Health care workers at highest risk of contracting coronavirus
In India, a drill of preparedness in hospitals across states began on Sunday as Covid-19 numbers crossed 340 and the infection reached 22 states and union territories.Updated: Mar 23, 2020 06:23 IST
The health staff the world over working to stem the tide of coronavirus disease (Covid-19) is overworked and doing long shifts in sub-optimal conditions, which puts them at the highest risk of the disease that has sickened 310,000 people and killed 13,000 in a little over three months.
“Reports from medical staff describe physical and mental exhaustion, the torment of difficult triage decisions, and the pain of losing patients and colleagues, all in addition to the infection risk,” said an editorial published in The Lancet on March 21.
As numbers spike in the US, health officials in New York, California and other hard-hit regions said they will restrict testing to health care workers and the very sick to preserve resources and ensure the health system keeps functioning.
In India, a drill of preparedness in hospitals across states began on Sunday as Covid-19 numbers crossed 340 and the infection reached 22 states and union territories.
“The medical staff in high-risk departments like ICUs have more exposure to infection, both because the severely ill are more infective but also because they do the higher frequency of medical intervention and aerosol-generating procedures, like intubation and nebulising,” said Dr Randeep Guleria, professor of pulmonary medicine and the director of the All India Institute of Medical Sciences (AIIMS).
“It’s critical to protect them under all circumstances, and that is why testing all health staff with symptoms and unprotected exposure to Covid-19 cases has been prioritised,” he said.
Training of medical staff and support staff working in isolation wards and ICUs in use of personal protective equipment (PPE), which includes gowns, gloves, N95 respirators with face shields or goggles, began two weeks ago. In ICUs, respiratory infection through droplet and contact is higher than through airborne transmission.
Emerging data shows Covid-19 cases are disproportionately high among health workforce in Italy and China, which are among the worst hit. Around 3,387 health workers in China were infected till February 24 and, according to local media, 22 had died.
Dr Li Wenliang, the ophthalmologist at Wuhan Central Hospital who warned colleagues about a possible outbreak of an illness that resembled Sars on 30 December 2019, died of Covid-19 and became the face of public anger against the government’s early mismanagement of the disease.
With a 60-year-old doctor who treated India’s first coronavirus death in Hyderabad testing positive for Covd-19 last week, infection among exposed medical staff in India has already begun. “At the first sign of symptoms, people go to their local physician or diagnostic lab, from where they are referred to the government facility testing for Covid-19.
Health staff must be protected because they are out there saving lives,” said Dr Harsh Mahajan, chief radiologist, Mahajan Imaging, New Delhi.
During pandemics, the chances of infection are highest when infection peaks and medical staff work longer hours under pressure to save the lives of many severely ill and highly infectious patients.
Studies have linked higher susceptibility rate to respiratory infections like Covid-19 with the nature of work at the hospital, duty hours, and hand hygiene with higher susceptibility of respiratory infections.
“High-quality PPE is essential as contact transmission is one of the main routes of infection, both from direct contact with patients and from contaminated surfaces. Medical staff must stay safe because if healthworkers collapse, the health system will shut down, and people will die,” said Dr Naresh Trehan, chairman, Medanta-The Medicity.
Studies from China show exposure to contaminated surfaces, close contact with severely sick patients, and working outside the area of expertise raises the risk of infection, as do overwork and exhaustion, according to the Journal of Hospital Infection.
“Consideration of duty hour restrictions (less than 10 hours/day) should be considered, depending on the medical staff’s specific role,” recommended the study.
In the past, coronaviruses that cause severe acute respiratory syndrome (Sars) and middle east respiratory syndrome (Mers) have also fuelled high rates of nosocomial (hospital) infections marked by super-spreading events among the health workforce.
Sars data from seven hospitals in China shows infection rate was a high 13.53% among ICU staff.
Training staff on infection control began two weeks ago in India. check if this is what it means.
“For more than a week, infection-control training is being given to AIIIMS and AIIMS Trauma Centre residents and nurses, including on donning and doffing personal protection equipment. In anticipation of the numbers rising, training of health staff and paramedics across other departments will start this week,” said Dr Guleria.