Frontiers in Medicine (Sep 2020)

A COVID-19 Outbreak in a Rheumatology Department Upon the Early Days of the Pandemic

  • Vasco C. Romão,
  • Vasco C. Romão,
  • Filipa Oliveira-Ramos,
  • Filipa Oliveira-Ramos,
  • Ana Rita Cruz-Machado,
  • Ana Rita Cruz-Machado,
  • Patrícia Martins,
  • Patrícia Martins,
  • Sofia Barreira,
  • Sofia Barreira,
  • Joana Silva-Dinis,
  • Joana Silva-Dinis,
  • Luís Mendonça-Galaio,
  • Helena Proença,
  • José Melo Cristino,
  • Ema Sacadura-Leite,
  • Nikita Khmelinskii,
  • Nikita Khmelinskii,
  • José Carlos Romeu,
  • João Eurico Fonseca,
  • João Eurico Fonseca,
  • The CHULN Rheumatology Department,
  • Manuel António,
  • Pedro Ávila-Ribeiro,
  • Rita Barros,
  • Raquel Campanilho-Marques,
  • Susana Capela,
  • Inês Cordeiro,
  • Bianca Cristea,
  • Eduardo Dourado,
  • Luís Gaião,
  • Raquel Freitas,
  • Carla Macieira,
  • Joana Martins-Martinho,
  • Ana Teresa Melo,
  • Carlos Miranda Rosa,
  • Margarida Monteiro,
  • Lila Morena Bueno Silva,
  • Lurdes Narciso,
  • Joaquim Polido-Pereira,
  • Cristina Ponte,
  • Catarina Resende,
  • Maria João Saavedra,
  • Fernando Saraiva,
  • Rui Lourenço Teixeira,
  • Catarina Tenazinha,
  • Ana Valido,
  • Elsa Vieira-Sousa,
  • Pedro Vilas

DOI
https://doi.org/10.3389/fmed.2020.576162
Journal volume & issue
Vol. 7

Abstract

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Objectives: To describe our experience with a coronavirus disease 2019 (COVID-19) outbreak within a large rheumatology department early in the pandemic.Methods: Symptomatic and asymptomatic healthcare workers (HCWs) had a naso-oropharyngeal swab for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and were followed clinically. Reverse transcription polymerase-chain reaction (RT-PCR) was repeated to document cure, and serological response was assessed. Patients with risk contacts within the department in the 14 days preceding the outbreak were screened for COVID-19 symptoms.Results: 14/34 HCWs (41%; 40 ± 14 years, 71% female) tested positive for SARS-CoV-2, and 11/34 (32%) developed symptoms but were RT-PCR-negative. Half of RT-PCR-positive HCWs did not report fever, cough, or dyspnea before testing, which were absent in 3/14 cases (21%). Mild disease prevailed (79%), but 3 HCWs had moderate disease requiring further assessment, which excluded severe complications. Nevertheless, symptom duration (28 ± 18 days), viral shedding (31 ± 10 days post-symptom onset, range 15–51), and work absence (29 ± 28 days) were prolonged. 13/14 (93%) of RT-PCR-positive and none of the RT-PCR-negative HCWs had a positive humoral response Higher IgG indexes were observed in individuals over 50 years of age (14.5 ± 7.7 vs. 5.0 ± 4.4, p = 0.012). Of 617 rheumatic patients, 8 (1.3%) developed COVID-19 symptoms (1/8 hospitalization, 8/8 complete recovery), following a consultation/procedure with an asymptomatic (7/8) or mildly symptomatic (1/8) HCW.Conclusions: A COVID-19 outbreak can occur among HCWs and rheumatic patients, swiftly spreading over the presymptomatic stage. Mild disease without typical symptoms should be recognized and may evolve with delayed viral shedding, prolonged recovery, and adequate immune response in most individuals.

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