Clinical Factors, Preventive Behaviours and Temporal Outcomes Associated with COVID-19 Infection in Health Professionals at a Spanish Hospital
Abstract
:1. Introduction
2. Materials and Methods
2.1. Analysis
2.2. Ethical Considerations
3. Results
4. Discussion
4.1. Symptoms
4.2. Preventive Behaviours before the Pandemic
4.3. Main Concerns
4.4. Follow-up Strategy: Median Times to Negative PCR Results
4.5. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Wu, F.; Zhao, S.; Yu, B.; Chen, Y.M.; Wang, W.; Song, Z.G.; Hu, Y.; Tao, Z.W.; Tian, J.H.; Pei, Y.Y.; et al. A new coronavirus associated with human respiratory disease in China. Nature 2020, 579, 265–269. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Lu, R.; Zhao, X.; Li, J.; Niu, P.; Yang, B.; Wu, H.; Wang, W.; Song, H.; Huang, B.; Zhu, N.; et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet 2020, 395, 565–574. [Google Scholar] [CrossRef][Green Version]
- Huang, C.; Wang, Y.; Li, X.; Ren, L.; Zhao, J.; Hu, Y.; Zhang, L.; Fan, G.; Xu, J.; Gu, X.; et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020, 395, 497–506. [Google Scholar] [CrossRef][Green Version]
- Phan, L.T.; Nguyen, T.V.; Luong, Q.C.; Nguyen, T.V.; Nguyen, H.T.; Le, H.Q.; Nguyen, T.T.; Cao, T.M.; Pham, Q.D. Importation and human-to-human transmission of a novel coronavirus in Vietnam. N. Engl. J. Med. 2020, 382, 872–874. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Rothe, C.; Schunk, M.; Sothmann, P.; Bretzel, G.; Froeschl, G.; Wallrauch, C.; Zimmer, T.; Thiel, V.; Janke, C.; Guggemos, W.; et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N. Engl. J. Med. 2020, 382, 970–971. [Google Scholar] [CrossRef][Green Version]
- Holshue, M.L.; DeBolt, C.; Lindquist, S.; Lofy, K.H.; Wiesman, J.; Bruce, H.; Spitters, C.; Ericson, K.; Wilkerson, S.; Tural, A.; et al. First case of 2019 novel coronavirus in the United States. N. Engl. J. Med. 2020, 382, 929–936. [Google Scholar] [CrossRef]
- Arashiro, T.; Furukawa, K.; Nakamura, A. COVID-19 in 2 Persons with Mild Upper Respiratory Tract Symptoms on a Cruise Ship, Japan. Emerg. Infect. Dis. 2020, 26, 1345–1348. [Google Scholar] [CrossRef]
- Park, W.B.; Kwon, N.-J.; Choi, S.-J.; Kang, C.K.; Choe, P.G.; Kim, J.Y.; Yun, J.; Lee, G.-W.; Seong, M.W.; Kim, N.J.; et al. Virus isolation from the first patient with SARS-CoV-2 in Korea. J. Korean Med. Sci. 2020, 35, e84. [Google Scholar] [CrossRef]
- Chen, N.; Zhou, M.; Dong, X.; Qu, J.; Gong, F.; Han, Y.; Qiu, Y.; Wang, J.; Liu, Y.; Wei, Y.; et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020, 395, 507–513. [Google Scholar] [CrossRef][Green Version]
- Ministerio de Sanidad, Gobierno de España. Información Científica-Técnica. Enfermedad por coronavirus, COVID-19. Available online: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/20200417_ITCoronavirus.pdf (accessed on 15 April 2020).
- World Health Organization (WHO). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Available online: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf (accessed on 20 April 2020).
- European Centers for Disease Prevention and Control (ECDC). Coronavirus Disease 2019 (COVID-19) Pandemic: Increased Transmission in the EU/EEA and the UK—Seventh Update. 25 March 2020. Available online: https://www.ecdc.europa.eu/sites/default/files/documents/RRA-seventh-update-Outbreak-of-coronavirus-disease-COVID-19.pdf (accessed on 20 April 2020).
