key: cord-0760935-12sic0dp
authors: Chas, Julie; Nadal, Marine; Siguier, Martin; Fajac, Anne; Denis, Michel; Morand-Joubert, Laurence; Pialoux, Gilles
title: Broad-based SARS-CoV-2 Testing Program for Healthcare Workers in a Primary Care Hospital In France
date: 2021-05-14
journal: Infect Dis Now
DOI: 10.1016/j.idnow.2020.11.016
sha: ecc39248fdaaa94beb29c8bdc0c3c69369c0328a
doc_id: 760935
cord_uid: 12sic0dp

A broad-based SARS-CoV-2 testing program for all symptomatic healthcare workers (HCWs) was implemented in Tenon hospital, Paris, France. From February 26 to April 22, 2020, 701 symptomatic HCWs were screened, of whom 247 (35.2%) tested positive for SARS-Cov-2. Myalgia, fever, anosmia and ageusia were associated with RT-PCR positivity. Testing of HCWs is an essential step toward control of the epidemic. Further studies could establish clinical algorithms for SARS-CoV-2 diagnosis to compensate for RT-PCR test and chest CT limits or unavailability.

Hospital, AP-HP, and Sorbonne Université Paris, France (gilles.pialoux@aphp.fr) HIGHLIGHTS  The curve representing the number of healthcare workers (HCWs) testing positive for SARS-CoV-2 on a day-to-day basis was congruent with the curve corresponding to patients in the hospital. It began to decline about ten days after masks began to be worn continuously by HCWs and the French lockdown was put in place, whereas the total number of patients hospitalized for SARS-CoV-2 in all French hospitals continued to rapidly increase before leveling off.

 As a means of overcoming RT-PCR test and chest CT limits, decision algorithms based solely on clinical criteria for SARS-CoV-2 infection (such as those applied in our study) may be useful for public health purposes, particularly with regard to a population of highly exposed paucisymptomatic HCWs, and possibly in emerging countries. They could compensate for low RT-PCR or TC sensitivity and/or its lack of availability in certain regions or countries.

The first three European cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were reported in France on January 24, 2020 and the first death on The curve of the number of HCWs tested positive daily for SARS-CoV-2 is congruent with the curve corresponding to patients in the hospital (Figure) . It began to decline about ten days after masks began to be worn continuously by HCWs and the French lockdown was put in place, whereas the total number of patients hospitalized for SARS-CoV-2 in all French hospitals continued to rapidly increase before leveling off.

Contrary to what was described at the outset of the epidemic 7,8 , the symptoms significantly associated with positive SARS-CoV-2 infection are generally non-respiratory. It also bears mentioning that in our study, the incidence rate among HCWs was probably underestimated because at first, only HCWs with fever and respiratory signs were encouraged to come for testing; only later was the clinical picture widened to include other possible signs of SARS-CoV-2 infection. Even though the numbers are small, our study highlights an increasing risk among maintenance workers (OR 3.8 [1.3-11,2 95% CI; p:0.014). The cleaning staff included in the "maintenance workers" group are not part of the hospital staff insofar they are often employed by a private company. While some of them were included in our study when they showed symptoms, the results are not exhaustive of this group. As proof, we have included them more widely in our current serological study (data not shown); out of the first 50 serologies performed in the cleaning agents, 23/50 were negative and 27/50 (54%) were positive, 9 of whom were included in the present RT-PCR study, i.e. 7/10 PCR positive and 2/5 negative, which effectively illustrates the limits of RT-PCR.

More generally, our findings data highlight a group of in-hospital workers who may have been widely contaminated in the social conditions of living and transport during a lockdown period. This is particularly the case at the hospital for cleaning staff, firemen, security guards, kitchen staff... This highly diversified population requires special attention in terms of screening, information and isolation of positive persons in the event of a second wave.. As a b Cardiovascular history (complicated hypertension, stroke, coronary artery disease, heart surgery, heart failure stage NYHA III or IV), insulin-dependent diabetes that is unbalanced or with complications, chronic respiratory pathology that may decompensate in viral infection, chronic kidney disease dialysis, treated cancer, congenital or acquired immunosuppression (drug: cancer chemotherapy, immunosuppressive chemotherapy, biotherapy and/or immunosuppressive dose corticosteroid therapy; uncontrolled HIV infection or with CD4 <200/mm3; following a solid organ or hematopoietic stem cell transplant; related to a malignant hemopathy being treated), cirrhosis at least stage B of the Child-Pugh classification, morbid obesity (body mass index > 40 kg/m2), splenectomy, women in the 2nd and 3rd trimester of pregnancy, caregivers aged 70 and over. c 46 missing answers (201/247).

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