India reported almost 45 million cases of the coronavirus (COVID-19) as of October 20, 2023, with more than 44 million recoveries and about 532 thousand fatalities. The number of cases in the country had a decreasing trend in the past months.

Burden on the healthcare system

With the world's second largest population in addition to an even worse second wave of the coronavirus pandemic seems to be crushing an already inadequate healthcare system. Despite vast numbers being vaccinated, a new variant seemed to be affecting younger age groups this time around. The lack of ICU beds, black market sales of oxygen cylinders and drugs needed to treat COVID-19, as well as overworked crematoriums resorting to mass burials added to the woes of the country. Foreign aid was promised from various countries including the United States, France, Germany and the United Kingdom. Additionally, funding from the central government was expected to boost vaccine production.

Situation overview
Even though days in April 2021 saw record-breaking numbers compared to any other country worldwide, a nation-wide lockdown has not been implemented. The largest religious gathering - the Kumbh Mela, sacred to the Hindus, along with election rallies in certain states continue to be held. Some states and union territories including Maharashtra, Delhi, and Karnataka had issued curfews and lockdowns to try to curb the spread of infections.

The Indian state of Punjab reported the highest number of active coronavirus (COVID-19) cases of over one thousand cases as of October 20, 2023. Kerala and Karnataka followed, with relatively lower casualties. That day, there were a total of over 44 million confirmed infections across India.

Executive summary

The novel coronavirus SARS-CoV2 (COVID-19), first detected by Wuhan Municipal Health Commission, China, in Wuhan, Hubei Province in December 2020 and eventually the disease became pandemic. It was declared as Public Health Emergency of International Concern (PHEIC) by WHO in January 2020. The COVID-19 disease primarily spreads through droplets of saliva or discharge from the nose when an infected person coughs or sneezes. People infected with the COVID-19 virus experiences mild, moderate or serious respiratory illness.

Health workers play a critical role in the clinical management of patients with COVID-19 and hence are likely to be the most vulnerable for contracting the disease. Therefore, investigating the extent of infection in health care settings and identifying risk factors for infection among health workers along with follow-up within a facility in which a confirmed case of COVID-19 infection is receiving care can provide useful information on virus transmissibility and routes of transmission, and will bear important step in limiting amplification events in health care facilities.

Objectives:

1. To find out the extent of human-to-human transmission of the SARS-CoV-2 infection among health workers
2. To study the clinical presentations of COVID-19 infection and the risk factors for infection among health workers.
3 To evaluate the effectiveness of infection prevention and control measures among health workers in protecting against COVID-19.
4. To evaluate the effectiveness of infection prevention and control programmes at health facility level
5. To determine the serological response of health workers with symptomatic and possibly asymptomatic COVID-19 infection.

Materials and Methods:

This was a prospective cohort study conducted over a period of seven months, from December 2020 to June 2021, the period covering India’s deadly second wave of COVID-19 pandemic. This was done among the health care workers working in HIMSR & HAHC hospital, a tertiary health care setting (Dedicated COVID-19 Hospital) providing care to patients with a laboratory-confirmed COVID-19 infection. This hospital located in South East Delhi has 200 bedded COVID-19 Care Hospital and 1050 registered healthcare workers who come in contact with COVID-19-infected persons. The study population (sampling frame) included all the health personnel like doctors, nurses, paramedical staff, housekeeping staff, security staff, students of medical, nursing and paramedical sciences and other front office staff who come in contact with the patients. In this study, the first visit / interview (Baseline) was done when the staff came in contact with a confirmed COVID-19 case. The second visit / interview (Endline) was done between 22-28 days. During each of these two visits, biological sample in the form of serum was collected to check the presence of anti-COVID-19 antibodies

Results:

A total of 192 HCW were recruited in this study. All of them were interviewed and blood was collected for serology at the baseline visit as well as at endline. Out of 192 participants, 119 (61.97%) were detected with SARS-CoV2 antibodies at baseline whereas 73 (38.02%) were seronegative. Again, on22-28 days of follow-up, the seropositivity was 77.7% at the endline. We found that seropositivity was significantly and negatively associated with doctor as profession [OR:0.353, CI:0.176-0.710], COVID-19 symptoms [OR:0.210, CI:0.054-0.820], comorbidities [OR:0.139 , CI: 0.029 - 0.674], recent IPC Training [OR:0.250, CI:0.072 -0.864] , while positively associated with Partially [OR:3.303,CI: 1.256-8.685], as well as fully Vaccinated for COVID-19 [OR:2.428, CI:1.118-5.271]. We also observed seroconversion among 36.7% while 64.0% had increase in titre of antibodies during our follow-up period. The seroconversion was 63.2% in doctors, 42.9% in nurses and 13.0% in paramedics staff. Seroconversion was positively associated with doctor as profession [OR:11.43, CI:2.47 - 52.79] and with partially, as well as fully vaccinated for COVID-19 [OR: 32.63, CI: 5.11 - 208.49]. None of the HCW who were smokers and with any comorbidity did not found to have been seroconversion. We observe a negative and significant relationship of increase in titre of antibodies with recent any ILI symptoms [OR:0.17, 0.13 - 0.94], smokers[OR: 0.35, 95%CI: 0.13 - 0.94], HCW with comorbidities [OR:0.08,95CI: 0.01 - 0.71],, recent full IPC Training [OR:0.07, CI:0.01 -0.63] , while positively associated with partially [OR: 7.87, 95CI: 2.18 - 28.40)], as well as fully Vaccinated for COVID-19 [OR: 3.59, 95CI: 1.46 - 8.87]. Majority of the health care worker enrolled in our study had close contact exposure with COVID-19 patients while 5 had indirect exposure. It was observed that almost all (100% in both) doctors and nurses as well as almost all paramedical staff (99%) were wearing some kind of personal protective equipment (PPE) when they were exposed to a COVID-19 patient. We did not found adherences to any of the infection prevention measure adopted by the enrolled HCW during the recent contact with COVID-19 patients to be significantly associated with seroconversion.

Conclusion:

Majority of the health care worker (67% doctor, 80% nurses & 55% paramedics) enrolled in our study had close contact exposure with COVID-19 patient. The results show that among 192 HCW enrolled, 62% were seropositive at the baseline. At end line the seropositivity was increased to 77.7%. The seroconversion rate was also studied. It was found to be 36.7% in our study population (63.2% in doctors, 42.9% in nurses and 13.0% in paramedic’s staff.). Adherence to the recommended IPC measures was reported by most participants. About two third (63%) of the HCW in our study were not vaccinated against COVID-19; nurses and paramedics were higher in proportion among those who were unvaccinated. Fifteen percentage were partially vaccinated and 22% were fully vaccinated against COVID-19, with doctors comprising majority among them. We also found that vaccination had the strongest association with seropositivity, seroconversion as well as serial rise of titre.