SARS-CoV-2 与无症状和近期有症状的医护人员的高病毒载量有关。
SARS-CoV-2 is associated with high viral loads in asymptomatic and recently symptomatic healthcare workers.
机构信息
Department of Medicine, Infectious Diseases Section, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America.
Department of Medicine, Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, United States of America.
出版信息
PLoS One. 2021 Mar 18;16(3):e0248347. doi: 10.1371/journal.pone.0248347. eCollection 2021.
BACKGROUND
Healthcare workers (HCW) are at increased risk of SARS-CoV-2 infection from both patients and other HCW with coronavirus disease 2019 (COVID-19). RT-PCR cycle threshold (Ct) values of SARS-CoV-2 ≤ 34 and the first 7-9 days of symptoms are associated with enhanced infectivity. We determined Ct values and duration of symptoms of HCW with a positive SARS-CoV-2 test. As HCW often assume their greatest risk of acquiring SARS-CoV-2 is working on a COVID-19 unit, we also determined Ct values and symptom duration of inpatients with a positive SARS-CoV-2 test.
METHODS
From 6/24/2020-8/23/2020, Ct values and duration of symptoms from 13 HCW, 12 outpatients, and 28 inpatients who had a positive nasopharyngeal swab for SARS-CoV-2 were analyzed.
RESULTS
Among HCW with a positive SARS-CoV-2 test, 46.2% (6/13) were asymptomatic and requested testing due to an exposure to someone with COVID-19; 83.3% (5/6) of those exposures occurred in the community rather than in the hospital. The median Ct value of HCW was 23.2, and 84.6% (11/13) had a Ct value ≤ 34. The median Ct value of 29.0 among outpatients with COVID-19 did not significantly differ from HCW. In contrast, inpatients with a positive SARS-CoV-2 test had a median Ct value of 34.0 (p = 0.003), which translated into a median ~1,000-fold lower viral load than observed in HCW. Among those with symptoms related to COVID-19, no (0/6) HCW compared to 50% (6/12) of inpatients had symptoms for at least one week (p = 0.04).
CONCLUSIONS
At our institution, asymptomatic COVID-19 accounted for nearly half of the cases among HCW. Symptomatic HCW had high viral loads and short duration of symptoms, both of which are associated with peak infectivity. Infection prevention programs should educate HCW on these findings in an effort to increase adherence to the requirement to maintain six feet separation in workspaces and breakrooms, in addition to consistently wearing personal protection equipment.
背景
医护人员（HCW）因患有 2019 年冠状病毒病（COVID-19）的患者和其他 HCW 而面临 SARS-CoV-2 感染的风险增加。SARS-CoV-2 的 RT-PCR 循环阈值（Ct）值≤34 以及症状出现的前 7-9 天与增强的传染性有关。我们确定了 SARS-CoV-2 检测呈阳性的 HCW 的 Ct 值和症状持续时间。由于 HCW 通常认为他们感染 SARS-CoV-2 的最大风险是在 COVID-19 病房工作，因此我们还确定了 SARS-CoV-2 检测呈阳性的住院患者的 Ct 值和症状持续时间。
方法
从 2020 年 6 月 24 日至 2020 年 8 月 23 日，分析了 13 名 HCW、12 名门诊患者和 28 名住院患者的 SARS-CoV-2 鼻咽拭子检测呈阳性的 Ct 值和症状持续时间。
结果
在 SARS-CoV-2 检测呈阳性的 HCW 中，46.2%（6/13）无症状，因接触 COVID-19 患者而要求进行检测；其中 83.3%（5/6）的接触发生在社区而不是医院。HCW 的中位 Ct 值为 23.2，84.6%（11/13）的 Ct 值≤34。29.0 的门诊 COVID-19 患者的中位 Ct 值与 HCW 无显着差异。相比之下，检测呈阳性的住院患者的中位 Ct 值为 34.0（p = 0.003），这意味着病毒载量中位数低约 1000 倍，与 HCW 观察到的情况相比。在与 COVID-19 相关的症状中，没有（0/6）HCW 与 50%（6/12）的住院患者的症状持续至少一周（p = 0.04）。
结论
在我们的机构中，无症状 COVID-19 占 HCW 病例的近一半。有症状的 HCW 具有高病毒载量和症状持续时间短，这两者都与高峰传染性有关。感染预防计划应向 HCW 传授这些发现，以提高他们遵守在工作场所和休息室保持六英尺距离以及始终佩戴个人防护设备的要求的意识。
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