Training and reployment of non-specialists is an effective solution for the shortage of health care workers in the COVID-19 pandemic

Importance In the COVID-19 pandemic many countries encounter problems arising from shortage of specialists. Short intensive training and reployment of non-specialists is an option but the effectiveness is unknown. Objective To investigate whether there was difference in in-hospital mortality rates between COVID-19 patients managed by a mixed team (including non-specialists who had short intensive training and operated to a strict protocol) and those managed by a specialist team of health care workers. Design Cohort study, from January 26, 2020 to April 7, 2020, follow up to April 7, 2020. Setting Multicenter - Wuhan Hankou Hospital and Wuhan Xiehe Hospital, Wuhan, China. Participants 261 HCWs deployed to Wuhan from Guangdong emergency rescue team and the 269 COVID-19 patients they treated. Exposure Among 261 health care workers, 130 were in the specialist team and included 33 physicians, 32 of whom (97.0%) of whom were from relevant specialties. Each physician was in charge of 25-27 beds, with a 6-hour shift time. The mixed team included 131 health care workers, with 7 of the 28 physicians (25.0%) from relevant specialties. Each physician managed 12-13 beds, with a 4-hour shift time. Non-specialists received short-term intensive training and then followed strict management protocols. Specialists practiced as normal. Main Outcomes and Measures Main outcome was in-hospital mortality of COVID-19 patients. Another outcome was rate of SARS-CoV-2 infection in health care workers. Results A total of 269 patients were included (144 male). In-hospital mortality rate of patients treated by the specialist teams and the mixed teams was 12.6% (20/159) and 12.7% (14/110) respectively (Difference = −0.1%, 95% CI −8.2% to 7.9%, p=.97). None of the health care workers were infected. Conclusions and Relevance Training and reployment of non-specialists is an effective solution for the shortage of health care workers in the COVID-19 pandemic. Question Was there difference in mortality rates between COVID-19 patients managed by a mixed team (including non-specialists who had short intensive training and operated to a strict protocol) and those managed by a specialist team of health care workers (HCWs)? Findings In-hospital mortality rate among patients managed by specialist team (130 HCWs, 159 patients) and mixed team (131 HCWs, 110 patients) was 12.6% (20/159) and 12.7% (14/110) respectively (Difference = −0.1%, 95% CI −8.2% to 7.9%, p=.97). Meaning With shortage of specialist HCWs, training and reployment of non-specialists is an effective option in the management of COVID-19 patients. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement None. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University, Wuhan Xiehe Hospital and Wuhan Hankou Hospital. The informed consent was waived. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Haipeng Xiao had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.