Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic
On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch teaching hospitals, 9 health care workers (HCWs) received a diagnosis of COVID-19, 8 of whom had no history of travel to China or northern Italy, r...
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| Published in | JAMA network open Vol. 3; no. 5; p. e209673 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
American Medical Association
01.05.2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2574-3805 2574-3805 |
| DOI | 10.1001/jamanetworkopen.2020.9673 |
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| Abstract | On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch teaching hospitals, 9 health care workers (HCWs) received a diagnosis of COVID-19, 8 of whom had no history of travel to China or northern Italy, raising the question of whether undetected community circulation was occurring.
To determine the prevalence and clinical presentation of COVID-19 among HCWs with self-reported fever or respiratory symptoms.
This cross-sectional study was performed in 2 teaching hospitals in the southern part of the Netherlands in March 2020, during the early phase of the COVID-19 pandemic. Health care workers employed in the participating hospitals who experienced fever or respiratory symptoms were asked to voluntarily participate in a screening for infection with the severe acute respiratory syndrome coronavirus 2. Data analysis was performed in March 2020.
The prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase-polymerase chain reaction on oropharyngeal samples. Structured interviews were conducted to document symptoms for all HCWs with confirmed COVID-19.
Of 9705 HCWs employed (1722 male [18%]), 1353 (14%) reported fever or respiratory symptoms and were tested. Of those, 86 HCWs (6%) were infected with severe acute respiratory syndrome coronavirus 2 (median age, 49 years [range, 22-66 years]; 15 [17%] male), representing 1% of all HCWs employed. Most HCWs experienced mild disease, and only 46 (53%) reported fever. Eighty HCWs (93%) met a case definition of fever and/or coughing and/or shortness of breath. Only 3 (3%) of the HCWs identified through the screening had a history of travel to China or northern Italy, and 3 (3%) reported having been exposed to an inpatient with a known diagnosis of COVID-19 before the onset of symptoms.
Within 2 weeks after the first Dutch case was detected, a substantial proportion of HCWs with self-reported fever or respiratory symptoms were infected with severe acute respiratory syndrome coronavirus 2, likely as a result of acquisition of the virus in the community during the early phase of local spread. The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected COVID-19 should be used less stringently. |
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| AbstractList | Importance On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch teaching hospitals, 9 health care workers (HCWs) received a diagnosis of COVID-19, 8 of whom had no history of travel to China or northern Italy, raising the question of whether undetected community circulation was occurring. Objective To determine the prevalence and clinical presentation of COVID-19 among HCWs with self-reported fever or respiratory symptoms. Design, Setting, and Participants This cross-sectional study was performed in 2 teaching hospitals in the southern part of the Netherlands in March 2020, during the early phase of the COVID-19 pandemic. Health care workers employed in the participating hospitals who experienced fever or respiratory symptoms were asked to voluntarily participate in a screening for infection with the severe acute respiratory syndrome coronavirus 2. Data analysis was performed in March 2020. Main Outcomes and Measures The prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase–polymerase chain reaction on oropharyngeal samples. Structured interviews were conducted to document symptoms for all HCWs with confirmed COVID-19. Results Of 9705 HCWs employed (1722 male [18%]), 1353 (14%) reported fever or respiratory symptoms and were tested. Of those, 86 HCWs (6%) were infected with severe acute respiratory syndrome coronavirus 2 (median age, 49 years [range, 22-66 years]; 15 [17%] male), representing 1% of all HCWs employed. Most HCWs experienced mild disease, and only 46 (53%) reported fever. Eighty HCWs (93%) met a case definition of fever and/or coughing and/or shortness of breath. Only 3 (3%) of the HCWs identified through the screening had a history of travel to China or northern Italy, and 3 (3%) reported having been exposed to an inpatient with a known diagnosis of COVID-19 before the onset of symptoms. Conclusions and Relevance Within 2 weeks after the first Dutch case was detected, a