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ORIGINAL ARTICLE
Year : 2022  |  Volume : 49  |  Issue : 1  |  Page : 20-24

Clinical characteristics and risk factors for mortality in 1048 Health care workers hospitalised with COVID 19 in a Tertiary care hospital, India


1 Department of Community Medicine, HBTMC and Dr. RN Cooper Hospital, Mumbai, Maharashtra, India
2 Department of Community Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India

Date of Submission13-Jul-2021
Date of Acceptance15-Sep-2021
Date of Web Publication22-Apr-2022

Correspondence Address:
Smita Santosh Chavhan
Department of Community Medicine, HBTMC and Dr. RN Cooper Hospital, U 15, Bhaktivedanta Swami Rd., JVPD Scheme, Juhu, Mumbai - 400 056, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.jss_99_21

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  Abstract 


Objectives: We aim to study the clinical characteristics and risk factors for mortality of doctors and nurses hospitalized with COVID-19. Materials and Methods: This was a hospital-based cross-sectional study. All doctors and nurses positive on reverse transcriptase–polymerase chain reaction test of nasopharyngeal or/and oropharyngeal samples for COVID-19 who were admitted in this designated COVID hospital from April 2020 to January 2021 and with a definite outcome (death or discharge) till the end of January 2021 were included in this study. To explore the risk factors associated with mortality of health-care workers (HCWs), bivariate and multivariate logistic regression analysis was done. Results: Out of 1048 HCWs, 846 (80.7%) were doctors and 202 (19.3%) were nurses. Majority (619, 59.15%) of the HCWs were young (18–30 years). Most (185, 91.6%) of the nurses were female, while majority (533, 63%) of the doctors were male. The 11 (1%) HCWs who died were all doctors, but the difference was not statistically significant. Total 121 (11.54%) HCWs had comorbidities, and hypertension 70 (6.7%) and diabetes 62 (5.9%) were most common. Age >60 years (adjusted odds ratios [AOR] [confidence interval (CI)] = 36.01 [3.45–375.5]) and suffering from diabetes mellitus (AOR [CI] = 10.4 [1.82–59.51]) were found to be significant predictors for the death of HCWs after adjusting for potential confounders. Conclusion: The mortality rate due to COVID-19 in doctors and nurses was lower (1%) as compared to the general population as most of the HCWs were young and with a low prevalence of comorbidities. Age >60 years and diabetes mellitus were risk factors for death; such HCWs should avoid contact with COVID-19 patients. Screening of HCWs for COVID-19 is important to reduce its transmission.

Keywords: Comorbidities, COVID-19, health personnel, mortality, tertiary care centers


How to cite this article:
Dhikale PT, Chavhan SS, Adsul B, Gokhale C, Ingale A, Kinge K. Clinical characteristics and risk factors for mortality in 1048 Health care workers hospitalised with COVID 19 in a Tertiary care hospital, India. J Sci Soc 2022;49:20-4

How to cite this URL:
Dhikale PT, Chavhan SS, Adsul B, Gokhale C, Ingale A, Kinge K. Clinical characteristics and risk factors for mortality in 1048 Health care workers hospitalised with COVID 19 in a Tertiary care hospital, India. J Sci Soc [serial online] 2022 [cited 2022 Aug 17];49:20-4. Available from: https://www.jscisociety.com/text.asp?2022/49/1/20/343714




  Introduction Top


The coronavirus disease (COVID-19) pandemic has affected 18.5 crore cases across the world as of July 10, 2021.[1] India accounts for 16.6% of world cases, and the mortality rate is 1.32%.[1] The COVID dedicated facilities in India were divided into three types, namely COVID care center, dedicated COVID health center, and dedicated COVID hospital (DCH).[2] Health-care workers (HCWs) are at the forefront of COVID-19 pandemic response and have high exposure to SARS-CoV-2. The occupational risks to HCWs are infection with SARS-CoV-2, fatigue, mental stress, skin disorders, etc.[3] The repeated exposure to pathogens with different strains may alter the course of infectious disease in HCWs. Rising infection and mortality rates in HCWs can paralyze the response against COVID-19. The information about the profile of HCWs who are infected and their outcome is important for effective health-care workforce management, and these data are lacking mainly from the developing countries.

