Prevalence and Clinical Characteristics of COViD-19 in Frontline Health Care Workers

2019 – Coronavirus diseases caused by severe acute respiratory syndrome coronavirus 2. in Gujarat, COViD-19's first two cases were confirmed in Rajkot and Surat on 19th March 2020. in india to prevent COViD-19 cases from being: "test, track and treat": For testing, Rt-PCR is the gold standard test or frontline testing for the Coronavirus. the most prominent cause of infection in health care workers due to they were directly exposed to unrecognized COViD-19 patients. to determine the infection rate and also assess the clinical profile of COViD-19 infections in health care workers. Sample collected from 2081 health care workers by universal sampling method during the period from April 2020 to November 2020. Nasopharyngeal and Oro-pharyngeal swabs were collected at the collection center and tested at the Viral Research Diagnostic laboratory (VRDl), by Rt-PCR (Real-time Polymerase Chain Reaction) Method. During the study period, there were 2081 suspected healthcare workers samples received from 70 Health care workers were positive. We observed 3.36 % Positivity rate, positivity was high in the age group of 20–30 years 64.2%, most common clinical presentation was a fever 82.8%, cough 47.1% and Sore throat 50% and 01 severely infected health care worker died during hospitalization. Health care workers were at a higher risk of COViD-19 infection. So, to protect health care workers routine screening of asymptomatic staff and early identification of staff with potential infection could help to lower the risk. COViD-19 mortality was lower in health care workers.

iNtRODuCtiON 2019 -Coronavirus disease was first identified in China as a newly emerging infectious disease in December 2019. In January 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. COVID-19 was caused by the SARS-CoV-2 virus. 1 In Gujarat, the first two cases were confirmed in Rajkot and Surat on 19th March 2020. 2 National Institute of virology scientists isolated the strain SARS-CoV-2 virus on 14 march 2020, which will help towards the development of drugs, diagnostic kits, and vaccines. 3 In India to prevent COVID-19 cases from being: "test, track and treat": For testing RT-PCR is the gold standard or frontline test for the Coronavirus but other types of tests available like antibody/antigen detection, Truenat (Chip-based, rapid molecular test) and CBNAAT (Cartridge-based nucleic acid amplification test) were introduced; ICMR advised antigen/ antibody detection test are as "supplementary test" to molecular testing. 4 The disease burden is expected to rise due to community transmission from asymptomatic individuals. The SARS-CoV-2 virus spreads when person to person in close contact. The virus can spread from an infected person's respiratory tract (mouth or nose) by larger 'respiratory droplets' or smaller 'aerosols' during the person sneezes, coughs, heavily breathes, or talks. 5 In the first wave of COVID-19 the sporadic cases evolved; so, the chains of transmission were broken by effective contact tracing, defined quarantine zone, Sanitary curfew, and isolation of COVID-19 positive patients at treatment centers. 6 In Asia, currently, India has the largest number of confirmed cases, with 26.7 million cases reported for COVID-19 infection and 3rd largest number of COVID-19 deaths. [7][8][9] Health care workers were serving as a vector for transmission of illnesses because of higher exposure to infectious diseases as compared to the general population, and also repeated exposure to the same pathogen may alter the course of infectious diseases. 10 Thousands of doctors, Nurses, and health workers have been infected with COVID-19; because in patient-facing roles, they will be front-line healthcare workers. [11][12] As Frontline health -care workers they were exposed to large numbers of infected patients for a long period, and inadequate knowledge and training for infection prevention and control, the most prominent causes are directly exposed to unrecognized COVID-19 patients and also some medical procedures that generate aerosols that lead to aerosol transmission during procedures. 13 Here we outline the testing of both symptomatic and asymptomatic cases of Healthcare workers. This study shows the prevalence of COVID-19 in Health care workers and their characteristics who tested positive for COVID-19 by RT-PCR method (Using kit Meril diagnostic) at Jamnagar, Gujarat.

Aim and Objective
To determine the Infection rate of COVID-19 among healthcare workers.
To assess the clinical profile of COVID-19 infected health care workers.

MAteRiAlS AND MetHODS target Population
All frontline health care workers involved in care, screening, diagnosis and Management, sample collection, transportation of sample, testing, and Bio-medical waste handlers of Ahmedabad, Botad, Dang, Dwarka, Gir-Somnath, Jamnagar, Junagadh, Kutch, Morbi, Porbandar, Rajkot, Surendra Nagar districts. Sample size: A total of 2081 samples were collected from health care workers by universal sampling method during the period from April 2020 to November -2020. Type of Study: Cross-sectional study.

inclusion Criteria
All health care workers exposed directly or indirectly to COVID-19 patient care and willing to participate in the study and gave written consent.

exclusion Criteria
History of close contact with a family member or close friends outside the working area. The study got approval from the Ethical Institution Committee, M.P. Shah Medical College and Guru Gobind Singh Hospital, Jamnagar, IEC/ Certi/93/03/2020.