substantial proportion of HCWs with self-reported fever or respiratory symptoms were infected with severe acute respiratory syndrome coronavirus 2, likely as a result of acquisition of the virus in the community during the early phase of local spread. The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected COVID-19 should be used less stringently. This cross-sectional study examines the prevalence and clinical presentation of coronavirus disease 2019 among health care workers in the Netherlands with self-reported fever or respiratory symptoms. On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch teaching hospitals, 9 health care workers (HCWs) received a diagnosis of COVID-19, 8 of whom had no history of travel to China or northern Italy, raising the question of whether undetected community circulation was occurring.ImportanceOn February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch teaching hospitals, 9 health care workers (HCWs) received a diagnosis of COVID-19, 8 of whom had no history of travel to China or northern Italy, raising the question of whether undetected community circulation was occurring.To determine the prevalence and clinical presentation of COVID-19 among HCWs with self-reported fever or respiratory symptoms.ObjectiveTo determine the prevalence and clinical presentation of COVID-19 among HCWs with self-reported fever or respiratory symptoms.This cross-sectional study was performed in 2 teaching hospitals in the southern part of the Netherlands in March 2020, during the early phase of the COVID-19 pandemic. Health care workers employed in the participating hospitals who experienced fever or respiratory symptoms were asked to voluntarily participate in a screening for infection with the severe acute respiratory syndrome coronavirus 2. Data analysis was performed in March 2020.Design, Setting, and ParticipantsThis cross-sectional study was performed in 2 teaching hospitals in the southern part of the Netherlands in March 2020, during the early phase of the COVID-19 pandemic. Health care workers employed in the participating hospitals who experienced fever or respiratory symptoms were asked to voluntarily participate in a screening for infection with the severe acute respiratory syndrome coronavirus 2. Data analysis was performed in March 2020.The prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase-polymerase chain reaction on oropharyngeal samples. Structured interviews were conducted to document symptoms for all HCWs with confirmed COVID-19.Main Outcomes and MeasuresThe prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase-polymerase chain reaction on oropharyngeal samples. Structured interviews were conducted to document symptoms for all HCWs with confirmed COVID-19.Of 9705 HCWs employed (1722 male [18%]), 1353 (14%) reported fever or respiratory symptoms and were tested. Of those, 86 HCWs (6%) were infected with severe acute respiratory syndrome coronavirus 2 (median age, 49 years [range, 22-66 years]; 15 [17%] male), representing 1% of all HCWs employed. Most HCWs experienced mild disease, and only 46 (53%) reported fever. Eighty HCWs (93%) met a case definition of fever and/or coughing and/or shortness of breath. Only 3 (3%) of the HCWs identified through the screening had a history of travel to China or northern Italy, and 3 (3%) reported having been exposed to an inpatient with a known diagnosis of COVID-19 before the onset of symptoms.ResultsOf 9705 HCWs employed (1722 male [18%]), 1353 (14%) reported fever or respiratory symptoms and were tested. Of those, 86 HCWs (6%) were infected with severe acute respiratory syndrome coronavirus 2 (median age, 49 years [range, 22-66 years]; 15 [17%] male), representing 1% of all HCWs employed. Most HCWs experienced mild disease, and only 46 (53%) reported fever. Eighty HCWs (93%) met a case definition of fever and/or coughing and/or shortness of breath. Only 3 (3%) of the HCWs identified through the screening had a history of travel to China or northern Italy, and 3 (3%) reported having been exposed to an inpatient with a known diagnosis of COVID-19 before the onset of symptoms.Within 2 weeks after the first Dutch case was detected, a substantial proportion of HCWs with self-reported fever or respiratory symptoms were infected with severe acute respiratory syndrome coronavirus 2, likely as a result of acquisition of the virus in the community during the early phase of local spread. The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected COVID-19 should be used less stringently.Conclusions and RelevanceWithin 2 weeks after the first Dutch case was detected, a substantial proportion of HCWs with self-reported fever or respiratory symptoms were infected with severe acute respiratory syndrome coronavirus 2, likely as a result