Highlights
- •COVID-19 can cause a series of clinical symptoms.
- •The lung is the organ most affected by infection of SARS-CoV-2.
- •Interventions should be implemented to help recovery of healthcare workers with COVID-19.
Abstract
Objectives
Methods
Results
Conclusion
Keywords
Introduction
World Health Organization. WHO Coronavirus (COVID-19) Dashboard, https://www.who.int/, 2022 (accessed on 18 June 2022).
Methods
Study design and participants
Data collection
State Sport General Administration. https://sky.nankai.edu.cn/_upload/article/files/f1/da/da63a2a84531a6457617e9e86256/87b0d024-7de9-4596-aff9-12864d685bfe.pdf, 2003; (accessed on 18 June 2022)
Statistical analysis
Results
Characteristics of the HCWs

Characteristics | All (N = 779) | nonsevere (N = 316) | Severe (N = 463) | P |
---|---|---|---|---|
Demographic characteristics | ||||
Age (years) | 35.0 (30.0-43.0) | 34.0 (28.0-40.0) | 36.0 (31.0-45.0) | <0.001 |
BMI (kg/m2) | 22.8 (20.8-25.2) | 22.0 (20.0-23.8) | 23.4 (21.2-25.7) | <0.001 |
Sex (female) | 601 (77%) | 249 (79%) | 352 (76%) | 0.386 |
Education (college and higher) | 586/732 (80%) | 234/288 (81%) | 352/444 (79%) | 0.019 |
Location of the hospital work for | 0.378 | |||
Hankou, Wuhan | 452 (58%) | 188 (59%) | 264 (57%) | |
Wuchang, Wuhan | 196 (25%) | 79 (25%) | 117 (25%) | |
Hanyang, Wuhan | 40 (5%) | 11 (4%) | 29 (6%) | |
Outside Wuhan in Hubei | 91 (12%) | 38 (12%) | 53 (12%) | |
Roles in work | 0.003 | |||
Doctors | 184/755 (24%) | 72/298 (24%) | 112/457 (24%) | |
Nurses | 445/755 (59%) | 182/298 (61%) | 263/457 (58%) | |
Other | 126/755 (17%) | 44/298 (15%) | 82/457 (18%) | |
Smoking habit (yes) | 24/756 (3%) | 9/300 (3%) | 15/456 (3%) | 0.016 |
Time from discharge to follow-up (days) | 387.4 (379.3-393.4) | 386.4 (382.3-396.1) | 387.4 (379.1-393.3) | 0.271 |
Clinical characteristics | ||||
The highest respiratory support in hospital | <0.001 | |||
No supplemental oxygen | 278/740 (38%) | 159/295 (54%) | 119/445 (27%) | |
Supplemental oxygen by nasal cannula or mask | 443/743 (60%) | 136/295 (46) | 307/445 (69%) | |
Noninvasive or invasive mechanical ventilation | 19/740 (2%) | 0(0%) | 19/445 (4%) | |
ICU admission (yes) | 20/753 (3%) | 1/299 (0.3%) | 19/454 (4%) | <0.001 |
Comorbidities (yes) | 167/747 (22%) | 28/298 (9%) | 139/449 (31%) | <0.001 |
Symptoms at admission | ||||
Fatigue | 412 (53%) | 127 (60%) | 285 (62%) | <0.001 |
Fever | 404 (52%) | 119 (38%) | 285 (62%) | <0.001 |
Muscle soreness | 252 (32%) | 58 (18%) | 194 (42%) | <0.001 |
Dry cough | 238 (31%) | 79 (25%) | 159 (34%) | 0.006 |
Cough | 232 (30%) | 72 (23%) | 160 (35%) | <0.001 |
Chest distress | 212 (27%) | 49 (16%) | 163 (35%) | <0.001 |
Diarrhea | 175 (23%) | 56 (18%) | 119 (26%) | 0.009 |
Shortness of breath | 169 (22%) | 29 (9%) | 140 (30%) | <0.001 |
Headache | 147 (19%) | 33 (10%) | 114 (24%) | <0.001 |
Dyspnea | 99 (13%) | 7 (2%) | 92 (20%) | <0.001 |
Vomiting | 43 (6%) | 8 (3%) | 35 (8%) | 0.002 |
