At the end of the data collection period we have received 718 responses. After eliminating the participants who were out of our target population from seven pandemic hospitals there were 564 physicians remaining for analysis comprising to 93% of the initial sample size. The mean age of the physicians who participated in the study was 36 (sd:8.9), and 295 (52%) of the participants were women (Table 1).
Table 1
Basic Characteristics of Physicians
| Total n = 564 (%) | Received prophylaxis n = 148 (%) | P | Infected n = 28 (%) | p |
Age > 40 | 170 (30) | 63 (42.6) | < 0.001 | 6 (21.4) | 0.27 |
Gender (Male) | 269 (48) | 65 (44) | 0.284 | 16 (57.1) | 0.305 |
Frontline departments | 310 (55) | 77 (52) | 0.403 | 21 (75) | 0.029 |
Current smoker | 76 (13.5) | 25 (17) | 0.156 | 4 (14.2) | 0.897 |
Comorbidities | | | | | |
Hypertension | 34 (6) | 12 (8.1) | 0.216 | 2 (7.1) | 0.799 |
DM | 12 (2) | 4 (2.7) | 0.572 | 1 (3.6) | 0.587 |
Hyperlipidemia | 19 (3.3) | 7 (4.7) | 0.285 | 0 | |
CVS | 9 (1.6) | 1 (0.7) | 0.298 | 1 (3.6) | 0.392 |
Arrhythmia | 6 (1) | 2 (1.3) | 0.691 | 1 (3.6) | 0.185 |
Any comorbidity | 124 (22) | 41 (27.7) | 0.051 | 7 (25) | 0.693 |
Patient care in a week | | | 0.753 | | 0.307 |
0 hrs | 56 (10) | 19 (12.8) | | 0 (0) | |
< 8 hours | 117 (20.8) | 31 (20.9) | | 4 (14.2) | |
8–12 hours | 36 (6.4) | 11 (7.4) | | 1 (3.6) | |
12–24 hrs | 66 (11.7) | 15 (10.1) | | 5 (17.9) | |
24–48 hrs | 137 (24.4) | 35 (23.6) | | 8 (28.6) | |
> 48 hrs | 149 (26.5) | 37 (25) | | 10 (35.7) | |
Patient care > 12 hours per week | 352 (62.4) | 87 (58.8) | 0.289 | 23 (82.1) | 0.027 |
History of exposure | 184 (32.6) | 56 (37.8) | 0.115 | 16 (57) | 0.005 |
Used HQN prophylaxis | 148 (26.3) | N/A | N/A | 8 (28.5) | 0.774 |
pre-exposure HQN Use | 118 | N/A | N/A | 6 (21.4) | 0.946 |
post-exposure HQN Use | 30 | N/A | N/A | 2 (7.1) | 0.659 |
During this study, 28 out of 564 physicians (5%) were infected. Pneumonia developed in 15 of 28 (54%) infected physicians.
In the study group, 148 (26%) physicians used hydroxychloroquine for prevention for a while or continuously. Among the physicians who used HQN, 8 of 148 (5.4%) infected, compared to 20 of the 416 (4.8%) physicians who did not use HQN (p = 0.773, Fig. 1).
There were 310 (55%) physicians that worked more than 12 hours a week with COVID-19 patients. These frontline physicians were from 18 different departments including Infectious diseases, Emergency, Pulmonology, Internal Medicine, Intensive Care, ENT and Pediatrics departments. Out of these 310 physicians 21 (6.7%) were infected while only seven physicians (2.7%) from other departments were infected (p = 0.029). Also, physicians providing care for COVID-19 patients more than 12 hours a week were infected more than physicians working for fewer hours (23/352 p = 0.027, Table 1).
In the study, 184 physicians stated that they had contacted at least one COVID-19 patient without having appropriate personal protective equipment. Among the physicians with suspected contact, 16 (8.7%) were infected (p = 0.005).
