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Observational Study
. 2020 Nov 26;10(11):e040216.
doi: 10.1136/bmjopen-2020-040216.

Delayed healthcare seeking and prolonged illness in healthcare workers during the COVID-19 pandemic: a single-centre observational study

Angus de Wilton  1 , Eliz Kilich #  2 , Zain Chaudhry #  2 , Lucy Ck Bell #  2 , Joshua Gahir #  2 , Jane Cadman  3 , Robert A Lever  2   4 , Sarah A Logan  2 ; UCLH COVID-19 Response Team
Affiliations
Observational Study

Delayed healthcare seeking and prolonged illness in healthcare workers during the COVID-19 pandemic: a single-centre observational study

Angus de Wilton et al. BMJ Open. .

Abstract

Objectives: To describe a cohort of self-isolating healthcare workers (HCWs) with presumed COVID-19.

Design: A cross-sectional, single-centre study.

Setting: A large, teaching hospital based in Central London with tertiary infection services.

Participants: 236 HCWs completed a survey distributed by internal staff email bulletin. 167 were women and 65 men.

Measures: Information on symptomatology, exposures and health-seeking behaviour were collected from participants by self-report.

Results: The 236 respondents reported illness compatible with COVID-19 and there was an increase in illness reporting during March 2020 Diagnostic swabs were not routinely performed. Cough (n=179, 75.8%), fever (n=138, 58.5%), breathlessness (n=84, 35.6%) were reported. Anosmia was reported in 42.2%. Fever generally settled within 1 week (n=110/138, 88%). Several respondents remained at home and did not seek formal medical attention despite reporting severe breathlessness and measuring hypoxia (n=5/9, 55.6%). 2 patients required hospital admission but recovered following oxygen therapy. 84 respondents (41.2%) required greater than the obligated 7 days off work and 9 required greater than 3 weeks off.

Conclusion: There was a significant increase in staff reporting illness compatible with possible COVID-19 during March 2020. Subsequent serology studies at the same hospital study site have confirmed sero-positivity for COVID-19 up to 45% by the end of April 2020 in frontline HCWs. The study revealed a concerning lack of healthcare seeking in respondents with significant red flag symptoms (severe breathlessness, hypoxia). This study also highlighted anosmia as a key symptom of COVID-19 early in the pandemic, prior to this symptom being more widely recognised as a feature of COVID-19.

Keywords: epidemiology; health policy; human resource management; infectious diseases; public health.

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Conflict of interest statement

Competing interests: EK was employed in 2018–2019 by the London School of Hygiene of Tropical Medicine undertaking research on attitudes toward maternal vaccination. This research was funded by a grant from GlaxoSmithKline (commercial funder) to support research on maternal vaccination. All other authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Self-perceived PPE usage and date of symptom onset in healthcare workers. (A) Eighty-one of 236 respondents reported an exposure to a patient who was confirmed or subsequently confirmed to be SARS-CoV-2 positive. The pie chart shows the breakdown of responses in this group when asked whether they considered that they were wearing appropriate PPE, partly appropriate PPE or no appropriate PPE at the time of this exposure. 40.74% of respondents in this group (n=33, 13.98% of overall cohort) reported they considered that they were not wearing any appropriate PPE at the time of exposure. (B) Respondents were asked to report their first day of symptom onset. most reported symptom onset occurring within the first 3 weeks of March 2020. HCWs, healthcare workers; PPE, personal protective equipment.
Figure 2
Figure 2
Healthcare-seeking behaviour as triggered by breathlessness in HCWs (A); access to self-isolation facilities (B); illness in close contacts of HCWs (C); return to work timeline (D). (A) Eighty-four respondents reported breathlessness (35.6%); increased severity of breathless did not appear to lead to increased formal healthcare seeking in respondents. Of those respondents reporting breathlessness at rest (n=12), only 41.7% (n=5/12), sought formal medical attention (NHS 111, GP, A&E). (B) Nine respondents reported a combination of breathlessness and saturations of <94% (measured using home oximeters). A majority (n=5/9) of those respondents sought either no or informal advice only. (C) Respondents were asked if they felt able to self-isolate away from other household members (separate bedroom, bathroom). A majority did not feel able to self-isolate in this way (n=126, 57.27%). (D) Respondents were asked whether their partner became unwell (phrased as ‘sharing bed on night of symptom onset’) during 14 days after symptom onset. A majority (n=125, 61.13%) reported their partners did become unwell during this period. A&E, Accident and Emergency; GP, general practitioner; HCWs, healthcare workers.
Figure 3
Figure 3
Duration of reported fever in self-isolating healthcare workers (A); clustering of headache and anosmia (B) and characterisation of anosmia (C). (A) respondents were asked to report the duration of their fever. The majority of respondents reported fever duration less than 7 days (n=110, 88). fever persisted to 7 days or more in 12% (n=15). (B) Proportional Venn diagrams (generated using BioVenn2) demonstrating the crossover between headache and anosmia. grey circles demonstrate the denominator (all respondents). Percentages in white show the proportion of the overall group of respondents reporting both symptoms in each Venn. (C) Respondents reporting anosmia (n=91, 41.1%) were asked the day of onset and duration of this symptom. The majority of respondents developed anosmia early in illness (median day 3, SD 1.96) and had resolution of anosmia within 2 weeks of its onset (n=75, 84%).
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References

    1. Public Health England Guidance on social distancing for everyone in the UK. GOV. UK, 2020. Available: https://www.gov.uk/government/publications/covid-19-guidance-on-social-d... [Accessed 14 Apr 2020].
    1. Houlihan C, Vora N, Byrne T, et al. Pandemic peak SARS-CoV-2 infection and seroconversion rates in London frontline health-care workers, 2020. Available: https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31484-7.pdf [Accessed 9 Sep 2020]. - PMC - PubMed
    1. SARS-CoV-2 viral load and the severity of COVID-19 - CEBM, 2020. Available: https://www.cebm.net/covid-19/sars-cov-2-viral-load-and-the-severity-of-... [Accessed 14 Apr 2020].
    1. England PH. COVID-19: management of exposed healthcare workers and patients in hospital settings. GOV. UK, 2020. Available: https://www.gov.uk/government/publications/covid-19-management-of-expose... [Accessed 14 Apr 2020].
    1. England PH. Stay at home: guidance for households with possible coronavirus (COVID-19) infection. GOV. UK, 2020. Available: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidanc... [Accessed 28 Apr 2020].

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