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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Have 1 Million Healthcare Workers Been Infected in Pandemic?

By Gary Evans, Medical Writer

It is possible some 1 million healthcare workers have been infected with the pandemic coronavirus, as public health officials report that there are likely 10 unknown COVID-19 cases for every one that is documented overall in the United States.

As of June 28, 2020, the Centers for Disease Control and Prevention reported that there were 87,348 COVID-19 infections in healthcare workers, with 470 deaths. However, the precise count is likely much higher, as the CDC data came from limited reports. These limitations include the many asymptomatic cases or those with symptoms who were never tested. Applying the 10-fold formula to the national case count as of June 28 reveals a staggering total of 25 million cases.

“[That is] one of the realities, because this virus causes so much asymptomatic infection,” Robert Redfield, CDC director, said at a recent press conference. “And again, we don’t know the exact number. There are ranges between 20% to as high as 80% in different groups. The traditional approach of looking for symptomatic illness and diagnosing it obviously underestimated the total amount of infections.”

The CDC now has more serology tests and the new assays for antibodies, he added. These diagnostics clearly suggest the numbers are much higher than the official tallies, perhaps by a range of multiples from five to one to 12 to one, he said.

“I think a good rough estimate right now is 10 to one,” he said. “I wanted to highlight that, because at the beginning we were seeing diagnosis in cases of individuals that presented in hospitals and emergency rooms and nursing homes. We were selecting for symptomatic or higher-risk groups. There wasn’t a lot of testing that was done of younger-age asymptomatic individuals.”

That means roughly 90% of the outbreak has been the bottom of the iceberg for both healthcare workers and the general public, at least for March, April, and May.

“We are continuing to try to enhance surveillance systems for individuals that are asymptomatic to be able to start detecting that asymptomatic infection more in real time,” he says.

A recent CDC study of more than 9,000 healthcare workers with COVID-19 found that 90% recovered without hospitalization. However, as with the public, there is a range of severity of illness, and the mortality figures are based on partial data that underestimate the total.

“For the 87,348 cases of COVID-19 among healthcare personnel, death status was only available for 57,092 (65.4%),” the CDC states.

For more on this story, see the upcoming issue of Hospital Employee Health.