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Universal COVID-19 screening of 4040 health care workers in a resource-limited setting: an Egyptian pilot model in a university with 12 public hospitals and medical centers.
Int J Epidemiol. 2021 03 03; 50(1):50-61.IJ

Abstract

BACKGROUND

The scale of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health care workers (HCWs), particularly in resource-limited settings, remains unclear. To address this concern, universal (non-symptom-based) screening of HCWs was piloted to determine the proportion of SARS-CoV-2 infection and the associated epidemiological and clinical risk factors at a large public health care facility in Egypt.

METHODS

Baseline voluntary screening of 4040 HCWs took place between 22 April and 14 May 2020 at 12 hospitals and medical centres in Cairo. Epidemiological and clinical data were collected using an online survey. All participants were tested for SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) and rapid IgM and IgG serological tests.

RESULTS

Of the 4040 HCWs screened, 170 [4.2%; 95% confidence interval (CI): 3.6-4.9] tested positive for SARS-CoV-2 by either of the three tests (i.e. infected); 125/170 (73.5%) tested PCR-positive. Most infected HCWs were nurses (97/170, 57.5%). Median age of infected HCWs was 31.5 [interquartile range (IQR): 27.0-41.3] years. Of infected HCWs, 78 (45.9%) reported contact with a suspected case and 47 (27.6%) reported face-to-face contact within 2 m with a confirmed case. The proportion of infection among symptomatic HCWs (n = 54/616) was 8.8% (95% CI: 6.7-11.3); 6/54 (11.1%) had fever ≥38°C and 7/54 (13.0%) reported severe symptoms. Most infected HCWs were asymptomatic (116/170, 68.2%). The proportion of infection among asymptomatic HCWs (n = 116/3424) was 3.4% (95% CI: 2.8-4.0).

CONCLUSIONS

The high rate of asymptomatic infections among HCWs reinforces the need for expanding universal regular testing. The infection rate among symptomatic HCWs in this study is comparable with the national rate detected through symptom-based testing. This suggests that infections among HCWs may reflect community rather than nosocomial transmission during the early phase of the COVID-19 epidemic in Egypt.

Authors+Show Affiliations

Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Clinical Research Center (MASRI-CRC), Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Community, Environmental, and Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Infection Control Unit, Ain Shams University Hospitals, Cairo, Egypt.Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Clinical Research Center (MASRI-CRC), Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.Department of Hepatobiliary Surgery and Liver Transplantation, Ain Shams Center for Organ Transplantation (ASCOT), Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33094320

