key: cord-0821003-e0da74hu
authors: Diez-Manglano, J.; Solis Marquinez, N.; Alvarez Garcia, A.; Alcala Rivera, N.; Maderuelo Riesco, I.; Gerico Aseguinolaza, M.; Beato Perez, J. L.; Mendez Bailon, M.; Laburua-Iturburu Ruiz, A. E.; Garcia Gomez, M.; Martinez Cilleros, C.; Pesqueira Fontan, P. M.; Abella Vazquez, L.; Blazquez Encinar, J. C.; Boixeda, R.; Gil Sanchez, R.; de la Pena Fernandez, A.; Loureiro Amigo, J.; Escobar Sevilla, J.; Guzman Garcia, M.; Martin Escalante, M. D.; Magallanes Gamboa, J. O.; Martinez Gonzalez, A. L.; Lumbreras Bermejo, C.; Anton Santos, J. M.
title: Healthcare workers hospitalized due to COVID-19 have no higher risk of death than general population. Data from the Spanish SEMI-COVID-19 Registry.
date: 2020-11-24
journal: nan
DOI: 10.1101/2020.11.23.20236810
sha: 1c1bf6171dc2f597ac39c2ba70a75e8461e9b086
doc_id: 821003
cord_uid: e0da74hu

Aim: To determine whether healthcare workers (HCW) hospitalized in Spain due to COVID-19 have a worse prognosis than non-healthcare workers (NHCW). Methods: Observational cohort study based on the SEMI-COVID-19 Registry, a nationwide registry that collects sociodemographic, clinical, laboratory, and treatment data on patients hospitalised with COVID-19 in Spain. Patients aged 20-65 years were selected. A multivariate logistic regression model was performed to identify factors associated with mortality. Results: As of 22 May 2020, 4393 patients were included, of whom 419 (9.5%) were HCW. Median (interquartile range) age of HCW was 52 (15) years and 62.4% were women. Prevalence of comorbidities and severe radiological findings upon admission were less frequent in HCW. There were no difference in need of respiratory support and admission to intensive care unit, but occurrence of sepsis and in-hospital mortality was lower in HCW (1.7% vs. 3.9%; p=0.024 and 0.7% vs. 4.8%; p<0.001 respectively). Age, male sex and comorbidity, were independently associated with higher in-hospital mortality and healthcare working with lower mortality (OR 0.219, 95%CI 0.069-0.693, p=0.01). 30-days survival was higher in HCW (0.968 vs. 0.851 p<0.001). Conclusions: Hospitalized COVID-19 HCW had fewer comorbidities and a better prognosis than NHCW. Our results suggest that professional exposure to COVID-19 in HCW does not carry more clinical severity nor mortality.

admissions to hospital (7). In Spain and USA, 10% and 8% of HCW with 141 COVID-19 were hospitalized respectively (6,8). Young women nurses were 142 more frequently infected (9-11). Comorbidities were frequent in HCW 143 hospitalized with COVID-19, particularly diabetes, hypertension, obesity, 144 asthma and immunodepression (6, 10, 11) . 145 146 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 24, 2020. ; https://doi.org/10.1101/2020.11.23.20236810 doi: medRxiv preprint There is still controversy over the risk of death in HCW with While it is high in Mexico, it is low in Germany and Malaysia (12, 13) . The main 148 objectives of this study were to describe the clinical characteristics and 149 outcomes of HCW hospitalised in Spain due to SARS-CoV-2 infection, and to 150 determine if working in healthcare is associated with higher rates of 151 complications and mortality. 152 153 METHODS 154

The SEMI-COVID-19 Registry is an ongoing, nationwide, multicentre, 156 observational retrospective registry, participated by 150 hospital centres 157 throughout Spain. Detailed features of the registry have been reported 158 elsewhere (14-16). A total of 10,600 consecutive patients were recruited from 159

March 1, 2020 to May 22, 2020. 160 161

The SEMI-COVID-19 Registry includes patients > 18 years admitted to 163 hospital with COVID-19 confirmed microbiologically by reverse transcription 164 polymerase chain reaction (RT-PCR) testing of a nasopharyngeal swab sample, 165 sputum specimen or bronchoalveolar lavage. The exclusion criteria were 166 subsequent admission of the same patient or denial or withdrawal of informed 167 consent. This study analyses the subpopulation of patients between 20 and 65 168 years of age. In Spain, 20 years is the youngest possible age for working in 169 healthcare and 65 years is the retirement age. HCW were defined as 170 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 24, 2020. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 24, 2020. ; https://doi.org/10.1101/2020.11.23.20236810 doi: medRxiv preprint

The study was carried out in accordance with the Declaration of Helsinki. 