of acquisition of the virus in the community during the early phase of local spread. The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected COVID-19 should be used less stringently. On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch teaching hospitals, 9 health care workers (HCWs) received a diagnosis of COVID-19, 8 of whom had no history of travel to China or northern Italy, raising the question of whether undetected community circulation was occurring. To determine the prevalence and clinical presentation of COVID-19 among HCWs with self-reported fever or respiratory symptoms. This cross-sectional study was performed in 2 teaching hospitals in the southern part of the Netherlands in March 2020, during the early phase of the COVID-19 pandemic. Health care workers employed in the participating hospitals who experienced fever or respiratory symptoms were asked to voluntarily participate in a screening for infection with the severe acute respiratory syndrome coronavirus 2. Data analysis was performed in March 2020. The prevalence of severe acute respiratory syndrome coronavirus 2 infection was determined by semiquantitative real-time reverse transcriptase-polymerase chain reaction on oropharyngeal samples. Structured interviews were conducted to document symptoms for all HCWs with confirmed COVID-19. Of 9705 HCWs employed (1722 male [18%]), 1353 (14%) reported fever or respiratory symptoms and were tested. Of those, 86 HCWs (6%) were infected with severe acute respiratory syndrome coronavirus 2 (median age, 49 years [range, 22-66 years]; 15 [17%] male), representing 1% of all HCWs employed. Most HCWs experienced mild disease, and only 46 (53%) reported fever. Eighty HCWs (93%) met a case definition of fever and/or coughing and/or shortness of breath. Only 3 (3%) of the HCWs identified through the screening had a history of travel to China or northern Italy, and 3 (3%) reported having been exposed to an inpatient with a known diagnosis of COVID-19 before the onset of symptoms. Within 2 weeks after the first Dutch case was detected, a substantial proportion of HCWs with self-reported fever or respiratory symptoms were infected with severe acute respiratory syndrome coronavirus 2, likely as a result of acquisition of the virus in the community during the early phase of local spread. The high prevalence of mild clinical presentations, frequently not including fever, suggests that the currently recommended case definition for suspected COVID-19 should be used less stringently. |
| Author | van den Bijllaardt, Wouter Verweij, Jaco J. Bentvelsen, Robbert G. Kluytmans-van den Bergh, Marjolein F. Q. Kluytmans, Jan A. J. W. Pas, Suzan D. Koopmans, Marion P. G. van Oudheusden, Anne J. G. Buiting, Anton G. M. van Rijen, Miranda M. L. |
| AuthorAffiliation | 6 Microvida Laboratory for Medical Microbiology, Bravis Hospital, Roosendaal, the Netherlands 7 Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, the Netherlands 9 Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands 8 Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands 4 Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands 1 Department of Infection Control, Amphia Hospital, Breda, the Netherlands 5 Department of Infection Control, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands 2 Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, the Netherlands 3 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands |
| AuthorAffiliation_xml | – name: 9 Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands – name: 6 Microvida Laboratory for Medical Microbiology, Bravis Hospital, Roosendaal, the Netherlands – name: 1 Department of Infection Control, Amphia Hospital, Breda, the Netherlands – name: 8 Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands – name: 3 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands – name: 5 Department of Infection Control, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands – name: 7 Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, the Netherlands – name: 4 Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands – name: 2 Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, the Netherlands |
