COVID-19 in healthcare workers (literature review and own data)

Introduction. Health care workers are at risk of infection with the SARS-CoV-2 virus. However, many aspects of the professionally conditioned COVID-19 are still poorly understood.

The aim of study is to conduct a brief review and analysis of scientific data on the prevalence, features of clinical and laboratory COVID-19 syndromes in medical professionals. To evaluate the structure of post-COVID syndrome in health care workers who are observed in a large multidisciplinary medical organization that has a center for occupational pathology. To present the current state of the problem of examination of the connection of COVID-19 with the profession and admission to work in conditions of high risk of SARS-CoV-2 infection.

Materials and methods. At the first stage, a brief review of the literature on the problem of COVID-19 in health care workers was performed, at the second — a single-center observational prospective study of COVID-19 convalescents. The main group consisted of health care workers (n=203), the comparison group — people who do not have occupational health risks (n=156). The groups were comparable in demographic characteristics. The work experience of the medical staff was 15 (5; 21) years. Of the participants in the main group, 20.2% worked in hospitals, and 79.8% in outpatient institutions. Three of the participants (1.5%) were employees of specialized COVID hospitals. Doctors were 25.6%, secondary medical personnel — 51.7%, junior medical and technical personnel — 22.7%. A severe form of COVID-19 was suffered by 25 (12.3%) people, after the artificial ventilation of the lungs (AVL) — two participants. The observation time is 60 days. Statistical analysis included standard methods of descriptive statistics, determination of relationships by the method of logistic regression. The significance level is p<0.05.

Results. Most of the known data on COVID-19 in health care workers is obtained in cross-sectional studies. The possibility of occupational infection has been sufficiently proven. The risk probably depends on the work performed and is higher in conditions of direct contact of medical personnel with adults, potentially infected patients, but not in a specialized hospital. It is possible that the course of COVID-19 in health care workers differs from the general population of patients there is evidence of a greater frequency of weakness and myalgia. Studies of the features of post-COVID syndrome in health care workers in available sources could not be identified.

According to the results of their own research, health care workers who had experienced COVID-19 had a higher frequency of central thermoregulation disorders, arrhythmias, heart failure, panic attacks and depression.

Conclusions. Health care workers are at risk of COVID-19. Professionally conditioned post-COVID syndrome is characterized by the frequency of violations of the central mechanisms of thermoregulation and arrhythmias. COVID-19 in health care workers meets the definition of occupational disease.

1. Jones R.M., Xia Y. Annual Burden of Occupationally-Acquired Influenza Infections in Hospitals and Emergency Departments in the United States. Risk Anal. 2018; 38(3): 442-53. https://doi.org/10.1111/risa.12854

2. Hosuru Subramanya S., Thapa S., Dwedi S.K., Gokhale S., Sathian B., Nayak N., Bairy I. Streptococcus pneumoniae and Haemophilus species colonization in health care workers: the launch of invasive infections? BMC Res Notes. 2016; 9: 66. https://doi.org/10.1186/s13104-016-1877-x

3. Houlihan C.F., Vora N., Byrne T. et al. Pandemic peak SARS-CoV-2 infection and seroconversion rates in London frontline health-care workers. Lancet. 2020; 396(10246): e6-e7. https://doi.org/10.1016/S0140-6736(20)31484-7

4. Martin C.A., Patel P., Goss C., Jenkins D.R., Price A., Barton L. et al. Demographic and occupational determinants of anti-SARS-CoV-2 IgG seropositivity in hospital staff. J Public Health (Oxf). 2020 Nov 16: fdaa199. https://doi.org/10.1093/pubmed/fdaa199

5. Lidström A.K., Sund F., Albinsson B., Lindbäck J., Westman G. Work at inpatient care units is associated with an increased risk of SARS-CoV-2 infection; a cross-sectional study of 8679 healthcare workers in Sweden. Ups J Med Sci. 2020 Nov; 125(4): 305-310. https://doi.org/10.1080/03009734.2020.1793039

6. Shields A., Faustini S.E., Perez-Toledo M., Jossi S., Aldera E., Allen J.D. et al. SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study. Thorax. 2020; 75(12): 1089-94. https://doi.org/10.1136/thoraxjnl-2020-215414

7. Hunter E., Price D.A., Murphy E., van der Loeff I.S., Baker K.F., Lendrem D. et al. First experience of COVID-19 screening of health-care workers in England. Lancet. 2020; 395(10234): e77-e78. https://doi.org/10.1016/S0140-6736(20)30970-3

8. Rivett L., Sridhar S., Sparkes D., Routledge M., Jones N.K., Forrest S. et al. Screening of healthcare workers for SARS-CoV-2 highlights the role of asymptomatic carriage in COVID-19 transmission. Elife. 2020 May 11; 9: e58728. https://doi.org/10.7554/eLife.58728

