Epidemiological and Clinical Profile of Healthcare Providers Affected With Covid-19 at Civil Hospital, Medicity Campus, Ahmedabad, Gujarat

December 2019. This infection has since spread globally at a rapid pace, with COVID-19 cases having been identified in several other countries and territories, causing significant morbidity and mortality. The ABSTRACT Background: SARS-CoV-2 has spread globally at a rapid pace, causing significant morbidity and mortality. Healthcare providers are especially vulnerable to infection with important implications. There might be adverse effects on their health, they could transmit the infection to vulnerable patients, family contacts and other staff if not quickly isolated and high rates of infection could cause problems due to health system manpower shortage. Methodology: A cross-sectional study was conducted where a preformed semi-structured questionnaire was sent using Google forms. A total of 311 healthcare providers were sent the form out of which 161 responded. Analysis was done using Microsoft Excel 2019 and Google Forms. Result: 75.16% healthcare providers always wore PPE, 11.18% wore it as per duty requirements and 13.66% used mask and sanitizer in non Covid duty areas. They were infected even with use of protective measures. 14.91% reported having co morbidities. Hypertension 8.7% followed by Diabetes 4.96% was the commonest. A significant association was present between sex and work profile of respondents with hospital admission. Conclusion: Our study data can be used for making appropriate management strategies. Training should be provided in infection prevention control practices. Duty schedule should be designed so as to evenly distribute duties.


INTRODUCTION
An epidemic caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), a positive sense single stranded RNA virus of zoonotic origin, emerged in Wuhan, Hubei Province, China, in De-cember 2019.This infection has since spread globally at a rapid pace, with COVID-19 cases having been identified in several other countries and territories, causing significant morbidity and mortality.The COVID-19 transmission is potent, and the secondary attack rate is high. 1 Over 97,00,000 cases have been detected in India as of 10 th December 2020, leading it to become the primary cause of health related concern in the country. 2 Healthcare workers (HCWs) are especially vulnerable to infection by SARS-CoV-2.In the first published series of 138patients from Wuhan (China), 29% of the cases were HCWs.Very few studies have focused on SARS-CoV-2 infection among HCWs.Moreover, the data available so far have focused on the proportion of HCWs infected but have not sufficiently described epidemiological and clinical characteristics of the affected workers. 3,4,5,6,7ere are important implications of COVID-19 among HCWs.First, there might be adverse effects on their health: in the previously mentioned series from China, 14.8% of the cases among HCWs were classified as severe or critical and five of the patients died.Second, if they are infected they could also transmit the infection to vulnerable patients if they are not adequately and quickly isolated.Third, high rates of infection among them could cause problems due to shortage of staff in the health system.Fourth, they may transmit the infection to close family contacts, other HCWs, and the community. 3,4,5,6,7e to the importance of COVID-19 implications among HCWs, and the paucity of information published on this, it is important that we study its epidemiology and clinical characteristics better in order to make appropriate prevention and management strategies by decision-makers.

MATERIALS AND METHODS
A cross-sectional study was conducted where a pre formed semi structured questionnaire was sent using google forms.A pretested questionnaire was used which was validated with the help of a pilot study.A pilot study was conducted among 20 persons taking 5 respondents each from doctors, nursing staff, paramedical staff and other allied departments.The questionnaire was prepared in English, Hindi and Gujarati and circulated amongst all cadres of Covid positive healthcare providers.Informed consent was taken from all respondents.The details for Covid positive healthcare providers was obtained from the Covid Control Room set up at Civil Hospital, Medicity Campus, Ahmedabad.The questionnaire was sent using whatsapp, sms and email to all concerned staff thus allowing data capture from various places.Ethical approval was approved for this study.
A total of 311 healthcare providers (total no. of healthcare providers positive as of 20 th of November) were sent the form out of which 161 responded.Analysis was done using Microsoft Excel 2019 and Google Forms.
Majority of healthcare providers 95 (59.01%) were working in the hospital IPD when infected while 11 (6.83%) were working in the hospital OPD.55 (34.16%) were working in other related departments.
Study reported that there were more female respondents (63.35%) than male.Majority (45.96%) were in the 20-29 years age group followed by the 30-39 years age group.Mean age of the respondents was 34.5 years while the median age was 30 years.(Table 1)      2) 53 (32.92%) had taken HCQ prophylaxis.It was observed that amongst those who had taken HCQ prophylaxis, 26.4% required hospital admission which was greater than amongst those who did not take HCQ prophylaxis where 18.5% required admission.
A total of 24 (14.91%)respondents reported having co morbidities.Generalized weakness (59.6%) followed by fever (53.4%) were the most commonly reported symptoms.Hypertension (8.7%) followed by Diabetes (4.96%) were the common co morbidities reported.(Table 3 A significant association (p<0.05) was present between sex and work profile of respondents with hospital admission.(Table 5)