Objectives

We aim to study the clinical characteristics and risk factors for mortality of doctors and nurses hospitalized with COVID-19.


  Materials and Methods Top


Study setting

The study was done in a DCH with 1500 beds including 250 intensive care unit (ICU) beds.

Study design and population

This was a hospital-based cross-sectional study. All doctors and nurses positive on reverse transcriptase–polymerase chain reaction (RT-PCR) test of nasopharyngeal or/and oropharyngeal samples for COVID-19 who were admitted in this DCH from April 2020 to January 2021and with definite outcome (death or discharge) till the end of January 2021 were included in this study. Suspected cases of COVID-19 whose RT-PCR never came positive were excluded. The information was collected in a predesigned pro forma which included sociodemographic data, duration of stay, comorbidities, and outcome by trained staff. Permission of the institute ethics committee was taken. Informed consent of all participants was taken. Study variables were sociodemographic factors, duration of hospital stay, and comorbidities. The interval between first positive and negative RT-PCR swab results was considered as time for cessation of viral shedding (CVS). The HCW term was used to denote doctor and nurses working for patient care.

Statistical analysis

Data entry was done by using Microsoft Excel version 2010 and statistical analysis was done using IBM SPSS Statistics for Windows (Version 23.0. Armonk, NY: IBM Corp), Chi-square test, Fisher's exact test, t-test, and Kaplan–Meier test were used to compare doctors and nurses. To explore the risk factors associated with mortality of HCWs, bivariate and multivariate logistic regression analysis was done. Six predictors were entered into the model using the “enter” selection method. The multiple coefficient of determination (R2) was used as the goodness-of-fit statistic for the model. The level of significance was fixed at 0.05.


  Results Top


Total 1048 COVID-19 doctors and nurses who were admitted in this DCH from April 2020 to January 2021 and with definite outcome (death or discharge) till the end of January 2021 were included in the study. These HCWs were working in different hospitals/clinics in and around the city; few of them were retired. This paper describes the sociodemographic and clinical profile of these 1048 HCWs. The age (mean ± standard deviation [SD]) of the HCWs was 33.81 ± 14.1 years (range: 18–92 years) and majority (619, 59.1%) were young (18–30 years). As shown in [Table 1], there was a significant difference between doctors and nurses with respect to age, gender, symptomatics, and hypothyroidism.
Table 1: Clinical characteristics of health-care workers with coronavirus disease 2019

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Most (185, 91.6%) of the nurses were female, while majority (533, 63%) of the doctors were male. The 11 (1%) HCWs who died were all doctors, but the difference was not statistically significant. The mortality rate of COVID-19 patients in our hospital for study period was 6.2%. The duration of hospital stay (mean ± SD) of the HCWs was 13.44 ± 13 days (range: 1–84 days). Total 121 (11.54%) HCWs had comorbidities, and hypertension 70 (6.7%) and diabetes 62 (5.9%) were most common. Majority (940, 89.7%) of the HCWs were symptomatic. The patients requiring ICU and respiratory support were 36 (3.4%) and 13 (1.3%), respectively. Out of 13, 4 patients required nasal O2, 2 – NIV, 4 – NRBM, and 3 – ventilatory support. In doctors, the interval (mean ± standard error [SE]) between first positive and negative swab results (CVS) on RT-PCR was 13.65 ± 0.48 days. In nurses, this CVS (mean ± SE) was 11.875 ± 0.99 days.

As shown in [Table 2], in multivariate analysis, two variables emerged as significant predictors for mortality. HCWs >60 years of age were at 36.01 times (confidence interval [CI]: 3.45–375.5) higher risk of death as compared to age group (18–40 years) (P < 0.05). HCWs who were suffering from diabetes were at 10.4 times (CI: 1.82–59.51) higher risk of death as compared to nondiabetic HCWs. The Nagelkerke pseudo-R2 value for the final model was 50.1%. Most (90.9%) deaths occurred in men, but the difference was not statistically. Mortality was more in males than females. This difference was statistically significant in Univariate analysis but not in multivariate analysis. Out of the 11 HCWs who died, 8 (72.72%) were above 60 years of age and 10 (90.9%) had comorbidities. The mean duration from admission to death was 9.36 days.
Table 2: Univariate and multivariate analysis of determinants of mortality of health-care workers with coronavirus disease 2019

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  Discussion Top


This study gives valuable insights about the clinical presentation, mortality, its risk factors, and viral clearance in doctors and nurses with COVID-19.

