US reports 27 deaths and 9,282 COVID-19 cases among healthcare workers but experts say numbers much higher
More than 9,000 healthcare workers in the US have contracted the new coronavirus and 27 have died, according to the first preliminary nationwide analysis of how the COVID-19 pandemic is hitting front-line caretakers in the country. The figures released by the US Centers for Disease Control and Prevention (CDC) show that of the confirmed cases, nearly three quarters or 73% (6,603) are women.
"Limited information is available about COVID-19 infections among US healthcare personnel," the CDC says and adds, "During February 12-April 9, among 315,531 COVID-19 cases reported to CDC using a standardized form, 49,370 (16%) included data on whether the patient was a healthcare worker in the US; including 9,282 (19%) who were identified as healthcare personnel."
The experts say that this is likely an underestimation because information on healthcare personnel was available for only 16% of reported cases nationwide. Healthcare personnel with mild or asymptomatic infections might have been less likely to be tested, thus less likely to be reported, say experts. "Approximately 84% of patients were missing data on healthcare personnel status. Thus, the number of cases in medical workers reported here must be considered a lower bound because additional cases likely have gone unidentified or unreported," says the team.
Overall in the US, only 3% (9,282 of 315,531) of reported cases were among healthcare workers. But among states with more complete reporting of healthcare personnel status, the medical workers accounted for 11% (1,689 of 15,194) of reported cases, the CDC says though it does not mention the states.
The researchers say that the total number of COVID-19 cases among medical workers is expected to rise as more US communities experience widespread transmission. "It is critical to make every effort to ensure the health and safety of this essential national workforce of approximately 18M healthcare personnel, both at work and in the community. Surveillance is necessary for monitoring the impact of COVID-19-associated illness and better informing the implementation of infection prevention and control measures. Improving surveillance through routine reporting of occupation and industry not only benefits medical personnel but all workers during the COVID-19 pandemic," the team suggests.
Over 639,050 cases have been reported from across the US and more than 30,920 have died in the COVID-19 pandemic as of April 16, shows the Johns Hopkins tracker.
Among the cases reported on medical workers, the median age was 42 years and 1,779 (38%) reported at least one underlying health condition. "Compared with reports of COVID-19 patients in the overall populations of China and Italy, reports of healthcare personnel patients in the US were slightly younger, and a higher proportion were women. This likely reflects the age and sex distributions among the US medical workforce," says the analysis.
Preliminary estimates of the prevalence of underlying health conditions among all patients with COVID-19 reported to CDC through March 2020 suggested that 38% had at least one underlying condition, the same percentage found in this healthcare personnel patient population.
Available data on healthcare, household and community exposures on healthcare workers show that 780 (55%) reported contact with a COVID-19 patient only in healthcare settings, 384 (27%) reported contact only in a household setting, 187 (13%) reported contact only in a community setting and 72 (5%) reported contact in more than one of these settings.
"Although 4,336 (92%) healthcare personnel patients reported having at least one symptom among fever, cough or shortness of breath, the remaining 8% did not report any of these symptoms. Two thirds (3,122, 66%) reported muscle aches, and 3,048 (65%) reported headache. Loss of smell or taste was written in for 750 (16%) HCP patients as an 'other' symptom," says the report.
Similar to earlier findings, increasing age was associated with a higher prevalence of severe outcomes. Most medical workers with COVID-19 (6,760, 90%) were not hospitalized. An estimated 723 (8%-10%) were hospitalized, 184 (2%-5%) were admitted to an ICU, and 27 (0.3%–0.6%) died. However, severe outcomes, including 27 deaths, occurred across all age groups, and deaths most frequently occurred in those who were 65 or above.
"Although only 6% of healthcare personnel patients were aged ≥65 years, 10 (37%) deaths occurred among persons in this age group. These preliminary findings highlight that whether healthcare personnel acquires infection at work or in the community, it is necessary to protect the health and safety of this essential national workforce," say experts.
They further say, "Older healthcare personnel or those with underlying health conditions should consider consulting with their health care provider and employee health program to better understand and manage their risks regarding COVID-19. The increased prevalence of severe outcomes in older medical personnel should be considered when mobilizing retired medical personnel to increase surge capacity, especially in the face of limited personnel protective equipment (PPE) availability. One consideration is the preferential assignment of retired HCP to lower-risk settings (for example, telemedicine, administrative assignments, or clinics for non–COVID-19 patients)."
The study also gives an initial analysis of race and ethnicity among healthcare workers. It says that among the 3,801 (41%) healthcare workers with available data on race, 2,743 (72%) were white, 801 (21%) were black, 199 (5%) were Asian and 58 (2%) were other or multiple races. Among 3,624 (39%) with specified ethnicity, 3,252 (90%) were reported as non-Hispanic/Latino and 372 (10%) as Hispanic/Latino.
"Among cases reported in healthcare personnel, the amount of missing data varied across demographic groups, exposures, symptoms, underlying conditions, and health outcomes; cases with available information might differ systematically from those without available information. Therefore, additional data are needed to confirm findings of the impact of potentially important factors, for example, disparities in race and ethnicity or underlying health conditions among medical personnel," says the research team.