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. 2020 May;151(5):459-467.
doi: 10.4103/ijmr.IJMR_2234_20.

Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19

Pranab Chatterjee  1 , Tanu Anand  2 , Kh Jitenkumar Singh  3 , Reeta Rasaily  4 , Ravinder Singh  5 , Santasabuj Das  6 , Harpreet Singh  7 , Ira Praharaj  8 , Raman R Gangakhedkar  8 , Balram Bhargava  9 , Samiran Panda  10
Affiliations

Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19

Pranab Chatterjee et al. Indian J Med Res. 2020 May.

Abstract

Background & objectives: Healthcare workers (HCWs) are at an elevated risk of contracting COVID-19. While intense occupational exposure associated with aerosol-generating procedures underlines the necessity of using personal protective equipment (PPE) by HCWs, high-transmission efficiency of the causative agent [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] could also lead to infections beyond such settings. Hydroxychloroquine (HCQ), a repurposed antimalarial drug, was empirically recommended as prophylaxis by the National COVID-19 Task Force in India to cover such added risk. Against this background, the current investigation was carried out to identify the factors associated with SARS-CoV-2 infection among HCWs in the country.

Methods: A case-control design was adopted and participants were randomly drawn from the countrywide COVID-19 testing data portal maintained by the ICMR. The test results and contact details of HCWs, diagnosed as positive (cases) or negative (controls) for SARS-CoV-2 using real-time reverse transcription-polymerase chain reaction (qRT-PCR), were available from this database. A 20-item brief-questionnaire elicited information on place of work, procedures conducted and use of PPE.

Results: Compared to controls, cases were slightly older (34.7 vs. 33.5 yr) and had more males (58 vs. 50%). In multivariate analyses, HCWs performing endotracheal intubation had higher odds of being SARS-CoV-2 infected [adjusted odds ratio (AOR): 4.33, 95% confidence interval (CI): 1.16-16.07]. Consumption of four or more maintenance doses of HCQ was associated with a significant decline in the odds of getting infected (AOR: 0.44; 95% CI: 0.22-0.88); a dose-response relationship existed between frequency of exposure to HCQ and such reductions (χ[2] for trend=48.88; P <0.001). In addition, the use of PPE was independently associated with the reduction in odds of getting infected with SARS-CoV-2.

Interpretations & conclusions: Until results of clinical trials for HCQ prophylaxis become available, this study provides actionable information for policymakers to protect HCWs at the forefront of COVID-19 response. The public health message of sustained intake of HCQ prophylaxis as well as appropriate PPE use need to be considered in conjunction with risk homoeostasis operating at individual levels.

Keywords: Dose-response relationship - healthcare workers - hydroxychloroquine prophylaxis - personal risk management - rapid evidence generation - SARS-CoV-2.

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Conflict of interest statement

None

Figures

Figure
Figure
Dose-response relationship between hydroxychloroquine (HCQ) exposure and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
See this image and copyright information in PMC

