Impact of COVID-19 outbreak on healthcare workers in a Tertiary Healthcare Center in India: a cross sectional study

Data formatting and analysis

General demographic data

The study enrolled a total of 3329 HCWs belonging to over 20 departments. The mean age of the study group was 28.11 (± 8.95) years, with 2110 (63.38%) females and 1219 (36.62%) males. Undergraduate students (n = 849, 25.50%) and nurses (n = 822, 24.69%) comprised the major proportion of the dataset. Chefs and clerks were included under the administrative category and infection control staff in the nurse’s category. The majority of the participants had no history of smoking, tobacco chewing or alcohol drinking. Blood groups B (1043, 31.33%) and Rh positive (3003, 90.21%) were found to be the most common. 75.3% of the total enrolled were found to possess no clinical comorbidities, whereas asthma (57, 1.71%), diabetes (54, 1.62%), hypertension (64, 1.92%), stroke (1, 0.03%), hypo- and hyperthyroidism (68, 2.04%) were reported by the rest.

Vaccination status

The study population found to be vaccinated at least once was 78.5% (2615), with the vaccines being Covishield (2293), Covaxin (303), Pfizer (7), Covovax (6), Sinopharm (5) or Sputnik (1), while the rest (714, 21.4%) were unvaccinated. There were multiple reasons reported for not taking a vaccine, including pregnancy, allergies, unavailability of slots and personal disinterest. Undergraduate students (91.76%), residents (92.61%), interns (96.64%) and faculty (91.19%) were found to be vaccinated while nurses (68.90%), technicians (63.48%) and other admin staff (69.13%) were vaccinated in lower percentages as compared with the prior groups as depicted in Fig. 1. No serious adverse effects following immunization (AEFIs) were observed in the current study.

Schematic representation of the statistical association of vaccination status and occupational categories of healthcare workers enrolled in the study.

Development of infection and severity of outcomes

This study found 654 (19.65%) HCWs to be SARS-CoV-2 positive at least once, of which a small proportion (98, 15%) did not get their infection confirmed by RT-PCR or antigen tests despite being symptomatic. Supplementary Table 1(A) provides a schematic representation of the odds of developing infection among various occupational categories of health care workers enrolled in the study. Fever, cough, body ache, breathing difficulties, and loss of smell and taste (symptoms typically observed during the delta wave) were the most reported symptoms. Of the infected HCWs, 75.1% (n = 491) did not require hospitalization, whereas the rest (24.6%, n = 161) were hospitalized for an average duration of 9 days. Oral and injectable antibiotics were the most administered treatments, followed by favipiravir, steroids, anticoagulants, supplemental oxygen, and remdesivir, as shown in Fig. 2. Based on symptoms and the history of hospitalization, infected patients were categorized as severe (needing ICU admission or intubation), moderate (general hospitalization) and mild (symptomatic but under home isolation). Of the total participants enrolled in the study, 55 (8.41%) were found to be asymptomatic, while 571 (87.31%), 23 (3.52%), and 5 (0.76%) experienced mild, moderate, and severe COVID-19 respectively. Although hypothyroidism and reinfection were found to be significantly associated with moderate and severe infections, owing to their minimal counts, the exact reliability of these results could not be ascertained.

Schematic representation of the proportion of administration of various COVID-19 treatments.

A total of 165 (25.23%) cases had breakthrough infections of which 147 (single dose: 38, double dose: 109) took Covishield and 18 (single dose: 8, double dose: 10) took Covaxin. Symptoms due to breakthrough infections were largely mild with 16 and 145 individuals demonstrating asymptomatic or mild infections, while two each had moderate and severe disease. The mean time for breakthrough infection from the time of the first vaccine dose was found to be 61.89 days (range: 2 to 281 days). No significant difference was found between partially or fully vaccinated when breakthrough infection time was compared from the day of initial vaccination.

In addition, 25 (3.82%) cases of reinfection were also observed in our study population. Surprisingly, all reinfections were found in vaccinated individuals—6 (24%) partially vaccinated and 19 (76%) fully vaccinated. Further, 14 individuals with reinfection (56%) also reported the presence of long COVID symptoms.

Overview of long covid analysis

The survey listed a range of long covid symptoms along with an open-ended option to allow us to capture unlisted symptoms, in keeping with the wide variability of symptoms. Two hundred and sixteen (216, 6.19%) individuals were found to be suffering from long COVID. Persistent weakness/tiredness, lasting from 12 weeks to 6 months, was the most experienced post-COVID symptom. Asthenia, loss of smell, myalgia, headache, neurotic symptoms, shortness of breath, loss of appetite, menstrual abnormalities, cough, joint pain, sore throat, frequent sleeping troubles, difficulties in concentration/confusion and leg pain were found to be the other common long covid symptoms. A handful of cases with rectal bleeding, weakness in eyesight, and panic attacks were also seen. The distribution of these symptoms is shown in Supplementary Fig. 1.

Surprisingly, undergraduate students (50%) who were attending most classes remotely for the study period (except for the in-person clinics/wards) were found to experience long covid symptoms more commonly, followed by nurses (14.08%) and residents (11.65%) as compared to the rest of the study group. The precise summary of the prevalence of long covid among various age groups and occupations is schematically shown in Supplementary Fig. 2.

We then tried to identify the presence of significant associations between long covid and various comorbid conditions, lifestyle factors, demographic factors, blood group, vaccination status, and history of infections. On univariate analysis, it was found that females possessed a significantly higher risk of long covid in comparison to males. In addition, drinking alcohol (22, 10.7%) and blood group B (65, 31.1%) were identified as significant risk factors for long covid in healthcare workers., as shown in Supplementary Table 2(B). A summarized tabulation of the demographic and clinical dataset is provided in Table 1, while Fig. 3 summarizes the statistically significant potential predictors and risk factors of long covid.

Schematic representation of statistically significant potential predictors and risk factors of long COVID.

Temporal trends of COVID-19 risk in healthcare workers

To identify significant differences in the susceptibility to COVID-19 infections between the general population and healthcare professionals, a temporal trend analysis was performed to compare the infection rates reported in Pune from February 2020 to October 2021 with the infection rates estimated from the study dataset. Although our data was collected in 2021, the exact date of covid positivity and vaccination ranged from 2020, hence the overlap with the general population. Information on the daily reported COVID-19 cases from Pune was fetched from Covid19tracker.in. Our analysis revealed that there were no significant differences in the trend of COVID-19 onset between the general population and healthcare workers. An overview of the similarity observed in the infection rates is shown in Fig. 4.

Graph representing the trend of cases observed in Pune, Maharashtra (the peaks in blue represent the overall cases reported in the city by occupation wise by while the bars in yellow represent the number of cases observed in each category in the study dataset).