COVID-19 Toll on Healthcare Personnel

Healthcare workers are on the front line of COVID-19 response, and, in this position, we are voluntarily placed into arenas of heightened risk. A couple of recent CDC assessments clarify this risk. The very nature of medical practice is communal; we come together to provide comprehensive and multidisciplinary care. This community of care is illustrated in a case study of 1 hospitalized COVID-19 patient in California.¹ During a 4-day stay, no fewer than 121 healthcare personnel (HCP) were exposed to this individual; it should be said that COVID-19 was not suspected during this hospitalization. Of those exposed, 43 (36%) became symptomatic and 3 (2.4%) were found to be positive for SARS-CoV-2. All 3 of the secondary cases had unprotected patient contact. Moreover, they spent significantly longer time in the patient‘s hospital room than did those not contracting SARS-CoV-2.

In a larger analysis, the CDC COVID-19 Response Team analyzed data from nearly 50,000 COVID-19 cases associated with completed standardized data forms, of which 9282 (19%) were HCP.² This percentage is likely inflated, however, by the likelihood of HCP to complete forms; in another population-based assessment, HCPs account for about 11% of COVID-19 cases. The median age of cases was 42 years, 73% were female, and 38% had an underlying health condition. Moreover, 55% of HCP cases reported that their only exposures to SARS-CoV-2 were within healthcare settings, with household exposures accounting for an additional 27%. Most cases (92%) reported fever, cough, and/or shortness of breath.

The great majority of HCP cases were not hospitalized (90%), but 2% to 5% were admitted to an ICU and 0.3% to 0.6% died of COVID-19. As noted elsewhere, increasing age was a significant factor in hospitalization, ICU admission, and death.

The take-home lessons for primary care clinicians and other healthcare personnel are summarized here:

• Early recognition and isolation of COVID-19 cases is essential for safe care management.

• Prolonged and unprotected exposures as well as some aerosol-generating procedures are associated with HCP acquisition of SARS-CoV-2 infection.

• Consistent use of the appropriate PPE is required for patient care.

• All HCP should be screened for fever and respiratory symptoms at the beginning of shifts or upon entry to healthcare facilities.

• HCP should be prioritized for SARS-CoV-2 testing.

• HCP should be discouraged from working while ill.

• Older HCP and those with underlying health conditions should consult with their healthcare providers and employee health programs to better understand and manage risk.