DISCUSSION
Covid has had manifold implications on physical, mental and social health of frontline workers.On an already overburdened healthcare system Covid has had catastrophic effects.Apart from being infected themselves, they also have the potential to infect the patients they take care of.Staying away from their family and the fear of infecting them has added to mental burden of the aforementioned workers.
In our study 10.9% of the total healthcare providers working were infected.Out of all respondents, it was observed that 17 (42.5%)persons required hospital admission were aged 40 and above while 17 (14.05%)were aged below 40 years.It shows that those in a higher age group required more hospital admissions as compared to lower age groups.
The mean age of our respondents was 34.5 years which was similar to the mean age of the respondents of the study conducted in Delhi.The median age of our study was 30 years which was lower than the study conducted in Spain which had a higher median age (42 years). 1,3,8The difference might be due to different age proportions between the country.
32.92% had taken hydroxychloroquine prophylaxis which was lower than the no. of healthcare workers who had taken HCQ prophylaxis in the study conducted in Delhi (57.5%).Despite taking HCQ, our study showed that more respondents required hospital admissions among those who had taken HCQ prophylaxis compared to those who had not.Despite using protective measures it was observed in our study that healthcare providers were at increased risk of infection than the general population.
The most common symptom reported in our study was weakness (59.6%) while fever was the most common symptom reported in the studies conducted in other studies.14.91% respondents reported one or more comorbid conditions in our study which was lower than the study conducted in Canada (29.1%)but higher than the Delhi study (10.6%).Hypertension was the most common comorbidity reported which was similar to the studies conducted in Canada and Delhi where Cardiovascular disease and Hypertension were the commonest comorbid conditions reported respectively. 1,8 our study, 21.12 % respondents required hospital admission which was higher than the studies conducted in Canada (2.5%) and Spain (5.2%). 3,8his may be due the fact that initial hospital policy required all infected healthcare providers to get admitted.This policy was modified later.2.48 % reported long Covidi i.e. symptoms and complications persisting for more than 3 weeks after the initial infection.Higher infection rate was seen among healthcare providers, especially among those coming directly in patient contact.

CONCLUSION AND RECOMMENDATIONS
59.01% healthcare providers were working in the hospital IPD when infected while 6.83% were in the hospital OPD and 34.16% in other related departments.
75.16% healthcare providers always wore PPE while11.18%wore it as per duty requirements and 13.66% used mask and sanitizer in non Covid duty areas.It is important to note that healthcare providers were infected even with the use of protective measures.
14.91% reported having co morbidities.Hypertension 8.7% followed by Diabetes 4.96% were the common co morbidities reported.
A significant association was present between sex and work profile of respondents with hospital admission.
The data provided by our study can be used for making appropriate prevention and management strategies.All health care personnel should be provided with appropriate training in infection prevention control practices.The duty schedule should be so designed so as to evenly distribute duties among various healthcare providers.A pre placement examination of all workers should be carried out to segregate those having comorbid conditions and associated high risk conditions and preventing severity of outcome.Incentives and use of innovative technologies such as video calls with loved ones would help in reducing stress among them.Adequate care should be taken of infected healthcare providers.