- Hu, Y.; Sun, J.; Dai, Z.; Deng, H.; Li, X.; Huang, Q.; Wu, Y.; Sun, L.; Xu, Y. Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis. J. Clin. Virol. 2020, 127, 104371. [Google Scholar] [CrossRef]
- Lechien, J.R.; Chiesa-Estomba, C.M.; De Siati, D.R.; Horoi, M.; Le Bon, S.D.; Rodriguez, A.; Dequanter, D.; Blecic, S.; El Afia, F.; Distinguin, L.; et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): A multicenter European study. Eur. Arch. Otorhinolaryngol. 2020, 6, 1–11. [Google Scholar]
- Assiri, A.; Al-Tawfiq, J.A.; A Al-Rabeeah, A.; A Al-Rabiah, F.; Al-Hajjar, S.; Al-Barrak, A.; Flemban, H.; Al-Nassir, W.N.; Balkhy, H.H.; Al-Hakeem, R.F.; et al. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: A descriptive study. Lancet Infect. Dis. 2013, 13, 752–761. [Google Scholar] [CrossRef][Green Version]
- Zhang, H.; Li, H.-B.; Lyu, J.-R.; Lei, X.-M.; Li, W.; Wu, G.; Lyu, J.; Dai, Z.-M. Specific ACE2 expression in small intestinal enterocytes may cause gastrointestinal symptoms and injury after 2019-nCoV infection. Int. J. Infect. Dis. 2020, 96, 19–24. [Google Scholar] [CrossRef]
- Rothan, H.A.; Byrareddy, S. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J. Autoimmun. 2020, 109, 102433. [Google Scholar] [CrossRef] [PubMed]
- Bezerra, T.B.; Valim, M.D.; Bortolini, J.; Ribeiro, R.P.; Marcon, S.R.; Moura, M.E.B. Adherence to hand hygiene in critical sectors: Can we go on like this? J. Clin. Nurs. 2020, 29, 2691–2698. [Google Scholar] [CrossRef]
- Carr-Locke, D.L.; Soetikno, R.; Sharaiha, R.Z. Whatever happened to universal/standard precautions? Gastroinest. Endosc. 2020, 20, 34139-0. [Google Scholar]
- Wang, C.; Pan, R.; Wan, X.; Tan, Y.; Xu, L.; Ho, C.S.; Ho, R.C. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19). Epidemic among the general population in China. Int. J. Environ. Res. Public Heal. 2020, 17, 1729. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Petzold, M.B.; Plag, J.; Ströhle, A. Dealing with psychological distress by healthcare professionals during the COVID-19 pandemia. Nervenarzt. 2020, 91, 417–421. [Google Scholar] [CrossRef][Green Version]
- Wu, W.; Zhang, Y.; Wang, P.; Zhang, L.; Wang, G.; Lei, G.; Xiao, Q.; Cao, X.; Bian, Y.; Xie, S.; et al. Psychological stress of medical staffs during outbreak of COVID-19 and adjustment strategy. J. Med. Virol. 2020. [Google Scholar] [CrossRef]
- Jin, Y.H.; Cai, L.; Cheng, Z.S.; Cheng, H.; Deng, T.; Fan, Y.P.; Fang, C.; Huang, D.; Huang, L.Q.; Huang, Q.; et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil. Med. Res. 2020, 7, 4. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Wölfel, R.; Corman, V.M.; Guggemos, W.; Seilmaier, M.; Zange, S.; Müller, M.A.; Niemeyer, D.; Jones, T.C.; Vollmar, P.; Rothe, C.; et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020, 581, 465–469. [Google Scholar] [CrossRef] [PubMed][Green Version]
- Centers for Disease Prevention and Control (ECDC). Coronavirus disease 2019 (COVID-19). Symptom-Based Strategy to Discontinue Isolation for Persons with COVID-19. Available online: https://https://www.cdc.gov/coronavirus/2019-ncov/community/strategy-discontinue-isolation.html (accessed on 19 May 2020).