| Author_xml | – sequence: 1 givenname: Marjolein F. Q. surname: Kluytmans-van den Bergh fullname: Kluytmans-van den Bergh, Marjolein F. Q. organization: Department of Infection Control, Amphia Hospital, Breda, the Netherlands, Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, the Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands – sequence: 2 givenname: Anton G. M. surname: Buiting fullname: Buiting, Anton G. M. organization: Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands, Department of Infection Control, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands – sequence: 3 givenname: Suzan D. surname: Pas fullname: Pas, Suzan D. organization: Microvida Laboratory for Medical Microbiology, Bravis Hospital, Roosendaal, the Netherlands – sequence: 4 givenname: Robbert G. surname: Bentvelsen fullname: Bentvelsen, Robbert G. organization: Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, the Netherlands, Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands – sequence: 5 givenname: Wouter surname: van den Bijllaardt fullname: van den Bijllaardt, Wouter organization: Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, the Netherlands – sequence: 6 givenname: Anne J. G. surname: van Oudheusden fullname: van Oudheusden, Anne J. G. organization: Department of Infection Control, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands – sequence: 7 givenname: Miranda M. L. surname: van Rijen fullname: van Rijen, Miranda M. L. organization: Department of Infection Control, Amphia Hospital, Breda, the Netherlands – sequence: 8 givenname: Jaco J. surname: Verweij fullname: Verweij, Jaco J. organization: Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands – sequence: 9 givenname: Marion P. G. surname: Koopmans fullname: Koopmans, Marion P. G. organization: Department of Virology, Erasmus Medical Center, Rotterdam, the Netherlands – sequence: 10 givenname: Jan A. J. W. surname: Kluytmans fullname: Kluytmans, Jan A. J. W. organization: Department of Infection Control, Amphia Hospital, Breda, the Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands, Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, the Netherlands |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32437576$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | 2020. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Copyright 2020 Kluytmans-van den Bergh MFQ et al. . |
| Copyright_xml | – notice: 2020. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: Copyright 2020 Kluytmans-van den Bergh MFQ et al. . |
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| References | zoi200403r1 zoi200403r2 Arentz (zoi200403r5) 2020; 323 zoi200403r3 Corman (zoi200403r4) 2020; 25 Wu (zoi200403r6) 2020; 323 Wang (zoi200403r7) 2020 Munster (zoi200403r8) 2020; 382 32437571 - JAMA Netw Open. 2020 May 1;3(5):e209687 |
| References_xml | – volume: 382 start-page: 692 issue: 8 year: 2020 ident: zoi200403r8 article-title: A novel coronavirus emerging in China: key questions for impact assessment. publication-title: N Engl J Med doi: 10.1056/NEJMp2000929 – ident: zoi200403r1 – volume: 25 issue: 3 year: 2020 ident: zoi200403r4 article-title: Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. publication-title: Euro Surveill doi: 10.2807/1560-7917.ES.2020.25.3.2000045 – ident: zoi200403r2 – ident: zoi200403r3 – volume: 323 start-page: 1239 issue: 13 year: 2020 ident: zoi200403r6 article-title: Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72?314 cases from the Chinese Center for Disease Control and Prevention. publication-title: JAMA doi: 10.1001/jama.2020.2648 – volume: 323 start-page: 1612 issue: 16 year: 2020 ident: zoi200403r5 article-title: Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. publication-title: JAMA doi: 10.1001/jama.2020.4326 – year: 2020 ident: zoi200403r7 article-title: Detection of SARS-CoV-2 in different types of clinical specimens. publication-title: JAMA doi: 10.1001/jama.2020.3786 – reference: 32437571 - JAMA Netw Open. 2020 May 1;3(5):e209687 |
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| Snippet | On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2 Dutch... Importance On February 27, 2020, the first patient with coronavirus disease 2019 (COVID-19) was reported in the Netherlands. During the following weeks, at 2... This cross-sectional study examines the prevalence and clinical presentation of coronavirus disease 2019 among health care workers in the Netherlands with... |
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| SubjectTerms | Adult Aged Betacoronavirus - isolation & purification Community-Acquired Infections - epidemiology Community-Acquired Infections - virology Coronavirus Infections - epidemiology Coronavirus Infections - virology Coronaviruses COVID-19 Cross Infection - epidemiology Cross Infection - virology Cross-Sectional Studies Female Fever Health Personnel Humans Infectious Diseases Male Middle Aged Netherlands - epidemiology Online Only Original Investigation Pandemics Pneumonia, Viral - epidemiology Pneumonia, Viral - virology Prevalence SARS-CoV-2 Self report Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Teaching hospitals Young Adult |
| Title | Prevalence and Clinical Presentation of Health Care Workers With Symptoms of Coronavirus Disease 2019 in 2 Dutch Hospitals During an Early Phase of the Pandemic |
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