Socio-demographics characteristic. A total of 389 doctors who survived COVID-19 infection were included in the final analyses. These participants were spread across 25 of 34 provinces in Indonesia. The highest number of participants were Jakarta, West Java, and Banten (46.1%, 11.0%, and 6.4% of total participants, respectively) as seen in Figure 1.
Most of the participants were young doctors (20-39 years: 69.7%), general practitioners (50.4%), working in COVID-19 designated hospitals (62.5%), and had worked more than 40 hours per week (57.8%). Almost half of suspected transmission source was from the patients (47.8%), followed by their medical colleagues (15.4%), and other health care workers (7.5%). Eighty percents HCWs thought that they got infection in their workplaces (80.5%). Fifty five percents of participants were not hospitalized during infection as seen in Table 1.
Table 1
Characteristics of study participants (n=389).
|
n (%)
|
A. SOCIO-DEMOGRAPHIC
|
|
Age
20-39 years
40-59 ears
≥60 years
|
271 (69.7)
106 (27.2)
12 (3.1)
|
Male gender
|
167 (43.0)
|
Married
|
291 (74.8)
|
Profession
General practitioner
Specialist - consultant
Resident
|
196 (50.4)
120 (30.8)
73 (18.8)
|
Working in COVID-19 designated hospital
|
243 (62.5)
|
Working > 40 hours per week
|
225 (57.8)
|
IMA occupational risk stratification
Low
Moderate
High
Very high
|
19 (4.9)
163 (41.9)
160 (41.1)
47 (12.1)
|
Body mass index
<18.5 (underweight)
18.5-22.9 (normal)
23.0-24.9 (overweight)
>25.0 (obesity)
|
4 (1.0)
77 (19.8)
81 (20.8)
227 (58.4)
|
≥1 high risk comorbidities*
|
102 (26.2)
|
Smoker
|
7 (1.8)
|
B. CLINICAL DATA
|
|
Clinical symptoms
Fever or history of fever
Myalgia
Cough
Malaise
Anosmia
Dysgeusia
Headache
Sore throat
Diarrhea
Common cold
Nausea – vomitus
Shortness of breath
Anorexia
Insomnia
Abdominal pain
Skin abnormality
Conjuctivitis
|
189 (60.8)
182 (58.5)
171 (55.0)
162 (52.1)
155 (49.8)
142 (45.7)
131 (42.1)
122 (39.2)
118 (37.9)
111 (35.7)
108 (34.7)
82 (26.4)
65 (20.9)
53 (17.0)
42 (13.5)
26 (8.4)
17 (5.5)
|
Suspected location of transmission
Workplaces
Home
Public places
Unknown
|
313 (80.5)
33 (8.5)
28 (7.2)
15 (3.8)
|
Suspected sources of transmission
Patients
Colleagues
Family
Unknown
Other health workers**
Others***
Other friends
Administrative staff
|
186 (47.8)
60 (15.4)
42 (10.8)
41 (10.5)
29 (7.5)
21 (5.4)
7 (1.8)
3 (0.8)
|
Severity COVID-19
Asymptomatic
Mild
Moderate
Severe
|
96 (24.7)
181 (46.5)
100 (25.7)
12 (3.1)
|
Hospitalization
Hospitalized
Not hospitalized
|
174 (44.7)
215 (55.3)
|
Long COVID-19 symptoms (n=192)
Anxiety
Chronic fatigue
Cough
Myalgia
Decreased of lung functional capacity
Decreased of cognitive function and attention
Hypogeusia
Hyposmia
Decreased of appetite
|
108 (56.5)
89 (46.6)
40 (20.9)
31 (16.2)
28 (14.7)
23 (12.0)
16 (8.4)
13 (6.8)
8 (4.2)
|
*) Hypertension, type 2 diabetes mellitus, heart disease, chronic pulmonary obstructive disease, asthma, autoimmune disease, hematological disease, and cancer. **) Nurse, midwifes, nutritionist, etc. ***) Drivers, housemaid, security, etc. |
Clinical manifestations, comorbidities, and long haulers of COVID-19. Of all participants, 46.5% experienced mild disease, 25.7% had moderate disease, and 3.1% had severe disease. Fever, myalgia, and cough were reported as the common symptoms of the COVID-19. Comorbidities were reported among 55% of these participants. The most common comorbidity was lung diseases (23.4%), followed by hypertension (18.2%), type 2 diabetes mellitus (7.9%), autoimmune disease (5.1%), heart disease (2.3%), hematologic disease (1.4%), cancer (0.5%).
