COVID-19 infection among emergency department healthcare providers in a large tertiary academic medical center following the peak of the pandemic

Abstract

The COVID-19 pandemic has spread through the US during the last few months exposing healthcare providers to possible infection. Here we report testing of emergency department (ED) healthcare providers (HCP) for exposure to COVID-19 through lateral flow point of care (POC) and lab-based enzyme-linked immunosorbent assay (ELISA), and RTq-PCR for evidence of acute infection. 138 ED HCP were tested between May 26th (approximately one month after the peak of COVID-19 first wave of cases) and June 14th. Enrolled ED HCP represented about 70% of the total ED HCP workforce during the study period. Subjects were tested with a POC COVID-19 antibody test, and standard ELISA performed by a university-based research lab. Subjects also provided a mid-turbinate swab and a saliva specimen for RT-PCR. All subjects provided demographic information, past medical history, information about personal protective equipment (PPE) use, COVID-19 symptoms, as well as potential COVID-19 exposures during the previous 4 weeks, both in the ED, and outside the clinical setting. None of the HCP had positive RT-PCR results; 7 HCP (5%) had positive IgG for COVID-19; there was strong agreement between the lab-based ELISA (reference test) and the POC Ab test ( P ≤ 0.0001). For the POC Ab test there were no false negatives and only one false positive among the 138 participants. There was no significant difference in demographic/ethnic variables, past medical history, hours worked in the ED, PPE use, or concerning exposures between seropositive and seronegative individuals. Moreover, there was no significant difference in reported symptoms between the two groups during the previous four weeks. The rate of COVID-19 seroconversion in our ED was 5% during the month following the pandemic's first wave. Based on questionnaire responses, differences in demographics/ethnicity, medical history, COVID-19 exposures, and PPE use were not associated with ED HCP having been infected with SARS-CoV-2. In the setting of our limited cohort of subjects the COVID-19 POC Ab test performed comparably to the ELISA lab-based standard.

SARS-CoV-2 routes of transmission and recommendations for preventing acquisition: joint British Infection Association (BIA), Healthcare Infection Society (HIS), Infection Prevention Society (IPS) and Royal College of Pathologists (RCPath) guidance

“…However, there were seven articles, 134 , 135 , 136 , 137 , 138 , 139 , 140 which were published after the search date and during the data extraction process that were felt to be of significant clinical importance. Further 55 articles 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 were identified and recommended by experts and via other searches and were included in this guidance after the first draft was written. These are included as the additional literature in section 9 .…”

“… 137 , 138 , 139 , 140 Lastly a total of 74 studies described clusters and outbreaks. 6 , 7 , 9 , 16 , 23 , 27 , 28 , 31 , 32 , 33 , 34 , 37 , 38 , 41 , 43 , 47 , 48 , 57 , 60 , 61 , 63 , 65 , 70 , 74 , 76 , 77 , 78 , 80 , 83 , 84 , 86 , 98 , 99 , 100 , 103 , 107 , 109 , 116 , 118 , 123 , 128 , 162 , 163 , 164 , 165 , 166 , 167 , 168 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 , 183 …”

“…Unprotected exposure differed between the studies but all described contact (close or casual) with an infected patient without PPE or with PPE which was not considered sufficient. Combining the results obtained from twelve studies, which reported a total number of exposed and total number of infected HCWs, 7 , 16 , 28 , 32 , 84 , 168 , 172 , 173 , 174 , 182 , 187 , 189 the overall attack rate was 1.6% (84/5298). This included a total of 18/1138 (1.6%) HCWs who were reported to have a high-risk contact (defined in studies as prolonged, at least 10min direct contact <2m with the infected patient or being present during AGPs performed on infected patient).…”

“…There was moderate evidence from 23 studies 165 , 166 , 167 , 168 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 , 183 , 187 , 188 , 189 , 193 , 195 which investigated the occurrence of SARS-CoV-2 transmission affecting HCWs in acute healthcare settings. The total number of infected HCWs reported in these studies combined with the studies reported previously 7 , 16 , 28 , 32 , 83 , 84 , 100 was 2170.…”

“…The total number of infected HCWs reported in these studies combined with the studies reported previously 7 , 16 , 28 , 32 , 83 , 84 , 100 was 2170. Seven studies 168 , 172 , 173 , 174 , 182 , 187 , 189 reported unprotected exposure of HCWs to undiagnosed (and not suspected) COVID-19 patients. Unprotected exposure differed between the studies but all described contact (close or casual) with an infected patient without PPE or with PPE which was not considered sufficient.…”