COVID-19 in health care workers in a university hospital during the quarantine in São Paulo city

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brazjinfectdis2020;24(5):462–465

w w w . e l s e v i e r . c o m / l o c a t e / b j i d

The

Brazilian

Journal

of

INFECTIOUS

DISEASES

Brief

communication

COVID-19

in

health

care

workers

in

a

university

hospital

during

the

quarantine

in

São

Paulo

city

Klinger

Soares

Faíco-Filho

∗

,

Joseane

Mayara

Almeida

Carvalho,

Danielle

Dias

Conte,

Luciano

Kleber

de

Souza

Luna,

Nancy

Bellei

UniversidadeFederaldeSãoPaulo,SãoPaulo,SP,Brazil

a

r

t

i

c

l

e

i

n

f

o

Articlehistory:

Received9June2020

Accepted9August2020

Availableonline10September2020

Keywords:

Coronavirus

Healthcareworkers

Pandemic

a

b

s

t

r

a

c

t

Healthcareworkers(HCW)areatahigherriskofbeinginfectedintheirworkplace.Out

ofatotalof466HCWofHospitalSãoPaulowithinﬂuenza-likeillnessesor anyclinical

suspicionofCOVID-19weretestedforCOVID-19byRT-PCRforSARS-CoV-2169(36%)turned

outpositiveandwereanalyzedbytypeofexposureandhospitaloccupation.DataofHCW

householdlocationswerealsoobtained.Logisticworkershadthehighestpositivityratefor

SARS-CoV-2(p=0.002),whilenursetechnicianshadthehighestrateamongthosereporting

routinecontactswithpatients(p=0.001).Physicianspresentedthelowestrateofinfection,

althoughlivinginmostaffecteddistricts(p<0.001).Policiesandadequatetrainingforall

hospitalemployeesmayimprovepreventionofCOVID-19amongallhealthcareservice

categories.

anopenaccessarticleundertheCCBY-NC-NDlicense(http://creativecommons.org/

licenses/by-nc-nd/4.0/).

On March 11th, WHO declared COVID-19 as a pandemic.

Twodaysafter,theﬁrstcaseofCOVID-19wasconﬁrmedat

HospitalSãoPaulo,alargeuniversity hospitalinSãoPaulo

city.OnMarch23rd,aquarantinewasdeclaredbythelocal

authorities.1_Despite_social_distancing_measures,_SARS-CoV-2

infectionsincreasedinmanymetropolitanareas.

Healthcareworkers(HCW)are atahigher riskofbeing

infectedintheir workplace and atthecommunity level as

theoutbreakexpandsinurbanareas.WediagnosedCOVID-19

amongHCWandanalyzedtheirtypeofexposureand

house-holdlocationinthecity.2

From March 22nd to April 22nd, during the quarantine

inthe city,HCW from Hospital São Paulo presenting with

∗ _{Corresponding}_author_at627_Rua_Pedro_de_Toledo,781_-_Vila_Clementino,_04024-002_São_Paulo,_Brazil.

E-mailaddress:Klingerfaiko@hotmail.com(K.S.Faíco-Filho).

inﬂuenza-likeillnessesoranyclinicalsuspicionofCOVID-19

wereevaluatedattheHCWMedicalAssistanceServiceaspart

ofaroutinesurveillanceafterthepandemicwasdeclared.Of

note,144patientswerehospitalizedwithaCOVID19diagnosis

duringthisperiod.

Nasopharyngealswabswerecollected,immediately

trans-portedtothevirologylaboratory,andweretestedbyaspeciﬁc

polymerasechainreactionmethodforSARS-CoV-2according

totheCDCUSAprotocol.

HCWwere categorizedbasedonthetypeofexposureto

patients (daily contact or not) and the hospital job

occu-pation.Logisticworkersincludedlaundry,cleaningservices,

and security staff. Data regarding the HCW’ household

https://doi.org/10.1016/j.bjid.2020.08.003

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brazj infect dis.2020;24(5):462–465

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Fig.1–SARS-CoV-2infectedhealthcareworkersdistributedbyresidentialAdministrativeDistricts(n=106)

locations were also obtained and analyzed according the

residentialadministrativedistricts.Fig.1showsthegeneral

population ofconﬁrmed COVID-19cases inSão Paulo city,

and the green areas with 120–238 cases were considered

the most affected, having the highest risk of SARS-COV-2

transmission.

Statisticalanalysis:Studentt-test,contingencytable

analy-siscalculatedusingchi-squareorFisher’sexacttestwasused,

andap-value<0.05wasconsideredstatisticallysigniﬁcant.

Atotalof466swabsforCOVID-19wereanalyzed,and36%

(n=169)werePositiveforSARS-CoV-2.Themedianagewas

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braz j infect dis.2020;24(5):462–465

Table1–Healthcareworkers’typeofexposureandcitydistrictofresidencediagnosedwithCOVID-19atHospitalSão Paulo.

