Impact of the COVID-19 Pandemic on Healthcare Workers' Risk of Infection and Outcomes in a Large, Integrated Health System

doi:10.1007/s11606-020-06171-9

. 2020 Nov;35(11):3293-3301.

doi: 10.1007/s11606-020-06171-9. Epub 2020 Sep 1.

Impact of the COVID-19 Pandemic on Healthcare Workers' Risk of Infection and Outcomes in a Large, Integrated Health System

Anita D Misra-Hebert^{1

2

3}, Lara Jehi^{4

5}, Xinge Ji⁶, Amy S Nowacki⁶, Steven Gordon⁷, Paul Terpeluk⁸, Mina K Chung⁹, Reena Mehra¹⁰, Katherine M Dell¹¹, Nathan Pennell¹², Aaron Hamilton¹³, Alex Milinovich⁶, Michael W Kattan⁶, James B Young^{14

9}

Affiliations

¹ Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA. misraa@ccf.org.
² Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA. misraa@ccf.org.
³ Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA. misraa@ccf.org.
⁴ Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
⁵ Information Technology Division Administration, Cleveland Clinic, Cleveland, OH, USA.
⁶ Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
⁷ Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA.
⁸ Department of Occupational Health, Cleveland Clinic, Cleveland, OH, USA.
⁹ Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
¹⁰ Sleep Disorders Center, Cleveland Clinic, Cleveland, OH, USA.
¹¹ Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
¹² Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
¹³ Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA.
¹⁴ Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA.

PMID: 32875500
PMCID: PMC7462108
DOI: 10.1007/s11606-020-06171-9

Impact of the COVID-19 Pandemic on Healthcare Workers' Risk of Infection and Outcomes in a Large, Integrated Health System

Anita D Misra-Hebert et al. J Gen Intern Med. 2020 Nov.

. 2020 Nov;35(11):3293-3301.

doi: 10.1007/s11606-020-06171-9. Epub 2020 Sep 1.

Authors

Affiliations

¹ Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA. misraa@ccf.org.
² Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA. misraa@ccf.org.
³ Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA. misraa@ccf.org.
⁴ Department of Neurology, Cleveland Clinic, Cleveland, OH, USA.
⁵ Information Technology Division Administration, Cleveland Clinic, Cleveland, OH, USA.
⁶ Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
⁷ Department of Infectious Disease, Cleveland Clinic, Cleveland, OH, USA.
⁸ Department of Occupational Health, Cleveland Clinic, Cleveland, OH, USA.
⁹ Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
¹⁰ Sleep Disorders Center, Cleveland Clinic, Cleveland, OH, USA.
¹¹ Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
¹² Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
¹³ Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA.
¹⁴ Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA.

PMID: 32875500
PMCID: PMC7462108
DOI: 10.1007/s11606-020-06171-9

Abstract

Background: Understanding the impact of the COVID-19 pandemic on healthcare workers (HCW) is crucial.

Objective: Utilizing a health system COVID-19 research registry, we assessed HCW risk for COVID-19 infection, hospitalization, and intensive care unit (ICU) admission.

Design: Retrospective cohort study with overlap propensity score weighting.

Participants: Individuals tested for SARS-CoV-2 infection in a large academic healthcare system (N = 72,909) from March 8-June 9, 2020, stratified by HCW and patient-facing status.

Main measures: SARS-CoV-2 test result, hospitalization, and ICU admission for COVID-19 infection.

Key results: Of 72,909 individuals tested, 9.0% (551) of 6145 HCW tested positive for SARS-CoV-2 compared to 6.5% (4353) of 66,764 non-HCW. The HCW were younger than the non-HCW (median age 39.7 vs. 57.5, p < 0.001) with more females (proportion of males 21.5 vs. 44.9%, p < 0.001), higher reporting of COVID-19 exposure (72 vs. 17%, p < 0.001), and fewer comorbidities. However, the overlap propensity score weighted proportions were 8.9 vs. 7.7 for HCW vs. non-HCW having a positive test with weighted odds ratio (OR) 1.17, 95% confidence interval (CI) 0.99-1.38. Among those testing positive, weighted proportions for hospitalization were 7.4 vs. 15.9 for HCW vs. non-HCW with OR of 0.42 (CI 0.26-0.66) and for ICU admission: 2.2 vs. 4.5 for HCW vs. non-HCW with OR of 0.48 (CI 0.20-1.04). Those HCW identified as patient facing compared to not had increased odds of a positive SARS-CoV-2 test (OR 1.60, CI 1.08-2.39, proportions 8.6 vs. 5.5), but no statistically significant increase in hospitalization (OR 0.88, CI 0.20-3.66, proportions 10.2 vs. 11.4) and ICU admission (OR 0.34, CI 0.01-3.97, proportions 1.8 vs. 5.2).

