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Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic

Educational Objective
To understand what the infection rate amongst Health Care Workers in 2 Dutch Hospitals can tell us about necessary prevention measures
1 Credit CME
Key Points

Question  What was the prevalence and clinical presentation of coronavirus disease 2019 among health care workers with self-reported fever or respiratory symptoms in 2 Dutch hospitals within 2 weeks after the first patient with coronavirus disease 2019 was detected in the Netherlands?

Findings  In this cross-sectional study that included 1353 health care workers with self-reported fever or respiratory symptoms, 6% were infected with severe acute respiratory syndrome coronavirus 2. Most health care workers with coronavirus disease 2019 experienced mild disease, and only 53% reported fever.

Meaning  The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected coronavirus disease 2019 should be used less stringently.

Abstract

Importance  On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch teaching hospitals, 9 health care workers (HCWs) received a diagnosis of COVID-19, 8 of whom had no history of travel to China or northern Italy, raising the question of whether undetected community circulation was occurring.

Objective  To determine the prevalence and clinical presentation of COVID-19 among HCWs with self-reported fever or respiratory symptoms.

Design, Setting, and Participants  This cross-sectional study was performed in 2 teaching hospitals in the southern part of the Netherlands in March 2020, during the early phase of the COVID-19 pandemic. Health care workers employed in the participating hospitals who experienced fever or respiratory symptoms were asked to voluntarily participate in a screening for infection with the severe acute respiratory syndrome coronavirus 2. Data analysis was performed in March 2020.

Main Outcomes and Measures  The prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase–polymerase chain reaction on oropharyngeal samples. Structured interviews were conducted to document symptoms for all HCWs with confirmed COVID-19.

Results  Of 9705 HCWs employed (1722 male [18%]), 1353 (14%) reported fever or respiratory symptoms and were tested. Of those, 86 HCWs (6%) were infected with severe acute respiratory syndrome coronavirus 2 (median age, 49 years [range, 22-66 years]; 15 [17%] male), representing 1% of all HCWs employed. Most HCWs experienced mild disease, and only 46 (53%) reported fever. Eighty HCWs (93%) met a case definition of fever and/or coughing and/or shortness of breath. Only 3 (3%) of the HCWs identified through the screening had a history of travel to China or northern Italy, and 3 (3%) reported having been exposed to an inpatient with a known diagnosis of COVID-19 before the onset of symptoms.

Conclusions and Relevance  Within 2 weeks after the first Dutch case was detected, a substantial proportion of HCWs with self-reported fever or respiratory symptoms were infected with severe acute respiratory syndrome coronavirus 2, likely as a result of acquisition of the virus in the community during the early phase of local spread. The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected COVID-19 should be used less stringently.

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Article Information

Accepted for Publication: April 24, 2020.

Published: May 21, 2020. doi:10.1001/jamanetworkopen.2020.9673

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Kluytmans-van den Bergh MFQ et al. JAMA Network Open.

Corresponding Author: Marjolein F. Q. Kluytmans-van den Bergh, PhD, Department of Infection Control, Amphia Hospital, PO Box 90158, 4800 RK Breda, the Netherlands (marjoleinkluytmans@gmail.com).

Author Contributions: Dr Kluytmans-van den Bergh had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kluytmans-van den Bergh, Buiting, Koopmans, Kluytmans.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Kluytmans-van den Bergh.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Kluytmans-van den Bergh, Kluytmans.

Administrative, technical, or material support: Kluytmans-van den Bergh, Buiting, Pas, van den Bijllaardt, van Oudheusden, Verweij.

Supervision: Buiting, Pas, Koopmans, Kluytmans.

Conflict of Interest Disclosures: Dr Pas reported serving as a scientific advisory board consultant for Luminex from 2016 to 2019 and received travel reimbursement; her employer (Microvida Laboratory for Medical Microbiology, Bravis Hospital, Roosendaal, the Netherlands) received her advisory board consultancy fee. No other disclosures were reported.

Additional Contributions: Anneke M. C. Bergmans, PhD (Microvida Laboratory for Medical Microbiology, Bravis Hospital, Roosendaal, the Netherlands), provided facility management and interpretation of laboratory tests. Harold Verbakel, BSc, and Wilma Ritmeester, BSc (Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands), provided facility management. Martijn van der Ent, BSc, and Meike Wennekes, BSc (Microvida Laboratory for Medical Microbiology, Bravis Hospital, Roosendaal, the Netherlands), provided technical support. Ingrid Aarts, BSc, Caroine Phiri, BSc, Petra van Esch, BSc, Rini Geurts, BSc, Astrid van Eersel, BSc, Henny Broeders, BSc, Helen van Raak, BSc, Ine Michelbrink, BSc, and Iris Geboers, BSc (Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands), provided technical support. They were not compensated beyond their salaries.

References
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