Características clínicas de COVID-19 en trabajadores sanitarios de tres hospitales de Madrid durante la primera ola de la pandemia
DOI:
https://doi.org/10.4321/s0465-546x2021000100002Palabras clave:
COVID-19, SARS-CoV-2, trabajadores de la salud, PCR de SARS-CoV-2 características clínicasResumen
Introducción: El objetivo Disminuir el área de incertidumbre con la comprensión de la sintomatología y la caracterización clínica dentro del entorno hospitalario.
Método: Este es un estudio descriptivo comparativo, donde se revisaron y compararon las manifestaciones clínicas de 255 trabajadores sanitarios con COVID-19 durante la primera ola (marzo-abril 2020). De acuerdo a las características se hizo el análisis de los resultados utilizando las pruebas chi cuadrado, U de Mann-Whitney/w de Wilcoxon y las medidas de tendencia central.
Resultados: La anosmia y la ageusia tuvieron un vínculo estadísticamente significativo con la obtención de un resultado positivo en la PCR: Anosmia p=0,001; Ageusia: p=0,00; fiebre (p=0,01) y la odinofagia (p=0,03). La tos 75,56%, mialgias 68,11%, cefalea 43,53%, anosmia 37,25%, fiebre 34,12 % y ageusia 31,76% sobresalieron dentro de los síntomas. La positividad de la PCR tras el inicio de los síntomas estuvo entre 1.5 a 4 días.
Conclusiones: Es primordial utilizar un enfoque que al menos incluya la fiebre, anosmia o ageusia al establecer aislamiento y la determinación de pruebas diagnósticas. La caracterización clínica es fundamental para poder establecer estrategias sanitarias efectivas. Nuevas variantes del SARS CoV-2 podrían alterar la efectividad de estas estrategias.
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Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020 Mar 12;579(7798):270–3.
Canova V, Lederer-Schlpfer H, Piso RJ, Droll A, Fenner L, Hoffmann T, et al. Transmission risk of SARS-CoV-2 to healthcare workers –observational results of a primary care hospital contact tracing. Swiss Med Wkly [Internet]. 2020 Apr 25 [cited 2020 May 2];150:w20257. DOI: 10.4414/smw.2020.20257. Disponible en: https://doi.emh.ch/smw.2020.20257
Park SE. Epidemiology, virology, and clinical features of severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2; Coronavirus Disease-19) [Internet]. Korean J Pediatr. 2020 [cited 2021 Feb 19];63(4):119–24. DOI: 10.3345/cep.2020.00493. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32252141/
Cascella M, Rajnik M, Cuomo A, Dulebohn SC, Di Napoli R. Features, Evaluation and Treatment Coronavirus (COVID-19) [Internet]. StatPearls Publishing. 2020 [cited 2021 Feb 19]. PMID: 32150360. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32150360
RENAVE, CNE, CNM (ISCIII). Informe nº 63 -Situación de COVID-19 en España-Casos diagnosticados a partir de 10 de mayo [Internet]. ISCIII. 2021 [cited 2021 Ene 19]. Disponible en: https://bit.ly/3EVD8dP
Gandhi RT, Lynch JB, del Rio C. Mild or Moderate Covid-19. Solomon CG, editor. N Engl J Med [Internet]. 2020 Apr 24 [cited 2020 May 2];383:1757-66. DOI: 10.1056/NEJMcp2009249. Disponible en: http://www.nejm.org/doi/10.1056/NEJMcp2009249
Smyk W, Janik MK, Portincasa P, Milkiewicz P, Lammert F, Krawczyk M. COVID-19: focus on the lungs but do not forget the gastrointestinal tract. Eur J Clin Invest [Internet]. 2020 May 14 [cited 2020 May 16];50(9):e13276. DOI: 10.1111/eci.13276. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/eci.13276
Liu M, He P, Liu HG, Wang XJ, Li FJ, Chen S, et al. Clinical characteristics of 30 medical workers infected with new coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za Zhi [Internet]. 2020 Mar 12 [cited 2020 May 2];43(3):209–14. DOI: 10.3760/cma.j.issn.1001-0939.2020.03.014. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/32164090
