COVID-19 outcomes in health care workers and over the long term, vaccine evidence and uptake among the latest research

Health care workers who were hospitalized for COVID-19 had shorter stays and no worse outcomes than other patients, according to a study published by JAMA Network Open on Jan. 28. The retrospective study compared 127 hospitalized health care workers from 36 hospitals to 366 matched non-health care workers. The odds of the primary outcome, mechanical ventilation or death, were not significantly different. The health care workers were less likely to require ICU care or stay a week or longer. The authors noted that, although patients were matched, the study could have been affected by confounding, including possible earlier diagnosis or treatment among health care workers. They also called for attention to the “physical, psychological, social, and practical burdens of this disease on [health care workers], who collectively represent a disproportionately affected population.”

Another study of COVID-19 in health care workers found that demographic and community factors were more predictive of infection than workplace exposure to the novel coronavirus. The study, published by Annals of Internal Medicine on Jan. 29, was based on SARS-CoV-2 testing and surveys within a health care system in Georgia. The seropositivity rate among the more than 10,000 health care workers was 3.8% overall, and 8.3% among Black individuals. Infection was associated with community contact with a person who had known or suspected COVID-19 (adjusted odds ratio [aOR], 1.9; 95% CI, 1.4 to 2.6) and community COVID-19 incidence (aOR, 1.5; 95% CI, 1.0 to 2.2). The observed racial differences may result from “entrenched, systemic social processes that underlie many individual and population health disparities,” the authors said. They recommended that “ongoing efforts to keep the health care workforce safe should emphasize risk mitigation in and outside the workplace.”

Fewer than 60% of health care workers expressed intent to receive a COVID-19 vaccine in a survey of more than 5,000 employees of a New York State health care system, conducted in late November and early December and published by Clinical Infectious Diseases on Jan. 25. Intent varied by role, with 80.4% of physicians and scientists planning to be vaccinated. By contrast, among registered nurses, 41.2% would get the vaccine, 33.6% were unsure, and 25.2% said no. Those who provided direct patient care and those who had cared for COVID-19 patients were less likely to express intent to be vaccinated compared to other health care workers. “This high level of vaccination intent uncertainty raises concern about whether adequate vaccination coverage can be achieved through vaccination campaigns and education, without a state or federal mandate,” the authors said. They noted that the intent among physicians was important because by setting the example of being vaccinated, they “may positively influence staff, who may be unsure and want to delay vaccination until others are vaccinated.”

The first phase 3 efficacy and safety data were released on another vaccine candidate. According to press releases from Johnson & Johnson and the NIH providing non-peer-reviewed data, their single-dose vaccine was 66% effective at preventing moderate to severe COVID-19 at 28 days after vaccination. It was 85% effective in preventing severe disease, defined as signs consistent with severe systemic illness, ICU admission, respiratory failure, shock, organ failure, or death, among other factors. Moderate disease was defined as evidence of pneumonia, deep venous thrombosis, shortness of breath or abnormal blood oxygen saturation, abnormal respiratory rate, or two or more systemic symptoms. Protection was generally consistent across race, age groups, and virus variants studied. Fever occurred in 9%, and serious adverse events were higher with placebo. No anaphylaxis was observed. The manufacturer said it intends to file for an emergency use authorization in early February.

In other recent research on COVID-19, reductions in lung capacity and physical function were common among survivors of severe COVID-19 four months after discharge, according to an Italian study published Jan. 27 by JAMA Network Open. Of 767 invited patients, 64.4% declined to participate and 4.6% died during follow-up. Among the remaining patients, diffusing lung capacity for carbon monoxide was reduced to less than 80% in 51.6% and less than 60% in 15.5%. Impairment in physical function was found in 53.8% of patients, and post-traumatic stress symptoms were reported in 17.2%. The authors noted that patients treated in the ICU had worse physical performance at follow-up but that age was not associated with reduced lung capacity or impaired motor function. “We speculate that older people may have a higher baseline comorbidity burden, which was detrimentally associated with their survival probability during acute illness, but in survivors, the residual damage was not worse than in younger people,” the authors said. “This observation has important implications, given that advancing age is often among the major limitations to admit patients with COVID-19 to an ICU.”