In this study, the mortality rate among HCWs was 1% while the overall mortality rate in all COVID-19 patients was 6.2%. The mortality rate for COVID-19 for the general population in India and Maharashtra was 1.43% and 2.49%, respectively.[1] However, in this DCH, many severe cases were admitted. In a study in Nair DCH, Mumbai, also the mortality rate was 1% in the 413 HCWs having COVID-19.[4] The mean age of patients and symptomatic percentage were similar in both studies, but in our study, we had only doctors and nurses, more elderly patients, no co-infections, lesser patients requiring ICU, and lesser HCWs with comorbidities. In a meta-analysis (preprint), the mortality rate of HCWs was 0.5%.[5] In a systematic review, the mortality rate of HCWs was 1%.[6] The reason for the mortality among HCWs being lower compared to the mortality rate in the general population can be due to better overall knowledge about disease leading to better care among HCWs, different age, economic, and educational level.

In our study, 80% of HCWs were doctors and 20% were nurses. Although all deaths occurred in doctors, difference was not statistically significant. According to a meta-analysis, the most frequently affected HCWs were nurses (50%).[5] In a systematic review, the most frequently affected HCWs were nurses (38.6%), but most (51.4%) deaths occurred in doctors.[6]

In our study, 52% of HCWs were male, and 90.9% of those who were dead were men, but the difference between the morality of males and females was not statistically in multivariate analysis. In a systematic review, 28.4% of infected HCWs were male, but 70.8% of dead HCWs were male.[6] In Maharashtra for COVID-19, 39% of cases were male and 65% of those dead were male.[1]

In our study, 10.3% of HCWs were asymptomatic. In a study in Nair DCH, Mumbai, also 15% of HCWs were asymptomatic. During the screening of HCWs in London Maternity Home, 34% of HCWs were asymptomatic.[7] In a meta-analysis in 15 studies, the pooled prevalence of asymptomatic HCWs was 40%.[5] In our study, many asymptomatic HCWs opted for home isolation, so the percentage of asymptomatic HCWs is less. Screening of all symptomatic HCWs and asymptomatic HCWs exposed to COVID 19 is important to reduce its transmission.

The duration for CVS was 13.6 days in doctors and 11.9 days in nurses. The difference can be due to difference in age, gender, or comorbidity. Comorbidities lower the probability of the termination of viral shedding.[8]

In our study, the prevalence of comorbidities among HCWs was 11.54% and hypertension 6.7% and diabetes 5.9% were most common. In the study in Nair DCH, comorbidities were reported in 19% of HCWs with COVID-19 and hypertension and diabetes were the most common.[4] In a meta-analysis among the 11,772 COVID-19-positive HCWs, the pooled prevalence of comorbidities was 7%.[5] In our study, most (90.9%) of the HCWs who died had comorbidities. Many studies on COVID-19 in general population show that morality is more in the elderly.[9],[10],[11],[12],[13],[14],[15],[16],[17],[18] Many studies in the general population show that morality is more in diabetic patients.[9],[10],[11],[17],[18] In our study, age >60 years and diabetes were found to be independent risk factors for mortality of HCWs suffering from COVID-19. Such HCWs should be given administrative/office work and avoid contact with patients.

Limitations

This is a Hospital based study and may not represent the scenario in all doctors and nurses (possibility of Berksonian bias).


