Health Care Workers Hospitalized with COVID-19 May Have Lower Risks

Health care workers hospitalized with coronavirus disease 2019 (COVID-19) may have better outcomes, with less likelihood of intensive care unit admission and shorter hospital stays, according to a new study.

The study, published in JAMA Network Open, included 127 health care workers (HCW) and 1663 non-health care workers who were hospitalized with COVID-19 at 36 North American centers from April 15 to June 5, 2020. Propensity matching narrowed the group to 122 health care workers and 366 non-health care workers based on such factors as age, gender, race and health conditions.

“In this study, hospitalized individuals with confirmed HCW status did not experience worse COVID-19–related outcomes compared with a matched non-HCW cohort,” the study authors wrote. “In fact, HCW status was modestly but significantly associated with a lack of requirement for ICU admission and with a shorter overall length of hospitalization.”

The odds of mechanical ventilation or death were not significantly different among the propensity-matched groups. Health care workers were less likely to require ICU admission (AOR, 0.56; 95% CI, 0.34-0.92) and less likely to require hospitalization for 7 days or longer (AOR, 0.53; 95% CI, 0.34-0.83).

Previous studies have found that health care workers are more likely to contract COVID-19 than the general public, with one recent study finding a threefold increased risk of being hospitalized for COVID-19 among those with direct contact with patients.

“It appears that nurses are more likely than physicians to acquire COVID-19,” the authors noted. “This is probably not surprising given that it is well established that nurses, on average, spend the most time relative to other groups with individual patients, thereby increasing their total risk of exposure as well as their potential infectious dose.”

Possible factors contributing to the equivalent to slightly better outcomes among health care workers who are hospitalized with COVID-19 include meticulous PPE practices, connections to the medical community leading to more prompt diagnosis and treatment, and a possible healthy worker effect. Health care workers had lower Charlson Comorbidity Index (CCI) scores than non-health care workers. The mean (standard deviation) CCI score for health care workers was 0.9 (1.4) vs 1.6 (1.8) for all non-health care workers and 1.1 (1.6) for the matched cohort.

While the study demonstrated that health care workers were not more likely to have worse outcomes once hospitalized, the authors pointed out that “it is critical to recognize the physical, psychological, social, and practical burdens of this disease on HCWs, who collectively represent a disproportionately affected population.”

A recent study showed that the pandemic has put frontline health care workers at greater risk for mental health problems such as depression, insomnia, anxiety and acute traumatic stress.

“To add to this baseline state of unrest, HCWs with COVID-19 may be susceptible to experiencing additional negative emotions, such as frustration or helplessness in addition to shame or stigmatization by colleagues,” the study noted. “Workplaces should ensure that mechanisms are in place to both identify and support at-risk HCWs, including potential routine screening of personnel to evaluate risk factors for (or symptoms of) depression, anxiety, or high stress.”

Limitations of the study include that it didn’t distinguish where health care workers were exposed to the virus or identify how exposure intensity may affect outcomes. The study relied on medical record review and didn’t household contacts.

“Further research is needed to elucidate the proportion of HCW infections acquired in the workplace and to assess whether HCW type is associated with outcomes,” the authors wrote