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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Asymptomatic COVID-19 Infection among Healthcare Workers in Dedicated Tertiary Care Facility of Kolkata, India
Correspondence Address :
Dr. Debarup Das,
Senior Resident, Department of General Medicine, Medical College and Hospital, Kolkata, West Bengal, India.
E-mail: debarup1992das@gmail.com
Introduction: In view of the present Coronavirus Disease 2019 (COVID-19) pandemic it is of utmost importance to look out for the ‘trojan horse’ that is the asymptomatic population who are potential for spreading the disease. Healthcare Workers (HCWs) are the most vulnerable group. The possibility of having the infection does not always correlate well with the symptoms. It urges the need for development of certain special plans beyond continuous surveillance and symptom monitoring.
Aim: To explore asymptomatic COVID-19 infection among HCWs as a potential source of transmission.Materials and Methods: This hospital-based cross-sectional study was conducted at Medical College and Hospital, Kolkata, West Bengal, India, from June 2020 to September 2020. The data were collected from 714 HCWs over a period of three months of study period, with the help of a standard questionnaire and blood sample was analysed by serological assessment of Immunoglobulin G (IgG) for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by EUROIMMUN Kit, Enzyme-Linked Immunosorbent Assay (ELISA). Epi info software 7, available from the World Health Organisation (WHO) site was used to manage and analyse the data.
Results: The mean age was 35.30±11.79 years. Out of 714 people, 54.8% (391/714) were male and 45.2% (323/714) were female. In this survey, 9.16% of HCWs in COVID-19 designated duties were IgG positive; whereas 21.89% of HCWs designated in other parts of area were detected to be IgG positive. Seroprevalence was least amongst nursing staffs with 5.41% (8/148); among doctor’s it was 9.62% (41/426). Most interestingly among ward boys and cleaners this prevalence was found to be 29.90% (29/97) being the highest. Overall seroprevalence for IgG against SARS-CoV-2 was found to be 12.75% (91/714).
Conclusion: This serosurvey at this tertiary COVID-19 care facility is a unique venture to look for the possible sources of super-spread. The high rate of sero-positivity among ward boys and cleaners might be due to their lack of knowledge and training regarding steps to prevent a droplet borne pandemic. This study also points out that if adequate precautions are taken, infectivity is not to an alarming extent, even in a full-fledged COVID-19 care hospital.
Coronavirus disease 2019, Euroimmun kit, Immunoglobulin G, Serosurvey, Serological study
On December 31, 2019, China reported a cluster of pneumonia cases of unknown cause that would later be identified as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) (1),(2),(3),(4). Patients with the illness, called Coronavirus Disease 2019 (COVID-19), frequently present with fever, cough, and shortness of breath within 2-14 days after exposure (5). As of 21st September 2021, over 228 million COVID-19 cases and 4.6 million deaths have been reported globally (6). In recognition of the widespread global transmission of COVID-19, the World Health Organisation (WHO) declared COVID-19 to be a pandemic on 11th March 2020 (7). A total of 15,65,645 cases were reported in West Bengal with 7674 active cases (8). With case numbers and deaths, surging and making the curve grow steeper every day; it implies that a lot needs to be explored about this virus and the havoc it is creating on humans.
Unlike Severe Acute Respiratory Syndrome (SARS) or Middle East respiratory syndrome, COVID-19 was less virulent, with a lower mortality rate (9),(10),(11). Nevertheless, low virulence and longer incubation periods resulted in a significant number of asymptomatic carriers. These people might not take adequate precautions and thus could become a source of transmission (12). Thereby, a large part of transmission remains subclinical (13). There have been studies that have revealed infections spread by patients in the incubation period and by the asymptomatic carriers (14). Asymptomatic transmission could further increase the risk of super-spreading in hospitals (15).
Unlike Severe Acute Respiratory Syndrome (SARS) or Middle East respiratory syndrome, COVID-19 was less virulent, with a lower mortality rate (9),(10),(11). Nevertheless, low virulence and longer incubation periods resulted in a significant number of asymptomatic carriers. These people might not take adequate precautions and thus could become a source of transmission (12). Thereby, a large part of transmission remains subclinical (13). There have been studies that have revealed infections spread by patients in the incubation period and by the asymptomatic carriers (14). Asymptomatic transmission could further increase the risk of super-spreading in hospitals (15).
With less research in this area (16), present study aimed to cover the proportion of asymptomatic Healthcare Workers (HCWs) who might be involved in transmission of the COVID-19 infection in an otherwise non infected patient in a hospital setting. Thus, HCWs could be a potential carrier of the disease and identifying them at the right moment can serve as barrier to transmission.
