Low-Risk Exposures to COVID-19 Can Sometimes Pack Deadly Punch

For many states with a growing number of coronavirus disease 2019 (COVID-19) cases, a real issue has been the challenge of understanding exposures. With surging cases in Arizona, California, Texas, and Florida, this means that exposure risks for healthcare workers are growing in the community. For those of us in healthcare, this adds to the challenge of identifying when healthcare workers become sick. Checking against exposures we know might have happened, this can be problematic. How many of us truly know when we’ve been exposed? The knowledge we have in healthcare can be both a gift and burden. We know who has COVID-19, but once we leave the hospital, that knowledge of potential exposures likely goes right out the window.

A new study from the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) has shed light on how many people truly know where their exposure to SARS-CoV-2 occurred. Interviewing 364 participants during March 9-27 across Colorado, the researchers found some interesting sources for these COVID-19 cases.

The authors noted that “among the 265 (73%) participants without known contact with a laboratory-confirmed COVID-19 patient, 30% (79 of 265) reported contact with a person they knew who had fever or respiratory symptoms. The most commonly reported activities in the 2 weeks before becoming ill included attending gatherings of >10 persons (116; 44%), traveling domestically (76; 29%), working in a healthcare setting (75; 28%), visiting a healthcare setting not as a healthcare worker (61; 23%), and using public transportation (57; 22%).”

Moreover, nearly 30% reported contact with at least one person who had laboratory confirmed COVID-19. A majority of this group reported that their exposure was related to a household member, whereas 25% noted that exposure to a confirmed case occurred in the workplace. These two types of exposures represented the majority of those reported from people with known exposures to confirmed cases. Of those with workplace exposures, a majority stated that this contact occurred in healthcare settings (60% were in healthcare personnel), followed by public administration or military.

While these findings are important, perhaps the most concerning is that so many of newly diagnosed cases aren’t aware where their infection stemmed from – where the exposure occurred. This is an increasingly important trend as infection preventionists work to respond to surges of COVID-19 cases. While healthcare worker exposures can and do occur, so many also occur out in the community. It’s easy to assume the greatest risk is in the hospital, where cases occur. This is also where the greatest protection occurs though – the near universal masking, presence of enhanced isolation precautions, and intense focus on isolation precautions. It’s when we leave the hospital or go to get a coffee in the cafeteria, our behaviors can become lax. We opt to take breaks from masking, exhausted from it all. Communicating these risks are important though. Since it’s so easy to focus on those high-risk exposures, we may not realize how frequent those small moments occur. It’s a helpful to remind staff about the risk in the community and how they can protect themselves while still living their lives. Discussing risk spectrums and harm reduction measures can go a long way and help staff stay safe beyond the walls of the healthcare facility, which is ultimately our goal.