Functional fitness in HCWs with nonsevere and severe COVID-19
Categories | All (N = 446) | Median (IQR) | β (95% CI) | |||
---|---|---|---|---|---|---|
Nonsevere (N = 162) | Severe (N = 189) | Nonsevere (N = 114) | Severe (N = 189) | P | ||
Muscle strength test | ||||||
Grip strength test, N | 25.5 (21.2, 30.5) | 25.9 (21.4, 29.9) | 25.3 (21.3, 30.7) | 0 | 0.21 (-0.98, 1.41) | 0.726 |
30-second elbow flexion test, n | 19.0 (15.0, 20.5) | 18.0 (15.0, 24.0) | 19.0 (15.0, 23.0) | 0 | 0.21 (-0.83, 1.24) | 0.693 |
30-second chair stand, n | 17.0 (15.0, 20.5) | 18.0 (15.0, 21.0) | 17.0 (15.0, 20.0) | 0 | -0.50 (-1.50, 0.50) | 0.328 |
2-minute step test, n | 93.0 (80.0, 107.0) | 95.0 (83.0, 108.0) | 92.0 (79.0, 107.0) | 0 | -1.62 (-5.60, 2.36) | 0.423 |
Flexibility test | ||||||
Back scratch test (left) | -1.0 (-8.0, 3.0) | 0.0 (-5.9, 3.4) | -2.8 (-10.1, 2.6) | 0 | -0.76 (-2.51, 0.99) | 0.392 |
Back scratch test (right) | 2.0 (-2.1, 5.0) | 2.5 (0.0, 5.2) | 1.7 (-4.3, 4.4) | 0 | -1.01 (-2.39, 0.36) | 0.147 |
Chair sit-and-reach test, cm | 1.5 (-2.0, 6.5) | 2.3 (0.0, 7.0) | 1.0 (-3.5, 6.5) | 0 | 0.05 (-2.38, 2.48) | 0.969 |
Agility/dynamic balance | ||||||
Functional reach test, cm | 27.0 (22.2, 31.0) | 27.0 (22.0, 30.0) | 27.0 (23.0, 31.0) | 0 | 0.51 (-0.97, 1.99) | 0.500 |
YBT | ||||||
Anterior-L | 73.1 (69.0, 80.0) | 73.0 (69.4, 79.0) | 73.5 (68.0, 80.0) | 0 | 0.56 (-1.13, 2.26) | 0.512 |
Posterolateral-L | 76.0 (70.2, 81.0) | 75.9 (71.0, 81.0) | 77.0 (70.0, 81.0) | 0 | 0.52 (-1.40, 2.45) | 0.595 |
Posteromedial-L | 64.0 (54.9, 71.8) | 64.0 (56.0, 71.0) | 77.0 (70.0, 81.0) | 0 | 1.01 (-1.67, 3.71) | 0.460 |
Anterior-Rb | 75.0 (69.5, 80.0) | 75.0 (70.5, 80.0) | 75.0 (69.0, 80.0) | 0 | -0.27 (-1.85, 1.31) | 0.731 |
Posterolateral-R | 78.0 (71.5, 83.0) | 78.0 (73.0, 83.0) | 78.0 (71.0, 84.0) | 0 | 0.00 (-1.87, 1.87 | 0.999 |
Posteromedial-R | 62.0 (54.0, 70.0) | 61.0 (54.0, 81.0) | 63.0 (54.0, 71.0) | 0 | 1.29 (-1.42, 3.99) | 0.351 |
Leg length | 79.0 (76.8, 81.5) | 79.0 (76.8, 81.0) | 79.0 (76.8, 81.6) | 0 | 0.25 (-0.28, 0.77) | 0.358 |
Composite score-L | 211.8 (196.6, 227.0) | 211.0 (197.9, 228.4) | 212.0 (196.5, 227.9) | 0 | 2.10 (-2.80, 7.00) | 0.400 |
Composite score-R | 214.0 (197.0, 229.6) | 214.0 (197.9, 228.4) | 214.0 (196.0, 230.0) | 0 | 1.01 (-4.01, 6.03) | 0.692 |
Ratio of composite score to leg length-L | 0.9 (0.8, 0.9) | 0.9 (0.8, 0.9) | 0.9 (0.8, 0.9) | 0 | 0.01 (-0.01, 0.02) | 0.533 |
Ratio of composite score to leg length-R | 0.9 (0.8, 1.0) | 0.9 (0.8, 1.0) | 0.9 (0.8, 1.0) | 0 | 0.00 (-0.02, 0.02) | 0.931 |
Lung function in HCWs with nonsevere and severe COVID-19
Categories | All (N = 303) | N (%) | β (95% CI) | |||
---|---|---|---|---|---|---|
Nonsevere (N = 114) | Severe (N = 189) | Nonsevere (N = 114) | Severe (N = 189) | P | ||
FEV1 <80%, % of predicted | 24 (8%) | 13 (11%) | 11 (6%) | 1 | 0.51 (0.20, 1.31) | 0.160 |
FVC <80%, % of predicted | 7 (2%) | 4 (4%) | 3 (2%) | 1 | 0.57 (0.08, 4.29) | 0.583 |