Conclusions: In a large healthcare system, HCW had similar odds for testing SARS-CoV-2 positive, but lower odds of hospitalization compared to non-HCW. Patient-facing HCW had higher odds of a positive test. These results are key to understanding HCW risk mitigation during the COVID-19 pandemic.

Keywords: SARS coronavirus; employee health; healthcare workers.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

**Figure 1**
a Odds of SARS-CoV-2 positive test; hospital admission if SARS-CoV-2 positive and intensive care admission if SARS-CoV-2 positive by healthcare worker (HCW) status. b Odds of SARS-CoV-2 positive test; hospital admission if SARS-CoV-2 positive and intensive care admission if SARS-CoV-2 positive by patient-facing and non-patient-facing healthcare worker status. OR = odds ratio, LCL = lower confidence limit, UCL = upper confidence limit.

**Figure 2**
**Proportion of SARS-CoV-2 positive results during the study period. CCHS = Cleveland Clinic Health System.**

See this image and copyright information in PMC

Update of

Impact of the COVID-19 pandemic on healthcare workers risk of infection and outcomes in a large, integrated health system.
Misra-Hebert AD, Jehi L, Ji X, Nowacki AS, Gordon S, Terpeluk P, Chung MK, Mehra R, Dell KM, Pennell N, Hamilton A, Milinovich A, Kattan MW, Young JB. Misra-Hebert AD, et al. Res Sq [Preprint]. 2020 Aug 19:rs.3.rs-61235. doi: 10.21203/rs.3.rs-61235/v1. Res Sq. 2020. Update in: J Gen Intern Med. 2020 Nov;35(11):3293-3301. doi: 10.1007/s11606-020-06171-9. PMID: 32839766 Free PMC article. Updated. Preprint.

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References

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[1] CDC. Coronavirus disease 2019 (COVID-19). Centers for Disease Control and Prevention. Published February 11, 2020. Accessed May 20, 2020. https://www.cdc.gov/coronavirus/2019-ncov/index.html

[2] CDC. Coronavirus disease 2019 (COVID-19). Centers for Disease Control and Prevention. Published February 11, 2020. Accessed May 20, 2020. https://www.cdc.gov/coronavirus/2019-ncov/index.html

[3] Wang X, Liu W, Zhao J, et al. Clinical characteristics of 80 hospitalized frontline medical workers infected with COVID-19 in Wuhan, China, J Hosp Infect. 2020; 10.1016/j.jhin.2020.04.019 - PMC - PubMed

[4] Wang X, Liu W, Zhao J, et al. Clinical characteristics of 80 hospitalized frontline medical workers infected with COVID-19 in Wuhan, China, J Hosp Infect. 2020; 10.1016/j.jhin.2020.04.019 - PMC - PubMed

[5] CDC COVID-19 Response Team Characteristics of health care personnel with COVID-19 - United States, February 12-April 9, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):477–481. doi: 10.15585/mmwr.mm6915e6. - DOI - PMC - PubMed

[6] CDC COVID-19 Response Team Characteristics of health care personnel with COVID-19 - United States, February 12-April 9, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(15):477–481. doi: 10.15585/mmwr.mm6915e6. - DOI - PMC - PubMed

[7] Tostmann A, Bradley J, Bousema T, et al. Strong associations and moderate predictive value of early symptoms for SARS-CoV-2 test positivity among healthcare workers, the Netherlands, March 2020. Euro Surveill. 2020;25(16). 10.2807/1560-7917.ES.2020.25.16.2000508 - PMC - PubMed

[8] Tostmann A, Bradley J, Bousema T, et al. Strong associations and moderate predictive value of early symptoms for SARS-CoV-2 test positivity among healthcare workers, the Netherlands, March 2020. Euro Surveill. 2020;25(16). 10.2807/1560-7917.ES.2020.25.16.2000508 - PMC - PubMed

[9] Li W, Zhang J, Xiao S, Sun L. Characteristics of deaths amongst health workers in China during the outbreak of COVID-19 infection. J Infect. 2020; 10.1016/j.jinf.2020.03.030 - PMC - PubMed

[10] Li W, Zhang J, Xiao S, Sun L. Characteristics of deaths amongst health workers in China during the outbreak of COVID-19 infection. J Infect. 2020; 10.1016/j.jinf.2020.03.030 - PMC - PubMed

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Impact of the COVID-19 Pandemic on Healthcare Workers' Risk of Infection and Outcomes in a Large, Integrated Health System

Affiliations

Impact of the COVID-19 Pandemic on Healthcare Workers' Risk of Infection and Outcomes in a Large, Integrated Health System

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Update of

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Cited by

References

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