SARS-CoV-2 Infection Among Healthcare Workers in Tijuana, Mexico: A Cross-Sectional Study
Keywords:COVID-19, SARS-CoV-2, Coronavirus, Health personnel, Healthcare workers
Background: Healthcare workers (HCW) are a high-risk group for contraction of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of this study was to estimate the effect size of being a HCW and acquiring coronavirus disease 2019 (COVID-19) at the Mexican Institute of Social Security (IMSS) in Tijuana, Mexico.
Methods: A cross-sectional study of the Epidemiologic Surveillance Online Notification System database was conducted, including entries from Tijuana City between March 11, 2020 to May 1, 2020. Multiple imputation was performed for SARS-CoV-2 RT-PCR result where data was missing. Prevalence odds ratios (POR) were calculated to estimate the effect size of HCWs contracting COVID-19 compared to the general population (GP).
Results: From a total of 10,216 entries, 6,256 patients were included for analysis. HCW status was significantly associated with higher odds of acquiring COVID-19, (POR=1.730, 95% Confidence Interval [95%CI]=1.459;2.050). Nurses had double odds (POR=2.339, 95%CI=1.804;3.032) than the GP. Physicians had a POR=1.828 (95%CI=0.766;1.380). Resident physician status was double the likelihood of the GP (POR=2.166, 95%CI=0.933;5.025). Meanwhile, being an intern had a protective factor (POR=0.253, 95%CI=0.085;0.758). Among medical specialties, emergency medicine had the highest exposure-effect association, followed by anesthesiologists.
Conclusion: HCW had up to 73% increased odds of acquiring COVID-19 than the GP in Tijuana, Mexico. Nurses were the group with the highest likelihood out of all HCW, as a result of prolonged and close contact with patients. Emergency medicine and anesthesiology were the medical specialties with the highest odds of infection because they frequently perform aerosol-generating procedures.
Bhagavathula AS, Aldhaleei WA, Rahmani J, Mahabadi MA, Bandari DK. Knowledge and Perceptions of COVID-19 Among Health Care Workers: Cross-Sectional Study. J Med Internet Res. 2020 Apr 30;6(2):e19160.
Koh D. Occupational risks for COVID-19 infection. Occup Med (Lond). 2020 Mar 12;70(1):3-5
Udugama B, Kadhiresan P, Kozlowski HN, Malekjahani A, Osborne M, Li VYC, et al. Diagnosing COVID-19: The Disease and Tools for Detection. ACS Nano. 2020 Apr 28;14(4):3822–35.
Munster VJ, Koopmans M, van Doremalen N, van Riel D, de Wit E. A novel coronavirus emerging in China - Key questions for impact assessment. N Engl J Med. 2020 Feb 20;382(8):692–4.
Ran L, Chen X, Wang Y, Wu W, Zhang L, Tan X. Risk Factors of Healthcare Workers with Corona Virus Disease 2019: A Retrospective Cohort Study in a Designated Hospital of Wuhan in China. Clin Infect Dis. 2020 Nov 19;71(16):2218–21.
Hunter E, Price DA, Schim van der Loeff I, Baker KF, Lendrem D, Lendrem C, et al. First experience of COVID-19 screening of health-care workers in England. Lancet. 2020 May 2;395(10234):e77–78
Chang D, Xu H, Rebaza A, Sharma L, Dela Cruz CS. Protecting health-care workers from subclinical coronavirus infection. Lancet Respir Med. 2020 Mar;8(3):e13.
World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease2019 (COVID-19). Available from: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf. Last updated Feb 24, 2020; cited Nov 30, 2020.
García-Méndez N, Lagarda Cuevas J, Otzen T, Manterola C. Anesthesiologists and the High Risk of Exposure to COVID-19. Anesth Analg. 2020 Aug;131(2):e92–93.
Li R, Pei S, Chen B, Song Y, Zhang T, Yang W, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science. 2020 May;493(5):489–93.
Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020 Apr 7;323(13):1239–42.
Hamed E, Abd Elhamid M, Alemrayat B. Suspected cases of COVID-19: study protocol for reporting characteristics and the outcomes. Fam Med Community Heal. 2020 Apr;8(2):e000400.
Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: is fecal-oral transmisssion of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol. 2020 Apr;5(4):335–7.
Dijkhuizen LGM, Gelderman HT, Dujist WLJM. Review: The safe handling of a corpse (suspected) with COVID-19. J Forensic Leg Med. 2020 Jul;73:101999.
Shah PS, Diambomba Y, Acharya G, Morris SK, Bitnun A. Classification system and case definition for SARS-CoV-2 infection in pregnant women, fetuses, and neonates. Acta Obstet Gynecol Scand. 2020 May;99(5):565–8.
Huh S. How to train health personnel to protect themselves from SARS-CoV-2 (novel coronavirus) infection when caring for a patient or suspected case. J Educ Eval Health Prof. 2020 Jan;17:10.
