Author(s): N. Tlotleng, W. Jassat, C. Cohen, F. Made, T. Kootbodien M. Masha and N. Naicker

Source: Covid-19 Special Public Health Surveillance Bulletin, Vol 18. Supplementary Issue 10

Abstract: Healthcare workers (HCWs) in close contact with SARS-CoV-2-infected patients have an increased risk of infection compared to non-HCWs, but little is known about the clinical course and risks for mortality amongst HCWs in South Africa. In this study, we compared the characteristics of hospitalised HCWs against non-HCWs with COVID-19 and assessed those factors associated with COVID-19 mortality among HCWs. Data from 5 March 2020 to 30 April 2021 were obtained from DATCOV, the national surveillance programme monitoring COVID-19 admissions in all private and public hospitals across South Africa. A logistic regression model was used to determine factors associated with COVID-19 HCW admissions and mortality. As of 30 April 2021, there was a total 169,678 confirmed COVID-19 admissions reported on DATCOV, of which 6,364 (3.8%) were HCWs. Compared to non-HCWs, HCWs were more likely to be younger, to be white or of non-black race, have pre-existing obesity and asthma, be admitted in the private sector and in the Eastern Cape, Gauteng, KwaZulu-Natal, Limpopo, Northern Cape and North West provinces, be admitted in pre-wave 1 [(aOR 3.0; 95%CI 2.4-3.7)], wave 1 [(aOR 2.1; 95%CI 1.8-2.5)] and post-wave 1 [(aOR 1.3; 95%CI 1.0-1.7)] compared to wave 2, were less likely to be male (aOR 0.3, 95%CI 0.3- 0.4), and have HIV and chronic kidney diseases. There was an increased risk for in-hospital mortality in HCWs in the older age group (40-49 [aOR 3.8; 95%CI (1.6-8.80)]; 50-59 [(aOR 4.7; 95%CI 2.0-10.9)] and 60- 65 years [(aOR 9.8; 95%CI (4.2-23.0)] compared to HCWs less than 40 years, with comorbidities such as hypertension, diabetes, chronic kidney diseases, malignancy and TB. Mortality was decreased for HCWs who were coloured [aOR 0.5; 95%CI (0.3-0.8)], and admitted in the public sector [aOR 0.7; 95%CI (0.5- 0.9)] in pre-wave 1 [aOR 0.6; 95%CI (0.3-0.9)] compared to wave 1 period. It is concluded that in-hospital mortality in HCWs was associated with age, race, wave period, presence of comorbidites and health sector. Policies should be put in place to remove older HCWs with comorbidities from direct patient care. Acquired immunity from infections in the first wave could have led to a decline in HCW COVID-19 cases in the second wave. With the roll-out of vaccines amongst HCWs, we expect a further decrease in COVID-19 cases and mortality amongst this group, despite the fact that the country has entered a third wave of the COVID-19 pandemic.