Healthcare workers in elderly care: a source of silent SARS-CoV-2 transmission?

  1. Mirjam Dautzenberg
  2. Andrea Eikelenboom-Boskamp
  3. Miranda Drabbe
  4. Jacqueline Janssen
  5. Ewoud de Jong
  6. Eefke Weesendorp
  7. Marion Koopmans
  8. Andreas Voss

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Abstract

Importance

Healthcare workers (HCWs), including those with mild symptoms, may be an important source of COVID-19 within elderly care.

Objective

To gain insight into the spread of SARS-CoV-2 among HCWs working in elderly care settings.

Design

Cross-sectional study among HCWs working in elderly care in the South-East of the Netherlands, testing for SARS-CoV-2, between March 31 and April 17, 2020.

Setting

HCWs working in geriatric rehabilitation, somatic and psychogeriatric wards or small-scale living groups and district nursing, with a total of 5245 HCWs within 4 organisations.

Participants

621 HCWs with mild respiratory symptoms.

Main Outcomes

Number of HCWs testing positive for SARS-CoV-2 in pharyngeal swabs, using realtime reverse-transcriptase PCR targeting the SARS-CoV-2 E-gene, N-gene, and RdRP. HCWs filled out a survey to collect information on symptoms and possible sources of infection.

Results

133/615 (21.6%) HCWs tested positive for SARS-CoV-2, ranging from 15.6 to 44.4% per elderly care organisation, and from 0 to 64.3% per separate location of the organizations, respectively. 74.6% of tested HCWs were nursing staff, 1.7% elderly care physicians, 20.3% other HCWs with patient contact and 3.4% HCWs without patient contact. In the univariate analysis, fever, runny or stuffy nose, anosmia, general malaise, myalgia, headache and ocular pain were associated with SARS-CoV-2 positivity, while gastro-intestinal symptoms and respiratory symptoms, other than runny or stuffy nose were not. Risk factors for SARS-CoV-2 positivity were contact with patients or colleagues with suspected or proven COVID-19. Whole genome sequencing of 22 samples in 2 facilities strongly suggests spread within facilities.

Conclusions and Relevance

We found a high SARS-CoV-2 prevalence among HCWs in nursing homes and district nursing, supporting the hypothesis of undetected spread within elderly care facilities. Structural testing of elderly care HCWs, including track and trace of contacts, should be performed to control this spread, even when only mild symptoms are present.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.07.20178731: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board StatementConsent: Written informed consent was obtained from all HCWs.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were performed with SPSS version 25 (IBM, Armonk, NY, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    There are several limitations to this study. First, as HCWs were not familiar with nasopharyngeal swabs, throat swabs were used for testing, which might be less sensitive, and may have let to under detection of SARS-CoV-2.8,9 Also, as a consequence of the cross-sectional nature of our study, timing of swabs was not optimal, probably leading to underdetection of HCWs testing too late in the course of their disease. More studies are needed to determine the prevalence of COVID-19 in this population, possibly based on serological testing. In this study we showed a large previously undetected pool of COVID-19 within elderly care settings, namely the HCWs. Structural testing of elderly care HCWs, including track and trace of contacts, should take place to control this spread, even when only mild symptoms are present.

    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

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.09.07.20178731 on medRxiv