Klompas M, Morris CA, Sinclair J, Pearson M, Shenoy ES. Universal Masking in Hospitals in the Covid-19 Era. N Engl J Med. 2020 Apr 1;382:e63. DOI: 10.1056/NEJMp2006372. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmp2006372
Tong JY, Wong A, Zhu D, Fastenberg JH, Tham T. The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis [Internet]. Otolaryngol Head Neck Surg. 2020;163(1):3-11. DOI: 10.1177/0194599820926473. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32369429/
Gómez-Ochoa SA, Franco OH, Rojas LZ, Raguindin PF, Roa-Díaz ZM, Wyssmann BM, et al. COVID-19 in Health-Care Workers: A Living Systematic Review and Meta-Analysis of Prevalence, Risk Factors, Clinical Characteristics, and Outcomes. Am J Epidemiol [Internet]. 2021 Jan 1 [cited 2021 Feb 19];190(1):161–75. DOI: 10.1093/aje/kwaa191. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32870978/
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med [Internet]. 2020 Apr 30 [cited 2020 May 2];382(18):1708–20. DOI: 10.1056/NEJMoa2002032. Disponible en: http://www.nejm.org/doi/10.1056/NEJMoa2002032
Zhu J, Ji P, Pang J, Zhong Z, Li H, He C, et al. Clinical characteristics of 3062 COVID-19 patients: A meta-analysis. J Med Virol [Internet]. 2020 Oct 1 [cited 2021 Feb 19];92(10):1902–14. DOI: 10.1002/jmv.25884. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32293716/
Yuan J, Li M, Lv G, Lu ZK. Monitoring Transmissibility and Mortality of COVID-19 in Europe. Int J Infect Dis. 2020;95:311-5. DOI: 10.1016/j.ijid.2020.03.050. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32234343/
Forster P, Forster L, Renfrew C, Forster M. Phylogenetic network analysis of SARS-CoV-2 genomes. Proc Natl Acad Sci. 2020 Apr 8;117(17):9241-3. DOI: 10.1073/pnas.2004999117. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32269081/
Tegally H, Wilkinson E, Giovanetti M, Iranzadeh A, Fonseca V, Giandhari J, et al. Emergence and rapid spread of a new severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) lineage with multiple spike mutations in South Africa [Internet]. medRxiv. 2020 [cited 2021 Feb 19];10. DOI: 10.1101/2020.12.21.20248640. Disponible en: https://doi.org/10.1101/2020.12.21.20248640
Du Z, Wang L, Yang B, Taslim Ali S, Tsang TK, Shan S, et al. International risk of the new variant COVID-19 importations originating in the United Kingdom. Emerg Infect Dis [Internet]. 2021 may[cited 2021 Mar 24];27(5). DOI: 10.3201/eid2705.210050. Disponible en: https://wwwnc.cdc.gov/eid/article/27/5/21-0050_article
Forni G, Mantovani A, Moretta L, Rappuoli R, Rezza G, Bagnasco A, et al. COVID-19 vaccines: where we stand and challenges ahead [Internet]. Cell Death Differ. 2021;28(2):626-9. DOI: 10.1038/s41418-020-00720-9. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33479399/
Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med [Internet]. 2020 Dec 31 [cited 2021 Jan 15];383(27):2603–15. DOI: 10.1056/NEJMoa2034577. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa2034577
Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med [Internet]. 2021;384:403-16. DOI: 10.1056/NEJMoa2035389. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa2035389
Xie X, Zou J, Fontes-Garfias CR, Xia H, Swanson KA, Cutler M, et al. Neutralization of N501Y mutant SARS-CoV-2 by BNT162b2 vaccine-elicited sera. bioRxiv [Internet]. 2021 Jan 7 [cited 2021 Jan 15]. DOI: 10.1101/2021.01.07.425740. Disponible en: https://doi.org/10.1101/2021.01.07.425740
RENAVE, CNE, CNM (ISCIII). Informe sobre la situación de COVID- 19 en personal sanitario en España a 10 de mayo de 2020 [Internet]. ISCIII. 2021 [cited 2021 Feb 19]. Disponible en: https://bit.ly/3ocyTEK
