COVID-19 and the Health of our Health Care Providers
Author: Brian May
Romelia is shown here being comforted by a nurse Michele. Romelia is sitting at her dying husband's bedside.
Source: Jae C. Hong, 2020, Associated Press via Atlantic
As of December 2nd, 2020, at least 1,425 healthcare workers in the U.S. have died in the fight against COVID-19
Introduction
All workers have a right to a safe and healthy work environment. For the individuals that work in health care settings, occupational health is kept to a high standard. Our health care system must follow strict regulations to ensure the health and safety of both themselves and the communities they serve. Reducing the spread of infectious disease is a vital component of occupational health, especially within health care environments. Given that COVID-19 has disrupted almost every aspect of our daily lives, the occupational experience of our health care providers is no exception.
Since the beginning of the COVID-19 pandemic, health care providers are experiencing unforeseen rates of both illness and death.
Confirmed Deaths - State
As of December 2nd, 2020, at least 1,425 healthcare workers in the U.S. have died in the fight against COVID-19.
The figures to the left and directly below are from The Guardian's profiling of 278 individuals that have lost their lives to COVID-19.
As of December 2nd, 2020:
172 of 278, or 62%, were people of color
32% reported that they were concerned about insufficient personal protective equipment (PPE)
35% were nurses
Almost 30% were from outside the United States
Confirmed Deaths - Occupation
Confirmed Deaths - Race & Ethnicity
Health care workers are at a higher risk of contracting COVID-19. Barrett et al. (2020) observed at least a 7% greater risk for health care workers when compared to non-health care workers.
When comparing health care providers working in COVID-19 wards to providers in other settings, it has been found that the former experience higher rates of both depressive symptoms and post-traumatic stress symptoms (Tella et al., 2020).
In an open-ended survey of 455 nurses on experienced stress, 6 major themes emerged. New COVID-19-related stressors included:
The workplace - 51%
Illness and death of others - 39%
Exposure to or infection with COVID-19 - 30%
Associated unknowns of the pandemic - 23%
Lack of enough or appropriate PPE - 22%
The politicization and perceived administrative failures regarding COVID-19 - 10%
Transmission
There is also evidence of the virus spreading to surfaces via air transmission. Surfaces out of reach by both patients and health workers in a COVID-19 ward unit tested positive for the virus after 72 hours (Orenes-Piñero et al., 2021).
Even though there is current debate about the specific manner in which COVID-19 is transmitted through the air, there is evidence of COVID-19 presenting on surfaces and in the air.
Surface and air samples tested positive for SARS-CoV-2 in both fully contaminated and semi-contaminated COVID-19 wards. The contamination rates of various measured surfaces are:
Hand sanitizer dispensers - 100%
Touch screens on medical equipment - 50%
Medical equipment itself - 50%
Medical equipment shelves - 40%
Bed rails - 33.3%
Door handles - 25%
It has been found recently that COVID-19 transmission to health care workers is associated with medical procedures that are considered lower-risk and exposures in the community (Lentz et al., 2020).
Current and Future Solutions
PPE
There is evident need for proper PPE to reduce the transmission of COVID-19 from infected persons to their providers.
However, in a survey of 2,711 health care workers, it was found that 52% of the sample was missing at least one piece of the standard PPE set and that 30% reused a single-use item (Tabah et al., 2020).
During the treatment of patients with COVID-19, it is important that health care providers wear a full PPE set during both aerosol-generating and "lower risk" non-aerosol-generating procedures.
A proper PPE set includes:
At least a N95/FFP3 mask with or without a surgical mask
Eye protection (goggles, face shield, etc.)
Gloves
Gown
The Responsibilities of our Health Care Leaders
Resource limitations need to be addressed on multiple levels:
Planning for the challenges associated with a crisis and reaching capacity
Acquiring enough PPE and establishing other protective measures
Addressing any new barriers to delivery of care as they arise
For an example of the challenges at one institution, in an article on November 24th, 2020, Ian Kullgren (2020) stated that over 100 physician assistants, doctors, and nurses walked out of their jobs in Washington state that week. They accuse their employer of declining to lessen 12-hour shift times or providing PPE.
In addition to PPE, there are additional steps that may help protect our health care workers
Health care environments adhering to strict guidelines for the continuous sanitation of all surfaces and attaining excellent levels of air filtration and ventilation.
Staying home as much as possible and exercising social distancing to help reduce the community spread of COVID-19.
Providing mental health support services, at little or no cost, to address the new emotional burden and stressors that COVID-19 has placed upon our health care providers.
It is time for our leaders and society to step up to the plate and protect the individuals that dedicate their lives to saving ours.
Video Summary
4:51m video; Script
Disclaimer: The Guardian regularly updates its data on this topic. Please follow the link in the References section for the latest.
References
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doi:10.3390/ijerph17218126
Barrett, E. S., Horton, D. B., Roy, J., Gennaro, M. L., Brooks, A., Tischfield, J., . . . Panettieri, R. A. (2020). Prevalence of SARS-CoV-2
infection in previously undiagnosed health care workers in New Jersey, at the onset of the U.S. COVID-19 pandemic. BMC Infectious
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Kullgren, I. (2020, November 24). Health-Care Workers Turning to Strikes as Covid-19 Surges Again. Bloomberg Law: Daily Labor Report.
Retrieved from https://news.bloomberglaw.com/daily-labor-report/health-care-workers-turning-to-strikes-as-covid-19-surges-again
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MPH 2022 Health Promotion, OHSU-PSU School of Public Health
Page last updated on Dec. 6th, 2020