Document Type : original article


1 Department of pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran

2 Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

4 Community Medicine Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.


Background: During the pandemic of COVID-19, Healthcare Workers (HCWs) have been at the forefront of infection; they could also carry the disease to the others.
Methods: In this cross-sectional study, HCWs in five hospitals of Mashhad University of Medical Sciences were included from 20 March to 21 July, 2020. HCWs were divided into two categories of frontline and second-line. The checklist was researcher-made and was on the basis of WHO risk factors regarding COVID-19, MERS and SARS. The participants were analyzed. The participants were asked, via phone call, to answer questions in 3 sections of demographics, probable risk factors, and clinical manifestations. The need for Personal Protective Equipment (PPE) and its availability were also evaluated.
Results: From among 534 HCWs included in this study, 197(57.6%) were females; most of them were nurses, and the mean ± SD age was 36.02 ± 8.5 years. Eighteen HCWs were hospitalized due to the severity of disease, most of whom were front-line HCWs. Malaise (78.7%), fever (68.1%) and gastrointestinal symptoms (63.7%) were the most common manifestations in the participants. Smoking (OR=0.078, P=0.001) and underlying diseases (OR=2.19, P=0.025) were known as the factors predicting HCWs hospitalization. Being smoker and participating in intubation procedure were independent predictors of hospitalization in HCWs.
Conclusion: Frontline HCWs had a significantly higher risk of COVID-19 infection, as compared to the second-line group. Although adequate supplies of PPE are necessary, they do not completely mitigate high-risk 


