COVID-19 Among U.S. Health Care Workers in Early 2020

A report from the first months of the pandemic, posted as an MMWR Early Release on April 14, 2020.

Summary

• Known before: little was known about COVID-19 among U.S. health care personnel (HCP).
• New here: among 9,282 HCP with COVID-19 reported to CDC, the median age was 42 and 73% were women — mirroring the health care workforce. They reported contact with COVID-19 patients at work, at home and in the community. Most were not hospitalized, but severe outcomes, including death, occurred in every age group.
• What it means: HCP must be protected both at work and in the community, and routine reporting of occupation and industry would improve surveillance for all workers.

The data

By April 9, 2020, the pandemic had caused 1,521,252 cases and 92,798 deaths worldwide, including 459,165 cases and 16,570 deaths in the United States. HCP are paid and unpaid people in health care settings who may be exposed, directly or indirectly, to patients or infectious materials.

CDC analyzed laboratory-confirmed cases reported on a standard form from all 50 states, four territories and affiliated islands and the District of Columbia, February 12–April 9. Of 315,531 cases, only 49,370 (16%) said whether the patient was a health care worker, and 9,282 (19%) of those were. In 12 states that recorded HCP status for more than 80% of cases, HCP made up 11% of all cases.

Daily COVID-19 cases by date of symptom onset among health care personnel and others. Chart: CDC.

Who they were

Where they were exposed

Of 1,423 who reported contact with a confirmed patient in the 14 days before illness:

• 780 (55%) — only in a health care setting;
• 384 (27%) — only at home;
• 187 (13%) — only in the community;
• 72 (5%) — in more than one setting.

Symptoms and outcomes

• 92% had fever, cough or shortness of breath — so 8% had none of the three. Other common symptoms: muscle aches (66%), headache (65%), sore throat (38%), diarrhea (32%); loss of smell or taste was written in by 16%.
• 6,760 (90%) were not hospitalized; 723 (8%–10%) were hospitalized, 184 (2%–5%) went to intensive care, and 27 (0.3%–0.6%) died. Though only 6% were 65 or older, that group accounted for 10 of the deaths (37%).

Ranges run from all cases in the denominator to only those with known outcomes.

What it means

• An undercount: HCP status was missing for 84% of cases, and people with mild or no symptoms were less likely to be tested.
• Younger and more female than COVID-19 patients reported in China and Italy, reflecting the U.S. health care workforce; race and ethnicity also resembled the workforce more than the general population.
• Exposure everywhere: most reported contact at work, but exposures at home and in the community — and from people without symptoms — mean tracing work exposures alone will miss many at-risk workers.
• Prevention: screen all HCP for fever and respiratory symptoms at the start of each shift; prioritize them for testing; offer flexible, non-punitive sick leave; cover the nose and mouth in the community and have HCP, patients and visitors do the same in health care settings (source control) — while HCP still wear recommended PPE (gown, N95 respirator or facemask, eye protection, gloves) for COVID-19 patients, with training in hand hygiene and PPE.
• Hospitalization (8%–10%) was lower than the 21%–31% among all U.S. cases, likely reflecting HCP's younger age and priority testing. Older HCP and those with underlying conditions should talk with their provider and employee health program; retired HCP recalled for surge capacity might be placed in lower-risk roles such as telemedicine, administration or non-COVID clinics.

Limitations: missing HCP status and uneven missing data; outcomes still being determined; no details on occupation or setting; and unknown details of workplace exposures — whether contact was with a patient, visitor or colleague, whether PPE was worn, or whether aerosol-generating procedures were involved.

The nation's roughly 18 million health care workers are an essential workforce whose health and safety must be protected.

Sources

Based on CDC COVID-19 Response Team, "Characteristics of Health Care Personnel with COVID-19 — United States, February 12–April 9, 2020," MMWR Morbidity and Mortality Weekly Report, volume 69, Centers for Disease Control and Prevention; a work of the United States government in the public domain.