COVID-19 in health care workers in a university hospital during the quarantine in São Paulo city | The Brazilian Journal of Infectious Diseases

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Source: Hospital de Messejana, Fortaleza, Ceará, Brazil. *100% means the total hospital capacity (beds), which was increased due to COVID-19 pandemics; it reached a peak of 130% on 11th May, and a tendency to decrease was detected after the lockdown period, mainly from 21st May on, when the bed occupancy is near 100% of the hospital capacity." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Danielli Oliveira da Costa Lino, Renato Barreto, Francisco Daniel de Souza, Carlos José Mota de Lima, Geraldo Bezerra da Silva Junior" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Danielli Oliveira da Costa" "apellidos" => "Lino" ] 1 => array:2 [ "nombre" => "Renato" "apellidos" => "Barreto" ] 2 => array:2 [ "nombre" => "Francisco Daniel de" "apellidos" => "Souza" ] 3 => array:2 [ "nombre" => "Carlos José Mota de" "apellidos" => "Lima" ] 4 => array:2 [ "nombre" => "Geraldo Bezerra da" "apellidos" => "Silva Junior" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1413867020301161?idApp=UINPBA00003Y" "url" => "/14138670/0000002400000005/v5_202012221025/S1413867020301161/v5_202012221025/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1413867020301021" "issn" => "14138670" "doi" => "10.1016/j.bjid.2020.07.003" "estado" => "S300" "fechaPublicacion" => "2020-09-01" "aid" => "1004" "copyright" => "Sociedade Brasileira de Infectologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by/4.0/" "subdocumento" => "sco" "cita" => "Braz J Infect Dis. 2020;24:458-61" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Brief communication" "titulo" => "Triage tool for suspected COVID-19 patients in the emergency room: AIFELL score" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "458" "paginaFinal" => "461" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ian Levenfus, Enrico Ullmann, Edouard Battegay, Macé M. Schuurmans" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ian" "apellidos" => "Levenfus" ] 1 => array:2 [ "nombre" => "Enrico" "apellidos" => "Ullmann" ] 2 => array:2 [ "nombre" => "Edouard" "apellidos" => "Battegay" ] 3 => array:2 [ "nombre" => "Macé M." "apellidos" => "Schuurmans" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1413867020301021?idApp=UINPBA00003Y" "url" => "/14138670/0000002400000005/v5_202012221025/S1413867020301021/v5_202012221025/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Brief communication" "titulo" => "COVID-19 in health care workers in a university hospital during the quarantine in São Paulo city" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "462" "paginaFinal" => "465" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Klinger Soares Faíco-Filho, Joseane Mayara Almeida Carvalho, Danielle Dias Conte, Luciano Kleber de Souza Luna, Nancy Bellei" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Klinger Soares" "apellidos" => "Faíco-Filho" "email" => array:1 [ 0 => "Klingerfaiko@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Joseane Mayara Almeida" "apellidos" => "Carvalho" ] 2 => array:2 [ "nombre" => "Danielle Dias" "apellidos" => "Conte" ] 3 => array:2 [ "nombre" => "Luciano Kleber" "apellidos" => "de Souza Luna" ] 4 => array:2 [ "nombre" => "Nancy" "apellidos" => "Bellei" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Universidade Federal de São Paulo, São Paulo, SP, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at627 Rua Pedro de Toledo,781 - Vila Clementino, 04024-002 São Paulo, Brazil." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 4003 "Ancho" => 2917 "Tamanyo" => 579980 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "SARS-CoV-2 infected health care workers distributed by residential Administrative Districts (n = 106)" ] ] ] "textoCompleto" => "On March 11th, WHO declared COVID-19 as a pandemic. Two days after, the first case of COVID-19 was confirmed at Hospital São Paulo, a large university hospital in São Paulo city. On March 23rd, a quarantine was declared by the local authorities.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Despite social distancing measures, SARS-CoV-2 infections increased in many metropolitan areas.Health care workers (HCW) are at a higher risk of being infected in their workplace and at the community level as the outbreak expands in urban areas. We diagnosed COVID-19 among HCW and analyzed their type of exposure and household location in the city.