Anesthesiologists' and Intensive Care Providers' Exposure to COVID-19 Infection in a New York City Academic Center

A Prospective Cohort Study Assessing Symptoms and COVID-19 Antibody Testing

Miguel Morcuende, MD; Jean Guglielminotti, MD, PhD; Ruth Landau, MD

Disclosures

Anesth Analg. 2020;131(3):669-676. 

In This Article

Abstract and Introduction

Abstract

Background: Protecting first-line health care providers against work-related coronavirus disease 2019 (COVID-19) infection at the onset of the pandemic has been a crucial challenge in the United States. Anesthesiologists in particular are considered at risk, since aerosol-generating procedures, such as intubation and extubation, have been shown to significantly increase the odds for respiratory infections during severe acute respiratory syndrome (SARS) outbreaks. This study assessed the incidence of COVID-19–like symptoms and the presence of COVID-19 antibodies after work-related COVID-19 exposures, among physicians working in a large academic hospital in New York City (NYC).

Methods: An e-mail survey was addressed to anesthesiologists and affiliated intensive care providers at Columbia University Irving Medical Center on April 15, 2020. The survey assessed 4 domains: (1) demographics and medical history, (2) community exposure to COVID-19 (eg, use of NYC subway), (3) work-related exposure to COVID-19, and (4) development of COVID-19–like symptoms after work exposure. The first 100 survey responders were invited to undergo a blood test to assess antibody status (presence of immunoglobulin M [IgM]/immunoglobulin G [IgG] specific to COVID-19). Work-related exposure was defined as any episode where the provider was not wearing adequate personal protective equipment (airborne or droplet/contact protection depending on the exposure type). Based on the clinical scenario, work exposure was categorized as high risk (eg, exposure during intubation) or low risk (eg, exposure during doffing).

Results: Two hundred and five health care providers were contacted and 105 completed the survey (51%); 91 completed the serological test. Sixty-one of the respondents (58%) reported at least 1 work-related exposure and 54% of the exposures were high risk. Among respondents reporting a work-related exposure, 16 (26.2%) reported postexposure COVID-19–like symptoms. The most frequent symptoms were myalgia (9 cases), diarrhea (8 cases), fever (7 cases), and sore throat (7 cases). COVID-19 antibodies were detected in 11 of the 91 tested respondents (12.1%), with no difference between respondents with (11.8%) or without (12.5%) a work-related exposure, including high-risk exposure. Compared with antibody-negative respondents, antibody-positive respondents were more likely to use NYC subway to commute to work and report COVID-19–like symptoms in the past 90 days.

Conclusions: In the epicenter of the United States' pandemic and within 6–8 weeks of the COVID-19 outbreak, a small proportion of anesthesiologists and affiliated intensive care providers reported COVID-19–like symptoms after a work-related exposure and even fewer had detectable COVID-19 antibodies. The presence of COVID-19 antibodies appeared to be associated with community/environmental transmission rather than secondary to work-related exposures involving high-risk procedures.

Introduction

The coronavirus disease 2019 (COVID-19) pandemic reached the United States early 2020, with New York City (NYC) reporting its first case on March 1, 2020. The magnitude of transmission in the community has made NYC a global epicenter of COVID-19, with over 151,797 identified cases 7 weeks later.[1] Among 215 pregnant women admitted between March 22 and April 4, 2020, 15.3% tested positive for COVID-19 of which only 12% were symptomatic on admission, emphasizing the epidemiologic relevance of universal testing protocols in communities with a high rate of COVID-19 infection.[2]

Minimizing the transmission of COVID-19 in the community and protecting health care providers (HCP) remains challenging, with airborne versus droplet/contact risk exposure guiding recommendations on personal protective equipment (PPE).[3] One of the challenges resides in the dynamics of transmission of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). The reproductive number (R0) represents the number of secondary infections resulting from 1 COVID-19–infected individual; the median R0 value may be as high as 5.7 (95% confidence interval [CI], 3.8–8.9).[4] Based on pooled data evaluating pathogen transmission during severe acute respiratory syndrome (SARS) outbreaks within the past 2 decades, the odds of infection for HCP during aerosol-generating procedures (AGP) such as tracheal intubation was 6.6-fold higher compared to HCP not exposed to intubation.[5] In a publication from China, 5 of 44 (11.4%) anesthesiologists performing spinal anesthesia for cesarean delivery in COVID-19 patients subsequently developed confirmed COVID-19 infection,[6] although direct causality of transmission during the neuraxial procedure remains controversial.[7]

Antibody seroconversion has been evaluated during previous viral outbreaks and is thought to be useful to assess PPE efficiency, past exposure, and the potential for establishing herd immunity.[8–13] In the absence of clinical symptoms, confirmation of COVID-19 infection relies on the timely detection of SARS-CoV-2 by reverse-transcription polymerase chain reaction (RT-PCR). Detecting SARS-CoV-2 antibodies offers the opportunity to confirm past exposure,[14] which may be of particular interest in the case of asymptomatic or subclinical transmissions.

We identified several unresolved questions on the impact of work-related exposures for physicians working in close contact with COVID-19 patients. Deployment of physicians from affiliated specialties into direct patient care roles with participation in high-risk airway management procedures for critically ill COVID-19 patients occurred at our institution.[15,16] We therefore designed this descriptive study to (1) assess self-reported work-related exposures and COVID-19–like symptoms, and (2) detect the presence of COVID-19–specific antibodies among anesthesiologists and affiliated physicians working at the time of COVID-19 outbreak.

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