Does the CDC COVID-19 exposure assessment criteria for healthcare personnel work in a healthcare setting in Pakistan?

Imran Hassan, Aga Khan University
Unab Inayat Khan, Aga Khan University
Shehreen Ali, Aga Khan University
Asif Hakim, Aga Khan University
Syed Asad Ali, Aga Khan University


Objective: To evaluate the real-world performance of the CDC's "Interim US guidance for risk assessment and work restriction for healthcare personnel with exposure to COVID-19" at a private healthcare system in Pakistan.
Study design: Retrospective observational study.
Place and duration of study: The Aga khan University Hospital, Karachi, and its associated healthcare facilities in all four provinces of Pakistan, from February to September 2020.
Methodology: Healthcare personnel (HCPs) assessed and tested for exposures to COVID-19 were included in the study. An exposure category was assigned to each HCP presenting with exposure to COVID-19 based on the CDC criteria. Percentage positivity was recorded and compared among the different exposure categories. Logistic regression analysis was used to identify variables significantly associated with COVID-19 infection.
Results: Three thousand Six hundred and forty-seven HCPs were assessed for exposure to COVID-19 of whom 603 (16.5%) tested positive. Percent positivity was highest in high-risk symptomatic HCPs (18.2%), 15.6% in low-risk symptomatic HCPs, and 11% in high-risk asymptomatic HCPs. After controlling for age, gender, area of work, and source of exposure, compared to low-risk asymptomatic HCPs, the odds of a positive SARS-CoV-2 PCR were 2.13 (95%CI: 1.49-3.04) for high-risk symptomatic, 1.66 (95% CI: 1.12-2.46) for low-risk symptomatic, and 1.18 (95% CI: 0.83-1.68) for high-risk asymptomatic HCPs.
Conclusion: Regardless of exposure category, HCPs with symptoms consistent with COVID-19 have the highest likelihood of testing positive. The CDC exposure risk assessment criteria work best for symptomatic HCPs. Testing asymptomatic HCPs with high-risk exposures may not be necessary in low-resource settings with a limited healthcare workforce.