Fifty six (30.4%) physicians out of 184 used hydroxychloroquine for prophylaxis. While 26 physicians were using HQN before any exposure with a COVID-19 patient, 30 began HQN after exposure. It was also found that hydroxychloroquine did not differ statistically in terms of being infected among the exposed physicians (p = 0.52).
Diarrhea (7.4%) was the most common side effect among physicians using HQN, and only one patient who has diarrhea was infected. Arrhythmias (3.4%), nausea (3.4%), abdominal pain (2.7%), weakness (3%), rash (1.3%), and dizziness (1.3%) were other side effects, respectively.
While 68% of the physicians never used a loading dose, those who took the loading dose mostly received 400 mg for a day (17%). Eleven different maintenance dosages were documented in the study and 200 mg once a week (17.6%) was the most preferred dose for maintenance among physicians (Table 2).
Table 2
HQN Dosages used for prophylaxis among physicians
| HQN use N = 148 (%) |
Loading dose | |
No loading dose | 101 (68%) |
400 mg one day | 25 (17%) |
800 mg one day | 8 (5.4%) |
200 mg 3 days | 8 (5.4%) |
400 mg 3 days | 6 (4%) |
Maintenance | |
200 mg for once | 20 (13.5%) |
400 mg for once | 12 (8.1%) |
200 mg every 3 weeks | 20 (13.5%) |
400 mg every 3 weeks | 6 (4%) |
200 mg every 2 weeks | 5 (3.4%) |
400 mg every 2 weeks | 5 (3.4%) |
200 mg once a week | 26 (17.6) |
400 mg once a week | 13 (8.8%) |
200 mg twice a week | 20 (13.5%) |
200 mg once a day | 3(2%) |
200 mg twice a day | 18 (12.2) |
Of the 148 physicians using hydroxychloroquine prophylaxis, 44 were still on prophylaxis when the study was terminated. Five of the 144 (3.4%) physicians who stopped the drug stated that after stopping prophylaxis, they developed a complaint or finding related to COVID.
In the multivariable analysis conducted to determine who preferred hydroxychloroquine prophylaxis, we found that physicians over 40 years of age (p < 0.001) and who had unprotected exposure to a COVID-19 patient (p = 0.032) preferred prophylaxis ( Table 3).
Table 3
Univariate and multivariate analysis for the predictors of hydroxyquinoline use
| Univariable | Multivariable |
| OR | 95% CI | p | OR | 95% CI | p |
Age > 40 | 2.14 | 1.44–3.17 | < 0.001 | 2.20 | 1.44–3.36 | < 0.001 |
Any comorbidity | 1.53 | 0.99–2.37 | 0.052 | 1.23 | 0.78–1.95 | 0.366 |
High risk exposure | 1.36 | 0.92–2.02 | 0.116 | 1.55 | 1.03–2.32 | 0.032 |
Working at frontline | 0.85 | 0.58–1.24 | 0.403 | 0.87 | 0.59–1.28 | 0.499 |
Female gender | 1.22 | 0.84–1.79 | 0.285 | 1.42 | 0.96–2.10 | 0.078 |
We also examined the predictors of COVID-19 infection, and in both univariate and multivariable analysis, working at the front line was the single significant variable for developing an infection while using HQN was not found to be protective (Table 4).
Table 4
Univariate and multivariate analysis for the predictors of COVID-19 infection
| Univariable | Multivariable |
| OR | CI | p | OR | CI | p |
Working at frontline | 2.56 | 1.07–6.13 | 0.034 | 2.62 | 1.08–6.31 | 0.031 |
Age > 40 | 0.61 | 0.24–1.55 | 0.307 | 0.52 | 0.19–1.43 | 0.212 |
Female gender | 0.67 | 0.31–1.44 | 0.307 | 0.58 | 0.26–1.27 | 0.176 |
Any comorbidity | 1.19 | 0.49–2.87 | 0.693 | 1.44 | 0.56–3.68 | 0.446 |
Hydroxychloroquine | 1.13 | 0.48–2.62 | 0.774 | 1.2 | 0.54–3.03 | 0.576 |
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