Characteristics of Health Care Personnel With COVID-19

United States, February 12-April 9, 2020

CDC COVID-19 Response Team

Disclosures

Morbidity and Mortality Weekly Report. 2020;59(15):477-481. 

In This Article

Abstract and Introduction

Introduction

As of April 9, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in 1,521,252 cases and 92,798 deaths worldwide, including 459,165 cases and 16,570 deaths in the United States.[1,2] Health care personnel (HCP) are essential workers defined as paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials.[3] During February 12–April 9, among 315,531 COVID-19 cases reported to CDC using a standardized form, 49,370 (16%) included data on whether the patient was a health care worker in the United States; including 9,282 (19%) who were identified as HCP. Among HCP patients with data available, the median age was 42 years (interquartile range [IQR] = 32–54 years), 6,603 (73%) were female, and 1,779 (38%) reported at least one underlying health condition. Among HCP patients with data on health care, household, and community exposures, 780 (55%) reported contact with a COVID-19 patient only in health care settings. Although 4,336 (92%) HCP patients reported having at least one symptom among fever, cough, or shortness of breath, the remaining 8% did not report any of these symptoms. Most HCP with COVID-19 (6,760, 90%) were not hospitalized; however, severe outcomes, including 27 deaths, occurred across all age groups; deaths most frequently occurred in HCP aged ≥65 years. These preliminary findings highlight that whether HCP acquire infection at work or in the community, it is necessary to protect the health and safety of this essential national workforce.

Data from laboratory-confirmed COVID-19 cases voluntarily reported to CDC from 50 states, four U.S. territories and affiliated islands, and the District of Columbia, during February 12–April 9 were analyzed. Cases among persons repatriated to the United States from Wuhan, China, and the Diamond Princess cruise ship during January and February were excluded. Public health departments report COVID-19 cases to CDC using a standardized case report form* that collects information on patient demographics, whether the patient is a U.S. health care worker, symptom onset date, specimen collection dates, history of exposures in the 14 days preceding illness onset, COVID-19 symptomology, preexisting medical conditions, and patient outcomes, including hospitalization, intensive care unit (ICU) admission, and death. HCP patient health outcomes, overall and stratified by age, were classified as hospitalized, hospitalized with ICU admission, and deaths. The lower bound of these percentages was estimated by including all cases within each age group in the denominators. Upper bounds were estimated by including only those cases with known information on each outcome as denominators. Data reported to CDC are preliminary and can be updated by health departments over time. The upper quartile of the lag between onset date and reporting to CDC was 10 days. Because submitted forms might have missing or unknown information at the time of report, all analyses are descriptive, and no statistical comparisons were performed. Stata (version 15.1; StataCorp) and SAS (version 9.4; SAS Institute) were used to conduct all analyses.

Among 315,531 U.S. COVID-19 cases reported to CDC during February 12–April 9, data on HCP occupational status were available for 49,370 (16%), among whom 9,282 (19%) were identified as HCP (Figure). Data completeness for HCP status varied by reporting jurisdiction; among 12 states that included HCP status on >80% of all reported cases and reported at least one HCP patient, HCP accounted for 11% (1,689 of 15,194) of all reported cases.

Figure.

Daily number of COVID-19 cases, by date of symptom onset, among health care personnel and non-health care personnel (N = 43,986)*,† — United States, February 12–April 9, 2020
Abbreviation: COVID-19 = coronavirus disease 2019.
*Onset date was calculated for 5,892 (13%) cases where onset date was missing. This was done by subtracting 4 days (median interval from symptom onset to specimen collection date) from the date of earliest specimen collection. Cases with unknown onset and specimen collection dates were excluded.
Ten-day window is used to reflect the upper quartile in lag between the date of symptom onset and date reported to CDC.

Among the 8,945 (96%) HCP patients reporting age, the median was 42 years (IQR = 32–54 years); 6,603 (73%) were female (Table 1). Among the 3,801 (41%) HCP patients with available data on race, a total of 2,743 (72%) were white, 801 (21%) were black, 199 (5%) were Asian, and 58 (2%) were other or multiple races. Among 3,624 (39%) with ethnicity specified, 3,252 (90%) were reported as non-Hispanic/Latino and 372 (10%) as Hispanic/Latino. At least one underlying health condition was reported by 1,779 (38%) HCP patients with available information.

Among 1,423 HCP patients who reported contact with a laboratory-confirmed COVID-19 patient in either health care, household, or community settings, 780 (55%) reported having such contact only in a health care setting within the 14 days before their illness onset; 384 (27%) reported contact only in a household setting; 187 (13%) reported contact only in a community setting; 72 (5%) reported contact in more than one of these settings. Among HCP patients with data available on a core set of signs and symptoms,§ a total of 4,336 (92%) reported having at least one of fever, cough, shortness of breath. Two thirds (3,122, 66%) reported muscle aches, and 3,048 (65%) reported headache. Loss of smell or taste was written in for 750 (16%) HCP patients as an "other" symptom.

Among HCP patients with data available on age and health outcomes, 6,760 (90%) were not hospitalized, 723 (8%–10%) were hospitalized, 184 (2%–5%) were admitted to an ICU, and 27 (0.3%–0.6%) died (Table 2). Although only 6% of HCP patients were aged ≥65 years, 10 (37%) deaths occurred among persons in this age group.

*https://www.cdc.gov/coronavirus/2019-ncov/php/reporting-pui.html.
Preexisting medical conditions and other risk factors (yes, no, or unknown) included the following: chronic lung disease (inclusive of asthma, chronic obstructive pulmonary disease, and emphysema); diabetes mellitus; cardiovascular disease; chronic renal disease; chronic liver disease; immunocompromised condition; neurologic disorder, neurodevelopmental or intellectual disability; pregnancy; current smoker; former smoker; or other chronic disease. Data available for 4,733 (51%) HCP.
§Cases were included in the denominator if the patient had a known symptom status for fever, cough, shortness of breath, nausea or vomiting, and diarrhea. Data available for 4,707 (51%) HCP.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....