Update

Characteristics of Health Care Personnel With COVID-19 — United States, February 12–July 16, 2020

Michelle M. Hughes, PhD; Matthew R. Groenewold, PhD; Sarah E. Lessem, PhD; Kerui Xu, PhD; Emily N. Ussery, PhD; Ryan E. Wiegand, MS; Xiaoting Qin, PhD; Tuyen Do; Deepam Thomas, MPH; Stella Tsai, PhD; Alexander Davidson, MPH; Julia Latash, MPH; Seth Eckel, MPH; Jim Collins, MPH; Mojisola Ojo, MPH; Lisa McHugh, PhD; Wenhui Li, PhD; Judy Chen3; Jonathan Chan; Jonathan M. Wortham, MD; Sarah Reagan-Steiner, MD; James T. Lee, MD; Sujan C. Reddy, MD; David T. Kuhar, MD; Sherry L. Burrer, DVM; Matthew J. Stuckey, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(38):1364-1368. 

In This Article

Abstract and Introduction

Introduction

As of September 21, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in 6,786,352 cases and 199,024 deaths in the United States.* Health care personnel (HCP) are essential workers at risk for exposure to patients or infectious materials.[1] The impact of COVID-19 on U.S. HCP was first described using national case surveillance data in April 2020.[2] Since then, the number of reported HCP with COVID-19 has increased tenfold. This update describes demographic characteristics, underlying medical conditions, hospitalizations, and intensive care unit (ICU) admissions, stratified by vital status, among 100,570 HCP with COVID-19 reported to CDC during February 12–July 16, 2020. HCP occupation type and job setting are newly reported. HCP status was available for 571,708 (22%) of 2,633,585 cases reported to CDC. Most HCP with COVID-19 were female (79%), aged 16–44 years (57%), not hospitalized (92%), and lacked all 10 underlying medical conditions specified on the case report form (56%). Of HCP with COVID-19, 641 died. Compared with nonfatal COVID-19 HCP cases, a higher percentage of fatal cases occurred in males (38% versus 22%), persons aged ≥65 years (44% versus 4%), non-Hispanic Asians (Asians) (20% versus 9%), non-Hispanic Blacks (Blacks) (32% versus 25%), and persons with any of the 10 underlying medical conditions specified on the case report form (92% versus 41%). From a subset of jurisdictions reporting occupation type or job setting for HCP with COVID-19, nurses were the most frequently identified single occupation type (30%), and nursing and residential care facilities were the most common job setting (67%). Ensuring access to personal protective equipment (PPE) and training, and practices such as universal use of face masks at work, wearing masks in the community, and observing social distancing remain critical strategies to protect HCP and those they serve.

Data from laboratory-confirmed and probable COVID-19 cases, voluntarily reported to CDC from state, local, and territorial health departments during February 12–July 16, 2020, were analyzed. COVID-19 cases are reported using a standardized case report form, which collects information on demographic characteristics, whether the case occurred in a U.S. health care worker (HCP status), symptom onset date, underlying medical conditions, hospitalization, ICU admission, and death. HCP occupation type and job setting were added to the case report form in May, enabling prospective and retrospective entry of these elements. Case surveillance data were enriched with additional cases from a COVID-19 mortality-focused supplementary surveillance effort in three jurisdictions§.[3] Descriptive analyses were used to examine characteristics by vital status. HCP occupation type and job setting were reported by a subset of jurisdictions with at least five HCP cases for each variable. Analyses were conducted using Stata (version 15.1; StataCorp) and SAS (version 9.4; SAS Institute).

Among 2,633,585 U.S. COVID-19 cases reported individually to CDC during February 12–July 16, HCP status was available for 571,708 (22%) persons, among whom 100,481 (18%) were identified as HCP. Data completeness for HCP status varied by jurisdiction; among jurisdictions that included HCP status on ≥70% of cases and reported at least one HCP case (11), HCP accounted for 14% (14,938 of 109,293) of cases with HCP status available and 11% (14,938 of 132,340) of all reported cases. Case report form data were enriched with 89 additional HCP cases using supplementary mortality data; thus, the final HCP case total for analysis was 100,570 (Table 1).

Among HCP with COVID-19 overall, the median age was 41 years (interquartile range = 30–53 years); 79% of cases were in females. Among 69,678 (69%) HCP cases with data on race and ethnicity, 47% were in non-Hispanic Whites (Whites), 26% were in Blacks, 12% were in Hispanics or Latinos of any race (Hispanics), and 9% were in Asians. Of persons with known hospitalization or ICU admission status, 8% (6,832 of 83,202) were hospitalized and 5% (1,684 of 33,694) were treated in an ICU. Vital status was known for 67% (67,746) of HCP with COVID-19; among those, 641 (1%) died. Deaths among HCP with COVID-19 were reported in 22 jurisdictions. Compared with those who survived, decedents tended to be older (median age = 62 versus 40 years), male (38% versus 22%), Asian (20% versus 9%), or Black (32% versus 25%).

Among HCP cases with data on one or more of 10 underlying medical conditions specified on the case report form, 17,838 (44%) persons had at least one condition. The most common were cardiovascular disease (18%), chronic lung disease (16%), and diabetes mellitus (13%). The vast majority (92%) of fatal HCP cases were among HCP with an underlying medical condition. More than one half had cardiovascular disease (61%) or diabetes mellitus (52%), conditions known to increase the risk for severe COVID-19; 32% were reported to have both conditions (Table 1).

Six jurisdictions reported the occupation type** or job setting†† for at least five HCP with COVID-19 (Table 2). Among HCP with COVID-19 in these jurisdictions, occupation type was available for 59% (5,913 of 9,984) and job setting for 41% (6,955 of 17,052). Health care support workers accounted for the largest overall group of occupation types (32%), and nurses constituted the largest single occupation type (30%) (Table 2). Within this subset of HCP cases, two thirds (67%) were in persons reported to work in nursing and residential care facilities.

*https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html; https://www.cdc.gov/coronavirus/2019-ncov/covid-data/faq-surveillance.html; https://www.cdc.gov/coronavirus/2019-ncov/php/reporting-pui.html.
Underlying medical condition status was classified as "known" if any of these 10 conditions, specified on the standard case report form, were reported as present or absent: diabetes mellitus; cardiovascular disease (includes hypertension); severe obesity (body mass index ≥40 kg/m2); chronic renal disease; chronic liver disease; chronic lung disease; immunosuppressive condition; autoimmune condition; neurologic condition (including neurodevelopmental, intellectual, physical, visual, or health impairment); and psychologic/psychiatric condition.
§The supplementary mortality surveillance effort, which included persons with laboratory-confirmed COVID-19 who died during February 12–April 24, 2020, identified 89 additional HCP and two additional deaths among known HCP from three jurisdictions: Michigan, New Jersey, and New York City.
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html.
**Seventeen HCP occupation type categories: health care support worker (includes nursing assistant, medical assistant, and other care provider or aide); nurse; administrative staff member; environmental services worker; physician; medical technician; behavioral health worker; first responder; dietary services worker; dental worker; laboratorian; occupational, physical, or speech therapist; pharmacy worker; respiratory therapist; phlebotomist; physician assistant; and other; data were reported in five jurisdictions (Alaska, Kansas, Minnesota, North Carolina, and Utah).
††Three HCP job setting categories: nursing and residential care facility (includes long-term care facility [nursing home/assisted living facility], rehabilitation facility, and group home); hospital; ambulatory health care service (includes outpatient care center, home health care service, and dental facility); data were reported in five jurisdictions (Alaska, Kansas, Michigan, Minnesota, and Utah).

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