By Stan Deresinski, MD, FACP, FIDSA

Clinical Professor of Medicine, Stanford University

Dr. Deresinski reports no financial relationships relevant to this field of study.

SYNOPSIS: During the period of study, 5.9% of individuals hospitalized for COVID-19-related reasons were healthcare providers (HCP), with approximately one-third involving HCP who were not expected to directly contact patients.

SOURCE: Kambhampati AK, O’Halloran AC, Whitaker M, et al. COVID-19-associated hospitalizations among health care personnel — COVID-NET, 13 states, March 1-May 31, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1576-1583.

Kambhampati et al used data collected by the COVID-NET population-based survey to evaluate the proportion and characteristics of healthcare personnel (HCP) who had been hospitalized for COVID-19 in 98 counties of 13 states between March 1 and May 31, 2020. HCP were broadly defined to include anyone in a healthcare occupation with potential exposure to patients or infectious materials. In-depth medical chart abstractions were performed on a subset, and 438 of the 6,760 for whom documentation was available were HCP.

The median age of the HCP hospitalized with COVID-19 was 49 years, and 71.9% were women. Approximately one-half were categorized as non-Hispanic Black, one-fourth as non-Hispanic white, and one-tenth as Hispanic or Latino. Just more than two-thirds (67.4%) worked jobs for which direct patient contact was expected to occur, with 36.3% of the total in nursing-related categories. Almost nine in 10 had an underlying condition: obesity (72.5%), hypertension (40.6%), or diabetes mellitus (30.9%). Among the women who were age 18-49 years, 9.6% were pregnant. ICU attention was required for 27.5%, 15.9% received mechanical ventilation, and 4.2% died.

COMMENTARY

Kambhampati et al provide useful information regarding the burden of COVID-19 on HCP. However, they studied data from relatively early in the pandemic. Circumstances may be different today (e.g., possible better treatment options). During the time studied, some institutions may have owned limited supplies of personal protective equipment.

Although nursing occupations make up the largest single proportion of cases, no denominator data were presented. Registered nurses are reported to account for one-third of all U.S. healthcare practitioners. The picture presented in this study provides some useful input into initial tactics for COVID-19 vaccination. Although national recommendations for vaccine prioritization have been published, these will have to be adapted to circumstances at the level of healthcare organizations, including hospitals, something which has been addressed, to an extent, by the Society for Healthcare Epidemiology of America.1

The difficulties of vaccination prioritization will be dictated by the extent of vaccine availability. Many recommendations suggest the first target should be individuals who provide direct care to COVID-19 patients regularly. However, Kambhampati et al found approximately one-third of the hospitalized HCP did not directly contact patients. Other data from serosurveys suggest direct caregivers are not the HCP at greatest risk for infection. A recent survey at our institution revealed low levels of seropositivity overall, and the highest rates were not in HCP but in environmental and food workers. Others have reported the seroprevalence was not significantly different among direct-care providers vs. others.2,3 None of these data address the issue of where the infections occur. It is almost certain the most infections occur in the community rather than in the healthcare setting. Although different arguments can be made, the data indicate HCP, such as environmental and food workers, should be, at a minimum, at the same priority level as those providing direct care to COVID-19 patients. Also, the finding that three-fourths of HCP hospitalized for COVID-19-related reasons are obese suggests healthcare institutions should be directly addressing this problem among their employees.

REFERENCES

  1. The Society for Healthcare Epidemiology of America. SHEA statement for healthcare settings preparing for COVID-19 vaccination. Oct. 14, 2020.
  2. Dimcheff DE, Schildhouse RJ, Hausman MS, et al. Seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection among Veterans Affairs healthcare system employees suggests higher risk of infection when exposed to SARS-CoV-2 outside the work environment. Infect Control Hosp Epidemiol 2020; Sep 23;1-7. doi: 10.1017/ice.2020.1220. [Online ahead of print].
  3. Hunter BR, Dbeibo L, Weaver CS, et al. Seroprevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies among healthcare workers with differing levels of coronavirus disease 2019 (COVID-19) patient exposure. Infect Control Hosp Epidemiol 2020; Aug 3;1-2. doi: 10.1017/ice.2020.390. [Online ahead of print].