PURPOSE:

• The CDC COVID-19 Response Team analyzed the current data to determine the SARS-CoV-2 infection rate among healthcare personnel (HCP) in the US population

METHODS:

• Observational study
• Data sources (February 12 to April 9, 2020)
  • Cases: From 50 states, the District of Columbia, and 4 US territories
  • Laboratory-confirmed COVID-19 cases
  • Excluded: Persons repatriated to the US from Wuhan, China | Diamond Princess cruise ship
• Data collected using a standardized report form that included the following
  • Patient demographics | Whether the patient is a US health care worker | Symptom onset date | Specimen collection dates | History of exposures in the 14 days preceding illness onset | COVID-19 symptomology | Preexisting medical conditions | Patient outcomes (including hospitalization, ICU admission, and death)
  • HCP patient health outcomes (stratified by age) were classified as hospitalized, hospitalized with ICU admission, and deaths
• HCP definition
  • Essential workers defined as paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials
• Statistical analysis
  • “Because submitted forms might have missing or unknown information at the time of report, all analyses are descriptive, and no statistical comparisons were performed” | Ranges were used for some of the percentages

RESULTS:

• 315,531 U.S. COVID-19 cases | Data on HCP occupational status available for 49,370 (16%) among whom 9,282 (19%) were identified as HCP | 11% HPC in jurisdictions with more complete reporting metrics
• Median HCP age: 42 years (IQR 32–54 years) | 73% female
• Race available for 41% HCP patients
  • White: 72%
  • Black: 21%
  • Asian: 5%
  • Other: 2%
• Ethnicity specified in 39%
  • Non-Hispanic/Latino: 90%
  • Hispanic/Latino: 10%
• ≥1 underlying health condition (available for 51%): 38%
• 1,423 HCP patients reported contact with a laboratory-confirmed COVID-19 patient in either health care, household, or community settings
  • Healthcare setting only contact: 55%
  • Household contact only: 27%
  • Community contact only: 13%
  • More than one possible contact setting: 5%
• Signs and symptoms (included fever, cough, shortness of breath, nausea or vomiting, and diarrhea)
  • ≥1 symptom: 92%
  • Muscle aches: 66%
  • Headache: 65%
  • Loss of smell or taste: 16%
• Among HCP patients with data available on age and health outcomes
  • Not hospitalized: 90%
  • Hospitalized: 8% to 10%
  • ICU admission: 2% to 5%
  • Death: 0.3% to 0.6%

Note: “Although only 6% of HCP patients were aged ≥65 years, 10 (37%) of deaths occurred among persons in this age group”

CONCLUSION:

• Compared to non-HCP patients, HCP patients were
  • Slightly younger | Higher proportion were female
  • Demographics reflect HCP population | Similarly, “race and ethnicity distributions among HCP patients reported to CDC are different from those in the overall U.S. population but are more similar to those in the HCP workforce”
  • Similar to the general population, increasing age and co-morbidities are associated with higher prevalence of severe outcomes
• Hospitalization rate
  • Lower in HCP (8%–10%) vs previous general US reports (21% to 31%) and may be due to
    • Younger age | Prioritization for testing which would result in identification of less severe disease among HCP
• Strategies that will reduce risk to HCP include
  • Screening all HCP for fever and respiratory symptoms at the beginning of their shifts
  • Prioritizing HCP for testing
  • Ensuring flexible and nonpunitive medical leave policies so HCPs do not feel compelled to work while feeling unwell
  • Covering the nose and mouth (i.e., source control) is recommended to reduce presymptomatic and asymptomatic transmission when social distancing measures cannot be achieved
• In healthcare settings: Assure source control among all HCP, patients, and visitors
  • The CDC COVID-19 Response Team states that

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 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

It is critical to make every effort to ensure the health and safety of this essential national workforce of approximately 18 million HCP, both at work and in the community

Learn More – Primary Sources:

MMWR (CDC): Characteristics of Health Care Personnel with COVID-19 — United States, February 12–April 9, 2020

Related ObG Topics:

ARDS, Critical Care and COVID-19: ‘Surviving Sepsis Campaign’ Guidelines and Key Points

MMWR Reports on Initial US COVID-19 Experience: Demographics, Mortality and Outcomes 

CDC Weekly Update: Which Comorbidities are Associated with COVID-19 in the US?