key: cord-0784760-f3686dqw authors: Gómez-Ochoa, Sergio Alejandro; Franco, Oscar H; Rojas, Lyda Z; Raguindin, Peter Francis; Roa-Díaz, Zayne Milena; Wyssmann, Beatrice Minder; Guevara, Sandra Lucrecia Romero; Echeverría, Luis Eduardo; Glisic, Marija; Muka, Taulant title: COVID-19 in Healthcare Workers: A Living Systematic Review and Meta-analysis of Prevalence, Risk Factors, Clinical Characteristics, and Outcomes date: 2020-09-01 journal: Am J Epidemiol DOI: 10.1093/aje/kwaa191 sha: 789d9bb7d152e7cfd9aef6ecdcb4de0157613001 doc_id: 784760 cord_uid: f3686dqw Health care workers (HCW) are at the frontline response to the new coronavirus disease 2019 (COVID-19), being at a higher risk of acquiring the disease, and subsequently, exposing patients and colleagues. Searches in eight bibliographic databases were performed to systematically review the evidence on the prevalence, risk factors, clinical characteristics, and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among HCW. Ninety-seven studies (All published in 2020), including 230,398 HCW, met the inclusion criteria. From the screened HCW using RT-PCR and the presence of antibodies, the estimated prevalence of SARS-CoV-2 infection was 11% (95%CI; 7%-15%) and 7% (95% CI; 4%-11%), respectively. The most frequently affected personnel were the nurses (48%. 95%CI; 41%-56%), while most of the COVID-19 positive medical personnel were working in hospitalization/non-emergency wards during the screening (43%, 95%CI;28%-59%). Anosmia, fever and myalgia were identified as the only symptoms associated with HCW SARS-CoV-2 positivity. Among RT-PCR positive HCW, 40% (95%CI;17%-65%) did not show symptoms at the time of diagnosis. Finally, 5% (95%CI;3%-8%) of the COVID-19 positive HCW developed severe clinical complications, and 0.5% (95% CI; 0.02%-1.3%) died. HCW suffer a significant burden from COVID-19, with HCW working in hospitalization/non-emergency wards and nurses being the most infected personnel. . Several studies have shown that asymptomatic carriers contribute substantially to the spread of the virus, even by merely breathing in a room (3) (4) (5) . Among asymptomatic carriers and individuals at risk due to asymptomatic coronavirus transmission, health care workers (HCW) represent an important but yet understudied population(6). HCW may experience an increased risk of SARS-CoV-2 infection due to their close contact with highly infectious patients, but also due to exposure to undiagnosed or subclinical infectious cases. This could be even more problematic, considering the poor access to personal protective equipment (PPE) worldwide(7). A recent report of the Centers for Disease Control and Prevention (CDC) shows that, as of April 9th, 2020, 9, 282 Currently, there is no clarity regarding the prevalence of SARS-CoV-2 infection among HCW according to specific clinical settings, limiting the possibility of designing effective preventive measures to limit the transmission of the virus within a hospital, and from hospitals to the community(9,10). Furthermore, it is unknown whether the clinical characteristics and outcomes of HCW may be different from those of the general population, considering that the repeated exposure to the virus may lead to higher SARS-CoV-2 viral load and therefore to worse clinical outcomes(11,12). Therefore, characterizing SARS-CoV-2 infection within health-care workers is critical for achieving optimal control of the pandemic. The present systematic review and meta-analysis aimed to identify, analyze, and quantify the prevalence, risk factors, clinical characteristics, and outcomes of COVID-19 among HCW. This systematic review and meta-analysis was conducted following a recently published guideline on how to perform a systematic review and reported following the PRISMA guidelines (Web Table 1 ) (13, 14) . clinical course, severity of illness, outcomes, among others. We limited our search to human studies, with no language restriction. The complete search strategy is described in the Web Appendix 1. All observational studies (e.g., cross-sectional, cohort, case-control studies, and caseseries), except for case reports, were included. We included studies that reported the prevalence of COVID-19 in HCW by using either RT-PCR or a serum antibodies assay. We also included studies evaluating the risk factors for SARS-CoV-2 infection and those analyzing the clinical characteristics and outcomes of laboratory-confirmed COVID-19 among HCW. We excluded those articles that evaluated HCW with suspected but not laboratory-confirmed SARS-CoV-2 infection. Two independent reviewers screened the titles and abstracts according to the selection criteria. Based on the extracted data of each study (performed by two independent investigators), we The initial search yielded 4,107 studies, from which ninety-seven studies met the inclusion criteria ( Figure 1) I P T studies evaluated risk factors for COVID-19 positivity among HCW(24,34,44,48,57,63,65,67,70,89,93,108,109) . Forty-six studies evaluated the prevalence of SARS-CoV-2 infection among HCW using Figure 2 and Table 2 ). Table 2 ). Twenty-eight studies evaluated the prevalence of antibodies against SARS-COV-2 in HCW using serum antibody tests. The data regarding the sensitivity and specificity of the antibody detection kits used in each study are available in Web Fifteen studies analyzed the factors potentially associated with SARS-CoV-2 infection in HCW. From these, four studies provided sufficient data from infected and non-infected HCW to perform a meta-analysis for anosmia and five for fever, finding a significantly were consistent with multiple introductions into the hospitals through community-acquired infections and local amplification of the viral disease in the community context (93) . Interestingly, two studies evaluated the benefit of pharmacological prophylaxis with hydroxychloroquine (HCQ) to prevent SARS-CoV-2 infection among high-risk HCW, with both studies showing that the history of having taken maintenance doses of HCQ was associated with a significantly lower risk of COVID-19 (70, 108) . The majority of studies were of moderate (n=61 [62.9%]) quality, with 29.9% (n=29) being high quality, while of the rest of low quality (n=7, 7.2%). Web Tables 5, 6, and 7 present a summary of the studies' quality evaluation. The current evidence shows that around a tenth of the total HCW in the screened hospitals Washington. In this study, screening only for fever, cough, shortness of breath, or sore throat might have missed 17% of symptomatic HCW at the time of illness onset. The authors also mention that expanding criteria for symptoms screening to include chills and myalgia may still have missed 10% (21) . According to the results of the present systematic review and meta-analysis, malaise (48%) and headache (36%) represent additional common symptoms with a high prevalence among positive HCW (Table 3) . Therefore, the inclusion of these symptoms in the screening criteria for testing may improve the identification of None to declare The Coronavirus App COVID-19 has killed more people than SARS and MERS combined, despite lower case fatality rate COVID-19 transmission through asymptomatic carriers is a challenge to containment. 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