Sample Collection
Oropharyngeal and Nasopharyngeal swabs were collected at the collection center and The following steps to get the quantitative detection for SARS CoV-2: 1) Viral RNA Extraction: QIAamp Viral RNA mini kit (Qiagen, Valencia, CA, USA) was used for RNA extraction by following the manufacturer's protocol. In the microcentrifuge tube add 560 μl prepared Buffer and 140 μl sample. Mix by pulse-vertexing for 15 seconds then Incubate for 10 min at room temperature (15-25°C). To remove drops from the inside of the lid centrifuge the tube. RNA precipitation was done using 560 μl of ethanol (96%-100%) mixed into the sample by pulse-vertexing for 15 seconds. The

Data Collection
Data were collected, cleaned, and analyzed using Microsoft Excel for Windows 10. Distribution statistics are used.

ReSultS
During the study period, there were 2081 suspected HCWs samples received from various districts (by universal sampling method) [ Figure  1 / Table] in our laboratory at M.P. Shah Govt. Medical College, Jamnagar, out of which 70 Health care workers were positive. We observed 3.36 % Positivity rate in HCWs. Out of 70 HCWs 83% (n= 58) were Symptomatic while 17% (n=12) were Asymptomatic.
One severely infected HCW (1.43%) died during hospitalization. All the HCWs had a mild infection so, do require hospitalization but some HCWs (n=12, 17.14%) were moderate to severe infections were admitted to the hospital.

DiSCuSSiON
The present study summarized the clinical information, characteristics, comorbidity, and risk factors of COVID-19 in health care workers.
The Study determines positivity was 3.4% in HCWs, similar to sabetian et al. 14 5.6%, Al Maskari Z et al. 15 4.3%, Nguyen L H et al. 16 3.9%, which explains the lower infection rates in HCWs may be due to the proper use of personal protective equipment's, like N95 masks, gloves and face shield in flu OPD and COVID-19 wards, 17 but in opposite higher in Gholami, Mandana et al. 18 51. 7% indicate inappropriate workplace setting, long-term exposure, and insufficient use of Personal protective equipment; while one study by Lai, Xiaoquan et al. 19 1.1% which shows much lower positivity signify the diligent prevention action taken in hospitals to prevent transmission in a health care setting. In a study out of 70, Positive HCWs 83% (n=58) were Symptomatic and 17% (n=12) were asymptomatic compared with Tolpadi A et al. 20 shows respectively 88% and 12% and Xiaoquan et al. 19 shows a total of 0.9% of positive HCWs were asymptomatic. Overall, the percentage might become very less but high risks for close contact with persons and the community. So, to avoid cross-infection early recognition of asymptomatic carriers would be important and should be set apart from co-workers and family.
Positivity was higher in males 38 (54.3%) as compared to females 32 (45.7%), which may be due to the majority of the male working outside than females; which was similar to Chu J et al. 21 63.2% and 36.8%, Huang, Chaolin et al. 22 73% and 27% respectively, in contrast to that Tolpadi A et al. 20 shows higher in female 55.1%, than male 44.8%, also higher in the USA (73%). This may be due to a large number of female nursing staff working in the hospital area. 17 In this study more affected age group was 21-30 years 64.2%, followed by 31-40 years 18.5%, similarly was seen in Al Maskari Z et al. 15 41.5% and Nguyen L H et al. 16 28.1%, which was conflicting to reported by Huang et al. 22 and Wang et al. 23 Based on empirical assumptions some contraindications like the lower ratio of elder people in medical staff; and medial age staff (aged 20-40years) are the mainstays of the hospital due to longer work time and higher work intensity but this was not supported by quantitative analysis.
The most common clinical presentation was in the present study fever 82.8%, cough 47.1%, and Sore throat 50%; similar to Al Maskari Z et al. 15 Nguyen LH et al., 16 and Gholami, Mandana et al. 18 Study shows HCWs had mild or moderate symptoms; for these various possible reasons young adults HCWs were more affected; and early symptoms were easily noticed by HCWs, which could explain the reason for higher reporting of fever as a clinical presentation in our study. So, for a better outcome, early diagnosis and treatment were preferred.
However, death among HCWs is rare, and mostly older HCWs were more affected, and also universal availability and utilization of PPE reduce the infection in HCWs. Various recent study discovers that HCWs those without PPE were more infected than who had used PPE. 17

limitation
Our study was retrospective and we included only molecular (SARS-CoV2 PCR) tested patients because RT-PCR was high specificity; we were not included patients tested with other types of testing methods like rapid antigen/ antibody detection, CBNAAT, etc. In addition, we study for 8 months; so difficult to access host risk factors, disease severity, and mortality for SARS -Cov-2 infection. And also, does not discriminate against numerous types of HCWs according to their Occupation, Experience level, and amount of exposure to the infected patient or aerosolizing systems.

CONCluSiON
This finding shows HCWs were at a higher risk of COVID-19 infection during providing care to suspected or confirmed cases. HCWs patients had lower hospitalization due to younger age group and early detection of mild symptoms; that concludes regular screening of asymptomatic staff and quick identification of staff with probable infection help to defend HCWs. COVID-19 mortality was lower in health care workers due to early detection of symptoms, early treatment, and use of effective preventive measures; it highlights the regular training of HCWs regarding infection control practices related to COVID-19 and their strict implementation should be an essential component of a preventive strategy.