COVID Exposure Risk Outside of Work Increasing for Clinicians

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One third of COVID-19 exposures among health care providers (HCPs) in Minnesota are due to family or community exposure, not patient care, according to a study conducted by the Minnesota Department of Health (MDH) and published online October 30 in Morbidity and Mortality Weekly Report. And nonwork exposures were more likely to lead to COVID-19 infections.

Between March 6 and July 11, 2020, researchers with the MDH evaluated 21,406 incidences of HCP exposure to confirmed COVID-19 cases. Of those, 5374 (25%) were classified as higher-risk exposures, meaning the provider had close contact for 15 minutes or more, or during an aerosol-generating procedure.

Two thirds (66%) of the higher-risk exposures occurred during direct patient care and 34% were related to nonpatient care interactions (eg, coworkers, social and household contacts). Overall, 6.9% (373) of the HCPs with a higher-risk exposure received a positive SARS-CoV-2 test result within 14 days of the exposure. Notably, HCPs with household or social exposure had the highest positivity rate across all exposure types at 13%.

“Since the time period covered in this report, we’ve seen a significant increase in the proportion of HCPs who have had higher-risk exposures outside of work due to household or social contacts,” said lead author Ashley Fell, MPH, from the Minnesota Department of Health.

“HCPs with household or social exposures are also more likely to test positive than HCPs with higher risk exposures within the healthcare setting, which is an important message for both HCPs and the community at large that more COVID-19 spreading in our communities poses a greater risk to our HCPs and health care system,” Fell told Medscape Medical News.

When evaluating personal protective equipment (PPE) use among exposed HCPs, researchers found that 90% of providers in acute or ambulatory care were wearing a respirator or medical-grade face mask at time of exposure, compared with just 68% of HCPs working in congregate living or long-term care facilities.

Further, investigators found that an HCP with a positive SARS-CoV-2 test working in a congregate living or long-term care facility resulted in exposure of a median of three additional HCPs (interquartile range [IQR], 1-6) compared with a median of one additional HCP exposure in acute or ambulatory care (IQR, 1-3).

The researchers also found that, compared with HCPs in acute or ambulatory settings, HCPs working in long-term care or congregate living settings were more likely to return to work following a high-risk exposure (57% vs 37%) and work while symptomatic (4.8% vs 1.3%).

When asked whether these findings apply to HCPs in other states, Andrew T. Chan, MD, from Massachusetts General Hospital, Boston, noted: “These data are not surprising and confirm what many of us have been seeing in our own areas.

“Clearly, the risk of contracting COVID-19 is particularly high for front-line health care workers in long-term care facilities and nursing homes,” Chan said.

“Furthermore, the infection control practices in these care settings are often not as rigorous, and together these factors are probably contributing to higher risks of infection,” he said.¬†

The authors acknowledge potential study limitations including misclassification of HCP risk for exposure or misclassification of community exposure as workplace exposure.

“We also recognize that HCPs, like the rest of the community, are experiencing COVID fatigue and that facilities have to constantly be innovative and vigilant to help HCPs maintain rigorous safety precautions with their patients and around their colleagues,” Fell concluded.

The authors and Chan have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. 2020;69:1605-1610. Full text

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