- Xiao, A.T.; Tong, Y.X.; Zhang, S. Profile of RT-PCR for SARS-CoV-2: A preliminary study from 56 COVID-19 patients. Clin. Infect. Dis. 2020, ciaa460. [Google Scholar] [CrossRef] [PubMed]
Variable | Total | Males | Females | <55 Years | ≥55 Years | Hospitalized |
---|---|---|---|---|---|---|
n (%) | n (%) | n (%) | n (%) | n (%) | n (%) 1 | |
Total | 76 (100) | 23 (30.3) | 53 (69.7) | 53 (69.7) | 23 (30.3) | 11 (14.5) |
Professional group | ||||||
Medical | 24 (31.6) | 13 (56.5) | 11 (20.7) | 20 (37.7) | 4 (17.4) | 5 (20.8) |
Nursing | 39 (51.3) | 6 (26.1) | 33 (62.3) | 25 (47.2) | 14 (60.9) | 4 (10.3) |
Others | 13 (17.1) | 4 (17.4) | 9 (17.0) | 8 (15.1) | 5 (21.7) | 2 (50.0) |
Professional category | ||||||
Physicians | 15 (19.7) | 7 (30.4) | 8 (15.1) | 11 (20.8) | 4 (17.4) | 4 (26.7) |
Doctors in training | 8 (10.5) | 5 (21.7) | 3 (5.7) | 8 (15.1) | 0 (0.0) | 1 (12.5) |
Nurses | 25 (32.9) | 6 (26.1) | 19 (35.9) | 17 (32.1) | 8 (34.8) | 2 (8.0) |
Nursing assistants | 15 (19.7) | 1 (4.4) | 14 (26.4) | 9 (16.9) | 6 (26.1) | 2 (13.3) |
Others | 13 (17.1) | 4 (17.4) | 9 (17.0) | 8 (15.1) | 5 (21.7) | 2 (15.4) |
Hospital service | ||||||
Clinical specialties | 16 (21.1) | 3 (13.0) | 13 (24.5) | 7 (13.2) | 9 (39.1) | 2 (12.5) |
Surgical specialties | 23 (30.3) | 10 (43.5) | 13 (24.5) | 19 (35.9) | 4 (17.4) | 3 (13.0) |
Intensive care units | 8 (10.5) | 3 (13.0) | 5 (9.4) | 5 (9.4) | 3 (13.0) | 2 (25.0) |
Emergencies | 7 (9.2) | 1 (4.4) | 6 (11.3) | 5 (9.4) | 2 (8.7) | 1 (14.3) |
COVID hospitalization wards | 9 (11.8) | 1 (4.4) | 8 (15.1) | 7 (13.2) | 2 (8.7) | 1 (11.1) |
Other services | 13 (17.1) | 5 (21.7) | 8 (15.1) | 10 (18.9) | 3 (13.0) | 2 (15.4) |
Perceived risk contact before infection | ||||||
Professional/Colleague at the hospital | 32 (42.1) | 10 (43.5) | 22 (41.5) | 25 (47.2) | 7 (30.4) | 4 (12.5) |
Patients | 20 (26.3) | 7 (30.4) | 13 (24.5) | 13 (24.5) | 7 (30.4) | 4 (20.0) |
Community contact | 12 (15.8) | 5 (21.7) | 7 (13.2) | 6 (11.3) | 6 (26.1) | 4 (33.3) |
Risk contact after infection | ||||||
Reported cases in their setting after infection | 39 (51.3) | 10 (43.5) | 29 (54.7) | 25 (47.2) | 14 (60.9) | 8 (20.5) |
Reported cohabiting cases in their setting after infection | 29 (38.2) | 8 (34.8) | 21 (39.6) | 19 (35.9) | 10 (43.5) | 8 (27.6) |
Previous diseases | ||||||
Diabetes mellitus | 5 (6.6) | 1 (4.4) | 4 (7.8) | 1 (1.9) | 4 (17.4) * | 1 (20.0) |
Hypertension | 8 (10.5) | 2 (8.7) | 6 (11.3) | 3 (5.7) | 5 (21.7) * | 2 (25.0) |
Chronic lung disease | 5 (6.6) | 1 (4.4) | 4 (7.6) | 3 (5.7) | 2 (8.7) | 1 (20.0) |
Allergic asthma | 8 (10.5) | 3 (13.0) | 5 (9.4) | 6 (11.3) | 2 (8.7) | 1 (12.5) |
None | 63 (82.9) | 21 (91.3) | 42 (79.2) | 47 (88.7) | 16 (69.6) | 7 (11.1) |
Symptoms | ||||||
Fever < 38 °C | 59 (77.6) | 21 (91.3) | 38 (71.7) | 41 (77.4) | 18 (78.3) | 9 (15.3) |
Fever > 38 °C | 34 (44.7) | 10 (43.5) | 24 (45.3) | 24 (45.3) | 10 (43.5) | 8 (23.5) |