Dailycontacts Total(n=466) COVID-19(n=169)

(n/%)

Districtofresidence High-risk+_/All_districts

(n=106++₎ Nursetechnician# ₁₂₈ ₅₇_(44.0) _6/37 Nurse 54 16(29.0) -/8 Physician 107 26(24.2) 13/17# Laboratorypersonnel 14 4(28.5) -/3 Physiotherapist 16 4(25.0) 2/4 Phonoaudiologist 3 2(66.6) -/1 Nocontacts Administrativestaff 90 28(31.1) 4/14 Logisticworkers*# ₂₇ ₁₇_(62.9) _4/15 Others** 27 15(55.5) 2/7

High-risk:districtswith120-178and179-238conﬁrmedCOVID-19cases(upto04/17/2020)++_Information_on_district_of_residence_was_not

availablefor60COVID-19cases.

∗ _Laundry,_cleaning_services,_security_staff. ∗∗ _Dentist,_Pharmacist,_Radiologist.

+ _High-risk:_districts_with_120-178_and_179-238_conﬁrmed_COVID-19_cases₍_up_to_04/17/2020). ++_Information_on_district_of_residence_was_not_available_for₆₀_COVID-19_cases.

# _p-value_<_0.05

ofeachcategoryaccordingtoexposureandjobdescriptionis

showninTable1.

LogisticworkershadthehighestrateofSARS-CoV-2

infec-tion(p=0,0029),but nursetechnicianshadthe highestrate

amongthosereportingdailycontactwithpatients(p=0.0010).

Wealsoanalyzedthe householdgeographicdistribution

of the HCW positive cases in the administrative districts

ofSão Paulo. Fig. 1 shows different COVID-19 rates inthe

generalpopulation accordingtothe CityHealth Ofﬁcedata

distributedinthecityandalsothe106outof126HCW

pos-itivecasesdistributedbyhouseholdlocations.3_Nineteen_of

theseHCWlivednearthehospital’sneighborhood,themost

affected district bythe outbreak. The available location of

106HCWdiagnosedwithCOVID-19andtheirhousehold

loca-tionsarepresentedinTable1.Doctorspresentedthelowest

rate of infection although livingin most affected districts

(p<0.001).

COVID-19transmission among HCW is a common fact;

China,Spain,andtheUSAhavealsoobservedagreat

num-berofaffectedHCW.4,5_Our_COVID-19_study_was_conducted_in

auniversityhospitalofadistrictinSãoPaulowithahighrate

ofconﬁrmedcasesduringthequarantine.

Consideringroutinedailycontact,nursetechnicianswere

infectedthe most, probablydue tomany opportunitiesfor

exposure during their shift, although they had received

trainingontheuseofpersonalprotectiveequipment.

Unex-pectedly, we found that the highest rate of infection was

amongpersonnelwhohadnodirectpatientcontact.

Logis-ticworkerswerelesstrainedand/orunawareoftherisksof

COVID-19transmissionatthehospital.Quiteoften,

admin-istrative techniciansand logistic workers are not provided

withadequatetraining and personalprotectiveequipment.

In this sense, it is essential to implement health policies

for professionals who do not have routine contact with

patients.

InfectionofHCWinthecommunitycannotberuledout,

since many HCW live in high affected districtsand many

ofthepositivecasesliveinthehospital’sneighborhood.Liu

et al. intheir study about the aerodynamics of

SARS-CoV-2 reported high levels of airborne RNA in areas prone to

crowding, probably due toinfected carriers in the crowd.6

However,logisticworkers’householdlocationswerenot

sig-niﬁcantlyassociatedwiththemostaffectedCOVID-19districts

(p>0.05).

Limitationsofthisstudyincludesmallsamplesize,short

study timeframe, andlackofsomeHCW data.Facilitating

testingofsymptomaticprofessionals,creatingsickleave

poli-ciesthatarenon-punitive,ﬂexible,andconsistentwithpublic

health guidance, andproviding adequate training and

pro-tectiveequipmentcouldimprovethepreventionofinfection

transmissiontoemployees.

Conﬂicts

of

interest

Theauthorsdeclarenoconﬂictsofinterest.

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1.WorldHealthOrganization.WHO.

https://www.who.int/docs/default-source/coronaviruse/ situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn= 1ba62e57102.Accessedon20April.

2.ChowEJ,SchwartzNG,TobolowskyFA,etal.Symptom

screeningatillnessonsetofhealthcarepersonnelwith

SARS-CoV-2infectioninKingCounty,Washington.JAMA.

Publishedonline17April2020.

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3.PrefeituraMunicipaldeSãoPaulo.BoletimEpidemiológico.

https://www.prefeitura.sp.gov.br/cidade/secretarias/upload/ saude/PMSPSMSCOVID19Boletim%20Semanal20200417 atualizado.pdf.

4.WuZ,McGooganJM.Characteristicsofandimportantlessons

fromthecoronavirusdisease2019(COVID-19)outbreakin

China:summaryofareportof72314casesfromtheChinese

CenterforDiseaseControlandPrevention.JAMA.

2020;323:1239–42,http://dx.doi.org/10.1001/jama.2020.2648.

5.GuanWJ,NiZY,HuY,etal.Clinicalcharacteristicsof coronavirusdisease2019inChina.NEnglJMed. 2020;382(18):1708–20.

6.LiuY,NingZ,ChenY,etal.Aerodynamicanalysisof

SARS-CoV-2intwoWuhanhospitals.Nature.

2020;582(7813):557–60,