FEV1/FVC <70% | 24 (8%) | 9 (8%) | 15 (8%) | 1 | 1.11 (0.43, 2.84) | 0.827 |
RV <80%, % of predicted* | 43 (14%) | 17 (15%) | 26 (14%) | 1 | 0.75 (0.36, 1.57) | 0.449 |
TLC <80%, % of predicted | 18 (6%) | 9 (8%) | 9 (5%) | 1 | 0.51 (0.17, 1.57) | 0.243 |
FRC <80%, % of predicted | 57 (19%) | 17 (15%) | 40 (21%) | 1 | 1.52 (0.77, 3.00) | 0.223 |
DLCO <80%, % of predicted a Carbon monoxide diffusion capacity was not corrected for hemoglobin. Abbreviations: DLCO, diffusion capacity for carbon monoxide; FEV1, forced expiratory volume in one second; FRC, functional residual capacity; FVC, forced vital capacity; HCWs, healthcare workers; RV, residual volume; TLC, total lung capacity. The models adjusted for age, sex, education, roles in work, body mass index, smoking habit, and comorbidities. | 102 (34%) | 42 (37%) | 60 (32%) | 1 | 0.71 (0.41, 1.23) | 0.223 |
Immune function in HCWs with nonsevere and severe COVID-19
Categories | All (N = 534) | Nonsevere (N = 198) | Severe (N = 336) | P |
---|---|---|---|---|
IFN-γ (pg/ml) | 1.04 (0.96-1.16) | 1.04 (0.96-1.16) | 1.04 (0.96-1.16) | 0.881 |
Elevated | 1 (0.2%) | 1 (0.5%) | 0 (0.0%) | 0.371 |
Normal | 0.64-15.17 | 0.73-15.17 | 0.64-9.58 | |
Decreased | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | |
IL-10 (pg/ml) | 1.25 (1.09-1.45) | 1.25 (1.10-1.45) | 1.40 (1.05-1.45) | 0.952 |
Elevated | 3 (0.6%) | 2 (1.0%) | 1 (0.3%) | 0.559 |
Normal | 0.51-3.81 | 0.66-2.55 | 0.51-3.81 | |
Decreased | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | |
IL-2 (pg/ml) | 1.36 (1.23-1.52) | 1.36 (1.25-1.48) | 1.40 (1.23-1.52) | 0.271 |
Elevated | 3 (0.6%) | 2 (1.0%) | 1 (0.3%) | 0.558 |
Normal | 0.87-4.07 | 0.87-4.07 | 0.91-4.07 | |
Decreased | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | |
IL-4 (pg/ml) | 1.50 (1.39-1.61) | 1.46 (1.35-1.61) | 1.50 (1.39-1.60) | 0.598 |
Elevated | 1 (0.2%) | 1 (0.5%) | 0 (0.0%) | 0.371 |
Normal | 1.02-2.60 | 1.02-2.48 | 1.04-2.60 | |
Decreased | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | |
IL-6 (pg/ml) | 1.53 (1.20-2.55) | 1.51 (1.20-2.44) | 1.62 (1.14-2.74) | 0.589 |
Elevated | 64 (12.0%) | 25 (12.6%) | 39 (11.6%) | 0.783 |
Normal | 0.32-5.25 | 0.32-5.25 | 0.48-5.23 | |
Decreased | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | |
TNF-α (pg/ml) | 2.58 (1.60-5.60) | 2.49 (1.60-6.45) | 2.58 (1.58-5.08) | 0.596 |
Elevated | 8 (1.5%) | 3 (1.5%) | 5 (1.5%) | 0.980 |
Normal | 0.56-21.20 | 0.56-21.20 | 0.92-20.38 | |
Decreased | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) |
Categories | All (N = 534) | Nonsevere (N = 198) | Severe (N = 336) | P |
---|---|---|---|---|
B cells (%) | 9.90 (7.79-12.30) | 9.90 (7.85-12.08) | 9.90 (7.72-12.42) | 0.963 |
Elevated | 12 (2.2%) | 5 (2.5%) | 7(2.1%) | 0.918 |
Normal a Data are shown as the normal ranges of the indicators. Abbreviations: HCWs, healthcare workers; IQR, interquartile range The continuous covariate between two groups was compared with Mann-Whitney U test. The comparison of categoric covariates between two groups was evaluated using chi-square test and Fisher's exact test. | 4.29-18.31 | 4.29-17.60 | 4.30-18.31 | |