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>From March 22nd to April 22nd, during the quarantine in the city, HCW from Hospital São Paulo presenting with influenza-like illnesses or any clinical suspicion of COVID-19 were evaluated at the HCW Medical Assistance Service as part of a routine surveillance after the pandemic was declared. Of note, 144 patients were hospitalized with a COVID19 diagnosis during this period.Nasopharyngeal swabs were collected, immediately transported to the virology laboratory, and were tested by a specific polymerase chain reaction method for SARS-CoV-2 according to the CDC USA protocol.HCW were categorized based on the type of exposure to patients (daily contact or not) and the hospital job occupation. Logistic workers included laundry, cleaning services, and security staff. Data regarding the HCW’ household locations were also obtained and analyzed according the residential administrative districts. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the general population of confirmed COVID-19 cases in São Paulo city, and the green areas with 120–238 cases were considered the most affected, having the highest risk of SARS-COV-2 transmission.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Statistical analysis: Student t-test, contingency table analysis calculated using chi-square or Fisher’s exact test was used, and a p-value <0.05 was considered statistically significant.A total of 466 swabs for COVID-19 were analyzed, and 36% (n = 169) were Positive for SARS-CoV-2. The median age was 39.2 years and 71.8% were females (335/466). The positivity rate of each category according to exposure and job description is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Logistic workers had the highest rate of SARS-CoV-2 infection (p = 0,0029), but nurse technicians had the highest rate among those reporting daily contact with patients (p = 0.0010).We also analyzed the household geographic distribution of the HCW positive cases in the administrative districts of São Paulo. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows different COVID-19 rates in the general population according to the City Health Office data distributed in the city and also the 106 out of 126 HCW positive cases distributed by household locations.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Nineteen of these HCW lived near the hospital’s neighborhood, the most affected district by the outbreak. The available location of 106 HCW diagnosed with COVID-19 and their household locations are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Doctors presented the lowest rate of infection although living in most affected districts (p < 0.001).COVID-19 transmission among HCW is a common fact; China, Spain, and the USA have also observed a great number of affected HCW.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> Our COVID-19 study was conducted in a university hospital of a district in São Paulo with a high rate of confirmed cases during the quarantine.Considering routine daily contact, nurse technicians were infected the most, probably due to many opportunities for exposure during their shift, although they had received training on the use of personal protective equipment. Unexpectedly, we found that the highest rate of infection was among personnel who had no direct patient contact. Logistic workers were less trained and/or unaware of the risks of COVID-19 transmission at the hospital. Quite often, administrative technicians and logistic workers are not provided with adequate training and personal protective equipment. In this sense, it is essential to implement health policies for professionals who do not have routine contact with patients.Infection of HCW in the community cannot be ruled out, since many HCW live in high affected districts and many of the positive cases live in the hospital’s neighborhood. Liu et al. in their study about the aerodynamics of SARS-CoV-2 reported high levels of airborne RNA in areas prone to crowding, probably due to infected carriers in the crowd.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> However, logistic workers’ household locations were not significantly associated with the most affected COVID-19 districts (p > 0.05).Limitations of this study include small sample size, short study time frame, and lack of some HCW data. Facilitating testing of symptomatic professionals, creating sick leave policies that are non-punitive, flexible, and consistent with public health guidance, and providing adequate training and protective equipment could improve the prevention of infection transmission to employees.Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:3 [ "identificador" => "xres1439310" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1313628" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-06-09" "fechaAceptado" => "2020-08-09" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1313628" "palabras" => array:3 [ 0 => "Coronavirus" 1 => "Health care workers" 2 => "Pandemic" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "Health care workers (HCW) are at a higher risk of being infected in their workplace. Out of a total of 466 HCW of Hospital São Paulo with influenza-like illnesses or any clinical suspicion of COVID-19 were tested for COVID-19 by RT-PCR for SARS-CoV-2 169 (36%) turned out positive and were analyzed by type of exposure and hospital occupation. Data of HCW household locations were also obtained. Logistic workers had the highest positivity rate for SARS-CoV-2 (p = 0.002), while nurse technicians had the highest rate among those reporting routine contacts with patients (p = 0.001). Physicians presented the lowest rate of infection, although living in most affected districts (p < 0.001). Policies and adequate training for all hospital employees may improve prevention of COVID-19 among all health care service categories." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 4003 "Ancho" => 2917 "Tamanyo" => 579980 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "SARS-CoV-2 infected health care workers distributed by residential Administrative Districts (n = 106)" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "High-risk: districts with 120-178 and 179-238 confirmed COVID-19 cases ( up to 04/17/2020) ++ Information on district of residence was not available for 60 COVID-19 cases." 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entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Physician \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">107 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (24.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13/17 <a class="elsevierStyleCrossRef" href="#tblfn0025">#</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Laboratory personnel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (28.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-/3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Physiotherapist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (25.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Phonoaudiologist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (66.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-/1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; 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WHO. <a target="_blank" href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_102">https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_102</a>. Accessed on 20 April." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Chow EJ, Schwartz NG, Tobolowsky FA, et al. Symptom screening at illness onset of health care personnel with SARS-CoV-2 infection in King County, Washington. JAMA. Published online 17 April 2020. <a target="_blank" href="https://doi.org/10.1001/jama.2020.6637">https://doi.org/10.1001/jama.2020.6637</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Prefeitura Municipal de São Paulo. Boletim Epidemiológico. <a target="_blank" href="https://www.prefeitura.sp.gov.br/cidade/secretarias/upload/saude/PMSP_SMS_COVID19_Boletim%20Semanal_20200417_atualizado.pdf">https://www.prefeitura.sp.gov.br/cidade/secretarias/upload/saude/PMSP_SMS_COVID19_Boletim%20Semanal_20200417_atualizado.pdf</a>." ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Z. Wu" 1 => "J.M. McGoogan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2020.2648" "Revista" => array:5 [ "tituloSerie" => "JAMA" "fecha" => "2020" "volumen" => "323" "paginaInicial" => "1239" "paginaFinal" => "1242" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical characteristics of coronavirus disease 2019 in China" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W.J. Guan" 1 => "Z.Y. Ni" 2 => "Y. Hu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa2002032" "Revista" => array:7 [ "tituloSerie" => "N Engl J Med" "fecha" => "2020" "volumen" => "382" "numero" => "18" "paginaInicial" => "1708" "paginaFinal" => "1720" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32109013" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y. Liu" 1 => "Z. Ning" 2 => "Y. 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COVID-19 in health care workers in a university hospital during the quarantine in São Paulo city