Upper respiratory tract symptoms | 67 (88.2) | 20 (87.0) | 47 (88.7) | 47 (88.7) | 20 (87.0) | 10 (14.9) |
Cough | 47 (61.8) | 11 (47.8) | 36 (67.9) | 30 (56.6) | 17 (73.9) | 7 (14.9) |
Throat pain | 24 (31.6) | 4 (17.4) | 20 (37.7) | 17 (32.1) | 7 (30.4) | 1 (4.2) |
Sore throat | 34 (44.7) | 9 (39.1) | 25 (47.2) | 27 (50.9) | 7 (30.4) | 3 (8.8) |
Choking | 15 (19.7) | 0 (0.0) | 15 (28.3) * | 11 (20.8) | 4 (17.4) | 2 (13.3) |
Mucosal dryness | 43 (56.6) | 11 (47.8) | 32 (60.4) | 27 (50.9) | 16 (69.6) | 8 (18.6) |
Rhinorrhoea | 36 (47.4) | 8 (34.8) | 28 (52.8) | 25 (47.2) | 11 (47.8) | 5 (13.9) |
Otalgia | 3 (4.0) | 1 (4.4) | 2 (3.8) | 3 (5.7) | 0 (0.0) | 0 (0.0) |
Headache | 48 (63.2) | 11 (47.8) | 37 (69.8) | 33 (62.3) | 15 (65.2) | 8 (16.7) |
Periocular pain | 25 (32.9) | 6 (26.1) | 19 (35.9) | 16 (30.2) | 9 (39.1) | 4 (16.0) |
Ageusia | 51 (67.1) | 16 (69.6) | 35 (66.0) | 34 (64.2) | 17 (73.9) | 7 (13.7) |
Anosmia | 55 (72.4) | 17 (73.9) | 38 (71.7) | 38 (71.7) | 17 (73.9) | 8 (14.5) |
Gastrointestinal symptoms | 45 (59.2) | 9 (39.1) * | 36 (67.9) * | 27 (50.9) | 18 (78.3) * | 9 (20.0) |
Nausea | 17 (22.4) | 0 (0.0) | 17 (32.1) * | 10 (18.9) | 7 (30.4) | 4 (23.5) |
Vomiting | 7 (9.2) | 0 (0.0) | 7 (13.2) | 4 (7.6) | 3 (13.0) | 2 (28.6) |
Diarrhoea | 31 (40.8) | 5 (21.7) | 26 (49.1) * | 21 (39.6) | 10 (43.5) | 6 (19.4) |
Abdominal pain | 21 (27.6) | 5 (21.7) | 16 (30.2) | 11 (20.8) | 10 (43.5) * | 3 (14.3) |
Loss of appetite | 12 (15.8) | 2 (8.7) | 10 (18.8) | 6 (11.3) | 6 (26.1) | 2 (16.6) |
Fatigue | 64 (84.2) | 21 (91.3) | 43 (81.1) | 43 (81.1) | 21 (91.3) | 10 (15.6) |
Arthromyalgia | 56 (73.7) | 17 (73.9) | 39 (73.6) | 39 (73.6) | 17 (73.9) | 8 (14.3) |
Generalized AM | 14 (18.4) | 7 (30.4) | 7 (13.2) | 10 (18.9) | 4 (17.4) | 1 (7.1) |
Upper limb myalgia | 11 (14.5) | 3 (13.0) | 8 (15.1) | 7 (13.2) | 4 (17.4) | 1 (9.1) |
Lower limb myalgia | 17 (22.4) | 2 (8.7) | 15 (28.3) | 12 (22.6) | 5 (21.7) | 2 (11.8) |
Back myalgia | 21 (27.6) | 7 (30.4) | 14 (26.4) | 17 (32.1) | 4 (17.4) | 4 (19.0) |
Dyspnoea | 30 (39.5) | 9 (39.1) | 21 (39.6) | 21 (39.6) | 9 (39.1) | 8 (26.7) |
Rib pain | 24 (31.6) | 4 (17.4) | 20 (37.7) | 13 (24.5) | 11 (47.9) * | 5 (20.8) |
Dermatological symptoms | 11 (14.5) | 4 (17.4) | 7 (13.2) | 7 (13.2) | 4 (17.4) | 1 (9.1) |
Variable | Total | Males | Females | p-Value |
---|---|---|---|---|
Previous preventive behaviours | ||||
Adequate hand hygiene (yes/no) (n, %) | 63 (82.9) | 18 (81.8) | 45 (84.9) | 0.740 |
Hand hygiene (self-score 1–10) (mean, sd) | 7.4 (2.3) | 7.0 (0.5) | 7.6 (0.3) | 0.354 |
Self-use of masks (n, %) | 16 (21.1) | 1 (4.55) | 15 (28.3) | 0.022 |
Use of masks for patients (n, %) | 12 (15.8) | 3 (14.3) | 9 (17.0) | 0.777 |
Main concerns | ||||
Spreading the disease in the environment (n, %) | 34 (44.7) | 11 (47.8) | 23 (43.4) | 0.721 |
Clinical deterioration or sequelae (n, %) | 27 (35.5) | 9 (39.1) | 18 (34.0) | 0.665 |