The patients were divided into two groups: HCW and non HCW (NHCW) . Table 1 . HCW were more often Caucasian women, and reported more 238 frequent contact with a COVID-19 patient (57.8% vs. 22.1%, p<0.001). 239

Moderate and severe dependence was more frequent in NHCW. There was no 240 difference in comorbidity measured as Charlson index score, but the prevalence 241 of comorbidities as alcohol use disorder, hypertension, dyslipidemia, obesity, 242 diabetes, myocardial infarction, stroke, dementia, chronic obstructive pulmonary 243 disease, obstructive sleep apnea-hypopnea syndrome, chronic kidney disease 244 and malignancy was higher in NHCW. 245 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 24, 2020. The factors associated with in-hospital mortality are shown in Table 3 . In 282 the first multivariate analysis model, age, male sex and Charlson Comorbidity 283 index score were associated with higher in-hospital mortality and healthcare 284 working with lower mortality (OR 0.219, 95%CI 0.069-0.693, p=0.01). In the 285 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted November 24, 2020. ; https://doi.org/10.1101/2020.11.23.20236810 doi: medRxiv preprint second model, including comorbidities, healthcare working was also associated 286 with a lower in-hospital mortality (OR 0.285 95%CI 0.089-0.908; p=0.034). 287 288 The main findings of our study were that hospitalised HCW had less 292 severe COVID-19 and lower mortality. 293 294 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted November 24, 2020. ; https://doi.org/10.1101/2020.11.23.20236810 doi: medRxiv preprint The demographic characteristics of our patients were consistent with 295 other reports (14,18,19) . Worldwide, men were more likely to be infected by 296 SARS-CoV-2 than women. However, among HCW, women were the most 297 affected (8,9,13,20) . We think that this difference is due to the higher proportion 298 of females in healthcare professions. When we compared our HCW cohort with 299 those reported in other studies, our patients were more than ten years older (8- An interesting finding in our study was that upon admission HCW 309 presented milder symptoms, such as loss of smell or taste and arthralgia, less 310 severe radiological findings and lower lactate dehydrogenase, C-reactive 311 protein, serum ferritin and D-dimer levels. And all of it even though there was no 312 difference between HCW and NHCW in time from onset of symptoms and 313 admission. There was not an explanation for this, but we hypothesize that it 314 could be due to HCW were hospitalised earlier and more easily than NHCW. 315 316 ARDS is overwhelmingly the main cause of death in hospitalised COVID-317 19 patients. In our study, sepsis was less frequent in HCW but there was no 318 difference in ARDS, the rest of complications, the need of respiratory support 319 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 24, 2020. ; https://doi.org/10.1101/2020.11.23.20236810 doi: medRxiv preprint nor the ICU admission. In-hospital and 30-days mortality were lower in HCW. In 320 a systematic review Similar results were reported in the systematic review by 321 There are geographical differences in mortality observed in hospitalised 332 COVID-19 HCW. In a teaching hospital in Belgium the mortality of HCW was 333 0.5% (20). In a single-centre study in Wuhan, in-hospital death in HCW with 334 confirmed SARS-CoV-2 infection was 1.7%, more than twice in our study (11) . 335

The mortality in a multicentre study in New York City was 21%, far higher than 336 that we observed (19). Also, high mortality, 14.7%, was reported in Brazil (10). 337

In Mexico, a mortality of 2% of HCW with COVID-19 was reported (21). Their 338 mortality was higher than ours even though only 9% of them needed to be 339 hospitalized. The authors explain their high mortality because of different 340 reasons. On the one hand, in Mexico there is a high prevalence of comorbidities 341 which are associated with severe COVID-19. On the other hand, due to 342 structural inequalities, their healthcare system is highly heterogeneous and 343 there is a remarkable amount of marginalized communities. Therefore, the 344 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Acknowledgments. List of the SEMI-COVID-19 Network members 370 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

The copyright holder for this this version posted November 24, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) preprint

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