Several symptoms were still reported by 192 (49.9%) after the PCR SARS-CoV-2 examination were negative. Most of the long COVID-19 symptoms experienced by the participants were anxiety (56.5%), chronic fatigue (46.6%), and cough (20.9%) as seen in Table 1.
Factors associated with moderate-severe of COVID-19 infection. We identified four factors that associated with moderate-severe of COVID-19 infection. Doctors who had moderate occupational risk stratification that had contact with many people who unknown their COVID-19 status had a highest risk (aOR 4.14, 95% CI: 1.11-15.47; p=0.034) while middle age doctors (40-59 years) had 3.2 higher risk to develop severe COVID-19 infection (95% CI: 1.99-5.29; p<0.001) than doctors age 20-39 years old. Other associated factors were working in COVID-19 designated hospital (aOR 1.89, 95% CI: 1.18-3.01; p=0.008) and higher BMI (aOR 1.88, 95% CI: 1.00-3.54; p=0.049) (Table 2).
Table 2
Factors associated with moderate-severe COVID-19 infection among doctors in Indonesia.
|
Moderate - severe
n = 112
|
Asymptomatic - mild
n = 277
|
Bivariate analysis
|
Multivariate analysis
|
|
n (%)
|
n (%)
|
OR (95% CI)
|
P value
|
OR (95% CI)
|
P value
|
Age
≥60 years
40-59 years
20-39 years
|
3 (25.0)
50 (47.2)
59 (21.8)
|
9 (75.0)
56 (52.8)
212 (78.2)
|
1.19 (0.31 – 4.56)
3.21 (1.98 – 5.17)
1
|
0.792
<0.001
|
1.05 (0.27 – 4.12)
3.24 (1.99 – 5.29)
|
0.938
<0.001
|
Gender
Male
Female
|
53 (31.7)
59 (26.6)
|
114 (68.3)
163 (73.4)
|
1.28 (0.82 – 1.99)
1
|
0.266
|
|
|
Marrital status
Married
Not married
|
92 (31.6)
20 (20.4)
|
199 (68.4)
78 (79.6)
|
0.55 (0.32 – 0.96)
1
|
0.034
|
0.75 (0.41 – 1.35)
|
0.344
|
Profession
General practitioner
Resident
Specialist - Consultant
|
62 (31.6)
9 (12.3)
41 (34.2)
|
134 (68.4)
64 (87.7)
79 (65.8)
|
1.10 (0.66 – 1.78)
3.57 (1.60 – 7.99)
1
|
0.728
0.002
|
1.18 (0.65 – 2.12)
0.50 (0.21 – 1.19)
|
0.580
0.119
|
Working in COVID-19 designated hospital
Yes
No
|
59 (24.3)
53 (36.3)
|
184 (75.7)
93 (63.7)
|
1.77 (1.14 – 2.77)
1
|
0.011
|
1.89 (1.18 – 3.01)
|
0.008
|
Smoking status
Yes
No
|
1 (14.3)
111 (29.1)
|
6 (85.7)
271 (70.9)
|
0.40 (0.05 – 3.41)
1
|
0.678
|
|
|
Working hours per week
>40 hours
≤40 hours
|
39 (23.6)
73 (32.6)
|
126 (76.4)
151 (67.4)
|
0.64 (0.40 – 1.00)
1
|
0.054
|
0.92 (0.55 – 1.53)
|
0.749
|
Body mass index (BMI)
Obesity-overweight
Normal-underweight
|
97 (31.5)
15 (18.5)
|
211 (68.5)
66 (81.5)
|
2.02 (1.10 – 3.72)
1
|
0.022
|
1.88 (1.00 – 3.54)
|
0.049
|
Comorbidities
≥1 high risk comorbidities
None
|
26 (25.5)
86 (30.0)
|
76 (74.5)
201 (70.0)
|
0.80 (0.48 – 1.33)
1
|
0.465
|
|
|
IMA Occupational risk stratification
Very high
High
Moderate
Low
|
9 (19.1)
39 (24.4)
61 (37.4)
3 (15.8)
|
38 (80.9)
121 (75.6)
102 (62.6)
16 (84.2)
|
1.26 (0.30 – 5.28)
1.71 (0.47 – 6.21)
3.19 (0.89 – 11.39)
1
|
0.749
0.409
0.074
|
2.29 (0.51 – 10.32)
3.26 (0.84 – 12.64)
4.14 (1.11 – 15.47)
