Infection Rates of HCW
3.5-20% of HCW has been reported to be infected.(1, 37-40)
Initially, during the index outbreak in Wuhan, 13 HCWs were
infected.(41) They became the vectors of transmission to their
colleagues and families, and 42 000 HCWs had to be brought in to treat
patients as HCWs succumbed to COVID-19.(41, 42)
Wang D et al found nosocomial infection rate of 41.3%.(43) In a case
series of 138 patients, 29% (n=40) of these were HCW: 31 (77.5%)
worked on general wards, 7 (17.5%) in emergency department, and 2 (5%)
in intensive care unit.(43) They reported patient who presented with
abdominal symptom infected >10 HCW in the department.(43)
There was a report of a patient who was not identified as infected early
in the Wuhan outbreak and proceeded to infected 14 HCW during a stay for
transnasal pituitary surgery.(44) However, the patient was transferred
to 4 different wards and infected 10 neurosurgical nurses and 4 medical
staff who had no PPE, rather than the operating room team and
neurosurgeon.(29) Certain specialty like otolaryngology are
disproportionately affected in most countries affected by the COVID-19
pandemic.(44)
Wang X et al found none of the 278 staff in the quarantined area with
high exposure to the 28 patients with 2019-nCoV infection were
infected.(45) They wore N95 respirators, disinfected and performed hand
hygiene. Those in the Hepatobiliary Pancreatic Surgery, Trauma and
Microsurgery, and Urology departments wore no masks, but disinfected and
performed hand hygiene occasionally as there were not considered high
risk in the early days of the outbreak in January(45). 10 of the 213
staff were confirmed to be infected, despite their lower risk of
exposure.(45) The adjusted odds ration (OR) was 464.82.(45) The found no
infections in two other hospitals in the N95 respirators groups.(45)
The increasing evidence of aerosol transmission during routine care in
absence of AGPs, and concerns regarding efficient human transmission has
resulted in recommendation for airborne precautions with a fit-tested
N95 respirator and other PPE.(46, 47)
When the Chinese hospitals instituted full body PPE with goggles, head
coverings, N95 respirators, hazmat suits, and they were housed away from
their families, there was no new infections.(41) Since then, nosocomial
transmission has not been a major amplifier of transmission in China,
due to prevention and control.(31) It is believed that with the absence
of major nosocomial outbreaks, these are acquired in their families
where 85% of human-to-human transmission occurred.(12, 14, 15, 24, 31,
48)