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lack of healthcare staff&#44; or lack of infrastructure&#44; to ensure adequate isolation<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The Health District&#8217;s Public Health Unit implemented a specific program to control and trace infections among healthcare workers in these types of care facilities&#46; The very first outbreaks brought to light the potential role of workers in the mechanisms of transmission&#44; with screening for and active observation of symptoms representing an essential component&#46; This program included early case identification&#44; thorough information collection&#44; advising on surveillance and control measures&#44; support for processing temporary disability leave&#44; as well as a specific consultation phone line&#46; Similarly&#44; written recommendations were sent to the directors of long-term care centres regarding the importance of active symptom detection&#44; including taking and recording temperature and responsible declaration of a lack of symptoms prior to starting shifts&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To date&#44; there are few studies on the characteristics and roles of healthcare workers in COVID-19 epidemiology&#46; The data generated by the epidemiological surveillance program and by the outbreak control mechanism made it possible to obtain valuable information about the context of the pandemic&#46; This study aims to describe the epidemiological characteristics of COVID-19 among health professionals from the Seville Health District&#44; assessing their role in the temporary evolution of infection in the facilities that experienced outbreaks&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methodology</span><p id="par0030" class="elsevierStylePara elsevierViewall">An observational&#44; analytical study was conducted on the epidemiological characteristics of infection by SARS-CoV-2 among healthcare workers &#40;PSS according to the Spanish acronym&#41; during the period between 1 March and 12 May 2020&#46; The label of PSS was given to any individual dedicated to health&#44; social&#44; and educational assistance for groups of older individuals or individuals with disabilities&#44; including staff from external companies &#40;cleaning&#44; maintenance&#8230;&#41; who came into contact with residents&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Information sources included the daily tracking logs from the facilities regarding case detection &#40;Andalusian care strategy&#41; and the RedAlerta epidemiological surveillance program&#46; RedAlerta includes variables from the Andalusian Epidemiological Surveillance System &#40;SVEA according to the Spanish acronym&#41; regarding the characteristics of the cases&#44; data from epidemiological surveys&#44; and actions related to controlling outbreaks&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Following definition of the study variables&#44; a file was created with anonymised personal data&#44; ensuring safety and protection regulations throughout the entire process&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As a starting point&#44; we took the 88 centres included in the District program of nursing homes and long-term care centres located in the capital city of Seville &#40;34 nursing homes for the elderly&#59; 31 foster care centres&#59; 18 religious congregations and 5 care centres for the disabled&#41;&#44; with 2&#44;779 active workers&#46; A total of 732 PSS was included&#44; corresponding to 14 centres with at least one case of COVID-19 and which the case management nurses actively traced&#44; identifying the appearance of compatible symptomatology and collecting the positive results of the rapid antibody tests&#46; Afterwards&#44; cases were isolated&#44; and a PCR test was performed&#46; The definition of cases followed the procedures of the Ministry in force at all times&#58; any PSS that presented a positive PCR test or positive rapid antibody test&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the initial phase&#44; all the workers were screened to discover the prevalence of total antibodies in the city&#8217;s PSS&#46; In the second phase&#44; we collected all the information on the incident cases in the residential centres where a COVID-19 outbreak had been declared&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The following variables were collected&#58; age&#44; sex&#44; professional category&#44; confirmed close contact with COVID-19&#44; hospitalisation&#44; death&#44; presence of risk factors&#44; symptomatology and dates for symptom onset&#44; isolation&#44; case declaration&#44; and test results&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">To know the prevalence of SARS-CoV-2 antibodies in this population&#44; two rounds of screening were conducted using rapid antibody tests via immunochromatography&#44; with 7 days difference between the tests to reduce the possible window period effect of the infection&#46; To calculate the incidence of COVID-19 in the outbreak-affected centres&#44; PCR tests were performed on positive cases found in the screening&#44; as well as those PSS who developed symptoms compatible with the disease during the study&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Frequency tables were used to analyse the qualitative variables&#44; and measures of central tendency and dispersion for the quantitative variables&#44; including the interquartile range&#46; The