  1. McIntosh K, Hirsch MS, Bloom AJ. Coronavirus disease 2019 (COVID-19): Epidemiology, virology, and prevention. Lancet. Infect. Dis. 2020 Jul; 1:2019-20.
  2. Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. International journal of oral science. 2020 Mar 3; 12(1):1-6.
  3. Guo ZD, Wang ZY, Zhang SF, Li X, Li L, Li C, Cui Y, Fu RB, Dong YZ, Chi XY, Zhang MY. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerging infectious diseases. 2020 Jul; 26(7):1586.
  4. Bahl P, Doolan C, De Silva C, Chughtai AA, Bourouiba L, MacIntyre CR. Airborne or droplet precautions for health workers treating coronavirus disease 2019?. The Journal of infectious diseases. 2020 Apr 16.
  5. Palmore TN, Smith BA. COVID-19: Infection prevention for persons with SARS-CoV-2 infection.
  6. Chen W, Lan Y, Yuan X, Deng X, Li Y, Cai X, Li L, He R, Tan Y, Deng X, Gao M. Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity. Emerging microbes & infections. 2020 Jan 1; 9(1):469-73.
  7. Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, Tan W. Detection of SARS-CoV-2 in different types of clinical specimens. Jama. 2020 May 12; 323(18):1843-4.
  8. Colavita F, Lapa D, Carletti F, Lalle E, Bordi L, Marsella P, Nicastri E, Bevilacqua N, Giancola ML, Corpolongo A, Ippolito G. SARS-CoV-2 isolation from ocular secretions of a patient with COVID-19 in Italy with prolonged viral RNA detection. Annals of internal medicine. 2020 Aug 4; 173(3):242-3.
  9. Cheung KS, Hung IF, Chan PP, Lung KC, Tso E, Liu R, Ng YY, Chu MY, Chung TW, Tam AR, Yip CC. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: systematic review and meta-analysis. Gastroenterology. 2020 Jul 1; 159(1):81-95.
  10. Zheng S, Fan J, Yu F, Feng B, Lou B, Zou Q, Xie G, Lin S, Wang R, Yang X, Chen W. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. bmj. 2020 Apr 21; 369.
  11. Li D, Jin M, Bao P, Zhao W, Zhang S. Clinical characteristics and results of semen tests among men with coronavirus disease 2019. JAMA network open. 2020 May 1; 3(5):e208292-.
  12. Begashaw GB, Yohannes Y. Risk of Transmission and Knowledge Gap for Novel Coronavirus Disease 2019 (Covid-19) in Addis Ababa: Risk Estimation and Control Strategies.
  13. World Health Organization. Health workers exposure risk assessment and management in the context of COVID-19 virus: interim guidance, 4 March 2020. World Health Organization; 2020.
  14. Fischer RJ, Morris DH, van Doremalen N, Sarchette S, Matson MJ, Bushmaker T, Yinda CK, Seifert SN, Gamble A, Williamson BN, Judson SD. Assessment of N95 respirator decontamination and re-use for SARS-CoV-2. MedRxiv. 2020 Apr 24.
  15. Schwartz, A., Stiegel, M., Greeson, N., Vogel, A., Thomann, W., Brown, M., Sempowski, G.D., Alderman, T.S., Condreay, J.P., Burch, J. and Wolfe, C., 2020. Decontamination and reuse of N95 respirators with hydrogen peroxide vapor to address worldwide personal protective equipment shortages during the SARS-CoV-2 (COVID-19) pandemic. Applied Biosafety, 25(2), pp.67-70.
  16. Livingston E, Desai A, Berkwits M. Sourcing personal protective equipment during the COVID-19 pandemic. Jama. 2020 May 19; 323(19):1912-4.
  17. Zheng L, Wang X, Zhou C, Liu Q, Li S, Sun Q, Wang M, Zhou Q, Wang W. Analysis of the infection status of healthcare workers in Wuhan during the COVID-19 outbreak: a cross-sectional study. Clinical Infectious Diseases. 2020 Oct 15; 71(16):2109-13.
  18. Clemency BM, Varughese R, Scheafer DK, Ludwig B, Welch JV, McCormack RF, Ma C, Nan N, Giambra T, Raab T. Symptom criteria for COVID‐19 testing of healthcare workers. Academic Emergency Medicine. 2020 Jun; 27(6):469-74.
  19. Ran L, Chen X, Wang Y, Wu W, Zhang L, Tan X. Risk factors of healthcare workers with coronavirus disease 2019: a retrospective cohort study in a designated hospital of Wuhan in China. Clinical Infectious Diseases. 2020 Mar 17.
  20. Macintyre CR, Seale H, Yang P, Zhang Y, Shi W, Almatroudi A, Moa A, Wang X, Li X, Pang X, Wang Q. Quantifying the risk of respiratory infection in healthcare workers performing high-risk procedures. Epidemiology & Infection. 2014 Sep; 142(9):1802-8.
  21. Zou Q, Yin W, Du L. Study on severe acute respiratory syndrome nosocomial infection of doctors and nurses in intensive care units. Journal of Tropical Medicine. 2003; 3(4):416-9.
  22. Jaeger JL, Patel M, Dharan N, Hancock K, Meites E, Mattson C, Gladden M, Sugerman D, Doshi S, Blau D, Harriman K. Transmission of 2009 pandemic influenza A (H1N1) virus among healthcare personnel—Southern California, 2009. Infection Control & Hospital Epidemiology. 2011 Dec; 32(12):1149-57.
  23. Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo CG, Ma W, Mehta RS, Warner ET, Sikavi DR, Lo CH, Kwon S. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. The Lancet Public Health. 2020 Sep 1; 5(9):e475-83.
  24. Karanasos A, Aznaouridis K, Latsios G, Synetos A, Plitaria S, Tousoulis D, Toutouzas K. Impact of smoking status on disease severity and mortality of hospitalized patients with COVID-19 infection: a systematic review and meta-analysis. Nicotine & tobacco research. 2020 Aug 24.
  25. Cattaruzza MS, Zagà V, Gallus S, D’Argenio P, Gorini G. Tobacco smoking and COVID-19 pandemic: old and new issues. A summary of the evidence from the scientific literature. Acta Bio Medica: Atenei Parmensis. 2020; 91(2):106.
  26. McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG, Lewis J, Baer A, Kawakami V, Lukoff MD, Ferro J. Epidemiology of Covid-19 in a long-term care facility in King County, Washington. New England Journal of Medicine. 2020 May 21; 382(21):2005-11
  27. Liu XQ, Xue S, Xu JB, Ge H, Mao Q, Xu XH, Jiang HD. Clinical characteristics and related risk factors of disease severity in 101 COVID-19 patients hospitalized in Wuhan, China. Acta Pharmacologica Sinica. 2022 Jan; 43(1):64-75.
  28. Cheung KS, Hung IF, Chan PP, Lung KC, Tso E, Liu R, Ng YY, Chu MY, Chung TW, Tam AR, Yip CC. Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: systematic review and meta-analysis. Gastroenterology. 2020 Jul 1; 159(1):81-95.
  29. Weaver MD, Landrigan CP, Sullivan JP, O'Brien CS, Qadri S, Viyaran N, Wang W, Vetter C, Czeisler CA, Barger LK. The association between resident physician work-hour regulations and physician safety and health. The American journal of medicine. 2020 Jul 1; 133(7):e343-54.
  30. Li D, Wu S. Analysis on the health status and influencing factors of medical workers in a city of Fujian province. InThe Medical Forum 2016 (Vol. 20, No. 14, pp. 1893-5).