COVID-19 in Health Care Personnel: Significance of Health Care Role, Contact History, and Symptoms in Those Who Test Positive for SARS-CoV-2 Infection

Lepak, Alexander J.; Buys, Ashley; Stevens, Linda; LeClair-Netzel, Megan; Anderson, Laura; Osman, Fauzia; Brennan, Meghan B.; Bartels, Christie M.; Safdar, Nasia

Objective To identify significant factors that help predict whether healthcare personnel (HCP) will test positive for SARS-CoV-2. Patients and Methods We conducted a prospective cohort study among 7015 symptomatic HCP from March 25, 2020, through November 11, 2020. We analyzed the associations between healthcare role, contact history, symptoms, and a positive nasopharyngeal swab SARS-CoV-2 PCR test results, using univariate and multivariable modelling. Results 624 (9%) HCP were positive over the study period. On multivariable analysis, having a healthcare role other than physician or advanced practice provider (APP), contact with family or community member with known or suspected COVID-19, and seven individual symptoms (cough, anosmia, ageusia, fever, myalgia, chills, and headache) were significantly associated with higher adjusted odds ratios for testing positive for SARS-CoV-2. For each increase in symptom number, the odds of testing positive nearly doubled (OR, 1.93; 95% CI, 1.82-2.07, p<0.001). Conclusions Symptomatic HCP have higher adjusted odds of testing positive for SARS-CoV-2 based on three distinct factors: (1) non-physician/APP role, (2) contact with a family or community member with suspected or known COVID-19, and (3) specific symptoms and symptom number. Differences among healthcare roles, which persisted after controlling for contacts, may reflect the influence of social determinants. Contacts with COVID-19 positive patients and/or HCP were not associated with higher odds of testing positive, supporting current infection control efforts. Targeted symptom and contact questionnaires may streamline symptomatic HCP testing for COVID-19.