COVID-19 in Healthcare Workers and Serving Safe Healthcare During the Pandemic

Abstract

by the severe acute respiratory syndrome (SARS)-CoV-2 virus, was declared by the World Health Organization as a pandemic on March 11, 2020 to highlight the gravity of a unique healthcare experience that had not been previously experienced since 1918 with the Spanish flu pandemic. The increased demand on the healthcare facilities in providing medical care during pandemics creates unique challenges of providing care while ensuring the safety of vulnerable patients and healthcare workers (HCWs). HCWs are the most important resource in controlling the spread and propagation of the pandemic but they can also be the source for healthcare outbreaks and ongoing community transmission. Throughout the history of coronavirus outbreaks and epidemics, the personnel working in healthcare institutions have rarely been spared. In 2003, the SARS epidemic quickly spread worldwide with a great proportion of those with the disease being associated with hospital-based outbreaks.1,2 The infected HCWs accounted for 37%–63% of suspected SARS cases in highly affected countries forcing hospital closure and mandatory quarantine.3,4 In 2012, the second coronavirus epidemic emerged as the Middle East respiratory syndrome coronavirus (MERS-CoV) which, by the end of November 2019, resulted in a total of 2,494 laboratory-confirmed cases globally and associated deaths (case fatality rate: 34.4%).5 The overall proportion of MERS-CoV infected HCWs was 25%, which varied significantly by outbreak from 13–89% (P < 0.001). Interestingly, 70% of asymptomatic infections were reported among HCWs with no fatalities.6 In Oman, a total of 24 cases of MERS-COV were reported from 2013 to the end of 2019 including two mild cases in HCWs from two separate nosocomial outbreaks and the associated deaths (case fatality rate: 29.2%).7 In the early phase of the COVID-19 pandemic, data from Wuhan, China, up to 24 February 2020, showed that of 77,262 patients there were 3,387 infected HCWs (4.4%); 23 of these individuals had died by April of the same year.8 In a study from Wuhan, the source of HCW infection was found to be contact with infected colleagues (n = 12, 10.9%) while 14 (12.7%) were attributed to community acquisition.9 In areas where community transmission was established, a healthcare cluster was more likely due to lapse in early HCW case detection. This is particularly significant in COVID-19 because patients may have mild atypical symptoms and there could be pre-symptomatic transmission.10 A study of two Dutch hospitals found that out of 9,705 HCWs of which 1,353 were tested for COVID-19, a total of 86 (6%) were infected with SARS-CoV 2 out of which only 3 (3%) had been exposed to an admitted confirmed COVID-19 inpatient and that a substantial proportion of HCWs were infected with SARS CoV-2 two weeks prior.11 The first case was admitted to the facility which indicated that their exposure was most likely in the community.11 In a Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC), 121 HCWs were exposed to a patient with unrecognised COVID-19 of which 43 became symptomatic; only three were positive for SARSCoV-2 and all three had had unprotected patient contact.12 In the USA, as of 6 June 2020, it had been reported that nearly 600 frontline HCWs died due to COVID-19.13 A study from the UK and USA estimated that frontline HCWs had a 3.4 fold higher risk than people living in the general community for reporting a positive test, adjusting for the likelihood of receiving a test.14 Other studies however, reported lower illness severity in HCWs and identified personal protective equipment (PPE) use as a main factor associated with decreased infection risk.15 A retrospective study including 72 HCWs