by using appropriate Personal Protective Equipment (PPE) and following social distancing measures.


Keywords


Contact tracing; COVID‑19; epidemiology; medical staff

Full Text:

PDF

References


Cao Y, Li Q, Chen J, Guo X, Miao C, Yang H, et al. Hospital

emergency management plan during the COVID-19 epidemic.

Acad Emerg Med 2020;27:309‑11.

Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo CG, Ma W,

et al. Risk of COVID‑19 among front‑line health‑care workers

and the general community: A prospective cohort study. Lancet

Public Health 2020;5:e475‑83.

PHARMABIZ.com. Health and Insurance. ICMR study

reveals doctors and medical practitioners working in

hospitals are at high risk of getting infected with COVID‑19.

Available from: http://www.pharmabiz.com/NewsDetails.

aspx?aid=126514&sid=1. [Last accessed on 2020 Jul 24].

Ing EB, Xu Q, Salimi A, Torun N. Physician deaths from corona

virus (COVID‑19) disease. Occup Med 2020;70:370‑4.

Centers for Disease Control and Prevention. Characteristics

of health care personnel with COVID‑19 — United States,

February 12–April 9, 2020. MMWR Morb Mortal Wkly Rep

;69:477–81.

Lai X, Wang M, Qin C, Tan L, Ran L, Chen D, et al. Coronavirus

disease 2019 (COVID‑2019) infection among health care

workers and implications for prevention measures in a tertiary

hospital in Wuhan, China. JAMA Netw Open 2020;1;3:e209666.

Sikkema RS, Pas SD, Nieuwenhuijse DF, O’Toole Á, Verweij JJ,

van der Linden A, et al. COVID‑19 in health‑care workers in

three hospitals in the south of the Netherlands: A cross‑sectional

study. Lancet Infect Dis 2020;20:1273‑80.

World Health Organization. Contact Tracing in the context of

COVID 19. Interim Guidance. Dated: 10 May 2020. Available

from: https://apps.who.int/iris/rest/bitstreams/1277571/

retrieve. [Last accessed on 2020 Aug 23].

Delamater PL, Street EJ, Leslie TF, Yang YT, Jacobsen KH.

Complexity of the basic reproduction number (R0). Emerg Infect

Dis 2019;25:1.

Breban R, Vardavas R, Blower S. Theory versus data: How to

calculate R0?. PLoS One 2007;2:e282.

Stare J, Maucort‑Boulch D. Odds ratio, hazard ratio and relative

risk. Metodoloski Zvezki 2016;13:59‑67.

Centre for Disease Control and Prevention. Principles of

Epidemiology in Public Health Practice, Third Edition. An

Introduction to Applied Epidemiology and Biostatistics.

Available from: https://www.cdc.gov/csels/dsepd/ss1978/lesson3/

section2.html. [Last accessed on 2021 Apr 07].

Cuschieri S. The STROBE guidelines. Saudi J Anaesth

;13(Suppl 1):S31‑4.

CDC COVID‑19 Response Team. Characteristics of health care

personnel with COVID‑19: United States, February 12–April 9,

MMWR Morb Mortal Wkly Rep 2020;69:477‑81.

Lai X, Wang M, Qin C, Tan L, Ran L, Chen D, et al. Coronavirus

disease 2019 (COVID‑2019) infection among health care

workers and implications for prevention measures in a tertiary

hospital in Wuhan, China. JAMA Netw Open 2020;3:e209666.

Bobrovitz N, Arora RK, Cao C, Boucher E, Liu M, Rahim H,

et al. Global seroprevalence of SARS‑CoV‑2 antibodies:

A systematic review and meta‑analysis. medRxiv 2020. doi:

1101/2020.11.17.20233460.

Bwire GM. Coronavirus: Why men are more vulnerable to Covid‑19 than women? SN Compr Clin Med 2020;2:874‑6.

Wu C, Zheng S, Chen Y, Zheng M. Single‑cell RNA

expression profiling of ACE2, the putative receptor of

Wuhan 2019‑nCoV, in the nasal tissue. MedRxiv 2020. doi:

1101/2020.02.11.20022228.

Zabarsky TF, Bhullar D, Silva SY, Mana TS, Ertle MT,

Navas ME, et al. What are the sources of exposure in healthcare

personnel with coronavirus disease 2019 infection?. Am J Infect

Control 2021;49:392‑5.

Qin J, You C, Lin Q, Hu T, Yu S, Zhou XH. Estimation of

incubation period distribution of COVID‑19 using disease onset

forward time: A novel cross‑sectional and forward follow‑up

study. medRxiv 2020;6:eabc1202.

Ministry of Health and Family Welfare. Guidelines to be followed

on detection of suspect/confirmed COVID‑19 case in a non

COVID Health Facility. Available from: https://www.mohfw.gov.

in/pdf/Guidelinestobefollowedondetectionofsuspectorconfirmed

COVID19case.pdf. [Last accessed on 2020 Jul 27].

Jha S, Soni A, Siddiqui S, Batra N, Goel N, Dey S, et al.

Prevalence of flu‑like symptoms and COVID‑19 in healthcare

workers from India. J Assoc Physicians India 2020;68:27‑9.

Jeremias A, Nguyen J, Levine J, Pollack S, Engellenner W,

Thakore A, et al. Prevalence of SARS‑CoV‑2 infection among

health care workers in a tertiary community hospital. JAMA

Intern Med 2020;180:1707‑9.

Dioscoridi L, Carrisi C. COVID‑19 exposure risk for family

members of healthcare workers: An observational study. Int J

Infect Dis 2020;4:287‑9.