Klinger Soares Faíco-Filho

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Klingerfaiko@hotmail.com

Corresponding author at627 Rua Pedro de Toledo,781 - Vila Clementino, 04024-002 São Paulo, Brazil.

, Joseane Mayara Almeida Carvalho, Danielle Dias Conte, Luciano Kleber de Souza Luna, Nancy Bellei

Universidade Federal de São Paulo, São Paulo, SP, Brazil

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        "autoresLista" => "Klinger Soares Fa&#237;co-Filho, Joseane Mayara Almeida Carvalho, Danielle Dias Conte, Luciano Kleber de Souza Luna, Nancy Bellei"
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          0 => array:4 [
            "nombre" => "Klinger Soares"
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          4 => array:2 [
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            "apellidos" => "Bellei"
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          0 => array:2 [
            "entidad" => "Universidade Federal de S&#227;o Paulo&#44; S&#227;o Paulo&#44; SP&#44; Brazil"
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            "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author at</span>627 Rua Pedro de Toledo&#44;781 - Vila Clementino&#44; 04024-002 S&#227;o Paulo&#44; Brazil&#46;"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">SARS-CoV-2 infected health care workers distributed by residential Administrative Districts &#40;n&#8239;&#61;&#8239;106&#41;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">On March 11th&#44; WHO declared COVID-19 as a pandemic&#46; Two days after&#44; the first case of COVID-19 was confirmed at Hospital S&#227;o Paulo&#44; a large university hospital in S&#227;o Paulo city&#46; On March 23rd&#44; a quarantine was declared by the local authorities&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>Despite social distancing measures&#44; SARS-CoV-2 infections increased in many metropolitan areas&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Health care workers &#40;HCW&#41; are at a higher risk of being infected in their workplace and at the community level as the outbreak expands in urban areas&#46; We diagnosed COVID-19 among HCW and analyzed their type of exposure and household location in the city&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">From March 22nd to April 22nd&#44; during the quarantine in the city&#44; HCW from Hospital S&#227;o Paulo presenting with influenza-like illnesses or any clinical suspicion of COVID-19 were evaluated at the HCW Medical Assistance Service as part of a routine surveillance after the pandemic was declared&#46; Of note&#44; 144 patients were hospitalized with a COVID19 diagnosis during this period&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Nasopharyngeal swabs were collected&#44; immediately transported to the virology laboratory&#44; and were tested by a specific polymerase chain reaction method for SARS-CoV-2 according to the CDC USA protocol&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">HCW were categorized based on the type of exposure to patients &#40;daily contact or not&#41; and the hospital job occupation&#46; Logistic workers included laundry&#44; cleaning services&#44; and security staff&#46; Data regarding the HCW&#8217; household locations were also obtained and analyzed according the residential administrative districts&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the general population of confirmed COVID-19 cases in S&#227;o Paulo city&#44; and the green areas with 120&#8211;238 cases were considered the most affected&#44; having the highest risk of SARS-COV-2 transmission&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Statistical analysis&#58; Student t-test&#44; contingency table analysis calculated using chi-square or Fisher&#8217;s exact test was used&#44; and a p-value &#60;0&#46;05 was considered statistically significant&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 466 swabs for COVID-19 were analyzed&#44; and 36&#37; &#40;n&#8239;&#61;&#8239;169&#41; were Positive for SARS-CoV-2&#46; The median age was 39&#46;2 years and 71&#46;8&#37; were females &#40;335&#47;466&#41;&#46; The positivity rate of each category according to exposure and job description is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Logistic workers had the highest rate of SARS-CoV-2 infection &#40;p&#8239;&#61;&#8239;0&#44;0029&#41;&#44; but nurse technicians had the highest rate among those reporting daily contact with patients &#40;p&#8239;&#61;&#8239;0&#46;0010&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We also analyzed the household geographic distribution of the HCW positive cases in the administrative districts of S&#227;o Paulo&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows different COVID-19 rates in the general population according to the City Health Office data distributed in the city and also the 106 out of 126 HCW positive cases distributed by household locations&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Nineteen of these HCW lived near the hospital&#8217;s neighborhood&#44; the most affected district by the outbreak&#46; The available location of 106 HCW diagnosed with COVID-19 and their household locations are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Doctors presented the lowest rate of infection although living in most affected districts &#40;p&#8239;&#60;&#8239;0&#46;001&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">COVID-19 transmission among HCW is a common fact&#59; China&#44; Spain&#44; and the USA have also observed a great number of affected HCW&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Our COVID-19 study was conducted in a university hospital of a district in S&#227;o Paulo with a high rate of confirmed cases during the quarantine&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Considering routine daily contact&#44; nurse technicians were infected the most&#44; probably due to many opportunities for exposure during their shift&#44; although they had received training on the use of personal protective equipment&#46; Unexpectedly&#44; we found that the highest rate of infection was among personnel who had no direct patient contact&#46; Logistic workers were less trained and&#47;or unaware of the risks of COVID-19 transmission at the