key: cord-0731402-4a55qoi5
authors: Jary, A.; Flandre, P.; Chabouis, A.; Nguyen, S.; Marot, S.; Burrel, S.; Boutolleau, D.; Calvez, V.; Marcelin, A-G.; Louet, M.
title: Clinical presentation of Covid-19 in health care workers from a French University Hospital
date: 2020-06-21
journal: J Infect
DOI: 10.1016/j.jinf.2020.06.048
sha: 18be1a3e3cdcc4631272fb8cee52de68461cc1de
doc_id: 731402
cord_uid: 4a55qoi5

nan

A. Jary 1 , P. Flandre 2 , A. Chabouis 3 A recent study in this journal reported the environmental contamination of severe acute respiratory syndrome 2 (SARS-CoV-2) in healthcare premises 1 . Indeed, the health care workers (HCW) are highly exposed to SARS-CoV-2 infection and several recommendations have been made to protect them [2] [3] [4] . Here, we aimed to describe characteristics of HCW infected with SARS-CoV-2 and the spectrum of initial symptoms in order to identity new cases as early as possible.

This longitudinal study included all HCW managed by the occupational health department of the Pitié-Salpêtrière University Hospital, Paris, France, for suspected infection with SARS-CoV-2 from March 13 th to April 3 rd , 2020. Included participants were symptomatic and tested positive for SARS-CoV-2 RNA by RT-PCR in nasopharyngeal specimens. The following characteristics were recorded by physicians of the occupational health department: age, profession described as medical HCW (physicians and pharmacists), non-medical HCW (nurses, assistant-nurses, psychologist, physiotherapist, laboratory technician) and others (personal from administrative, maintenance and restoration services), department of work described as clinical (including medicine, surgical and intensive care unit [1] [2] [3] [4] days between the onset of symptoms and consultation ( Table 1 ). The most common initial symptoms were cough (n=189, 68%), myalgia (n=184, 66%) and fever (n=151, 54%) and overall, 90% (n= 251) reported at least one of the aforementioned symptoms. Headache, anosmia/dysgeusia and digestive disorders were found in 39%, 33% and 12% of cases, respectively ( Figure 1A ). Twenty (7%) patients reported dyspnea, of which a majority of women (n=19). None had a severe form of coronavirus disease 2019 (Covid-19).

The mean number of symptoms was higher in women (3.6 versus 3.0, p=0.003) and they tended to consult occupational medicine later than men (3.2 versus 2.6, p=0.09). No differences in term of symptoms number or delay to consultation were found between age categories or HCW department (Supplementary Table 1 and Table 1 ). By regression logistic analysis, only gender was associated with the number of symptoms and women had a higher risk of having 3 or more symptoms compared to men (OR= 1.86 [1.03-3.3]; p=0.04).

By increasing age categories order, 88%, 90%, 89% and 93% of the participants reported at least one of the following symptoms: cough, myalgia or fever, as well as 90% of men and 90% of women. These symptoms were the most prevalent excepted for the "20-29 years" category, in which 49% reported headache, before fever ( Figure 1B ). According to the department, cough, myalgia, and fever were also the most prevalent symptoms and 92% and 84% of cases reported at least one of these symptoms in clinical and non-clinical department, respectively (Supplementary Table 2 We reported for the first time the characteristics of HCW working in a French University Hospital with laboratory-confirmed SARS-CoV-2 infection. Although only symptomatic participants were tested, the majority of infected HCW were working in clinical department. This may be expected as they are more exposed to the risk of SARS-CoV-2 transmission by direct contact with patients experiencing Covid-19 but also by applying respiratory devices or collecting respiratory samples 2,4 . Indeed, although results of Ye and al are limited to SARS-CoV-2 RNA detection, they reported higher level of SARS-CoV-2 contamination in Covid-19 departments. They also reported that the most contaminated zones were in ICU taking care of Covid-19 patients whereas we evidenced that HCW from medicine were the most infected followed by surgical and ICU units. Different explanations can be put forward for these discrepancies. In the present study, we have not distinguished Covid-19 from Covid-19 free departments and medicine units are the largest units in our hospital. As reported by Ye and al, the prevalence of contaminated objects as desktop/keyboard and doorknob is about 15% in hospital, thus contaminated hand and surfaces by HCW, patients and visitors could potentially lead to SARS-CoV-2 exposure even in Covid-19 free departments; the transition to a focused care of Covid-19 patients was quick and thus HCW from department not designated as Covid-19 specifics unit may receive less infection prevention training. Overall, as the global delay during the onset of symptoms and consultation was 2 days, it is essential to reinforce barrier gestures, such as masks, especially since the majority of infected HCW are in direct contact with patients but also because transmission has been described a few days before the onset of symptoms or from asymptomatic cases [5] [6] [7] .

Many studies reported fever and cough as the most prevalent initial symptoms in mild form of Covid-19 8, 9 . With myalgia, having one of these 3 symptoms would identify at least 90% of Covid-19 cases, regardless of gender or age. About a third of cases also reported anosmiadysgeusia and surprisingly, this symptom was associated with an increased delay to consultation. However, anosmia-dysgeusia was firstly reported in the media and in the literature at the end of March, 2020 10 and given our study period, participants probably did not identify immediately such symptom to be related to Covid-19.

In conclusion, the quick identification of Covid-19 HCW should be improve in both Covid-19 and Covid-19 free departments, to prevent the in-hospital transmission of SARS-CoV-2; the presence of a cough, fever, myalgia, as well as anosmia-dysgeusia, should lead to systematic screening for SARS-CoV-2 infection and isolation of suspected HCW until a definite diagnosis is made. Each symptom is presented in the x-axis and the prevalence of each one according to age category on the left y-axis (percentage).

Others included dyspnea (n=20), chest pain (n=4), conjunctivitis (n=2), and neck pain (n=1)

One patient presented both dyspnea and chest pain.

Environmental contamination of SARS-CoV-2 in healthcare premises

World Health Organization. Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19) Interim guidance

orld ealth rgani ation linical management of severe acute respiratory infection S I when COVID-19 disease is suspected: interim guidance

European Centre for Disease Prevention and Control. Personal protective equipment (PPE) needs in healthcare settings for the care of patients with suspected or confirmed 2019-nCoV

Presumed Asymptomatic Carrier Transmission of COVID-19

Potential Presymptomatic Transmission of SARS-CoV-2

Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany

Clinical Characteristics of Coronavirus Disease 2019 in China

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

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