Decreased | 15 (2.8%) | 6 (3.0%) | 9 (2.7%) | |
CD3+ T cells (%) | 70.67 (64.37-75.92) | 71.17 (65.15-76.40) | 70.04 (63.92-75.55) | 0.254 |
Elevated | 7 (1.3%) | 0 (0.0%) | 7(2.1%) | 0.068 |
Normal a Data are shown as the normal ranges of the indicators. Abbreviations: HCWs, healthcare workers; IQR, interquartile range The continuous covariate between two groups was compared with Mann-Whitney U test. The comparison of categoric covariates between two groups was evaluated using chi-square test and Fisher's exact test. | 58.21-83.83 | 58.34-82.80 | 58.21-83.83 | |
Decreased | 58 (10.9%) | 18 (9.1%) | 40 (11.9%) | |
CD4+ T cells (%) | 35.58 (31.01-40.36) | 36.40 (31.49-40.10) | 35.02 (30.54-40.85) | 0.280 |
Elevated | 11 (2.0%) | 3 (1.5%) | 8 (2.4%) | 0.423 |
Normal a Data are shown as the normal ranges of the indicators. Abbreviations: HCWs, healthcare workers; IQR, interquartile range The continuous covariate between two groups was compared with Mann-Whitney U test. The comparison of categoric covariates between two groups was evaluated using chi-square test and Fisher's exact test. | 25.40-51.33 | 25.59-51.33 | 25.40-50.41 | |
Decreased | 26 (4.9%) | 7 (3.5%) | 19 (5.7%) | |
CD4+/CD8+ cell ratio | 1.42 (1.14-1.82) | 1.42 (1.18-1.77) | 1.42 (1.09-1.86) | 0.746 |
Elevated | 22 (4.1%) | 8 (4.0%) | 14 (4.2%) | 0.427 |
Normal a Data are shown as the normal ranges of the indicators. Abbreviations: HCWs, healthcare workers; IQR, interquartile range The continuous covariate between two groups was compared with Mann-Whitney U test. The comparison of categoric covariates between two groups was evaluated using chi-square test and Fisher's exact test. | 0.46-2.72 | 0.61-2.72 | 0.46-2.72 | |
Decreased | 1 (0.2%) | 1 (0.5%) | 0 (0.0%) | |
CD8+ T cells (%) | 25.20 (20.76-29.98) | 25.17 (21.13-29.72) | 23.35 (20.63-30.39) | 0.820 |
Elevated | 24 (4.5%) | 10 (5.1%) | 14 (4.1%) | 0.793 |
Normal | 14.24-38.48 | 14.24-38.48 | 14.41-38.32 | |
Decreased | 19 (3.6%) | 6 (3.0%) | 13 (3.9%) | |
NK cells (%) | 16.89 (12.01-22.75) | 16.07 (11.98-23.09) | 17.42 (12.01-22.58) | 0.668 |
Elevated | 44 (8.2%) | 15 (7.6%) | 29 (8.6%) | 0.852 |
Normal a Data are shown as the normal ranges of the indicators. Abbreviations: HCWs, healthcare workers; IQR, interquartile range The continuous covariate between two groups was compared with Mann-Whitney U test. The comparison of categoric covariates between two groups was evaluated using chi-square test and Fisher's exact test. | 3.51-30.44 | 4.58-29.66 | 3.51-30.44 | |
Decreased | 2 (0.4%) | 1 (0.5%) | 1 (0.3%) |
Discussion
Funding
Declarations of competing interest
Ethical approval
Availability of data and materials
Author contributions
Appendix. Supplementary materials
References
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