Seroprevalence and Risk Factors of SARS CoV-2 in Health Care Workers of Tertiary-Care Hospitals in the Province of Khyber Pakhtunkhwa, Pakistan

BackgroundHigh number of SARS-CoV-2 infected patients has overburdened healthcare delivery system, particularly in low-income countries. In the recent past many studies from the developed countries have been published on the prevalence of SARS CoV-2 antibodies and the risk factors of COVID-19 in healthcare-workers but little is known from developing countries. MethodsThis cross-sectional study was conducted on prevalence of SARS-CoV-2 antibody and risk factors for seropositivity in HCWs in tertiary-care hospitals of Peshawar city, Khyber Pakhtunkhwa province Pakistan. ResultsThe overall seroprevalence of SARS CoV-2 antibodies was 30{middle dot}7% (CI, 27{middle dot}8-33{middle dot}6) in 1011 HCWs. Laboratory technicians had the highest seropositivity (50{middle dot}0%, CI, 31{middle dot}8-68{middle dot}1). Risk analysis revealed that wearing face-mask and observing social-distancing within a family could reduce the risk (OR:0{middle dot}67. p<0{middle dot}05) and (OR:0{middle dot}73. p<0{middle dot}05) while the odds of seropositivity were higher among those attending funeral and visiting local-markets (OR:1{middle dot}83. p<0{middle dot}05) and (OR:1{middle dot}66. p<0{middle dot}01). In Univariable analysis, being a nursing staff and a paramedical staff led to higher risk of seropositivity (OR:1.58. p< 0{middle dot}05), (OR:1{middle dot}79. p< 0{middle dot}05). Fever (OR:2{middle dot}36, CI, 1{middle dot}52- 3{middle dot}68) and loss of smell (OR:2{middle dot}95, CI: 1{middle dot}46-5{middle dot}98) were significantly associated with increased risk of seropositivity (p<0.01). Among the seropositive HCWs, 165 (53{middle dot}2%) had no symptoms at all while 145 (46{middle dot}8%) had one or more symptoms. ConclusionThe high prevalence of SARS-CoV-2 antibodies in HCWs warrants for better training and use of protective measure to reduce their risk. Early detection of asymptomatic HCWs may be of special importance because they are likely to be potential threat to others during the active phase of viremia.

Patient characteristics and predictors of mortality in 470 adults admitted to a district general hospital in England with Covid-19

BackgroundUnderstanding risk factors for death in Covid-19 is key to providing good quality clinical care. Due to a paucity of robust evidence, we sought to assess the presenting characteristics of patients with Covid-19 and investigate factors associated with death. MethodsRetrospective analysis of adults admitted with Covid-19 to Royal Oldham Hospital, UK. Logistic regression modelling was utilised to explore factors predicting death. Results470 patients were admitted, of whom 169 (36%) died. The median age was 71 years (IQR 57-82), and 255 (54.3%) were men. The most common comorbidities were hypertension (n=218, 46.4%), diabetes (n=143, 30.4%) and chronic neurological disease (n=123, 26.1%). The most frequent complications were acute kidney injury (n=157, 33.4%) and myocardial injury (n=21, 4.5%). Forty-three (9.1%) patients required intubation and ventilation, and 39 (8.3%) received non-invasive ventilation Independent risk factors for death were increasing age (OR per 10 year increase above 40 years 1.87, 95% CI 1.57-2.27), hypertension (OR 1.72, 1.10-2.70), cancer (OR 2.20, 1.27-3.81), platelets <150x103/{micro}L (OR 1.93, 1.13-3.30), C-reactive protein [≥]100 {micro}g/mL (OR 1.68, 1.05-2.68), >50% chest radiograph infiltrates, (OR 2.09, 1.16-3.77) and acute kidney injury (OR 2.60, 1.64-4.13). There was no independent association between death and gender, ethnicity, deprivation level, fever, SpO2/FiO2 (oxygen saturation index), lymphopenia or other comorbidities. ConclusionsWe characterised the first wave of patients with Covid-19 in one of Englands highest incidence areas, determining which factors predict death. These findings will inform clinical and shared decision making, including the use of respiratory support and therapeutic agents. SummaryIncreasing age, hypertension, cancer, platelets <150x103/{micro}L, CRP[≥]100 {micro}g/mL, >50% chest radiograph infiltrates, and acute kidney injury predict in-hospital death from Covid-19, whilst gender, ethnicity, deprivation level, fever, SpO2/FiO2 (oxygen saturation index), lymphopenia and other comorbidities do not.