Citation

Mostafa, Aya, et al. "Universal COVID-19 Screening of 4040 Health Care Workers in a Resource-limited Setting: an Egyptian Pilot Model in a University With 12 Public Hospitals and Medical Centers." International Journal of Epidemiology, vol. 50, no. 1, 2021, pp. 50-61.
Mostafa A, Kandil S, El-Sayed MH, et al. Universal COVID-19 screening of 4040 health care workers in a resource-limited setting: an Egyptian pilot model in a university with 12 public hospitals and medical centers. Int J Epidemiol. 2021;50(1):50-61.
Mostafa, A., Kandil, S., El-Sayed, M. H., Girgis, S., Hafez, H., Yosef, M., Saber, S., Ezzelarab, H., Ramadan, M., Afifi, I., Hassan, F., Elsayed, S., Reda, A., Fattuh, D., Mahmoud, A., Mansour, A., Sabry, M., Habeb, P., Ebeid, F. S., ... El-Meteini, M. (2021). Universal COVID-19 screening of 4040 health care workers in a resource-limited setting: an Egyptian pilot model in a university with 12 public hospitals and medical centers. International Journal of Epidemiology, 50(1), 50-61. https://doi.org/10.1093/ije/dyaa173
Mostafa A, et al. Universal COVID-19 Screening of 4040 Health Care Workers in a Resource-limited Setting: an Egyptian Pilot Model in a University With 12 Public Hospitals and Medical Centers. Int J Epidemiol. 2021 03 3;50(1):50-61. PubMed PMID: 33094320.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Universal COVID-19 screening of 4040 health care workers in a resource-limited setting: an Egyptian pilot model in a university with 12 public hospitals and medical centers. AU - Mostafa,Aya, AU - Kandil,Sahar, AU - El-Sayed,Manal H, AU - Girgis,Samia, AU - Hafez,Hala, AU - Yosef,Mostafa, AU - Saber,Saly, AU - Ezzelarab,Hoda, AU - Ramadan,Marwa, AU - Afifi,Iman, AU - Hassan,Fatmaelzahra, AU - Elsayed,Shaimaa, AU - Reda,Amira, AU - Fattuh,Doaa, AU - Mahmoud,Asmaa, AU - Mansour,Amany, AU - Sabry,Moshira, AU - Habeb,Petra, AU - Ebeid,Fatma Se, AU - Saleh,Ayman, AU - Mansour,Ossama, AU - Omar,Ashraf, AU - El-Meteini,Mahmoud, PY - 2020/08/11/accepted PY - 2020/10/24/pubmed PY - 2021/3/12/medline PY - 2020/10/23/entrez KW - COVID-19 KW - Egypt KW - RT-PCR KW - SARS-CoV-2 KW - asymptomatic KW - epidemiology KW - health care workers KW - resource-limited setting KW - screening KW - serology SP - 50 EP - 61 JF - International journal of epidemiology JO - Int J Epidemiol VL - 50 IS - 1 N2 - BACKGROUND: The scale of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among health care workers (HCWs), particularly in resource-limited settings, remains unclear. To address this concern, universal (non-symptom-based) screening of HCWs was piloted to determine the proportion of SARS-CoV-2 infection and the associated epidemiological and clinical risk factors at a large public health care facility in Egypt. METHODS: Baseline voluntary screening of 4040 HCWs took place between 22 April and 14 May 2020 at 12 hospitals and medical centres in Cairo. Epidemiological and clinical data were collected using an online survey. All participants were tested for SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) and rapid IgM and IgG serological tests. RESULTS: Of the 4040 HCWs screened, 170 [4.2%; 95% confidence interval (CI): 3.6-4.9] tested positive for SARS-CoV-2 by either of the three tests (i.e. infected); 125/170 (73.5%) tested PCR-positive. Most infected HCWs were nurses (97/170, 57.5%). Median age of infected HCWs was 31.5 [interquartile range (IQR): 27.0-41.3] years. Of infected HCWs, 78 (45.9%) reported contact with a suspected case and 47 (27.6%) reported face-to-face contact within 2 m with a confirmed case. The proportion of infection among symptomatic HCWs (n = 54/616) was 8.8% (95% CI: 6.7-11.3); 6/54 (11.1%) had fever ≥38°C and 7/54 (13.0%) reported severe symptoms. Most infected HCWs were asymptomatic (116/170, 68.2%). The proportion of infection among asymptomatic HCWs (n = 116/3424) was 3.4% (95% CI: 2.8-4.0). CONCLUSIONS: The high rate of asymptomatic infections among HCWs reinforces the need for expanding universal regular testing. The infection rate among symptomatic HCWs in this study is comparable with the national rate detected through symptom-based testing. This suggests that infections among HCWs may reflect community rather than nosocomial transmission during the early phase of the COVID-19 epidemic in Egypt. SN - 1464-3685 UR - https://www.unboundmedicine.com/medline/citation/33094320/Universal_COVID_19_screening_of_4040_health_care_workers_in_a_resource_limited_setting:_an_Egyptian_pilot_model_in_a_university_with_12_public_hospitals_and_medical_centers_ L2 - https://academic.oup.com/ije/article-lookup/doi/10.1093/ije/dyaa173 DB - PRIME DP - Unbound Medicine ER -