Collateral damage of an HCP getting infected is huge: ExpertMay 9, 2020
For healthcare professionals (HCP), it is a matter of “when”, and not “if“, they will get infected with COVID-19, says a Clinical Professor of Microbiology at a leading super-specialty quaternary care medical centre in India, preferring to remain anonymous.
According to him, apart from the non-availability of PPE, the following factors play an important role in HCPs getting infected.
Environment & workload: Due to their working environment, HCPs are more prone to acquire the infection. Even with appropriate PPE, chances of infection are high as the whole hospital environment is laden with the virus. With the large number of interventions that an HCP needs to perform to manage the overwhelming number of patients, breaches in infection prevention protocols are bound to occur, leading to infection.
Every day, more and more evidence is emerging about the ability of SARS-CoV-2 virus to travel through the air (airborne transmission). At the last count, according to a recent CDC publication, the virus travelled 13 feet through the air. Airborne transmission is very likely in a hospital environment due to various interventions on the patient. Since N95 respirators are recommended only for aerosol-generating procedures, as of now, HCPs in the ward may be at risk of acquiring the infection while performing basic interventions.
The virus can survive on metal and plastic for up to 3 days. A recent study from Emerging Infectious Disease reported viral RNA on doorknobs, keyboards, computer mice, trash cans, sickbed handrails and the surface of exhaust fans in ICUs and wards. The same study also found that half of the ICU staff’s shoes were also positive for viral RNA, suggesting that the HCP is at risk for acquiring, as well as transmitting, the infection.
Transmission by stealth
Recent reports of transmissions by asymptomatic (no symptoms) and pre-symptomatic (1 to 3 days before symptoms) patients and the long incubation period (sometimes >25 days) add a new layer of complexity and challenge in tracing contacts, as they will never be tested under current guidelines. Notably, 6.4% of transmissions in Singapore and 12.6% in China were from pre-symptomatic patients. Therefore, it is not enough to isolate symptomatic patients to prevent transmission. These numbers underscore the importance of social distancing to contain COVID-19 pandemic. Until widespread testing of all patients becomes the norm, HCP will continue to be at risk of contracting the infection.
Ignorance & compliance
Ignorance on the part of HCPs about the proper use of PPE also contributes to getting them infected. For example, N95 respirators are effective only if the face is devoid of any hair. Therefore, a bearded HCP cannot take care of COVID-19 patients without running the risk of him getting infected. However, it is not difficult to find bearded physicians in online debates discussing the management and prevention of COVID-19 infection. Last, but not the least, historically, hand hygiene compliance among doctors is abysmally low (in spite of repeated training and warnings) and in the era of COVID-19, any oversight in this area is an open invitation for infection.
Seniority not a boon
A steep age gradient has been noted in deaths due to COVID-19. Case fatality is four times and 12 times higher for 60 years and those above 70 years respectively. Since the battle against COVID-19 is a long-drawn one, elderly HCPs should be ‘benched’ in phase 2 and early phase 3, and sent home for reverse isolation (isolating the uninfected, high-risk group).
The collateral damage of an HCP getting infected is huge, as any such incident will also mean that another 20-30 HCP who are close contacts of the infected person would be quarantined for 14-28 days. For small hospitals, it would mean a total shut down, while in case of large hospitals, the whole unit may have to shut down, further compromising the already fragile healthcare system.