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. 2020 Nov;35(11):3293-3301.
doi: 10.1007/s11606-020-06171-9. Epub 2020 Sep 1.

Impact of the COVID-19 Pandemic on Healthcare Workers' Risk of Infection and Outcomes in a Large, Integrated Health System

Anita D Misra-Hebert  1   2   3 , Lara Jehi  4   5 , Xinge Ji  6 , Amy S Nowacki  6 , Steven Gordon  7 , Paul Terpeluk  8 , Mina K Chung  9 , Reena Mehra  10 , Katherine M Dell  11 , Nathan Pennell  12 , Aaron Hamilton  13 , Alex Milinovich  6 , Michael W Kattan  6 , James B Young  14   9
Affiliations

Impact of the COVID-19 Pandemic on Healthcare Workers' Risk of Infection and Outcomes in a Large, Integrated Health System

Anita D Misra-Hebert et al. J Gen Intern Med. 2020 Nov.

Abstract

Background: Understanding the impact of the COVID-19 pandemic on healthcare workers (HCW) is crucial.

Objective: Utilizing a health system COVID-19 research registry, we assessed HCW risk for COVID-19 infection, hospitalization, and intensive care unit (ICU) admission.

Design: Retrospective cohort study with overlap propensity score weighting.

Participants: Individuals tested for SARS-CoV-2 infection in a large academic healthcare system (N = 72,909) from March 8-June 9, 2020, stratified by HCW and patient-facing status.

Main measures: SARS-CoV-2 test result, hospitalization, and ICU admission for COVID-19 infection.

Key results: Of 72,909 individuals tested, 9.0% (551) of 6145 HCW tested positive for SARS-CoV-2 compared to 6.5% (4353) of 66,764 non-HCW. The HCW were younger than the non-HCW (median age 39.7 vs. 57.5, p < 0.001) with more females (proportion of males 21.5 vs. 44.9%, p < 0.001), higher reporting of COVID-19 exposure (72 vs. 17%, p < 0.001), and fewer comorbidities. However, the overlap propensity score weighted proportions were 8.9 vs. 7.7 for HCW vs. non-HCW having a positive test with weighted odds ratio (OR) 1.17, 95% confidence interval (CI) 0.99-1.38. Among those testing positive, weighted proportions for hospitalization were 7.4 vs. 15.9 for HCW vs. non-HCW with OR of 0.42 (CI 0.26-0.66) and for ICU admission: 2.2 vs. 4.5 for HCW vs. non-HCW with OR of 0.48 (CI 0.20-1.04). Those HCW identified as patient facing compared to not had increased odds of a positive SARS-CoV-2 test (OR 1.60, CI 1.08-2.39, proportions 8.6 vs. 5.5), but no statistically significant increase in hospitalization (OR 0.88, CI 0.20-3.66, proportions 10.2 vs. 11.4) and ICU admission (OR 0.34, CI 0.01-3.97, proportions 1.8 vs. 5.2).

Conclusions: In a large healthcare system, HCW had similar odds for testing SARS-CoV-2 positive, but lower odds of hospitalization compared to non-HCW. Patient-facing HCW had higher odds of a positive test. These results are key to understanding HCW risk mitigation during the COVID-19 pandemic.

Keywords: SARS coronavirus; employee health; healthcare workers.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
a Odds of SARS-CoV-2 positive test; hospital admission if SARS-CoV-2 positive and intensive care admission if SARS-CoV-2 positive by healthcare worker (HCW) status. b Odds of SARS-CoV-2 positive test; hospital admission if SARS-CoV-2 positive and intensive care admission if SARS-CoV-2 positive by patient-facing and non-patient-facing healthcare worker status. OR = odds ratio, LCL = lower confidence limit, UCL = upper confidence limit.
Figure 2
Figure 2
Proportion of SARS-CoV-2 positive results during the study period. CCHS = Cleveland Clinic Health System.
See this image and copyright information in PMC

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