Abstract
PurposeTo determine risk factors for coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs), characterize symptoms, and evaluate preventive measures against SARS-CoV-2 spread in hospitals.MethodsIn a cross-sectional study conducted between May 27 and August 12, 2020, after the first wave of the COVID-19 pandemic, we obtained serological, epidemiological, occupational as well as COVID-19-related data at a quaternary care, multicenter hospital in Munich, Germany.Results7554 HCWs participated, 2.2% of whom tested positive for anti-SARS-CoV-2 antibodies. Multivariate analysis revealed increased COVID-19 risk for nurses (3.1% seropositivity, 95% CI 2.5–3.9%, p = 0.012), staff working on COVID-19 units (4.6% seropositivity, 95% CI 3.2–6.5%, p = 0.032), males (2.4% seropositivity, 95% CI 1.8–3.2%, p = 0.019), and HCWs reporting high-risk exposures to infected patients (5.5% seropositivity, 95% CI 4.0–7.5%, p = 0.0022) or outside of work (12.0% seropositivity, 95% CI 8.0–17.4%, p < 0.0001). Smoking was a protective factor (1.1% seropositivity, 95% CI 0.7–1.8% p = 0.00018) and the symptom taste disorder was strongly associated with COVID-19 (29.8% seropositivity, 95% CI 24.3–35.8%, p < 0.0001). An unbiased decision tree identified subgroups with different risk profiles. Working from home as a preventive measure did not protect against SARS-CoV-2 infection. A PCR-testing strategy focused on symptoms and high-risk exposures detected all larger COVID-19 outbreaks.ConclusionAwareness of the identified COVID-19 risk factors and successful surveillance strategies are key to protecting HCWs against SARS-CoV-2, especially in settings with limited vaccination capacities or reduced vaccine efficacy.
Highlights
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) rapidly evolved to a pandemic in early 2020 with more than 173.4 million confirmed cases and 3.73 millionPaul R
As COVID-19 vaccines were not administered to healthcare workers (HCWs) at the LMU Klinikum before or during study sampling, the detection of anti-SARS-CoV-2 antibodies in participants’ sera was indicative ofacute or resolved SARS-CoV-2 infection and according to the case definition of the European Centre for Disease Prevention and Control (ECDC), these HCWs were classified as COVID-19 cases [18]
Until August 12th, 2020, 231 COVID19 patients were hospitalized at the quaternary care hospital surveyed here, at peak times 70 per day (Fig. 1b, blue), Fig. 1 Dynamics of the COVID-19 pandemic and implementation of preventive measures. a COVID-19 cases officially reported for the Munich metropolitan region until August 12th, 2020 and the number of blood samples collected from staff members are depicted as one bar per day. b Number of HCWs who tested positive for SARS-CoV-2 by PCR within a two-week window preceding the reported date, number of COVID-19 patients treated in the hospital, and number of hospital staff in quarantine. c Time-resolved depiction of state-imposed and institutional measures taken to prevent SARS-CoV-2 spread at the multicenter hospital
Summary
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) rapidly evolved to a pandemic in early 2020 with more than 173.4 million confirmed cases and 3.73 million. Effective treatment options for COVID-19 have not been discovered and vaccination programs are not yet available at scale in many countries, potentially weakened by the emergence of variants of concern (VOCs) [2, 3], or not well-accepted by parts of the population [4]. The importance of identifying HCW-specific risk factors is underscored by the recent emergence of SARS-CoV-2 VOCs with substantially increased transmissibility, possibly elevated case fatality rates, and reduced vaccine efficacy for some [2,3,4, 15, 16]. Using a questionnaire covering epidemiological and COVID-19-specific items, we identified risk groups and risk factors, characterized symptoms of SARS-CoV-2 infection, and evaluated measures to identify and prevent SARS-CoV-2 infections among employees
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