prevalence of antibodies to SARS-CoV-2 was calculated in the entire sample&#46; In the facilities affected by outbreaks&#44; the following were calculated&#58; cumulative incidence of COVID-19 cases in PSS&#44; attack rate&#44; and average number of days that the workers attended work with symptoms&#46; The epidemic curves of the COVID-19 cases were created for both PSS and residents &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">Rapid antibody tests were performed on 2&#44;779 PSS from 88 facilities&#44; of which 78&#46;6&#37; were female and 21&#46;4&#37; were male &#40;femininity index of 368&#46;03&#37;&#41;&#46; In this first screening phase 40 workers were detected with a positive result&#44; of which 26 &#40;65&#37;&#41; reported having symptoms compatible with COVID-19 in the epidemiological survey&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">During the study period&#44; outbreaks occurred in 14 centres&#44; with 732 PSS&#46; A total of 79&#46;0&#37; were female and the median age was 33&#46;5 years &#40;interquartile range&#58; 27-45&#41;&#46; According to professional category&#44; 39&#46;7&#37; were nursing aides&#59; 17&#37; geriatrics assistants&#59; 8&#46;7&#37; cleaning staff&#59; 5&#46;7&#37; nurses&#59; 1&#46;7&#37; physical therapists&#44; and 1&#46;3&#37; doctors&#46; Cases also occurred in other categories of lesser proportion such as cooks&#44; concierge&#44; maintenance&#44; receptionists&#44; and social workers&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the study period&#44; a total of 124 cases of COVID-19 were confirmed among the PSS&#44; representing a cumulative incidence of 16&#46;9&#37;&#46; A total of 90 cases were confirmed by PCR and the rest by means of rapid antibody tests&#46; As seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; only one case occurred among PSS in 7 of the 14 centres&#46; The attack rates ranged from 2&#46;1&#37;-36&#46;1&#37;&#44; and 3 facilities had a percentage of affected staff of more than 25&#37; of the PSS&#46; The attack rate among the residents was 54&#46;3&#37; with a range of 18&#46;4&#37;-79&#46;8&#37;&#46; There is a correlation between the number of PSS and the attack rate &#40;unilateral&#44; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;05&#44; Spearman&#8217;s rank correlation of 0&#46;484&#41;&#46; This analysis is not confirmed if we divide the facilities between those with more or less than 50 PSS due to the small number of facilities&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Of the 90 cases detected by PCR&#44; 7 &#40;7&#46;7&#37;&#41; were identified via a prior positive antibody test &#40;4 of them acknowledged having had symptoms compatible with COVID-19&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> presents the data for the 7 outbreaks declared in the Seville district that presented more than one case among the PSS and which represent 94&#46;3&#37; of the total declared cases&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Of the confirmed cases&#44; 87&#46;1&#37; presented symptomatology&#46; The most common symptoms included cough &#40;49&#46;2&#37;&#41;&#44; fever &#40;31&#46;5&#37;&#41;&#44; headache &#40;25&#37;&#41;&#44; anosmia &#40;19&#46;4&#37;&#41; and asthenia &#40;18&#46;5&#37;&#41;&#46; The least frequent symptomatology was dyspnoea&#44; present in 8&#46;1&#37; of cases&#46; A total of 17&#46;7&#37; presented a risk factor for COVID-19&#44; with the most common being high blood pressure and chronic lung disease with 8&#46;5&#37; prevalence&#44; followed by age of over 60 with 4&#46;8&#37;&#46; A total of 5&#46;6&#37; required hospitalisation and no deaths occurred&#46; All cases recovered without sequelae&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In terms of the distribution over time&#44; the week from 16 to 22 March had the highest incidence for symptom onset date &#40;5&#46;12&#37;&#41; and the week from 23 to 29 March the highest incidence for date of case declaration &#40;3&#46;91&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Regarding the delay between symptom onset and isolation&#44; this was greater than 10 days for multiple weeks&#46; The delays until case declaration are somewhat longer&#44; though these follow a similar pattern &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Lastly&#44; the curves for symptomatic PSS cases and those for residents in the affected centres are shown&#44; according to the symptom onset date&#46; The first case in PSS started showing symptoms on 2 March&#44; while the first declared case did not occur until 17 March&#46; The highest peak was on 19 March in PSS and 25 March for residents &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The case rate was one PSS in 3 facilities&#46; In another facility&#44; 2 different waves can be discerned&#44; with the first starting on 17 March with one case among the residents and the second on 21 April with one case among the PSS&#46; From 31 March to 20 April&#44; no residents or PSS started to experience symptoms&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">This study shows the high impact of COVID-19 in long-term care centres in Seville during the period from March to May 2020&#44; in which 14 out of 88 centres in the district were affected&#44; with an attack rate of 54&#46;3&#37; among residents in centres with outbreaks&#46; The healthcare workers group was also particularly affected&#44; with an attack rate of 16&#46;9&#37; in centres