COVID-19 in Healthcare Workers: A Systematic Review and Meta-Analysis of Prevalence, Risk Factors, Clinical Characteristics, and Outcomes

Abstract

Background: Health care workers (HCW) are at the frontline response to the new coronavirus disease 2019 (COVID-19), exposing themselves to a higher risk of acquiring the disease, and subsequently, exposing patients and colleagues. We aimed to systematically review the evidence on the prevalence, risk factors, clinical characteristics, and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among HCW. Methods: Searches in Embase, Pubmed, LILACS, MedxRiv and Google Scholar databases (inception to May 24th, 2020) were performed. Preprint and peer-reviewed published articles of any language reporting the prevalence of COVID-19 in HCW and evaluating the risk factors, clinical characteristics, and clinical outcomes of SARS-CoV-2 infection among HCW were included. Two reviewers independently selected the studies, extracted the data, and assessed the quality of evidence. Estimates were pooled using random-effects meta-analysis. Findings: Forty-five studies, including 44,879 HCW, met the inclusion criteria. From the screened HCW using RT-PCR and the presence of antibodies, the estimated prevalence of SARS-CoV-2 infection was 11% (95%CI; 7%-16%) and 5% (95% CI; 2%-9%), respectively. The most frequently affected personnel were the nurses (54%. 95%CI; 48%-60%), while most of the COVID-19 positive medical personnel were working in hospitalization/non-emergency wards during the screening (50%, 95%CI; 37%-64%). Anosmia (OR 43.69; 95%CI 12.42-153.67) and fever (OR 5.45; 95%CI 1.33-22.34) were identified as the only symptoms significantly associated with SARS-CoV-2 positivity among HCW. Data from 8 studies revealed a pooled prevalence of asymptomatic carriers among RT-PCR positive HCW of 46% (95%CI 21%-72%). Finally, 7% (95% CI; 2-15) of the COVID-19 positive HCW developed severe clinical complications, and 0.3% (95% CI; 0.29-0.35) died. Interpretation: HCW suffer a significant burden from COVID-19. A significant proportion of HCW are positive for COVID-19 while asymptomatic, which leads to the silent transmission of the disease. The presence of anosmia and fever could be used as an indicator for screening, especially in settings with limited testing capacities. While more research is needed to understand more specific symptoms and other factors related to SARS-CoV-2 infection to improve the screening performance and early detection, it is clear that providing HCW with adequate Personal Protective Equipment is essential. Funding Statement: None. Declaration of Interests: None to declare.