COVID-19 Infects Many Healthcare Professionals, Mostly in Work Settings

As many as 11% of COVID-19-infected patients in some states are healthcare professionals. Where were they most likely to pick up the virus and what do public health officials advise to prevent HCP infections? A new CDC report and article offers some advice.

ATLANTA – In a sobering report, the national Centers for Disease Control reported that more than 9,000 healthcare professionals had been confirmed with COVID-19 infection and that most thought their exposure was in the healthcare setting.

In an article in the Morbidity & Mortality Weekly Report, CDC authors said that likely was an underestimation because HCP status was available for only 16% of reported cases nationwide. They also point out that HCP with mild or asymptomatic infections might also have been less likely to be tested and, therefore, reported.

The MMWR notes that only 3% (9,282 of 315,531) of reported cases were among HCP, although in states with more complete reporting of HCP status, the percentage of infected healthcare personnel jumped to 11%.

“The total number of COVID-19 cases among HCP is expected to rise as more U.S. communities experience widespread transmission,” the authors explain. “Compared with reports of COVID-19 patients in the overall populations of China and Italy (4,5), reports of HCP patients in the United States during February 12–April 9 were slightly younger, and a higher proportion were women; this likely reflects the age and sex distributions among the U.S. HCP workforce.”

Most HCPs reporting contact with a laboratory-confirmed COVID-19 patient said that occurred in healthcare settings, not in household or community settings. “However, there were also known exposures in households and in the community, highlighting the potential for exposure in multiple settings, especially as community transmission increases,” the authors point out. “Further, transmission might come from unrecognized sources, including pre-symptomatic or asymptomatic persons.”

Advising that contact tracing alone after recognized occupational exposure likely won’t identify many HCP at risk for developing COVID-19, the CDC says the information still raises some possibilities for prevention, including:

• screening all HCP for fever and respiratory symptoms at the beginning of their shifts,
• prioritizing HCP for testing, and
• ensuring options to discourage working while ill (e.g., flexible and nonpunitive medical leave policies).

Because of the risk of pre-symptomatic and asymptomatic transmission, the article recommends covering the nose and mouth in healthcare and community settings where other social distancing measures are difficult to maintain.

“Even if everyone in a health care setting is covering their nose and mouth to contain their respiratory secretions, it is still critical that, when caring for patients, HCP continue to wear recommended personal protective equipment (PPE) (e.g., gown, N95 respirator [or facemask if N95 is not available], eye protection, and gloves for COVID-19 patient care),” the CDC authors explain. “Training of HCP on preventive measures, including hand hygiene and PPE use, is another important safeguard against transmission in health care settings.”

The article also discusses the relationship between age and risk of COVID-19 severity and makes some related recommendations. The CDC found that, among HCP with COVID-19 whose age status was known, 8%–10% were reported to be hospitalized, which is lower than the 21%–31% of U.S. COVID-19 cases with known hospitalization status described in a recent report. One reason, it notes, is that the median age of HCP patients with reported COVID-19 WAS 42.

Yet increasing age and prevalence of underlying conditions – 38% of infected HCP had at least one -- were associated with a higher prevalence of severe outcomes, although severe outcomes, including death, were observed in all age groups, the article notes.

“Older HCP or those with underlying health conditions (8,9) should consider consulting with their health care provider and employee health program to better understand and manage their risks regarding COVID-19,” according to the report. “The increased prevalence of severe outcomes in older HCP should be considered when mobilizing retired HCP to increase surge capacity, especially in the face of limited PPE availability; one consideration is preferential assignment of retired HCP to lower-risk settings (e.g., telemedicine, administrative assignments, or clinics for non–COVID-19 patients).”