Suárez-García I, Martínez de Aramayona-López MJ, Sáez-Vicente A, Lobo-Abascal P. SARS-CoV-2 infection among healthcare workers in a hospital in Madrid, Spain. J Hosp Infect [Internet]. 2020 Oct 1 [cited 2021 Feb 14];106(2):357–63. DOI: 10.1016/j.jhin.2020.07.020. Disponible en: https://doi.org/10.1016/j.jhin.2020.07.020
Trullàs JC, Vilardell I, Blasco M, Heredia J. COVID-19 in health workers from the Olot Regional Hospital (Girona) [Internet]. Rev Clin Esp (Barc). 2020 [cited 2021 Feb 13];220(8):529-31. DOI: 10.1016/j.rce.2020.07.002. Disponible en: https://bit.ly/3F1M0yx
Información científica-técnica. Enfermedad por coronavirus, COVID-19 15 de enero 2021 [Internet]. [cited 2021 Feb 20]. España: Ministerio de Sanidad;2021. Disponible en: https://bit.ly/3D1tYuB
Spinato G, Fabbris C, Polesel J, Cazzador D, Borsetto D, Hopkins C, et al. Alterations in Smell or Taste in Mildly Symptomatic Outpatients with SARS-CoV-2 Infection [Internet]. JAMA Netw Open. 2020 [cited 2021 Feb 14];323(20):2089-90. DOI: 10.1001/jama.2020.6771. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2765183
Kluytmans-van den Bergh MFQ, Buiting AGM, Pas SD, Bentvelsen RG, van den Bijllaardt W, van Oudheusden AJG, et al. SARS-CoV-2 infection in 86 healthcare workers in two Dutch hospitals in March 2020 [Internet]. medRxiv. 2020 [cited 2021 Feb 14]. DOI: 10.1101/2020.03.23.20041913. Disponible en: https://doi.org/10.1101/2020.03.23.20041913
Folgueira MD, Munoz-Ruiperez C, Alonso-Lopez MA, Delgado R. SARS-CoV-2 infection in Health Care Workers in a large public hospital in Madrid, Spain, during March 2020. medRxiv. Pendiente de publicación [fecha aceptación: 2020 Apr 27]. DOI: 10.1101/2020.04.07.20055723. Disponible en: https://www.medrxiv.org/content/10.1101/2020.04.07.20055723v2
Agyeman AA, Chin KL, Landersdorfer CB, Liew D, Ofori-Asenso R. Smell and Taste Dysfunction in Patients With COVID-19: A Systematic Review and Meta-analysis. Mayo Clin Proc [Internet]. 2020 Aug 1 [cited 2021 Feb 14];95(8):1621–31. DOI: 10.1016/j.mayocp.2020.05.030. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32753137/
Tong JY, Wong A, Zhu D, Fastenberg JH, Tham T. The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Meta-analysis [Internet]. Otolaryngol Head Neck Surg. 2020 [cited 2021 Feb 14];163(1):3–11. DOI: 10.1177/0194599820926473. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32369429/
Lechien JR, Chiesa-Estomba CM, Place S, Van Laethem Y, Cabaraux P, Mat Q, et al. Clinical and Epidemiological Characteristics of 1,420 European Patients with mild-to-moderate Coronavirus Disease 2019. J Intern Med [Internet]. 2020 Apr 30 [cited 2020 May 2];288(3):335-44. DOI: 10.1111/joim.13089. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/joim.13089
Ong JJY, Bharatendu C, Goh Y, Tang JZY, Sooi KWX, Tan YL, et al. Headaches Associated With Personal Protective Equipment – A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19. Headache [Internet]. 2020 May 1 [cited 2021 Feb 21];60(5):864–77. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32232837/
Rudberg AS, Havervall S, Månberg A, Falk AJ, Aguilera K, Ng H, et al. SARS-CoV-2 exposure, symptoms and seroprevalence in health care workers in Sweden [Internet]. Nat Commun. 2020;11:5064. DOI: 10.1038/s41467-020-18848-0. Disponible en: https://www.nature.com/articles/s41467-020-18848-0
Clemency BM, Varughese R, Scheafer DK, Ludwig B, Welch JV, McCormack RF, et al. Symptom Criteria for COVID-19 Testing of Heath Care Workers. Acad Emerg Med [Internet]. 2020 Jun 8 [cited 2021 Feb 20];27(6):469–74. DOI: 10.1111/acem.14009. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14009