Zhang Z, Liu S, Xiang M, Li S, Zhao D, Huang C, et al. Protecting healthcare personnel from 2019-nCoV infection risks: lessons and suggestions. Front Med. 2020 Apr;14(2):229–31.
Gobierno de Mexico. Versión estenográfica. Conferencia de prensa. Informe diario sobre coronavirus COVID-19 en México 24-03-2020. Available from: https://www.gob.mx/presidencia/articulos/version-estenografica-conferencia-de-prensa-informe-diario-sobre-coronavirus-covid-19-en-mexico-240978?fbclid=IwAR0eb_SC3RN2f921tq-qw79EFSQIfpPNKzVHF5qsR0zTfBWtvccyvoM9rTg. Last updated Mar 24, 2020; cited May 26, 2020.
Wilder-Smith A, Teleman MD, Heng BH, Earnest A, Ling AE, Leo YS. Asymptomatic SARS coronavirus infection among healthcare workers, Singapore. Emerg Infect Dis. 2005 Jul;11(7):1142–5.
Secretaría de Salud. Lineamiento técnico de uso y manejo del equipo de protección personal ante la pandemia por COVID-19. Available from: https://coronavirus.gob.mx/wp-content/uploads/2020/05/Lineamiento_uso_manejo_EPP_COVID-19.pdf. Last updated May 12, 2020; cited May 26, 2020.
He X, Lau EHY, Wu P, Deng X, Wang J, Hao X, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. 2020 May;26(5):672–5.
Gandhi M, Yokoe DS, Havlir D V. Asymptomatic Transmission, the Achilles’ Heel of Current Strategies to Control Covid-19. N Engl J Med. 2020 May 28;382(22):2158–60.
Wang J, Zhou M, Liu F. Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect. 2020 May;105(1):100–101.
Chen MIC, Lee VJM, Barr I, Lin C, Goh R, Lee C, et al. Risk factors for pandemic (H1N1) 2009 virus seroconversion among hospital staff, Singapore. Emerg Infect Dis. 2010 Oct;16(10):1554–61.
Jackson D, Anders R, Padula W V, Daly J, Davidson PM. Vulnerability of nurse and physicians with COVID-19: Monitoring and surveillance needed. J Clin Nurs. 2020 Oct;29(19-20):3584–87.
Bernard H, Fischer R, Mikolajczyk RT, Kretzschmar M, Wildner M. Nurses’ contacts and potential for infectious disease transmission. Emerg Infect Dis. 2009 Sep;15(9):1438–44.
Huang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses’ protection during the COVID-19 epidemic. Crit Care. 2020 Mar 27;24(1):120.
Wei L, Fang T, Fang L-Q, de Vlas SJ, Ma H-J, Zhou J-P, et al. Risk factors for SARS infection among hospital healthcare workers in Beijing: a case control study. Trop Med Int Heal. 2009 Oct 7;14(1):52–9.
Prieto-Miranda SE, Jiménez-Bernardino CA, Cázares-Ramírez G, De Vera-Haro MJ, Esparza-Pérez RI. [Working hours and their repercussions on resident doctors in a second level hospital]. 2015 Nov;31:669–79. Esp
Acosta-Fernández M, Aguilera-Velasco MA, Pozos-Radillo BE, Torres-López TM, Parra Osorio L. [Experiences of Mexican resident physicians during their first year of education]. Inv Ed Med. 2017 Nov 8;6(23):169–79. Esp
Weiss P, Kryger M, Knauert M. Impact of extended duty hours on medical trainees. Sleep Health. 2016 Dec;2(4):309–15.
Ridout KK, Ridout SJ, Guille C, Mata DA, Akil H, Sen S. Physician-Training Stress and Accelerated Cellular Aging. Biol Psychiatry. 2019 Nov 1;86(9):725–30.
Dirección General de Calidad y Educación en Salud. Statement No DGCES-DG-0436-2020 Undergraduate Intern Physicians During Phase II of contingency due to COVID-19 pandemic. Mexico City; Apr 7, 2020. Available from: https://www.amfem.edu.mx/index.php/acerca/comunicados?start=3. Last updated Apr 7, 2020; cited May 26, 2020.
Whiteside T, Kane E, Aljohani B, Alsamman M, Pormand A. Redesigning emergency department operations amidst a viral pandemic. Am J Emerg Med. 2020 Jul;38(7):1448–53.
Canova V, Lederer Schlpfer H, Piso RJ, Droll A, Fenner L, Hoffmann T, et al. Transmission risk of SARS-CoV-2 to healthcare workers – observational results of a primary care hospital contact tracing. Swiss Med Wkly. 2020 Apr 25;150:w20257.
Weissman DN, de Perio MA, Radonovich Jr LL. COVID-19 and risks posed to personnel during endotracheal intubation. JAMA. 2020 May 26;323(20):2027–8.
How to Cite
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to firstname.lastname@example.org
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to email@example.com