Clinical and CT characteristics of healthcare workers with COVID-19: A single-centered, retrospective study

Abstract

A large number of healthcare workers have been infected with coronavirus disease-2019 (COVID-19). We aimed to investigate their clinical and chest computed tomography (CT) characteristics.The clinical, laboratory test and CT features of 43 medical and hospital staff with confirmed COVID-19 (MP group, 26-70 years old) were retrospectively analyzed, and compared to 43 non-medical related patients (non-MP group, 26-71 years old). Follow-up CT characteristics were analyzed to assess the disease progression in the period of hospitalization.At admission, the main complaints of the MP group, including fever (81.4%), fatigue (48.8%) and cough (41.9%), were similar to the non-MP group. The C-reactive protein, erythrocyte sedimentation rate, and lactate dehydrogenase levels were higher in the non-MP group than the MP group (17.5 ± 22.4 mg/L, 20.2 ± 23.4 mm/H and 219 ± 66U/L, respectively, P < .05). Ground-grass opacities, consolidation, interstitial thickening were common CT features of both groups. The severity of opacities on initial CT were less in the MP group (5.3 ± 3.9 scores) than in the non-MP group (9.1 ± 4.8 scores, P < .05). Before regular treatments, the sum score of the opacities showed weak to moderate correlations with duration, C-reactive protein, erythrocyte sedimentation rate and lactate dehydrogenase levels (R ranged from 0.341-0.651, P < .05). In the study time window, the duration from illness onset to when the most obvious pulmonary opacities were observed, according to CT findings, were similar in the MP group (13.3 ± 6.6 days) and the non-MP group (13.8 ± 5.1 days, P = .69). Mild to moderate anxiety and depression were observed in both groups.Despite greater knowledge of how to protect themselves than the general population, healthcare workers are also susceptible to COVID-19 infection. Occupational exposure is a very important factor. Healthcare workers have a higher vigilance about the infection in the early stage of the disease.

Figure 1

Common computed tomography imaging features. A: Multiple patchy ground-glass opacities (GGO), and GGO with interlobular septal thickening (arrows, like reticulation or “paving stone sign”) of a 44 years old male common patient (5 days from onset). B: Single GGO in peribronchial area (arrow) of the right lower lobe of a 44 years old male patient (a physician, 2 days from onset). C: Diffuse opacities and consolidation, as well as air bronchograms (arrow) in a 54 years old patient (a surgeon, 6 days from onset). D: Fibrous stripes (arrows) are shown in bilateral lower lobes in a 51 years old female patient (a radiology technician, 20 days from onset).

Figure 2

A-B: Correlation between sum score and days from illness onset to initial CT; and days from illness onset to the most obvious pulmonary opacities were observed (CT_peak). (R denotes Pearson correlation coefficient with age and gender as covariates). C-D: Differences in mean values of sum score and disease duration to initial CT, CT_peak and the CT began to show decreased extent/density of the opacities (CT_decrease), between the MP and non-MP groups. Note that at the timepoint of CT_decrease, 41 patients in MP group and 40 patients in non-MP group were included. The bar height indicates the mean, and the line on top of the bar represents the standard deviation. Asterisk indicates a significant difference (^∗P < .05, ^∗∗P < .01).

Figure 3

The initial computed tomography (CT), CT with most obvious opacities, and CT with decreased opacities of a 38 years old nurse. A: Patchy ground-glass opacities distributed bilaterally on the initial CT (3 days from onset). B: In the follow-up CT, ground-glass opacities progressed to multiple ground-glass infiltration in the lungs. C: Fibrous stripes could be a common sign during the remission stage. Images in the first and second lines represent different cross sections.

Figure 4

The initial and follow-up computed tomography of a 54 years old patient (a surgeon). A: Focal ground-glass opacities in the right upper lobe (3 days from onset). B: Ground-glass opacities progressed to multiple ground-glass infiltration and consolidation bilaterally. C: The disease progressed very fast. He was admitted in intense care unit and received ECMO treatment. Fibrous stripes, interstitial thickening, pneumonocele and bronchiectasia could be seen.

Figure 5

The initial computed tomography (CT), follow-up CT, CT with most obvious opacities, and CT with decreased opacities of a 28 years old common patient admitted in our institution. A: Patchy ground-glass opacities in the left lower lobe on the initial CT (8 days from onset). B, C: In the follow-up CT, ground-glass opacities progressed to multiple ground-glass infiltration and consolidation bilaterally. D: After absorption of some opacities, fibrous stripes and interstitial thickening could be seen. Images in the first and second lines represent different cross sections.