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Coronavirus Disease 2019 (COVID-2019) Infection Among Health Care Workers and Implications for Prevention Measures in a Tertiary Hospital in Wuhan, China

Educational Objective
To understand what the infection rate amongst Health Care Workers in Wuhan, China can tells us about necessary prevention measures
1 Credit CME
Key Points

Question  What are the exposure details and clinical characteristics of health care workers with coronavirus disease (COVID-19) in Wuhan, China?

Findings  In this single-center case series including 9684 health care workers, 110 of whom had COVID-19, a higher rate of infection was found among those working in the low-contagion area during the early stage of the disease outbreak, especially among nurses younger than 45 years. Most health care workers with COVID-19 had nonsevere disease, with an asymptomatic carrier prevalence of 0.9% and a mortality rate of 0.9%.

Meaning  In this study, most infections among health care workers occurred during the early stage of the COVID-19 outbreak and in low-contagion areas; routine screening may be helpful in identifying asymptomatic carriers.


Importance  Health care workers (HCWs) have high infection risk owing to treating patients with coronavirus disease 2019 (COVID-19). However, research on their infection risk and clinical characteristics is limited.

Objectives  To explore infection risk and clinical characteristics of HCWs with COVID-19 and to discuss possible prevention measures.

Design, Setting, and Participants  This single-center case series included 9684 HCWs in Tongji Hospital, Wuhan, China. Data were collected from January 1 to February 9, 2020.

Exposures  Confirmed COVID-19.

Main Outcomes and Measures  Exposure, epidemiological, and demographic information was collected by a structured questionnaire. Clinical, laboratory, and radiologic information was collected from electronic medical records. A total of 335 medical staff were randomly sampled to estimate the prevalence of subclinical infection among a high-risk, asymptomatic population. Samples from surfaces in health care settings were also collected.

Results  Overall, 110 of 9684 HCWs in Tongji Hospital tested positive for COVID-19, with an infection rate of 1.1%. Of them, 70 (71.8%) were women, and they had a median (interquartile range) age of 36.5 (30.0-47.0) years. Seventeen (15.5%) worked in fever clinics or wards, indicating an infection rate of 0.5% (17 of 3110) among first-line HCWs. A total of 93 of 6574 non–first-line HCWs (1.4%) were infected. Non–first-line nurses younger than 45 years were more likely to be infected compared with first-line physicians aged 45 years or older (incident rate ratio, 16.1; 95% CI, 7.1-36.3; P < .001). The prevalence of subclinical infection was 0.74% (1 of 135) among asymptomatic first-line HCWs and 1.0% (2 of 200) among non–first-line HCWs. No environmental surfaces tested positive. Overall, 93 of 110 HCWs (84.5%) with COVID-19 had nonsevere disease, while 1 (0.9%) died. The 5 most common symptoms were fever (67 [60.9%]), myalgia or fatigue (66 [60.0%]), cough (62 [56.4%]), sore throat (55 [50.0%]), and muscle ache (50 [45.5%]). Contact with indexed patients (65 [59.1%]) and colleagues with infection (12 [10.9%]) as well as community-acquired infection (14 [12.7%]) were the main routes of exposure for HCWs.

Conclusions and Relevance  In this case series, most infections among HCWs occurred during the early stage of disease outbreak. That non–first-line HCWs had a higher infection rate than first-line HCWs differed from observation of previous viral disease epidemics. Rapid identification of staff with potential infection and routine screening among asymptomatic staff could help protect HCWs.

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Article Information

Accepted for Publication: April 22, 2020.

Published: May 21, 2020. doi:10.1001/jamanetworkopen.2020.9666

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Lai X et al. JAMA Network Open.

Corresponding Authors: Wei Wang, MD, PhD (wwang@vip.126.com), and Shabei Xu, MD, PhD (xushabei@126.com), Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, No. 1095 Jiefang Ave, Wuhan 430030, China.

Author Contributions: Drs W. Wang and Xu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Lai, M. Wang, and Qin contributed equally to this work.

Concept and design: Lai, M. Wang, Xu, W. Wang.

Acquisition, analysis, or interpretation of data: Lai, M. Wang, Qin, Tan, Ran, Chen, Zhang, Shang, Xia, S. Wang, Xu.

Drafting of the manuscript: Lai, M. Wang, Qin, Zhang, Shang, Xu, W. Wang.

Critical revision of the manuscript for important intellectual content: Lai, M. Wang, Tan, Ran, Chen, Xia, S. Wang, Xu, W. Wang.

Statistical analysis: M. Wang, Qin, Chen, Shang.

Obtained funding: Lai.

Administrative, technical, or material support: Lai, Qin, Tan, S. Wang.

Supervision: Lai, S. Wang, Xu, W. Wang.

Conflict of Interest Disclosures: None reported.

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Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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