When I was a young doctor in the 1980s, I cared for several health-care workers who had acquired HIV infection after an occupational exposure — a needlestick, a cut, a laboratory accident. No effective treatment was available then, but I would see them every month and we would talk about the latest “cures” hitting the news. Some we tried and when zidovudine, the first approved medication, became widely available, we tried that too. But each person died, sooner rather than later.
Their tragic situation has recurred in recent years as well.
For example, 21% of all SARS cases in the 2002-3 outbreak, including many deaths, occurred in health-care workers. During the 2014-5 Ebola outbreak, more than 500 health-care workers died after acquiring the infection occupationally. This translated to a loss of 8% of the entire doctor, nurse and midwife workforce of Liberia, one of the countries hardest hit.
A US Centers for Disease Control report has just added Covid-19 to this grim list in an article entitled, “Characteristics of Health Care Personnel with COVID-19 — United States, February 12-April 9, 2020.”
Though much data is missing or incomplete, the basic numbers are as follows: 9,282 United States health-care workers have been diagnosed with the novel virus through April 2. Of the subset with usable information, 723 were hospitalized, including 184 in the ICU. Twenty-seven have died from Covid-19 infection.
Because this report likely will receive a great deal of scrutiny, the CDC laid out the many limitations of the data. Most limitations would be expected to result in a substantial underreporting of occupationally acquired cases (discussed below).
However, one glaring problem surely has inflated the first-glance appearance of occupational risk. Specifically, the data was extracted from standardized forms that included a question about occupation. No systematic attempt was made, however, to determine whether infection in a health-care worker was from a job-related versus a community or household exposure in a person who coincidentally was a health-care worker.
To examine the possible impact of this uncertainty, the CDC analyzed 1,423 of the infected workers (16% of the total) for whom — for whatever reason — assignment was made; in this small group, the likely exposure was occupational in 55% and household or community 40%.
As mentioned, the other large study limitations likely served to underestimate the number of occupational cases. For starters, only 16% of the 315,531 Covid-19 cases reported to CDC via the standardized form had any information at all (yes or no) regarding health-care worker status.
This gaping hole is mitigated somewhat by information from 12 states with low case numbers but very complete data: in these, health-care workers accounted for 1,689 (11%) of 15,194 reported cases; if these proportions were applicable broadly, and the 55% / 40% occupational-versus-community split estimated above were applied, this would mean that more than 5% of all Covid-19 cases reported nationwide have occurred in health-care workers who acquired the infection after occupational exposure.
Furthermore, clinical outcome was available for only 7,694 (83%) of the original 9,282 cases reported, meaning that the 27 fatalities likely is an undercount.
These limitations could open the CDC up to criticism for reporting potentially inflammatory information about health-care worker safety during the Covid-19 pandemic. Yet the CDC also understands the importance of this information, despite its flaws — all of which are explicitly laid out — in informing the debate regarding how the country can safely manage the pandemic in the months ahead.
No matter the actual number of health-care workers developing severe illness or dying from occupational exposure, it is far too many.
The tired, frightened faces of nurses, doctors, respiratory therapists, environmental services personnel and others, some wearing plastic trash bags for protection, others with homemade masks, are well-known to anyone who has watched the pandemic unfold.
By characterizing the experience in the impersonal aggregate, the CDC has shown the brutal consequences of the nation’s inept pandemic preparation, the impact of the shortages in masks and other personal protective equipment, and the continued lack of widely available, accurate and speedy diagnostic testing.
This CDC report should shame policymakers and add urgency to the pace of our response. It is important to realize that the shortages and poor planning that have led to these cases are not a thing of the past; rather, the dithering and profiteering and blame-shifting continue to expose all critical infrastructure workers to avoidable risks right now, today.
This can never be acceptable: a society that does not protect the lives of its citizens has failed at its most fundamental responsibility.