COVID-19 Outcomes Among Hospitalized Health Care Workers

Quick Takes

  • Health care workers (HCWs) hospitalized for COVID-19 do not appear to have worse outcomes compared to non-HCWs.
  • Generally, HCWs were younger and had less comorbidities than non-HCWs hospitalized for COVID-19.
  • The use of personal protective equipment and systematic testing in the hospital setting may lead to lower inoculum doses. Accordingly, the findings of this study cannot be used to make any inferences on the relationship between inoculum and severity of illness in COVID-19.

Study Questions:

Are coronavirus disease 2019 (COVID-19)-related outcomes in health care workers (HCWs) worse than the general population?

Methods:

In this retrospective, observational cohort study of 1,790 hospitalized patients with laboratory-confirmed COVID-19 enrolled across 36 North American centers from April 15 to June 5, 2020, the authors compared outcomes between HCWs (n = 127) and non-HCWs (n = 1,663). The primary outcome was a composite endpoint of mechanical ventilation or death. Secondary outcomes included individual components of the primary outcome, intensive care unit admission, any requirement for vasopressor support, and hospital length of stay. The authors compared HCWs and non-HCWs in the overall cohort, then performed a 3:1 propensity score match to minimize differences between groups.

Results:

Overall, HCWs were younger, consisted of more women, and had a lower burden of comorbidities compared with non-HCWs, and were less likely to require mechanical ventilation or die during hospitalization. After 3:1 propensity score matching, 122 HCWs were matched to 366 non-HCWs (58% women, mean age 57 years). In the matched cohort analysis, the odds of the primary outcome, mechanical ventilation or death, were not significantly different for HCWs compared with non-HCWs (adjusted odds ratio [AOR], 0.60; 95% confidence interval [CI], 0.34-1.04), but were less likely to require admission to an intensive care unit (AOR, 0.56; 95% CI, 0.34-0.92) and had shorter hospitalizations. They were also less likely to require an admission of 7 days or longer (AOR, 0.53; 95% CI, 0.34-0.83).

Conclusions:

HCWs did not have worse outcomes compared to non-HCWs among hospitalized patients with COVID-19.

Perspective:

The importance of this study lies in the rationale for pursuing it: the preconception that HCWs may be at higher risk of severe COVID-19 due to their potential exposure to higher infectious doses. This study, despite its flaws (nonsystematic data collection with high risk of selection bias), suggests otherwise. While the association between inoculum and mortality has been shown with many respiratory viruses and may also hold true in COVID-19, HCWs caring for COVID-19 patients during most of the pandemic have had access to personal protective equipment. Systematic testing of all hospitalized patients and identification of severe acute respiratory syndrome coronavirus 2–positive patients with subsequent adoption of isolation measures likely leads to lower inoculum doses, if any. HCWs, just like anyone else, can be infected through the community rather than workplace exposures. Accordingly, the findings of this study cannot be used to make any inferences on the relationship between inoculum and severity of illness in COVID-19.

Clinical Topics: Prevention

Keywords: Comorbidity, Coronavirus, COVID-19, Health Personnel, Hospitalization, Intensive Care Units, Outcome Assessment (Health Care), Length of Stay, Personal Protective Equipment, Primary Prevention, Respiration, Artificial, severe acute respiratory syndrome coronavirus 2, Vasoconstrictor Agents, Ventilation


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