Psychological effects and loneliness of confinement (n, %) | 6 (7.9) | 1 (4.4) | 5 (9.4) | 0.450 |
Concerns about returning to work (n, %) | 3 (4.0) | 1 (4.4) | 2 (3.8) | 0.906 |
Time-to-Outcome Intervals | Total Sample | Stratified for Sex | Stratified for Age | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Males | Females | Age <55 Years | Age ≥55 Years | |||||||
n at Day 0 | Outcomes | Censored | Median (IQR) | Median (IQR) | Median (IQR) | p-Value 1 | Median (IQR) | Median (IQR) | p-Value 1 | |
Date of perceived risk contact to Start of symptoms 2 | 39 | 39 | 0 | 4 (3, 7) | 5 (3, 7) | 4 (2, 7) | 0.387 | 5 (3, 7) | 4 (2, 5) | 0.125 |
Start of symptoms to End of symptoms | 76 | 55 | 21 | 14 (10, -) | 13 (8, 17) | 17 (11, -) | 0.024 | 14 (10, 22) | 19 (11, -) | 0.129 |
Start of symptoms to First positive PCR 3 | 76 | 76 | 0 | 2 (1, 5) | 2 (1, 4) | 3 (1, 5) | 0.081 | 2 (1, 4) | 3 (1, 6) | 0.784 |
Start of symptoms to Negative PCR | 76 | 44 | 32 | 31 (21, -) | 21 (18, -) | 33 (25, -) | 0.025 | 28 (10, 39) | 33 (25, -) | 0.207 |
First positive PCR to Negative PCR | 76 | 44 | 32 | 25 (18, 37) | 19 (16, -) | 30 (22, 37) | 0.076 | 22 (17, 37) | 31 (23, -) | 0.119 |
End of symptoms to Negative PCR 4 | 53 | 33 | 20 | 15 (9, 25) | 10 (8, 16) | 17 (12, 24) | 0.322 | 13 (8, 24) | 18 (14, 26) | 0.522 |
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Rivera-Izquierdo, M.; Valero-Ubierna, M.d.C.; Martínez-Diz, S.; Fernández-García, M.Á.; Martín-Romero, D.T.; Maldonado-Rodríguez, F.; Sánchez-Pérez, M.R.; Martín-delosReyes, L.M.; Martínez-Ruiz, V.; Lardelli-Claret, P.; et al. Clinical Factors, Preventive Behaviours and Temporal Outcomes Associated with COVID-19 Infection in Health Professionals at a Spanish Hospital. Int. J. Environ. Res. Public Health 2020, 17, 4305. https://doi.org/10.3390/ijerph17124305
Rivera-Izquierdo M, Valero-Ubierna MdC, Martínez-Diz S, Fernández-García MÁ, Martín-Romero DT, Maldonado-Rodríguez F, Sánchez-Pérez MR, Martín-delosReyes LM, Martínez-Ruiz V, Lardelli-Claret P, et al. Clinical Factors, Preventive Behaviours and Temporal Outcomes Associated with COVID-19 Infection in Health Professionals at a Spanish Hospital. International Journal of Environmental Research and Public Health. 2020; 17(12):4305. https://doi.org/10.3390/ijerph17124305
Chicago/Turabian StyleRivera-Izquierdo, Mario, María del Carmen Valero-Ubierna, Silvia Martínez-Diz, Miguel Ángel Fernández-García, Divina Tatiana Martín-Romero, Francisco Maldonado-Rodríguez, María Rosa Sánchez-Pérez, Luis Miguel Martín-delosReyes, Virginia Martínez-Ruiz, Pablo Lardelli-Claret, and et al. 2020. "Clinical Factors, Preventive Behaviours and Temporal Outcomes Associated with COVID-19 Infection in Health Professionals at a Spanish Hospital" International Journal of Environmental Research and Public Health 17, no. 12: 4305. https://doi.org/10.3390/ijerph17124305