A COVID-19 outbreak in a rheumatology department upon the early days of the pandemic

  1. Vasco C. Romão
  2. Filipa Oliveira-Ramos
  3. Ana Rita Cruz-Machado
  4. Patrícia Martins
  5. Sofia Barreira
  6. Joana Silva-Dinis
  7. Luís Mendonça-Galaio
  8. Helena Proença
  9. José Melo Cristino
  10. Ema Sacadura-Leite
  11. Nikita Khmelinskii
  12. José Carlos Romeu
  13. João Eurico Fonseca

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Abstract

Objectives

To describe our experience with a coronavirus disease 2019 (COVID-19) outbreak within a large rheumatology department, early in the pandemic.

Methods

Symptomatic and asymptomatic healthcare workers (HCWs) had a naso-oropharyngeal swab for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and were followed clinically. Reverse transcription polymerase-chain reaction (RT-PCR) was repeated to document cure, and serological response was assessed. Patients with risk contacts within the department in the 14 days preceding the outbreak were screened for COVID-19 symptoms.

Results

14/34 HCWs (41%; 40±14 years, 71% female) tested positive for SARS-CoV-2, and 11/34 (32%) developed symptoms but were RT-PCR-negative. Half of RT-PCR-positive HCWs did not report fever, cough, or dyspnoea before testing, which were absent in 3/14 cases (21%). Mild disease prevailed (79%), but 3 HCWs had moderate disease requiring further assessment, which excluded severe complications. Nevertheless, symptom duration (28±18 days), viral shedding (31±10 days post-symptom onset, range 15-51) and work absence (29±28 days) were prolonged. 13/14 (93%) of RT-PCR-positive and none of the RT-PCR-negative HCWs had a positive humoral response, with higher IgG-index in individuals over 50 years (14.5±7.7 vs 5.0±4.4, p=0.012). Of 617 rheumatic patients, 8 (1.3%) developed COVID-19 symptoms (1/8 hospitalisation, 8/8 complete recovery), following a consultation/procedure with an asymptomatic (7/8) or mildly-symptomatic (1/8) HCW.

Conclusions

A COVID-19 outbreak can occur among HCWs and rheumatic patients, swiftly spreading over the presymptomatic stage. Mild disease without typical symptoms should be recognised, and may evolve with delayed viral shedding, prolonged recovery, and adequate immune response in most individuals.

    Key messages

  • High infection rates have been reported in healthcare workers (HCWs) dealing with COVID-19 patients. Less is known about potential transmission by pre/asymptomatic carriers, which may be important in the context of rheumatology practice, among both HCWs and patients.

  • A COVID-19 outbreak in a rheumatology department affected 41% of HCWs, with fast spreading throughout the presymptomatic stage.

  • Mild disease without typical symptoms was common, especially in early phases, evolving with delayed viral shedding (unto 51 days), prolonged recovery (average one month), and adequate immune response (93%) in most individuals.

  • Transmission by mostly asymptomatic HCWs occurred to a minority of patients with rheumatic and musculoskeletal diseases (RMDs), who had a globally favourable outcome.

  • Asymptomatic and mild disease forms among HCWs should be recognised. Assertive infection control measures and testing strategies are warranted to prevent subclinical contagion between HCWs and patients with RMDs.

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  1. ScreenIT

    SciScore for 10.1101/2020.06.05.20107011: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: All study participants signed a study-specific informed consent.
    IRB: This study was approved by the Lisbon Academic Medical Centre Ethics Committee (reference 171/20).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical analyses were performed using Stata-12.1 for Mac (StataCorp, College Station, USA) and GraphPad-Prism-7 for MacOS (GraphPad Software, USA).
    StataCorp
    suggested: (Stata, RRID:SCR_012763)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)

    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:
    Our study has some limitations. Due to its real-life nature, clinical assessment and RT-PCR timing were clinically-based and differed slightly between subjects. As computed tomography was not performed, we cannot completely exclude COVID-19 pneumonia. Two fellows could not be tested for serology upon finishing their clerkship. Also, 9% of the identified RMD patients could not be reached. In conclusion, we demonstrate that a COVID-19 outbreak can occur among HCWs and rheumatic patients, spreading over the presymptomatic stage, and evolving with mild-to-moderate symptoms, delayed viral shedding and prolonged recovery.

    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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  2. Version published to 10.1101/2020.06.05.20107011v1 on medRxiv