hospital&#46; Quite often&#44; administrative technicians and logistic workers are not provided with adequate training and personal protective equipment&#46; In this sense&#44; it is essential to implement health policies for professionals who do not have routine contact with patients&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Infection of HCW in the community cannot be ruled out&#44; since many HCW live in high affected districts and many of the positive cases live in the hospital&#8217;s neighborhood&#46; Liu et al&#46; in their study about the aerodynamics of SARS-CoV-2 reported high levels of airborne RNA in areas prone to crowding&#44; probably due to infected carriers in the crowd&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> However&#44; logistic workers&#8217; household locations were not significantly associated with the most affected COVID-19 districts &#40;p&#8239;&#62;&#8239;0&#46;05&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Limitations of this study include small sample size&#44; short study time frame&#44; and lack of some HCW data&#46; Facilitating testing of symptomatic professionals&#44; creating sick leave policies that are non-punitive&#44; flexible&#44; and consistent with public health guidance&#44; and providing adequate training and protective equipment could improve the prevention of infection transmission to employees&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
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        1 => array:2 [
          "identificador" => "xpalclavsec1313628"
          "titulo" => "Keywords"
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        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        3 => array:1 [
          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-06-09"
    "fechaAceptado" => "2020-08-09"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1313628"
          "palabras" => array:3 [
            0 => "Coronavirus"
            1 => "Health care workers"
            2 => "Pandemic"
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    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Health care workers &#40;HCW&#41; are at a higher risk of being infected in their workplace&#46; Out of a total of 466 HCW of Hospital S&#227;o Paulo with influenza-like illnesses or any clinical suspicion of COVID-19 were tested for COVID-19 by RT-PCR for SARS-CoV-2 169 &#40;36&#37;&#41; turned out positive and were analyzed by type of exposure and hospital occupation&#46; Data of HCW household locations were also obtained&#46; Logistic workers had the highest positivity rate for SARS-CoV-2 &#40;p &#61; 0&#46;002&#41;&#44; while nurse technicians had the highest rate among those reporting routine contacts with patients &#40;p &#61; 0&#46;001&#41;&#46; Physicians presented the lowest rate of infection&#44; although living in most affected districts &#40;p &#60; 0&#46;001&#41;&#46; Policies and adequate training for all hospital employees may improve prevention of COVID-19 among all health care service categories&#46;</p></span>"
      ]
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">SARS-CoV-2 infected health care workers distributed by residential Administrative Districts &#40;n&#8239;&#61;&#8239;106&#41;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">High-risk&#58; districts with 120-178 and 179-238 confirmed COVID-19 cases &#40; up to 04&#47;17&#47;2020&#41; <span class="elsevierStyleSup">&#43;&#43;</span> Information on district of residence was not available for 60 COVID-19 cases&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Daily contacts</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">COVID-19 &#40;n&#8239;&#61;&#8239;169&#41;&#40;n&#47;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Nurse technician <a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">&#35;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Nurse&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">-&#47;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Physician&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;24&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">13&#47;17 <a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">&#35;</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;28&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">4 &#40;25&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Phonoaudiologist&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;66&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">No contacts</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Administrative staff&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;31&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Logistic workers<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">&#35;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;62&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#47;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Others<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;55&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;7&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 14138670
Original language: English

DOI:10.1016/j.bjid.2020.08.003

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2024 September	32	25	57
2024 August	48	30	78
2024 July	74	39	113
2024 June	70	43	113
2024 May	49	28	77
2024 April	53	17	70
2024 March	66	26	92
2024 February	47	27	74
2024 January	46	24	70
2023 December	45	33	78
2023 November	55	54	109
2023 October	47	28	75
2023 September	54	59	113
2023 August	39	26	65
2023 July	47	30	77
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2023 May	51	32	83
2023 April	45	28	73
2023 March	80	31	111
2023 February	59	23	82
2023 January	42	26	68
2022 December	95	42	137
2022 November	67	41	108
2022 October	71	29	100
2022 September	44	45	89
2022 August	54	44	98
2022 July	46	49	95
2022 June	55	57	112
2022 May	38	47	85
2022 April	57	53	110
2022 March	50	58	108
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2021 December	60	60	120
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2021 October	43	69	112
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2021 August	56	40	96
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2021 June	61	38	99
2021 May	61	69	130
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