with outbreaks&#46; While the cumulative incidence is similar between men and women&#44; in absolute terms the impact is higher in female workers as this sector is highly woman dominant&#46; The proportion of cases in women is around 75&#37;&#44; which is very similar to the data published by the Ministry of Health for cases among health professionals<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A significant percentage of the affected staff attended work with symptoms&#44; which could have conditioned the speed and spread of infection&#46; The majority of cases presented at least one of the characteristic symptoms of COVID-19&#44; despite delays in isolating and declaring the cases&#46; The little knowledge of the disease at the time&#44; difficulty to access diagnostic tests&#44; and strain on staff are considered the causes behind this diagnostic delay&#46; All of this was aggravated by the complicated definition of occupational disease in terms of temporary disability leave&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">These data coincide with the studies conducted in the hospital environment which show infection rates in workers ranging from 9&#37; to 29&#37;&#44; with delays exceeding 2 days and symptomatology similar to that already described<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;20</span></a>&#46; The facilities with the highest incidence among PSS and residents were affected during the first fortnight of March 2020&#44; with the incidence subsequently slowly decreasing&#46; This decrease over the course of the study period coincided with the improvements established within the Health Department&#8217;s control program and can be attributed to the learning and adoption of preventive measures&#44; as well as enhanced surveillance and early detection of cases&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Multiple studies have reported the significant role of unrecognised asymptomatic and presymptomatic infections as a contributing factor to transmission in these environments<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;21</span></a>&#46; These studies conducted screening in the context of the outbreaks&#44; finding that over half of the residents or workers with positive tests were asymptomatic<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17&#44;22&#44;23</span></a>&#46; Consequently&#44; interventions that could improve control would include early identification of potential cases by broadening the criteria for case suspicion and symptom detection&#44; increasing the use of testing with regular screenings&#44; and making it easier to process temporary disability leaves due to illness<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Similarly&#44; notifying the health authorities to establish emergency measures and the swift implementation of intervention have been shown to be key in reducing transmission in facilities and in controlling COVID-19 outbreaks<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Study limitations include difficulty in collecting data given the state of emergency due to the pandemic&#44; which could have affected the reliability of some of the variables&#46; Uncertainty in remembering exact dates could have affected the recording of onset of symptoms and their characteristics with mild symptomatology&#46; The high variability in the clinical picture of this disease&#44; as well as a reticence to declare cases&#44; causes patients with mild symptoms to potentially go unnoticed&#46; A number of diagnoses were made using antibody tests that were later confirmed to have low sensitivity and specificity&#44; but given that the proportion of these cases is low&#44; it is assumed that it should not alter the overall results&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In short&#44; the high incidence of infection by SARS-CoV-2 among healthcare workers was a deciding factor in the appearance of outbreaks in long-term care facilities&#44; as well as in the intensity and duration of transmission&#46; This situation mainly occurred during the initial weeks of the pandemic when there was little knowledge of the disease and little access to tests&#46; Currently&#44; the high vaccination coverage accomplished in these centres has achieved indirect protection for even those residents who have not been vaccinated&#46; Even with this strategy&#44; it is necessary to expand upon measures that improve labour and working conditions&#44; providing training in the prevention of infection transmission and management of temporary disability associated with COVID-19<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Promoting prevention programs for the new coronavirus will result in better global control of infections with regards to long-term care centres&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0150" class="elsevierStylePara elsevierViewall">This study was conducted without any specific funding&#46; All the resources used were those made available in the daily work of the Seville Health District epidemiology service&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest&#46;</p></span></span>"
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            1 => "Nursing homes"
            2 => "Nursing staff"