9. Pollán M., Pérez-Gómez B., Pastor-Barriuso R., Oteo J., Hernán M.A., Pérez-Olmeda M. et al.; ENE-COVID Study Group. Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study. Lancet. 2020; 396(10250): 535-44. https://doi.org/10.1016/S0140-6736(20)31483-5

10. Stringhini S., Wisniak A., Piumatti G., Azman A.S., Lauer S.A., Baysson H. et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study. Lancet. 2020; 396(10247): 313-9. https://doi.org/10.1016/S0140-6736(20)31304-0

11. Erikstrup C., Hother C.E., Pedersen O.B.V., Mølbak K., Skov R.L., Holm DK et al. Estimation of SARS-CoV-2 infection fatality rate by real-time antibody screening of blood donors. Clin Infect Dis. 2020; 25: ciaa849. https://doi.org/10.1093/cid/ciaa849

12. Rosenberg E.S., Tesoriero J.M., Rosenthal E.M., Chung R., Barranco M.A., Styer L.M. et al. Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York. Ann Epidemiol. 2020; 48: 23-29.e4. https://doi.org/10.1016/j.annepidem.2020.06.004

13. Steensels D., Oris E., Coninx L., Nuyens D., Delforge M.L., Vermeersch P., Heylen L. Hospital-Wide SARS-CoV-2 Antibody Screening in 3056 Staff in a Tertiary Center in Belgium. JAMA. 2020; 324(2): 195-7.

14. Korth J., Wilde B., Dolff S., Anastasiou O.E., Krawczyk A., Jahn M. et al. SARS-CoV-2-specific antibody detection in healthcare workers in Germany with direct contact to COVID-19 patients. J Clin Virol. 2020; 128: 104437.

15. Stubblefield W.B., Talbot H.K., Feldstein L., Tenforde M.W., Rasheed M.A.U., Mills L. et al. Influenza Vaccine Effectiveness in the Critically Ill (IVY) Investigators. Seroprevalence of SARS-CoV-2 Among Frontline Healthcare Personnel During the First Month of Caring for COVID-19 Patients - Nashville, Tennessee. Clin Infect Dis. 2020 Jul 6:ciaa936. https://doi.org/10.1093/cid/ciaa936

16. Grant J.J., Wilmore S.M.S., McCann N.S., Donnelly O., Lai R.W.L., Kinsella M.J. et al. Seroprevalence of SARS-CoV-2 antibodies in healthcare workers at a London NHS Trust. Infect Control Hosp Epidemiol. 2020; Aug 4: 1-3. https://doi.org/10.1017/ice.2020.402

17. Barrett E.S., Horton D.B., Roy J., Gennaro M.L., Brooks A., Tischfield J. et al. Prevalence of SARS-CoV-2 infection in previously undiagnosed health care workers in New Jersey, at the onset of the U.S. COVID-19 pandemic. BMC Infect Dis. 2020; 20(1): 853. https://doi.org/10.1186/s12879-020-05587-2

18. Magnavita N., Tripepi G., Di Prinzio R.R. Symptoms in Health Care Workers during the COVID-19 Epidemic. A Cross-Sectional Survey. Int J Environ Res Public Health. 2020; 17(14): 5218. https://doi.org/10.3390/ijerph17145218

19. Algado-Sellés N., Gras-Valentí P., Chico-Sánchez P., Mora-Muriel J.G., Soler-Molina V.M., Hernández-Maldonado M. et al. Frequency, Associated Risk Factors, and Characteristics of COVID-19 Among Healthcare Personnel in a Spanish Health Department. Am J Prev Med. 2020 Dec;59(6): e221-e229. https://doi.org/10.1016/j.amepre.2020.07.014

20. Ganz-Lord F., Segal K.R., Rinke M.L. COVID-19 Symptoms, Duration, and Prevalence Among Healthcare Workers in the New York Metropolitan Area. Infect Control Hosp Epidemiol. 2020; Nov 20: 1-26. https://doi.org/10.1017/ice.2020.1334

21. Wu M., Xie C., Wu R., Shu Y., Wang L., Li M., Wang Y. Epidemiological and clinical characteristics of SARS-CoV-2 infection among healthcare workers in Hubei Province of China. Infect Control Hosp Epidemiol. 2020 Nov 18: 1-20. https://doi.org/10.1017/ice.2020.1321

22. Wu Z., McGoogan J.M. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13): 1239-42. https://doi.org/10.1001/jama.2020.2648

23. Van Aerde N., Van den Berghe G., Wilmer A., Gosselink R., Hermans G., COVID-19 Consortium. Intensive care unit acquired muscle weakness in COVID-19 patients. Intensive Care Med. 2020; 1-3. https://doi.org/10.1007/s00134-020-06244-7

