Assessing the Burden of Coronavirus Disease 2019 (COVID-19) Among Healthcare Workers in Mexico City: A Data-Driven Call to Action

  1. Neftali Eduardo Antonio-Villa
  2. Omar Yaxmehen Bello-Chavolla
  3. Arsenio Vargas-Vázquez
  4. Carlos A Fermín-Martínez
  5. Alejandro Márquez-Salinas
  6. Julio Pisanty-Alatorre
  7. Jessica Paola Bahena-López

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Abstract

Background

Healthcare workers (HCWs) could be at increased occupational risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections due to increased exposure. Information regarding the burden of coronavirus disease 2019 (COVID-19) epidemic in HCWs living in Mexico is scarce. Here, we aimed to explore the epidemiology, symptoms, and risk factors associated with adverse outcomes in HCWs in Mexico City.

Methods

We explored data collected by the National Epidemiological Surveillance System in Mexico City, in HCWs who underwent real-time reverse transcription polymerase chain reaction (RT-PCR) test. We explored COVID-19 outcomes in HCWs and the performance of symptoms to detect SARS-CoV-2 infection.

Results

As of 20 September 2020, 57 758 HCWs were tested for SARS-CoV-2 and 17 531 were confirmed (30.35%); 6610 were nurses (37.70%), 4910 physicians (28.0%), 267 dentists (1.52%), and 5744 laboratory personnel and other HCWs (32.76%). Overall, 2378 HCWs required hospitalization (4.12%), 2648 developed severe COVID-19 (4.58%), and 336 required mechanical-ventilatory support (.58%). Lethality was recorded in 472 (.82%) cases. We identified 635 asymptomatic SARS-CoV-2 infections (3.62%). Compared with general population, HCWs had higher incidence, testing, asymptomatic cases, and mortality rates. No individual symptom offers adequate performance to detect SARS-CoV2. Older HCWs with chronic noncommunicable diseases and severe respiratory symptoms were associated with higher risk for adverse outcome; physicians were at higher risk compared with nurses and other HCWs.

Conclusions

We report a high prevalence of SARS-CoV-2 infection in HCWs in Mexico City. Symptoms as a screening method are not efficient to discern those HCWs with a positive PCR-RT test. Particular attention should focus on HCWs with risk factors to prevent adverse outcomes.

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  1. Version published to 10.1093/cid/ciaa1487
  2. Version published to 10.1101/2020.07.02.20145169v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.07.02.20145169: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code and data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study had some strengths and limitations. First, we analyzed a large dataset which included information on confirmed positive and negative SARS-CoV-2 cases in Mexico City, providing a unique opportunity to investigate COVID-19 specific risk factors in HCWs. A potential limitation of this study is the use of data collected from a sentinel epidemiological surveillance system model, which is skewed towards investigating high-risk cases based on the presentation of respiratory symptoms or only those with specific risk factors, which on the one hand increases power to detect the effect of comorbidities and on the other hand might not be representative of milder COVID-19 cases. This is particularly true for asymptomatic cases amongst HCWs, which were heavily underrepresented in our study and its prevalence must be assessed with widespread systematic testing amongst HCWs to reduce in-hospital transmission amongst peers. Although the testing performed in our HCWs population is higher compared to the general population living in Mexico City, it still remains low compared to other HCWs studies performed in other countries (43). Another potential limitation of our study is that our populational-based analyses of HCWs is limited to those living in Mexico City, without the exact number of recruited HCWs during the epidemic, thus our epidemiological rates should be interpreted as approximations. Moreover, all analyses were performed to estimate the burden of HCWs in Mexico City, which ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  4. Version published to 10.1101/2020.07.02.20145169v1 on medRxiv