This hospital-based, cross-sectional study was conducted at Medical College and Hospital, Kolkata, West Bengal, India, from June 2020 to September 2020, on 714 HCWs. The ethical clearance was obtained from the Institutional Ethics Committee (approval no. MC/KOL/IEC/NON SPON/717/06/2020). This study was a joint venture between the Department of General Medicine and Department of Biochemistry of this Hospital (the largest and longest serving COVID-19 care facility hospital of West Bengal, possibly the entire Eastern and North-eastern India). A written informed consent was taken from all the participating HCWs.
Sample size calculation: Considering the worst case scenario method to calculate the required sample size, authors considered prevalence (p) as 50% and q (1-p) as 50%, z was considered at 99% confidence level with absolute error of 5% (d). It came out to be 660. Moreover, 10% excess data was considered due to attrition factor resulting in a target sample size of 720.
Inclusion criteria: Cases were defined as HCWs indulged in designated COVID-19 or suspect wards and other parts of the hospital were included in the study.
Exclusion criteria: Individuals with age group <18 years and HCWs with previous laboratory diagnosed COVID-19 were excluded from the study.
Procedure
A complete questionnaire could be obtained from 725 subjects and collection blood sample was drawn in all 714 subjects. Thus, 11 subjects had to be excluded from data analysis and study population contains 714 subjects.
A brief history on the presence of symptoms like fever, cough, conjunctivitis etc., and any past medical history was taken. The data was collected from HCWs with the help of a self-made questionnaire (containing variables like job designation, type of COVID-19 designated duty, duration of such duty, episode of influenza like illness). The blood samples were collected from the HCWs for a period of three months from June 2020 to September 2020. A brief clinical examination was performed before drawing the samples and they were analysed by serological assessment of Immunoglobulin G (IgG) for COVID-19, Enzyme-Linked Immunosorbent Assay (ELISA), using EUROIMMUN kit {specificity of the Anti-SARS-CoV-2 ELISA (IgG) amounted to 99.6%} from serum samples. The standardised sensitivity of the kit was predetermined in reference to the kit manufacturer’s instructions. The cut-off value:
• ≥0.8- Positive
• >1.1- Strong positive.
Statistical Analysis
The data were entered in MS Excel and double-checked to avoid any error in the data entry. Epi info software 7, downloaded from the WHO site was used to manage and analyse the data. The hypothesis testing was done using Chi-squared test and the data were carefully described by tabular as well as graphical means.
Total 714 HCWs volunteered for sero-survey. Amongst them mean age was 35.30 with a standard deviation of 11.79. Out of 714 people, 54.8% (391/714) were male and 45.2% (323/714) were female. Among the HCWs, there were 426 physicians, 148 nursing staffs, 97 ward staffs and cleaners and 22 technicians (Table/Fig 1). It is also noted that 97 out of the total 714 (13.85%) have less than undergraduate level qualification. In addition, 513 HCWs were posted in COVID-19- designated duties and 201 HCWs did not have any COVID-19 duties (Table/Fig 1).
A total of 91 (12.4%) HCWs out of the total 714 were IgG positive for COVID-19 irrespective of the duties assigned (Table/Fig 2). Among them, 44 were not assigned any COVID-19 duties. The distribution of positive and negative IgG levels was further tabulated based on whether or not the HCW was posted in COVID-19 duty (Table/Fig 3). In this serosurvey, 21.89% people among HCWs not involved in COVID-19 designated duty were positive for IgG, which was much higher than the persons doing COVID-19 designated duties (9.16%) which were statistically significant.
In the study, it was evident that not a great amount of positivity was found from the highly COVID-19 exposed areas. 22% positivity was found in people who were not indulged in COVID-19 direct exposure compared to 18.59% further stratified into 9.16% among people doing COVID-19 ward duty, 9.43% among people doing COVID-19 Critical Care Unit (CCU) duty. Moreover the duration of COVID-19 duties was not significantly related to IgG positivity.
Maximum positivity rate/seroprevalence for IgG was found to be among ward staff and cleaners (29, 29.9%) (p-value<0.0001) when compared to other groups (Table/Fig 4),(Table/Fig 5). In this survey, seroprevalence was least amongst nursing staffs with 5.41% seroprevalence (8/148); among doctor’s it was 9.62% (41/426); most interestingly we stratified the others group further and among ward boys and cleaners this prevalence was found to be 29.90% (29/97) being the highest. When the population was analysed as per educational qualification into postgraduate/graduate/less than graduate strata persons belonging to ‘less than undergraduate’ group had maximum incidence of sero-positivity with 29.9% (29/97).
