Learning from Healthcare Personnel COVID-19 Hospitalizations

We’re in the middle of a third wave, cases are rising across the United States, and we’re still struggling in our response to coronavirus disease 2019 (COVID-19). While hospitalizations are increasing, they’re not at the same level of the early-pandemic waves, which is promising in how we respond to the virus. Still deadly, it gives hope that perhaps our medical management of COVID-19 is improving, but the coming weeks will be telling as hospitalizations are a lagging indicator.

Discussions surrounding hospitalizations though should also include those of healthcare personnel who have been hospitalized with COVID-19. This is something that has been a gap in our data but increasingly discussed. A new study published in the Center for Diseases Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR), reviewed healthcare personnel COVID-19 hospitalization data from 13 sites within the United States from March 1 to May 31, 2020. Of the over 6000 medical records reviewed for adults hospitalized with COVID-19, 5.9% were healthcare personnel.

The authors noted that “nursing-related occupations (36.3%) represented the largest proportion of HCP hospitalized with COVID-19. Median age of hospitalized HCP was 49 years, and 89.8% had at least one underlying medical condition, of which obesity was most commonly reported (72.5%). A substantial proportion of HCP with COVID-19 had indicators of severe disease: 27.5% were admitted to an intensive care unit (ICU), 15.8% required invasive mechanical ventilation, and 4.2% died during hospitalization.”

Looking at the breakdown by demographics, there was nearly an even distribution between the 18-49 and 50-64 age groups, and 60% of healthcare personnel were involved in direct patient care. In terms of race and ethnicity, the largest proportion of cases were in Black, non-Hispanic healthcare personnel (44%), followed by White, non-Hispanic (21%). Nearly 72% of cases were female and 90% had underlying health conditions. The most common COVID-19 symptom was shortness of breath, followed by a cough and fever/chills. Eighty-seven percent had infiltrates/consolidation on a chest X-ray. The significant cases in those Black, non-Hispanic healthcare personnel is deeply worrisome and emphasizes much of the health inequity that this pandemic is revealing.

While the researchers noted in their report, “findings from this analysis of data from a multisite surveillance network highlight the prevalence of severe COVID-19–associated illness among HCP and potential for transmission of SARS-CoV-2 among HCP, which could decrease the workforce capacity of the health care system.”

It is important that we take this information and not only continue to do focused surveillance and review of healthcare personnel COVID-19 hospitalizations, but also collect more information on use of personal protective equipment, and infection prevention awareness. One piece we cannot ignore though, is the social inequalities that create more vulnerabilities within the US but also the healthcare personnel workforce. From an infection prevention standpoint, this is where our work intersects with public health and should include focused efforts. COVID-19 infections are not solely about PPE or distancing or even disinfection and hand hygiene, but rather the fabric of what increases or decreases risk.