PDF(Pubmed)
Abstract：
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.
摘要：
目标：描述我们在大流行早期在大型风湿病科内爆发2019年冠状病毒病（COVID-19）的经验。方法：有症状和无症状的医护人员（HCWs）使用鼻口咽拭子检测严重急性呼吸综合征冠状病毒2（SARS-CoV-2），并进行临床随访。重复逆转录聚合酶链反应（RT-PCR）以记录治愈，并评估血清学反应。在爆发前14天在科室内与风险接触的患者接受了COVID-19症状筛查。结果：14/34HCWs(41%；40±14年，71％的女性）对SARS-CoV-2检测呈阳性，11/34（32％）出现症状，但RT-PCR阴性。一半的RT-PCR阳性HCWs没有报告发烧，咳嗽,或测试前呼吸困难，3/14例(21%)不存在。轻度疾病盛行（79%），但3名医护人员患有中度疾病，需要进一步评估，排除了严重的并发症。然而，症状持续时间（28±18天），病毒脱落(症状发作后31±10天，范围15-51)，缺勤时间(29±28天)延长。13/14（93％）的RT-PCR阳性和RT-PCR阴性的HCWs均无阳性体液反应，在50岁以上的个体中观察到较高的IgG指数（14.5±7.7vs.5.0±4.4，p=0.012）。在617名风湿病患者中，8人（1.3%）出现COVID-19症状（1/8住院，8/8完全恢复），在无症状（7/8）或轻度症状（1/8）的HCW的咨询/程序之后。结论：COVID-19暴发可发生在HCWs和风湿病患者中，在症状前阶段迅速蔓延。应认识到没有典型症状的轻度疾病，并且可能随着病毒的延迟脱落而发展，长时间恢复，和足够的免疫反应在大多数人。
