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By Gary Evans, Medical Writer
The recent announcement that more than 1,700 healthcare workers have been infected during the novel coronavirus outbreak in China has dramatically raised the stakes on hospital preparedness in the United States.
The infections raise “staggering” implications, including the availability and sustainability of personal protective equipment (PPE), training in proper use, and the "impact on the morale and family concerns for healthcare workers,” noted Daniel Lucey, MD, MPH, FIDSA, FACP, of the Infectious Diseases Society of America.
On February 14, China announced that 1,716 healthcare workers had been infected with COVID-19 and six have died. Potential factors that have been cited include that some of infections occurred earlier in the outbreak when the index of suspicion was lower, some were spread by asymptomatic cases, and shortages and/or improper use of PPE occurred. However, one overriding variable complicates analysis and undermines clear conclusions: The vast majority of worker infections occurred in Wuhan City amid a large and expanding outbreak in the community.
“You have to separate out the possibility of acquisition in the community before you assume that every healthcare provider is getting it from their work place,” says David Weber, MD, hospital epidemiologist and associate chief medical officer at University of North Carolina Health Care in Chapel Hill. “There are more than 50,000 cases just in Wuhan and Hubei province.”
This points to a major challenge of COVID-19 that differs from influenza season, when healthcare workers are one of the first groups to be immunized. With no COVID-19 vaccine, healthcare workers face risks in the community, which certainly increase as they treat infected patients in the hospital.
“Another vulnerability — as we saw with the case of Ebola with the healthcare providers [infected] in Dallas [in 2014] — is the failure to appropriately identity and isolate cases in the healthcare facility as soon as soon as they come in,” Weber says.
That is a major emphasis in U.S. hospitals, as many facilities are asking travel history and have masks at the ready to put on suspect patients. At this stage of the outbreak, PPE is providing a thin line of protection that can be compromised by incorrect use. The aforementioned Ebola outbreak revealed that healthcare workers may contaminate themselves, particularly when removing PPE. There are also issues of diminishing PPE supplies, which may press workers to reuse disposable gear.
“We know there have been shortages in China, so did the [infected personnel] have an adequate number of gowns, gloves, masks, and face shields?” Weber says. “Or did they run out and were reusing masks? We know they are not really designed to be reused.”
It’s possible that some of the healthcare workers could have done all these things correctly and still been infected, Weber concedes. The threat to healthcare workers will be revealed in clearer terms if occupational infections occur in other nations in the absence of a community outbreak, he adds.
“I think we will have a much better sense of what the risks are to healthcare providers once we begin following all of these cases that have occurred outside of China,” Weber says. “We don’t think there is any circulating disease in the communities as in China, and we will see if healthcare workers acquire disease there.”
In a related development, the Centers for Disease Control and Prevention has changed the way it is reporting U.S. cases of COVID-19. As of February 21, the CDC reported 12 travel-related cases and two cases resulting from person-to-person transmission. That totals 14 Americans whose infections were detected in the United States via public health surveillance. An additional 18 Americans were infected on the Diamond Princess cruise ship and three in Wuhan, China. Those cases raise the total to 35 U.S. citizens overall who have been infected with the emerging coronavirus.
As this story was posted, the World Health Organization was reporting 76,785 total cases with 2,249 deaths in 28 countries. The epicenter remains in China, with 75,567 cases, followed by South Korea with 204 cases and Japan with 93 cases.
For more on this story, see the April 2020 issue of Hospital Employee Health.