|
0.278
0.086
0.034
|
Behavioral adaptation of PPE usage before and after got COVID-19 infection. Before being infected with COVID-19, N95 respirators were used by 85% doctors working in isolation rooms, 70.2% confirmed always use N95 mask and 15.8% sometimes use N95. Others used KN-95 regularly (3.5%), KN-95 not-regularly (0.9%), only surgical mask regularly (4.4%), only surgical mask not regularly (3.5%), and only using fabric mask (1.8%). After recovering from COVID-19, the numbers of doctors who always use N95 increase to 80.9% and doctors who sometimes use N95 was decreased to 13.2%. 1.8% of them still use surgical mask only when working in isolation room. Fabric masks were used by 2 doctors (1.8%) before contracting COVID-19, but none after that (Figure 2A).
Outside the isolation room, before contracting with COVID-19, N95 respirators were routinely used by rank in operating room (56.0%), critical care unit (46.7%), emergency department (45.1 %), medical procedure room (42.3%), non-isolation ward (38.9%), and outpatient clinic (34.4%). Some doctors were using surgical mask only: in outpatient clinic (always 17.2%, sometimes 9.7%), in medical procedure room (always 14.1%, sometimes 0.7%), in non-isolation ward (always 12.2%, sometimes 6.8%), in critical care unit (always 8.2%, sometimes 4.9%), in emergency department (always 8.0%, sometimes 7.4%), and less in operating room (always 6.0%). Although, we demonstrated better trends in N95 respirator used after these doctors recovered from COVID-19, there were still some doctors used surgical mask only in all non-isolation room as seen in figure 2B-G. We identified there were some doctors who even used fabric masks only when working in non-isolation room: 3 doctors in medical procedure room, 2 doctors in emergency department, 2 doctors in outpatient clinic, and 1 doctor in non-isolation ward. After recovering from COVID-19, one doctor still used fabric mask only when working in emergency department.
Overall practices of using other PPE were improved after doctors survived from COVID-19 infection as seen in figure 3. Of the 114 doctors working in isolation rooms, 83.3% doctors routinely used headcap, 83.3% routinely used face protectors, 62.3% routinely used eye protectors, 81.6% routinely used hazmat suit, routinely used gown 53.5%, 71.1% boots, and 86.8% routinely used gloves before getting COVID-19 infection. The trends were increasing in all types of PPEs after they survived from COVID-19 infection as seen in figure 3A.
In non-isolation room, the routinely use of headcap, face protectors, gown, and gloves were also increased once these doctors doing medical practice after recovering from COVID-19 as seen in Figure 3B-G. Better patterns were seen in operating room even before getting COVID-19 infection, except the use of face protector, eye protector, and boots (Figure 3G).