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Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19.
Indian J Med Res. 2020 May; 151(5):459-467.IJ

Abstract

Background & objectives

Healthcare workers (HCWs) are at an elevated risk of contracting COVID-19. While intense occupational exposure associated with aerosol-generating procedures underlines the necessity of using personal protective equipment (PPE) by HCWs, high-transmission efficiency of the causative agent [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] could also lead to infections beyond such settings. Hydroxychloroquine (HCQ), a repurposed antimalarial drug, was empirically recommended as prophylaxis by the National COVID-19 Task Force in India to cover such added risk. Against this background, the current investigation was carried out to identify the factors associated with SARS-CoV-2 infection among HCWs in the country.

Methods

A case-control design was adopted and participants were randomly drawn from the countrywide COVID-19 testing data portal maintained by the ICMR. The test results and contact details of HCWs, diagnosed as positive (cases) or negative (controls) for SARS-CoV-2 using real-time reverse transcription-polymerase chain reaction (qRT-PCR), were available from this database. A 20-item brief-questionnaire elicited information on place of work, procedures conducted and use of PPE.

Results

Compared to controls, cases were slightly older (34.7 vs. 33.5 yr) and had more males (58 vs. 50%). In multivariate analyses, HCWs performing endotracheal intubation had higher odds of being SARS-CoV-2 infected [adjusted odds ratio (AOR): 4.33, 95% confidence interval (CI): 1.16-16.07]. Consumption of four or more maintenance doses of HCQ was associated with a significant decline in the odds of getting infected (AOR: 0.44; 95% CI: 0.22-0.88); a dose-response relationship existed between frequency of exposure to HCQ and such reductions (χ[2] for trend=48.88; P <0.001). In addition, the use of PPE was independently associated with the reduction in odds of getting infected with SARS-CoV-2.

Interpretations & conclusions

Until results of clinical trials for HCQ prophylaxis become available, this study provides actionable information for policymakers to protect HCWs at the forefront of COVID-19 response. The public health message of sustained intake of HCQ prophylaxis as well as appropriate PPE use need to be considered in conjunction with risk homoeostasis operating at individual levels.

Authors+Show Affiliations

Translational Global Health Policy Research Cell, New Delhi, India.Multidisciplinary Research Unit/Model Rural Health Research Unit, New Delhi, India.ICMR-National Institute of Medical Statistics, New Delhi, India.Division of Reproductive Biology, Maternal Health & Child Health, New Delhi, India.Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India.Division of Clinical Medicine, ICMR-National Institute of Cholera & Enteric Diseases, Kolkata, West Bengal, India.Informatics, Systems & Research Management Cell, Indian Council of Medical Research, New Delhi, India.Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India.Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi, India.Department of Health Research, Ministry of Health & Family Welfare; Indian Council of Medical Research, New Delhi, India.ICMR-National AIDS Research Institute, Pune, Maharashtra, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32611916

Citation

Chatterjee, Pranab, et al. "Healthcare Workers & SARS-CoV-2 Infection in India: a Case-control Investigation in the Time of COVID-19." The Indian Journal of Medical Research, vol. 151, no. 5, 2020, pp. 459-467.
Chatterjee P, Anand T, Singh KJ, et al. Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19. Indian J Med Res. 2020;151(5):459-467.
Chatterjee, P., Anand, T., Singh, K. J., Rasaily, R., Singh, R., Das, S., Singh, H., Praharaj, I., Gangakhedkar, R. R., Bhargava, B., & Panda, S. (2020). Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19. The Indian Journal of Medical Research, 151(5), 459-467. https://doi.org/10.4103/ijmr.IJMR_2234_20
Chatterjee P, et al. Healthcare Workers & SARS-CoV-2 Infection in India: a Case-control Investigation in the Time of COVID-19. Indian J Med Res. 2020;151(5):459-467. PubMed PMID: 32611916.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19. AU - Chatterjee,Pranab, AU - Anand,Tanu, AU - Singh,Kh Jitenkumar, AU - Rasaily,Reeta, AU - Singh,Ravinder, AU - Das,Santasabuj, AU - Singh,Harpreet, AU - Praharaj,Ira, AU - Gangakhedkar,Raman R, AU - Bhargava,Balram, AU - Panda,Samiran, PY - 2020/7/3/entrez PY - 2020/7/3/pubmed PY - 2020/7/14/medline KW - Dose-response relationship - healthcare workers - hydroxychloroquine prophylaxis - personal risk management - rapid evidence generation - SARS-CoV-2 SP - 459 EP - 467 JF - The Indian journal of medical research JO - Indian J Med Res VL - 151 IS - 5 N2 - Background & objectives: Healthcare workers (HCWs) are at an elevated risk of contracting COVID-19. While intense occupational exposure associated with aerosol-generating procedures underlines the necessity of using personal protective equipment (PPE) by HCWs, high-transmission efficiency of the causative agent [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] could also lead to infections beyond such settings. Hydroxychloroquine (HCQ), a repurposed antimalarial drug, was empirically recommended as prophylaxis by the National COVID-19 Task Force in India to cover such added risk. Against this background, the current investigation was carried out to identify the factors associated with SARS-CoV-2 infection among HCWs in the country. Methods: A case-control design was adopted and participants were randomly drawn from the countrywide COVID-19 testing data portal maintained by the ICMR. The test results and contact details of HCWs, diagnosed as positive (cases) or negative (controls) for SARS-CoV-2 using real-time reverse transcription-polymerase chain reaction (qRT-PCR), were available from this database. A 20-item brief-questionnaire elicited information on place of work, procedures conducted and use of PPE. Results: Compared to controls, cases were slightly older (34.7 vs. 33.5 yr) and had more males (58 vs. 50%). In multivariate analyses, HCWs performing endotracheal intubation had higher odds of being SARS-CoV-2 infected [adjusted odds ratio (AOR): 4.33, 95% confidence interval (CI): 1.16-16.07]. Consumption of four or more maintenance doses of HCQ was associated with a significant decline in the odds of getting infected (AOR: 0.44; 95% CI: 0.22-0.88); a dose-response relationship existed between frequency of exposure to HCQ and such reductions (χ[2] for trend=48.88; P <0.001). In addition, the use of PPE was independently associated with the reduction in odds of getting infected with SARS-CoV-2. Interpretations & conclusions: Until results of clinical trials for HCQ prophylaxis become available, this study provides actionable information for policymakers to protect HCWs at the forefront of COVID-19 response. The public health message of sustained intake of HCQ prophylaxis as well as appropriate PPE use need to be considered in conjunction with risk homoeostasis operating at individual levels. SN - 0971-5916 UR - https://www.unboundmedicine.com/medline/citation/32611916/Healthcare_workers_&_SARS_CoV_2_infection_in_India:_A_case_control_investigation_in_the_time_of_COVID_19_ L2 - http://www.ijmr.org.in/article.asp?issn=0971-5916;year=2020;volume=151;issue=5;spage=459;epage=467;aulast=Chatterjee DB - PRIME DP - Unbound Medicine ER -