24. Paneroni M., Simonelli C., Saleri M., Bertacchini L., Venturelli M., Troosters T. et al. Muscle strength and physical performance in patients without previous disabilities recovering from COVID-19 pneumonia. Am J Phys Med Rehabil. 2020; Nov 11. https://doi.org/10.1097/PHM.0000000000001641

25. Mo X., Jian W., Su Z., Chen M., Peng H., Peng P. et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020; 55(6): 2001217. https://doi.org/10.1183/13993003.01217-2020

26. You J., Zhang L., Ni-Jia-Ti M.Y., Zhang J., Hu F., Chen L. et al. Anormal pulmonary function and residual CT abnormalities in rehabilitating COVID-19 patients after discharge. J Infect. 2020; 81(2): e150-e152. https://doi.org/10.1016/j.jinf.2020.06.003

27. Huang W., Wu Q., Chen Z., Xiong Z., Wang K., Tian J., Zhang S. The potential indicators for pulmonary fibrosis in survivors of severe COVID-19. J Infect. 2020 Sep 28: S0163-4453(20)30632-0. https://doi.org/10.1016/j.jinf.2020.09.027

28. Cavalagli A., Peiti G., Conti C., Penati R., Vavassori F., Taveggia G. Cranial nerves impairment in post-acute oropharyngeal dysphagia after COVID-19: a case report. Eur J Phys Rehabil Med. 2020 Sep 17. https://doi.org/10.23736/S1973-9087.20.06452-7

29. Lodigiani C., Iapichino G., Carenzo L. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020; 19: 9-14.

30. Li Y., Li M., Wang M., Zhou Y., Chang J., Xian Y. et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol. 2020; 5(3): 279-84. https://doi.org/10.1136/svn-2020-000431

31. Toscano G., Palmerini F., Ravaglia S., Ruiz L., Invernizzi P., Cuzzoni M.G. et al. Guillain-Barré Syndrome Associated with SARS-CoV-2. N Engl J Med. 2020; 382(26): 2574-6. https://doi.org/10.1056/NEJMc2009191

32. Moriguchi T., Harii N., Goto J., Harada D., Sugawara H., Takamino J., Ueno M., Sakata H., Kondo K., Myose N., Nakao A., Takeda M., Haro H., Inoue O., Suzuki-Inoue K. et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. 2020; 94: 55-8. https://doi.org/10.1016/j.ijid.2020.03.062

33. Mao L., Jin H., Wang M., Hu Y., Chen S., He Q. et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020 Jun 1; 77(6): 683-90. https://doi.org/10.1001/jamaneurol.2020.1127

34. Helms J., Kremer S., Merdji H., Clere-Jehl R., Schenck M., Kummerlen C. et al. Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med. 2020; 382(23): 2268-70. https://doi.org/10.1056/NEJMc2008597

35. Parsons T., Banks S., Bae C., Gelber J., Alahmadi H., Tichauer M. COVID-19-associated acute disseminated encephalomyelitis (ADEM). J Neurol. 2020; 267(10): 2799-802. https://doi.org/10.1007/s00415-020-09951-9

36. Curci C., Pisano F., Bonacci E., Camozzi D.M., Ceravolo C., Bergonzi R. et al. Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 Rehabilitation Unit and proposal of a treatment protocol. Eur J Phys Rehabil Med. 2020; 56(5): 633-41. https://doi.org/10.23736/S1973-9087.20.06339-X

37. Liu H., Luo S., Zhang Y., Jiang Y., Jiang Y., Wang Y. et al. Chest CT Features of 182 Patients with Mild Coronavirus Disease 2019 (COVID-19) Pneumonia: A Longitudinal, Retrospective and Descriptive Study. Infect Dis Ther. 2020; 9(4): 1029-41. https://doi.org/10.1007/s40121-020-00352-z

38. Di Minno A., Ambrosino P., Calcaterra I., Di Minno M.N.D. COVID-19 and Venous Thromboembolism: A Meta-analysis of Literature Studies. Semin Thromb Hemost. 2020; 46(7): 763-71. https://doi.org/10.1055/s-0040-1715456

39. Simonneau G., Torbicki A., Dorfmüller P., Kim N. The pathophysiology of chronic thromboembolic pulmonary hypertension. Eur Respir Rev. 2017; 26(143): pii: 160112.