It is of utmost importance to look out for the ‘trojan horse’ that is the asymptomatic HCWs who can potentially spread the disease in the hospital set-up and subsequently, outside, in the community. Strictly adhering to infection prevention and control measures like mask-wearing, using protective gears, and frequent surveillance testing can prevent spread.
In this study sample, 391 subjects were male and 323 were females. Positivity among male HCWs was 63/391 (16.11%) and females 28/323 (8.67%). A similar study by Wattal C et al., involving 1033 HCWs shows that seropositivity was significantly lower among females 114/545 (20.9%) than among males 153/488 (31.4%), (p-value <0.001) (16).
In the same study by Wattal C et al., the seropositivity among doctors 16/240 (6.7%, p-value<0.001), the technical staff was 12/89 (13.4%, p-value <0.001), and nurses were 53/297 (17.8%, p-value <0.001). Seroprevalence in the former was much lower than that seen in security staff 32/53 (60.4%, p-value <0.001), sanitary workers 49/89 (55.42%, p-value <0.001), and ward boys 28/68 (41.2%, p-value <0.001) (16). The present study resonates with their study. It shows the least seropositivity among nursing staff with seroprevalence 8/148 (5.41%) and doctors with 41/426 (9.62%) seroprevalence. The highest was noted in ward boys and cleaners, 29/97(29.90%). This may be attributable to the difference in educational qualification and awareness about COVID-19 infection prevention and control guidelines. This study reveals people belonging to the ‘less than undergraduate’ group had a maximum incidence of seropositivity 30with 29/97 (29.90%). In this serosurvey, 44/201 (21.89%) HCWs not involved in COVID-19-designated duty tested positive for IgG, and only 47/513 (9.16%) tested positive among HCWs doing COVID-19-designated duty.
A similar finding was noted in a study by Khan MS et al., which showed HCWs who had worked at a dedicated COVID-19 hospital had a lower seroprevalence of 0.6% (95% CI, 0.2%-1.9%) and a lower multivariate-adjusted risk of seropositivity (odds ratio, 0.21; 95% CI, 0.06-0.66) compared to 2.8% seen in HCWs doing non COVID-19 duty (17). Also, all 140 samples collected from ICU/HAU and emergency at Royal Columbian Hospital were negative for COVID-19 in a study done by Deady B et al., (18).
In the study carried out by Olayanju O et al., in Nigeria 60/133 (45.1%) HCWs were seropositive for SARS-CoV-2. Among them 25/55 (45.0%) doctors, 8/33 (23.3%) nurses, 3/19 (16.7%) health assistants, 1/18 (6.7%) laboratory scientists and technicians, and 1/8 (8.3%) non medical staff. This discrepancy in Nigeria is most likely due to the lack of protective gears and minimum surveillance provided to the HCWs who attended COVID-19 positive patients at the peak of the pandemic (19). Data concerning COVID-19-infected asymptomatic HCWs is limited. Hence, this study delves into this aspect and also resurfaces other studies to highlight one of the vital modes of community spread of the infection that is otherwise generally disregarded.
Limitation(s)
The sample size was small and taken from a single tertiary care centre. Hence, the results cannot be generalised. The asymptomatic COVID-19 positive cases were not followed-up in the next two weeks. The patients who developed symptoms in those days were erroneously categorised as asymptomatic patients. There was no provision for separating the symptomatic and asymptomatic patients suffering from COVID-19 in wards. So, authors could not judge the transmission probability from an asymptotic patient exposure. Also, this study measured the IgG levels only which develop almost two weeks after an active infection. Thus, it limits authors ability to segregate the asymptomatic HCWs as a possible carrier of the disease early on.
This serosurvey has documented high seroprevalence among ward boys as well as cleaners and low seroprevalence among nurses and doctors. The knowledge of this disease as a droplet-borne infection, awareness, and education regarding adherence to strict precaution measures like wearing masks, protective gear, and hand hygiene at all times is the key to infection prevention and control. COVID-19 designated duties and hours spent in COVID-19 patient care are not significantly associated with disease transmission. Early detection of disease by frequent facility-based surveillance is required to prevent cross-infection in the hospital and super-spread of infection in the community.
Authors would like to thank the administration of Medical College and Hospital, Kolkata, the whole of Department of General Medicine, Department of Biochemistry for their support.
DOI: 10.7860/JCDR/2022/52612.16260
Date of Submission: Sep 29, 2021
Date of Peer Review: Dec 23, 2021
Date of Acceptance: Feb 04, 2022
Date of Publishing: Apr 01, 2022
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No
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