One in four cases of Covid-19 in Cyprus are healthcare workers, a new report shows.
The report, published on Thursday by a team of experts advising the Ministry of Health on Covid-19, presents for the first time data collected from the start of the outbreak in Cyprus until March 31.
Covering the period up until March 31 it provides valuable insight into the situation here, including the age and location of Covid-19 cases, the source of exposure and a comparison with other countries.
As at March 31, 267 COVID-19 cases and 8 associated deaths (case fatality rate: 3.0%) have been reported in the Republic of Cyprus.
Among these cases, 25% are healthcare workers (n = 67), of which 6% physicians (n = 15), 13% nurses (n = 35), 4% other health occupations (n = 11), and 2% auxiliary staff (n = 6).
The median age of cases is 48.5 years (interquartile range – IQR: 35-62 years); 53% are male.
Overall, locally acquired infections (index cases and close contacts of confirmed cases) were 183 (69%), of which 20% (n = 37) were related to a healthcare facility (General Hospital in Paphos) and 17.5% (n = 32) were reported in Aradippou municipality.
In total, 30% (n = 81) of cases received hospital care, of which 29 (36%) have been discharged alive from the hospital. Median age of all hospitalized patients is: 62 years (interquartile range: 52-75 years), and 72% are males.
Nine (11% of all hospitalized patients) patients are currently in intensive care units.
A total of 7,397 tests have been performed as of March 31 (844.5 per 100,000 population).
Figure 1: Number of laboratory-confirmed COVID-19-cases in Cyprus since 01/03/2020 by date of sample collection and date of symptoms onset (n = 261 and n = 154 with data available, respectively). Note: Recent data should be interpreted with caution due to the possibility that cases with date of onset within the reporting period have not yet been diagnosed.
Analyses are based on laboratory-confirmed cases notified to the Epidemiological Surveillance Unit of the Ministry of Health.
As at March 31, 267 laboratory-confirmed cases of coronavirus disease 2019 (COVID-19) have been reported (including four in the British Bases) (Figure 1 and 2).
The median time between symptoms onset and date of sampling was 4 days (IQR: 2- 7 days).
It should be noted that for four cases the date of sample collection was before the onset of symptoms, as a result of immediate testing of contacts of possible and laboratory-confirmed cases.
Figure 2: Number and cumulative number of laboratory-confirmed COVID-19- cases in Cyprus since 01/03/2020, by date of laboratory reporting (n = 267). Note: Recent data should be interpreted with caution due to the possibility that cases with date of onset within the reporting period have not yet been diagnosed.
Among these cases, 53% are male (n = 141) and 47% female (n = 125), while for one case sex has not been recorded at the moment. The median age of cases is 48.5 years (interquartile range: 35-62 years).
By age groups, cases included 11 children and adolescents aged 0-17 years-old (4%), 175 adults aged 18-59 years (66%), and 78 persons aged 60 years and older (30%). The age of 3 notified cases has not been recorded at the moment (Figure 3).
Figure 3: Laboratory-confirmed COVID-19-cases in Cyprus by sex and age groups (n=263 cases with data available).
Among all cases, 77 (29%) were reported in Nicosia district, 75 (28%) in Larnaca, 61 (23%) in Paphos, 30 (11%) in Limassol, 16 (6%) in Ammochostos (Famagusta), 4 (2%) in the British bases and 1 case was reported in a traveler from Germany (Figure 4). Information was not available at the moment for three cases.
Notably, 39 cases (15%) were reported in Aradippou, a municipality in Larnaca district. Cases in Aradippou are mainly females (59%; n = 23) and the median age is 61 years (interquartile range: 51-73 years).
Figure 4: Laboratory-confirmed COVID-19-cases in Cyprus by district of residence (n=264 cases with data available).
Among these 267 cases, 25% are health-care workers1 (n = 67), of which 6% physicians (n = 15), 13% nurses (n = 35), 4% other occupations (n = 11), and 2% auxiliary staff (n = 6). Table 1 shows the distribution of health-care workers by district of residence.
Table 1: Health-care workers by district of residence (n=67)
As at March 31, place of exposure is available for 253 cases (95%), and 14 cases are under investigation. In total, 28% (n = 70) of laboratory-confirmed COVID-19-cases had history of travel or residence abroad during the 14 days prior to symptom onset (imported). These cases have a direct link to the UK and Greece, mainly.
Locally acquired infections (index cases and close-contacts of confirmed cases) occurred in 72% (n =183) of the cases, of which 20% (n =37) were related to a healthcare facility (General Hospital in Pafos).
In Aradippou (Larnaca district) 32 cases were locally acquired and 3 imported. For four cases in Aradippou the epidemiological link was not recorded at the moment. Table A1 in appendix shows the number and the rate (per 100,000 population) of locally acquired cases by district of residence.
As at March 31, 8 COVID-19-related deaths were reported in Cyprus (Case Fatality Rate – CFR: 3.0%). The mortality rate for COVID-19 is 0.9 per 100,000 population. Seven deaths occurred in men; the median age of all deaths was 68.5 years (IQR: 60.5-76.5 years).
Three deaths were reported among residents in Paphos, two in Nicosia and Larnaca, respectively and one in Limassol (Appendix Table A2). Figure 5 reports the number of deaths by date.
Figure 5: Number of COVID-19 associated deaths in Cyprus by date of death (n = 8)
Of the 267 laboratory-confirmed COVID-19-cases, clinical information is available for 91% (n = 242), of which 13% (n = 32) reported no symptoms and 87% (n = 210) reported at least one symptom.
The most commonly reported symptom was cough (n = 118; 52%), followed by fever (n = 116; 50%), myalgia (n = 70; 31%), and sore throat (n = 65; 28%). Other reported symptoms were shortness of breath, diarrhoea, and headache.
Hospitalization and intensive care unit (ICU) admissions
In total, 30% (n = 81) patients received hospital care, and 29 patients (36%) have been discharged alive from the hospital. When age was available (n = 79), the median age of hospitalized patients was 62 years (interquartile range: 52-75 years).
Hospitalized cases were mainly males (n = 58; 72%). Overall, 14 cases (17% of all hospitalized patients) have been admitted to ICU2, of which 9 (11% of all hospitalized patients) are currently in ICU (as of March 31st).
The median age of patients admitted to ICU was 68 years (interquartile range: 61-75 years). The number of cases in ICU is 1.0 per 100,000 population. For comparison, Italy reported a rate of 6.8 per 100,000 population (n = 4,023).
Figure 6 shows the number of patients in ICU by day. Table A3 in Appendix shows the total number of ICU admissions by date.
Figure 6: Number of laboratory-confirmed COVID-19 cases currently in ICU by day
Comparison with selected countries
As at March 31, in Cyprus the reporting rate was 30.5 cases per 100,000 population, the mortality rate was 0.9 deaths per 100,000 population and the CFR 3%. Table 2 shows COVID-19 indicators for Cyprus and other selected countries.
Figure A1 in appendix reports the rates of cumulative tests and cases (per 100,000 population) in Cyprus and other selected countries. In Cyprus the testing rate is 844.5 per 100,000 population.
It should be noted that the number of cases, tests and deaths for Cyprus are aggregated and include people from abroad and the British Bases, while the total population does not include inhabitants from abroad or from the British Bases.
Table 2: COVID-19 indicators by selected countries, as of 31/03/2020
(Ministry of Health)