In what is likely a substantial undercount, the Centers for Disease Control and Prevention (CDC) reports that between Feb. 12 and July 16, there were 100,570 COVID-19 cases in healthcare workers and 641 deaths reported in the United States.1

“Healthcare personnel (HCP) status remains missing for most cases reported to CDC,” the agency noted. “HCP might be prioritized for testing, but the actual number of cases in this population is most certainly underreported and underdetected, especially in asymptomatic persons.”

Minority Workers Affected

General trends in COVID-19 in HCP mortality include the deaths occurred in those who were older, male, Asian, Black, and with an underlying medical condition, the CDC reported. The agency cobbled together data from various reporting systems and methods, and some data reflect only the subset provided by forms and limited public health jurisdictions.

“Compared with nonfatal COVID-19 HCP cases, a higher percentage of fatal cases occurred in males (38% vs. 22%), persons aged ≥ 65 years (44% vs. 4%), non-Hispanic Asians (20% vs. 9%), non-Hispanic Blacks (32% vs. 25%), and persons with any of the 10 underlying medical conditions specified on the case report form (92% vs. 41%),” the CDC reported.

The CDC previously reported COVID-19 in healthcare workers using national case surveillance data in April 2020.2 “Since then, the number of reported HCP with COVID-19 has increased tenfold,” the CDC noted.1

The CDC did not clarify in the report whether such a dramatic increase also was seen for the number of HCP deaths. But a look back at the first CDC surveillance report reveals 27 deaths occurred among 9,282 cases in healthcare workers, meaning by the same crude extrapolation the latest death count would be greater than a tenfold increase. There also is the larger issue of underreporting, as the CDC estimates actual cases in the pandemic for all groups could be 10 times higher than totals. (For more information, see Have 1 Million Healthcare Workers Been Infected in Pandemic? in the August issue of Hospital Employee Health, at: https://www.reliasmedia.com/articles/146520-have-1-million-healthcare-workers-been-infected-in-pandemic.)

Longstanding Inequities Contribute

This updated report used national data reported from February 12 to July 16, 2020. Among 69,678 HCP cases with data on race and ethnicity, 47% were in non-Hispanic whites, 26% were in Blacks, 12% were in Hispanics or Latinos, and 9% were in Asians.

“Longstanding inequities in social determinants of health can result in some groups being at increased risk for illness and death from COVID-19, and these factors must also be recognized and addressed when protecting essential workers in the workplace, at home, and in the community,” the CDC emphasized. “Ensuring adequate allocation of PPE [personal protective equipment] to all HCP in the workplace is one important approach to mitigating systemic inequalities in COVID-19 risk. As the COVID-19 pandemic continues in the United States, HCP are faced with increasing fatigue, demands, and stressors. HCP who are at higher risk for severe illness and death from COVID-19 should maintain ongoing communication with their personal healthcare providers and occupational health services to manage their risks at work and in the community.”

Of those with known hospitalization or intensive care unit (ICU) admission status, 8% were hospitalized and 5% were treated in an ICU. Forty-four percent had at least one of 10 underlying medical conditions specified on the case report form.

“The most common were cardiovascular disease (18%), chronic lung disease (16%), and diabetes mellitus (13%),” the CDC stated. “The vast majority (92%) of fatal HCP cases were among HCP with an underlying medical condition. More than one half had cardiovascular disease (61%) or diabetes mellitus (52%) — conditions known to increase the risk for severe COVID-19 — [and] 32% were reported to have both conditions.”

In the update, most HCP with COVID-19 were reported to work in nursing and residential care facilities. “Large COVID-19 outbreaks in long-term care facilities suggest that transmission occurs among residents and staff members,” the CDC reported. “During the COVID-19 pandemic, multiple challenges in long-term care settings have been identified, including inadequate staffing and PPE, and insufficient training in infection prevention and control.”

Nurses and healthcare support workers have frequent, close contact with patients that put them at risk, but cases also are occurring in nonmedical staff, administrative, and environmental services.

“Risk to HCP can occur through pathways other than direct patient care, such as exposure to co-workers, household members, or persons in the community,” the CDC concluded. “HCP who acquire SARS-CoV-2 can similarly introduce the virus to patients, co-workers, or persons outside the workplace. Thus, practices such as universal use of face masks at work, wearing masks in the community, observing social distancing, and practicing good hand hygiene remain critical strategies to protect HCP and the populations they serve. Screening HCP for illness before workplace entry and providing nonpunitive sick leave options remain critical practices.”

REFERENCES

  1. Hughes MM, Groenewold MR, Lessem SE, et al. Update: Characteristics of health care personnel with COVID-19 — United States, February 12-July 16, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1364-1368.
  2. CDC COVID-19 Response Team. Characteristics of Health Care Personnel with COVID-19 — United States, February 12-April 9, 2020. MMWR Morb Mortal Wkly Rep 2020;69:477-481.