40. Jenkins D., Madani M., Fadel E., D'Armini A.M., Mayer E. Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension. Eur Respir Rev. 2017; 26(143): pii: 160111 https://doi.org/10.1183/16000617.0111-2016

41. Carfì A., Bernabei R., Landi F.; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020; 324(6): 603-5. https://doi.org/10.1001/jama.2020.12603

42. Halpin S.J., McIvor C., Whyatt G., Adams A., Harvey O., McLean L. et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol. 2020; 30. https://doi.org/10.1002/jmv.26368

43. Rogers J.P., Chesney E., Oliver D., Pollak T.A., McGuire P., Fusar-Poli P., Zandi M.S., Lewis G., David A.S. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020; 7(7): 611-27. https://doi.org/10.1016/S2215-0366(20)30203-0

44. Sandoval Y., Januzzi J.L. Jr., Jaffe A.S. (2020) Cardiac troponin for assessment of myocardial injury in COVID-19: JACC review topic of the week. J Am Coll Cardiol. 76, 10, 1244-58.

45. Puntmann V.O., Carerj M.L., Wieters I., Fahim M., Arendt C., Hoffmann J. et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020; 5(11): 1265-73. https://doi.org/10.1001/jamacardio.2020.3557

46. Garrigues E., Janvier P., Kherabi Y., Le Bot A., Hamon A., Gouze H. et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020; 25: S0163-4453(20)30562-4. https://doi.org/10.1016/j.jinf.2020.08.029

47. Xiong Q., Xu M., Li J., Liu Y., Zhang J., Xu Y., Dong W. Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study. Clin Microbiol Infect. 2020 Sep 23: S1198-743X(20)30575-9. https://doi.org/10.1016/j.cmi.2020.09.023

48. Lodigiani C., Iapichino G., Carenzo L., Cecconi M., Ferrazzi P., Sebastian T. et al. Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020; 191: 9-14. https://doi.org/10.1016/j.thromres.2020.04.024

49. Dani M., Dirksen A., Taraborrelli P., Torocastro M., Panagopoulos D., Sutton R., Lim P.B. Autonomic dysfunction in 'long COVID': rationale, physiology and management strategies. Clin Med (Lond). 2020 Nov 26:clinmed.2020-0896. https://doi.org/10.7861/clinmed.2020-0896

50. Das A., Sil A., Jaiswal S., Rajeev R., Thole A., Jafferany M., Ali S.N. A Study to Evaluate Depression and Perceived Stress Among Frontline Indian Doctors Combating the COVID-19 Pandemic. Prim Care Companion CNS Disord. 2020 Oct 8; 22(5): 20m02716. https://doi.org/10.4088/PCC.20m02716

51. Wang B., Li R., Lu Z., Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY). 2020; 12(7): 6049-6057. https://doi.org/10.18632/aging.103000

52. Lai J., Ma S., Wang Y., Cai Z., Hu J., Wei N. et al. Factors Associated with Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020; 3(3): e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976

53. Awano N., Oyama N., Akiyama K., Inomata M., Kuse N., Tone M. et al. Anxiety, Depression, and Resilience of Healthcare Workers in Japan During the Coronavirus Disease 2019 Outbreak. Intern Med. 2020; 59(21): 2693-9. https://doi.org/10.2169/internalmedicine.5694-20

54. Lu W., Wang H., Lin Y., Li L. Psychological status of medical workforce during the COVID-19 pandemic: A cross-sectional study. Psychiatry Res. 2020; 288: 112936. https://doi.org/10.1016/j.psychres.2020.112936

55. Chew N.W.S., Lee G.K.H., Tan B.Y.Q., Jing M., Goh Y., Ngiam N.J.H. et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun. 2020; 88: 559-65. https://doi.org/10.1016/j.bbi.2020.04.049 Epub 2020 Apr 21. PMID: 32330593; PMCID: PMC7172854

56. Cao J., Wei J., Zhu H., Duan Y., Geng W., Hong X., Jiang J., Zhao X., Zhu B. A Study of Basic Needs and Psychological Wellbeing of Medical Workers in the Fever Clinic of a Tertiary General Hospital in Beijing during the COVID-19 Outbreak. Psychother Psychosom. 2020; 89(4): 252-4. https://doi.org/10.1159/000507453 Epub 2020 Mar 30. PMID: 32224612; PMCID: PMC7179543

57. Dimitriu M.C.T., Pantea-Stoian A., Smaranda A.C., Nica A.A., Carap A.C., Constantin V.D. et al. Burnout syndrome in Romanian medical residents in time of the COVID-19 pandemic. Med Hypotheses. 2020 Nov; 144: 109972. https://doi.org/10.1016/j.mehy.2020.109972

58. Zhang S., Liu L., Yang B., Li R., Luo J., Huang J. et al. Clinical characteristics of 134 convalescent patients with COVID-19 in Guizhou, China. RespirRes. 2020; 21(1): 314. https://doi.org/10.1186/s12931-020-01580-0