The outbreak of coronavirus disease in Wuhan, China caused by a severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) has led to a serious pandemic resulting in a global concern [1]. As of October 21, 2020, 41,076,644 COVID-19 cases have been confirmed Worldwide and 78,533 in the Kingdom of Bahrain [2].

According to WHO guidelines for occupational health and safety for health workers, health care workers are at risk of exposure to COVID-19 since they are at the front line of the outbreak response. Health care workers that are not at the front line may also get exposed to hazards such as long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence [3] A study in Wuhan, China, found that approximately 40% of cases were presumed hospital related-transmissions [4]. Hence, safety measures at hospitals are highly important.

COVID-19 can affect health care workers either from work through direct or indirect contact with infected patients or co-workers. It can also be acquired through community transmission. It has been evident that there was a rise in infected health care workers and also some incidences of death [5]. Although, universal precautions are usually expected to be well practiced among health care workers, however, specific Safety measures need to be implemented to protect health care workers and hence protecting the patients and the community. In this study, safety measures include the requirement of mask wearing, as well as a daily assessment of fitness for work.

Safety measures such as mask wearing and daily assessment of hospital workers’ COVID-19 symptoms prior to entering the hospital may be beneficial at limiting the spread of COVID-19 among hospital workers [6]. Daily assessment of fitness for work has been found to be a useful preventative measure to ensure safety in hospitals [6].

Due to the risk of exposure in COVID-19 and the workforce shortages that resulted from the pandemic, an alternative to physical on site symptom screening for work may not be the most efficient/safest way. An online self-screening questionnaire to determine fitness for work may be an alternative that ensures safety while maintaining efficiency and reducing exposure risk at local screening stations. Several hospitals have developed an online screening tool to assess fitness for work for hospital workers [6, 7]. A hospital in Massachusetts made the daily online symptom tracking a mandatory task prior to entering the hospital along with the mandatory use of facemasks. Using the online tool will help limit the spread of COVID-19 in the hospital while also minimizing interaction process (by for example, having a physical face-to-face assessment) as well as addressing the pressures and shortages of the workforce (it does not require a significant number of staff members) [6]. Moreover, responses can provide valuable information for researchers and hospital interventions. They can be used to calculate the most common symptoms, as well as the most common types of transmission across departments. This information can be used to guide interventions on reducing the spread of COVID-19 in the hospital. A potential limitation is if staff members enter the hospital without using the screening tool. This limitation can be addressed by having a staff member who monitors responses.

Bahrain Defence Force-Royal Medical Services (BDF-RMS) conducted several safety measures to help to prevent the spread of COVID-19 in the hospital, in line with following Bahrain National COVID-19 Team protocols. Perhaps one of the major measures taken is to closely monitor the staff for COVID-19 symptoms [8]. Since April 12, 2020, BDF-RMS has been assessing the COVID-19 symptoms among health care workers on a daily basis. The assessment is achieved using an in-house developed electronic self-assessment log that can be accessed either by mobile devices or computers. All health care workers were asked to complete the COVID-19 log before arriving to work. If the staff is asymptomatic they get a message saying that they are fit for duty, on the other hand, a symptomatic staff will get a message with instructions to stay at home and contact the designated isolated COVID-19 staff screening clinic for further instructions. Each symptomatic staff gets an appointment to be investigated and tested on the same day of reporting unfit. Thus, the log allows identifying the symptomatic staff before arrival to work and thus limiting the risk of infectious spread if present (Figs. 1 and 2).

COVID-19 Login page and Fit for duty

The COVID-LOG used in this study provided 24 h automated guidance that is individualized based on the answers. Similar tools have been used worldwide. A recent systematic review identified 63 apps that have been designated for COVID-19; for example, there were 25 in India and 18 each in UK and USA [9]. In Bahrain the government has launched Be Aware app that provides COVID-19 information and e-services such as contact tracing, test result, test appointment, PCR test certificate and announcements. Unlike our COVID-19 log, Be Aware app does not include self-assessment and monitoring of symptoms. [10] Successful use of electronic health app for COVID-19 self-assessment and symptoms monitoring has been demonstrated in Netherlands [11].

The aim of this study is to outline the characteristics of the health care workers infected with SARS- CoV-2 using data from the electronic COVID-19 Staff Daily Self-assessment Log.