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            1 => "Centros sociosanitarios"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Coronavirus disease 2019 &#40;COVID-19&#41;&#44; caused by SARS-CoV-2 infection&#44; spreads swiftly in nursing homes and assisted living facilities&#44; leading to a high degree of lethality&#46; The data generated by an epidemiological surveillance program allow for obtaining valid information on the diseases&#8217; epidemiology and possible prevention methods&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">This work aims to analyze COVID-19 epidemiology among healthcare staff based in the Seville healthcare district &#40;Spain&#41; and evaluate its role in outbreaks in nursing homes&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">This is an observational&#44; descriptive study of 88 assisted living facilities located in the city of Seville from March 1 to May 23&#44; 2020&#46; Data were obtained via epidemiological surveys on staff at centers where there were outbreaks &#40;n &#61; 732 in 14 nursing homes&#41;&#46; The cumulative incidence&#44; epidemic curves&#44; sociodemographic and clinical characteristics&#44; and delays in isolation and notification of cases were calculated&#46; For the statistical analysis&#44; measures of central tendency and dispersion were used as well as confidence intervals and statistical hypothesis tests&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">There were 124 cases in staff members &#40;cumulative incidence 16&#46;9&#37;&#41;&#44; 79&#46;0&#37; of which were in women&#46; The majority presented with mild symptoms &#40;87&#46;1&#37;&#41;&#46; The most common symptoms were fever &#40;31&#46;5&#37;&#41; and cough &#40;49&#46;2&#37;&#41;&#46; The median number of days from onset of symptoms to isolation was three&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A high incidence in nursing home staff along with delays in isolation were observed&#44; which could affect the dynamics of transmission in outbreaks&#46; It is necessary to review disease identification and isolation practices among staff as well as emphasize rapid implementation of prevention measures&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Antecedentes</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La infecci&#243;n por coronavirus SARS-CoV-2 se transmite r&#225;pidamente en residencias de mayores y centros sociosanitarios&#44; provocando una elevada letalidad&#46; Los datos generados por el programa de vigilancia epidemiol&#243;gica permiten informaci&#243;n v&#225;lida sobre la epidemiolog&#237;a del problema y las posibilidades de prevenci&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Analizar la epidemiolog&#237;a de la infecci&#243;n por COVID-19 entre los profesionales sociosanitarios del Distrito Sanitario Sevilla y su papel en la evoluci&#243;n de los brotes en las residencias de mayores&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Metodolog&#237;a</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Estudio sobre 88 centros sociosanitarios de la ciudad de Sevilla en el per&#237;odo del 1 marzo al 23 mayo de 2020&#44; partiendo de las encuestas epidemiol&#243;gicas en casos del personal donde hubo brotes &#40;n &#61; 732 en 14 residencias&#41;&#46; Se calcularon incidencias acumuladas&#44; curvas epid&#233;micas&#44; caracter&#237;sticas sociodemogr&#225;ficas y cl&#237;nicas&#44; y demoras en el aislamiento y notificaci&#243;n de los casos&#46; Para el an&#225;lisis estad&#237;stico se emplearon medidas de tendencia central y de dispersi&#243;n&#44; as&#237; como intervalos de confianza y pruebas de contraste de hip&#243;tesis&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Se produjeron 124 casos en trabajadores &#40;tasa de ataque 16&#44;9&#37;&#41;&#44; 79&#44;0&#37; en mujeres&#46; La gran mayor&#237;a presentaron s&#237;ntomas leves &#40;87&#44;1&#37;&#41;&#46; Los comunes fueron fiebre &#40;31&#44;5&#37;&#41; y tos &#40;49&#44;2&#37;&#41;&#46; La mediana de d&#237;as desde el inicio de los s&#237;ntomas hasta el aislamiento fue 3 d&#237;as&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Se objetiva una elevada incidencia en el personal sociosanitario con demoras en el aislamiento que pudieron condicionar la din&#225;mica de transmisi&#243;n en los brotes&#46; Es necesario revisar las pr&#225;cticas de identificaci&#243;n de la enfermedad y el aislamiento entre el personal&#44; &#233;nfasis en la implementaci&#243;n r&#225;pida de medidas de prevenci&#243;n&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Morales Viera A&#44; Rivas Rodr&#237;guez R&#44; Otero Aguilar P&#44; Briones P&#233;rez de Blanca E&#46; Epidemiolog&#237;a de la COVID-19 entre el personal de centros sociosanitarios de Sevilla&#46; Rev Clin Esp&#46; 2022&#59;222&#58;205&#8211;211&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Long-term care centre&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No&#46; of cases&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">A &#40;N&#160;&#61;&#160;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anosmia&#47;ageusia&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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Journal Information
Vol. 222. Issue 4.
Pages 205-211 (April 2022)
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Vol. 222. Issue 4.
Pages 205-211 (April 2022)
Original article
Epidemiology of COVID-19 among health personnel in long-term care centers in Seville
Epidemiología de la COVID-19 entre el personal de centros sociosanitarios de Sevilla
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A. Morales Vieraa,
Corresponding author
albamorales92@gmail.com