Comment in

  • Hydroxychloroquine prophylaxis for SARS-CoV-2 infection among healthcare workers.
    R Karim HM, Ahmed G. R Karim HM, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):119-120. doi: 10.4103/ijmr.IJMR_2372_20. Indian J Med Res. 2020. PMID: 32773410 Free PMC article. No abstract available.
  • Authors' response.
    Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Chatterjee P, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):120. doi: 10.4103/0971-5916.290073. Indian J Med Res. 2020. PMID: 32773411 Free PMC article. No abstract available.
  • False reassurance or inadequate drug levels?
    Tirlangi P, Khan AR, Desai D, Soneja M. Tirlangi P, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):121-123. doi: 10.4103/ijmr.IJMR_2485_20. Indian J Med Res. 2020. PMID: 32773412 Free PMC article. No abstract available.
  • Authors' response.
    Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Chatterjee P, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):122-123. doi: 10.4103/0971-5916.290075. Indian J Med Res. 2020. PMID: 32773413 Free PMC article. No abstract available.
  • Hydroxychloroquine for chemoprophylaxis in COVID-19: A case of motivated perception?
    Manjunath BG, Tyagi D, Chaudhry D, Singh PK. Manjunath BG, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):116-118. doi: 10.4103/ijmr.IJMR_2396_20. Indian J Med Res. 2020. PMID: 32773415 Free PMC article. No abstract available.
  • Authors' response.
    Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Chatterjee P, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):117-118. doi: 10.4103/0971-5916.290527. Indian J Med Res. 2020. PMID: 32773416 Free PMC article. No abstract available.
  • Observations on healthcare workers & SARS-CoV-2 infection.
    Barde P, Sarkate P, Gaikwad N. Barde P, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):137-138. doi: 10.4103/ijmr.IJMR_2564_20. Indian J Med Res. 2020. PMID: 32773418 Free PMC article. No abstract available.
  • Observations on article on healthcare workers & SARS-CoV-2 infection.
    Kulkarni AP. Kulkarni AP. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):141-142. doi: 10.4103/ijmr.IJMR_2649_20. Indian J Med Res. 2020. PMID: 32773422 Free PMC article. No abstract available.
  • Authors' response.
    Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Chatterjee P, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):141. doi: 10.4103/0971-5916.291338. Indian J Med Res. 2020. PMID: 32773423 Free PMC article. No abstract available.
  • Effect of quantitative real-time RT-PCR reaction sensitivity in determining the efficacy of HCQ prophylaxis for COVID-19.
    Gouda D, Goudra B. Gouda D, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):134. doi: 10.4103/ijmr.IJMR_2368_20. Indian J Med Res. 2020. PMID: 32773424 Free PMC article. No abstract available.
  • Authors' response.
    Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Chatterjee P, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):135-136. doi: 10.4103/0971-5916.291340. Indian J Med Res. 2020. PMID: 32773425 Free PMC article. No abstract available.
  • SARS-CoV-2 infection among healthcare workers in India: Limitations of the case-control investigation.
    Niranjan V, Kinnersley N. Niranjan V, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):143-144. doi: 10.4103/ijmr.IJMR_2360_20. Indian J Med Res. 2020. PMID: 32773426 Free PMC article. No abstract available.
  • Authors' response.
    Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Chatterjee P, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):144-145. doi: 10.4103/0971-5916.291398. Indian J Med Res. 2020. PMID: 32773427 Free PMC article. No abstract available.
  • Authors' response.
    Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Chatterjee P, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):128-129. doi: 10.4103/0971-5916.291401. Indian J Med Res. 2020. PMID: 32773429 Free PMC article. No abstract available.
  • Optimal dosing & time: Issues to get hydroxychloroquine safety & efficacy against COVID-19/SARS-CoV-2.
    Neves FS. Neves FS. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):124-126. doi: 10.4103/ijmr.IJMR_2609_20. Indian J Med Res. 2020. PMID: 32801224 Free PMC article. No abstract available.
  • Authors' response.
    Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Chatterjee P, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):125-126. doi: 10.4103/0971-5916.292028. Indian J Med Res. 2020. PMID: 32801225 Free PMC article. No abstract available.
  • A critical appraisal of a case-control study on healthcare workers.
    Mohanty T, Doke PP. Mohanty T, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):146-148. doi: 10.4103/ijmr.IJMR_3025_20. Indian J Med Res. 2020. PMID: 32801226 Free PMC article. No abstract available.
  • Authors' response.
    Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Chatterjee P, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):147-148. doi: 10.4103/0971-5916.292093. Indian J Med Res. 2020. PMID: 32801227 Free PMC article. No abstract available.
  • Hydroxychloroquine for prophylaxis in COVID-19: Need to revisit dosing regimen.
    Pareek A, Bhandari S, Mehta RT. Pareek A, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):130-132. doi: 10.4103/ijmr.IJMR_3077_20. Indian J Med Res. 2020. PMID: 32811798 Free PMC article. No abstract available.
  • Authors' response.
    Chatterjee P, Anand T, Singh KJ, Rasaily R, Singh R, Das S, Singh H, Praharaj I, Gangakhedkar RR, Bhargava B, Panda S. Chatterjee P, et al. Indian J Med Res. 2020 Jul & Aug;152(1 & 2):132-133. doi: 10.4103/0971-5916.292371. Indian J Med Res. 2020. PMID: 32811799 Free PMC article. No abstract available.

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