  Conclusion Top


The mortality rate due to COVID-19 in doctors and nurses was lower (1%) as compared to the general population as most of the HCWs were young and with a low prevalence of comorbidities. A greater proportion of HCWs who died were doctors and male. However, only age >60 years and diabetes mellitus were risk factors for death. Such HCWs should avoid contact with COVID-19 patients. Screening of HCWs for COVID-19 is important to reduce its transmission.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Report of COVID-19 Cases. Medical Education and Drugs Department. Public Health Department. Government of Maharashtra; 10 July, 2021.  Back to cited text no. 1
    
2.
Ministry of Health & Family Welfare Directorate General of Health Services EMR Division. Guidance Document on Appropriate Management of Suspect/Confirmed Cases of COVID 19. Available from: https://www.mohfw.gov.in/pdf/ FinalGuidanceonMangaementofCovidcasesversion 2.pdf. [Last accessed on 2021 Aug 30].  Back to cited text no. 2
    
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World Health Organization. COVID 19: Occupational Health and Safety for Health Workers. Available from: https://www.who.int/ publications/i/item/WHO 2019 nCoV HCW_advice 2021.1. [Last accessed on 2021 Aug 30].  Back to cited text no. 3
    
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Mahajan NN, Mathew A, Pantoja GA, Baharat S, Lichened PD, Rah V, et al. Prevalence, clinical presentations and treatment outcomes of COVID-19 among healthcare workers at a dedicated hospital in India. J Assoc Physicians India 2020;68:16-21.  Back to cited text no. 4
    
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Gómez-Ochoa SA, Franco OH, Rojas LZ, Raguindin PF, Roa-Díaz ZM, Wyssmann BM, et al. COVID-19 in health-care workers: A living systematic review and meta-analysis of prevalence, risk factors, clinical characteristics, and outcomes. Am J Epidemiol 2021;190:161-75.  Back to cited text no. 5
    
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Khalil A, Hill R, Ladhani S, Pattisson K, O'Brien P. COVID-19 screening of health-care workers in a London maternity hospital. Lancet Infect Dis 2021;21:23-4.  Back to cited text no. 7
    
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Kim B, Sohn JW, Nam S, Sohn JW, Choi WS, Kim HS. Factors associated with the delayed termination of viral shedding in COVID-19 patients with mild severity in South Korea. Medicina (Kaunas) 2020;56:659.  Back to cited text no. 8
    
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Tambe MP, Parande MA, Tapare VS, Borle PS, Lakde RN, Shelke SC, et al. An epidemiological study of laboratory confirmed COVID-19 cases admitted in a tertiary care hospital of Pune, Maharashtra. Indian J Public Health 2020;64:S183-7.  Back to cited text no. 9
    
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Yadaw AS, Li YC, Bose S, Iyengar R, Bunyavanich S, Pandey G. Clinical features of COVID-19 mortality: Development and validation of a clinical prediction model. Lancet Digit Health 2020;2:e516-25.  Back to cited text no. 10
    
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Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395:1054-62.  Back to cited text no. 11
    
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Joshi SR. Indian COVID-19 risk score, comorbidities and mortality. J Assoc Physicians India 2020;68:11-2.  Back to cited text no. 12
    
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Mishra V, Burma AD, Das SK, Parivallal MB, Amudhan S, Rao GN. COVID-19-hospitalized patients in Karnataka: Survival and stay characteristics. Indian J Public Health 2020;64:S221-4.  Back to cited text no. 13
    
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Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: A prospective cohort study. Eur Respir J 2020;55:2000524.  Back to cited text no. 14
    
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Porcheddu R, Serra C, Kelvin D, Kelvin N, Rubino S. Similarity in case fatality rates (CFR) of COVID-19/SARS-COV-2 in Italy and China. J Infect Dev Ctries 2020;14:125-8.  Back to cited text no. 15
    
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Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA 2020;323:1239-42.  Back to cited text no. 16
    
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Wortham JM, Lee JT, Althomsons S, Latash J, Davidson A, Guerra K, et al. Characteristics of persons who died with COVID-19 – United States, February 12-May 18, 2020. MMWR Morb Mortal Wkly Rep 2020;69:923-9.  Back to cited text no. 17
    
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Majeed J, Ajmera P, Goyal RK. Delineating clinical characteristics and comorbidities among 206 COVID-19 deceased patients in India: Emerging significance of renin angiotensin system derangement. Diabetes Res Clin Pract 2020;167:108349.  Back to cited text no. 18
    



 
 
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  [Table 1], [Table 2]



 

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