Corresponding author.
, R. Rivas Rodríguezb, P. Otero Aguilarc, E. Briones Pérez de Blancad,e
a Servicio de Medicina familiar y comunitaria del Distrito Sanitario de Sevilla, Centro de Salud La Candelaria, Sevilla, Spain
b Servicio de Medicina familiar y comunitaria del Distrito Sanitario de Sevilla, Centro de Salud Alamillo, Sevilla, Spain
c Servicio de Medicina familiar y comunitaria del Distrito Sanitario de Sevilla, Centro de Salud Mercedes Navarro, Sevilla, Spain
d Servicio de Medicina Preventiva y Salud Pública del Distrito Sanitario de Sevilla, Centro Distrito Sevilla, Sevilla, Spain
e CIBER de Epidemiología y Salud Pública (CIBERESP), Sevilla, Spain
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Table 1. Attack rate in PSS by long-term care centre.
Table 2. Clinical and demographic characteristics of confirmed cases in PSS by nursing home associated to outbreak.
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Abstract
Background

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 infection, spreads swiftly in nursing homes and assisted living facilities, leading to a high degree of lethality. The data generated by an epidemiological surveillance program allow for obtaining valid information on the diseases’ epidemiology and possible prevention methods.

Objective

This work aims to analyze COVID-19 epidemiology among healthcare staff based in the Seville healthcare district (Spain) and evaluate its role in outbreaks in nursing homes.

Methods

This is an observational, descriptive study of 88 assisted living facilities located in the city of Seville from March 1 to May 23, 2020. Data were obtained via epidemiological surveys on staff at centers where there were outbreaks (n = 732 in 14 nursing homes). The cumulative incidence, epidemic curves, sociodemographic and clinical characteristics, and delays in isolation and notification of cases were calculated. For the statistical analysis, measures of central tendency and dispersion were used as well as confidence intervals and statistical hypothesis tests.

Results

There were 124 cases in staff members (cumulative incidence 16.9%), 79.0% of which were in women. The majority presented with mild symptoms (87.1%). The most common symptoms were fever (31.5%) and cough (49.2%). The median number of days from onset of symptoms to isolation was three.

Conclusions

A high incidence in nursing home staff along with delays in isolation were observed, which could affect the dynamics of transmission in outbreaks. It is necessary to review disease identification and isolation practices among staff as well as emphasize rapid implementation of prevention measures.

Keywords:
COVID-19
Nursing homes
Nursing staff
Epidemiology
Resumen
Antecedentes

La infección por coronavirus SARS-CoV-2 se transmite rápidamente en residencias de mayores y centros sociosanitarios, provocando una elevada letalidad. Los datos generados por el programa de vigilancia epidemiológica permiten información válida sobre la epidemiología del problema y las posibilidades de prevención.

Objetivo

Analizar la epidemiología de la infección por COVID-19 entre los profesionales sociosanitarios del Distrito Sanitario Sevilla y su papel en la evolución de los brotes en las residencias de mayores.

Metodología

Estudio sobre 88 centros sociosanitarios de la ciudad de Sevilla en el período del 1 marzo al 23 mayo de 2020, partiendo de las encuestas epidemiológicas en casos del personal donde hubo brotes (n = 732 en 14 residencias). Se calcularon incidencias acumuladas, curvas epidémicas, características sociodemográficas y clínicas, y demoras en el aislamiento y notificación de los casos. Para el análisis estadístico se emplearon medidas de tendencia central y de dispersión, así como intervalos de confianza y pruebas de contraste de hipótesis.

Resultados

Se produjeron 124 casos en trabajadores (tasa de ataque 16,9%), 79,0% en mujeres. La gran mayoría presentaron síntomas leves (87,1%). Los comunes fueron fiebre (31,5%) y tos (49,2%). La mediana de días desde el inicio de los síntomas hasta el aislamiento fue 3 días.

Conclusiones

Se objetiva una elevada incidencia en el personal sociosanitario con demoras en el aislamiento que pudieron condicionar la dinámica de transmisión en los brotes. Es necesario revisar las prácticas de identificación de la enfermedad y el aislamiento entre el personal, énfasis en la implementación rápida de medidas de prevención.

Palabras clave:
COVID-19
Centros sociosanitarios
Personal de enfermería
Epidemiología

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