Comparing Dynamics and Determinants of Severe Acute Respiratory Syndrome Coronavirus 2 Transmissions Among Healthcare Workers of Adult and Pediatric Settings in Central Paris

  1. Adrien Contejean
  2. Jérémie Leporrier
  3. Etienne Canouï
  4. Fanny Alby-Laurent
  5. Emmanuel Lafont
  6. Lauren Beaudeau
  7. Perrine Parize
  8. Fabienne Lecieux
  9. Agnès Greffet
  10. Gérard Chéron
  11. Rémy Gauzit
  12. Jacques Fourgeaud
  13. Anne-Sophie L’Honneur
  14. Jean-Marc Tréluyer
  15. Caroline Charlier
  16. Anne Casetta
  17. Pierre Frange
  18. Marianne Leruez-Ville
  19. Flore Rozenberg
  20. Olivier Lortholary
  21. Solen Kernéis

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Abstract

Background

Healthcare workers (HCWs) have paid a heavy toll during the coronavirus disease 2019 (COVID-19) outbreak. Routes of transmission remain to be fully understood.

Methods

This prospective study compared a 1500-bed adult and 600-bed pediatric setting of a tertiary-care university hospital located in central Paris. From 24 February until 10 April 2020, all symptomatic HCWs were screened for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on a nasopharyngeal swab. HCWs screened positive were questioned on their profession, symptoms, and occupational and nonoccupational exposures to SARS-CoV-2.

Results

Among 1344 HCWs tested, 373 were positive (28%) and 336 (90%) corresponding questionnaires were completed. Three hospitalizations and no deaths were reported. Most HCWs (70%) had patient-facing occupational activities (22% in COVID-19 dedicated units). The total number of HCW cases peaked on 23 March, then decreased slowly, concomitantly with a continuous increase of compliance to preventive measures (including universal medical masking and personal protective equipment [PPE] for direct care to COVID-19 patients). Attack rates were of 3.2% and 2.3% in the adult and pediatric settings, respectively (P = .0022). In the adult setting, HCWs more frequently reported exposure to COVID-19 patients without PPE (25% vs 15%, P = .046). Report of contacts with children attending out-of-home care facilities dramatically decreased over the study period.

Conclusions

Universal masking, reinforcement of hand hygiene, and PPE with medical masks for patients’ care allowed protection of HCWs and containment of the outbreak. Residual transmissions were related to persistent exposures with undiagnosed patients or colleagues and not to contacts with children attending out-of-home care facilities.

Article activity feed

  1. Version published to 10.1093/cid/ciaa977
  2. ScreenIT

    SciScore for 10.1101/2020.05.19.20106427: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementIACUC: Ethics: This study was approved by the Ethical Review Committee for publications of the Cochin university Hospital (CLEP) (N°: AAA-2020-08012).
    Consent: According to French policy, a non-opposition statement was obtained for all participants, meaning that all had received written detailed information on the objectives of the study and were free to request withdrawal of their consent for participation at any time.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The main limitation of our study is the lack of a control group (i.e. inclusion of HCW that were not infected by SARS-Cov-2) to formally compare exposures and assess their respective role in transmission. Identification of negative controls is nevertheless difficult. Indeed, sensitivity of the rt-PCR on nasopharyngeal swabs is imperfect (23), therefore identification of controls only based on a negative rt-PCR result is questionable. The gold standard to rule out the diagnosis of COVID-19 is serologic assessment. Performances of these technics are still under investigation in France before large implementation among HCW. We chose to rapidly communicate timely data in order to guide decisions in view of the soon upcoming lift of containment measures. Further investigations are on the way to identify negative controls by serologic assessment and formally compare their exposures to HCW of our cohort. Another limitation is the recall bias which is inherent to the use of questionnaires in epidemiological studies, however infected HCW were interrogated prospectively and shortly after PCR assessment. Several conclusions can be drawn from our results: (i) HCW are exposed to emerging viral diseases, particularly at the early phase of the epidemic, as illustrated by the overall attack rate of 2.8%; (ii) compliance to control measures increased over the study period, concomitantly with containment of the outbreak among hospital staff; (iii) incidence was lower in HCW of the Children set...

    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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  3. Version published to 10.1101/2020.05.19.20106427v1 on medRxiv