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Annals of Emergency Medicine

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Coronavirus Disease 2019 Infections Among Emergency Health Care Personnel: Impact on Delivery of United States Emergency Medical Care, 2020 - 19/06/24

Doi : 10.1016/j.annemergmed.2024.01.023 
Kurt D. Weber, MD a, ⁎ , William Mower, MD, PhD b, Anusha Krishnadasan, PhD c, Nicholas M. Mohr, MD, MS d, Juan Carlos Montoy, MD, PhD e, Robert M. Rodriguez, MD e, Philip A. Giordano, MD a, Patrick Ten Eyck, PhD d, Karisa K. Harland, PhD d, Kelli Wallace, MS d, Lawrence Clifford McDonald, MD f, Preeta K. Kutty, MD, MPH f, g, Elisabeth M. Hesse, MD, MTM&H g, David A. Talan, MD b, c
for the

Project COVERED Emergency Department Network

Monica Bahamon, MPH, Jestin N. Carlson, MD, MSc, Makini Chisolm-Straker, MD, MPH, Brian Driver, MD, Brett Faine, Pharm D, MS, Brian M. Fuller, MD, James Galbraith, MD, John P. Haran, MD, PhD, Amanda Higgins, MS, Jeremiah Hinson, MD, Stacey House, MD, PhD, Ahamed H. Idris, MD, Efrat Kean, MD, Elizabeth Krebs, MD, MSc, Michael C. Kurz, MD, MS, Lilly Lee, SM, MD, Stephen Y. Liang, MD, MPHS, Stephen C. Lim, MD, Juan Carlos Montoy, MD, PhD, Robert M. Rodriguez, MD, Gregory Moran, MD, Utsav Nandi, MD, MSCI, Kavitha Pathmarajah, MPH, James H. Paxton, MD, Yesenia Perez, BA, Lynne D. Richardson, MD, Richard Rothman, MD, PhD, Walter A. Schrading, MD, Jessica Shuck, BA, Patricia Slev, MD, Howard A. Smithline, MD, Michelle St. Romain, MD, Kimberly Souffront, PhD, FNP-BC, RN, Mark T. Steele, MD, Amy Stubbs, MD, Morgan B. Swanson, Josh Tiao, MD, Jesus R. Torres, MD, MPH, Stacy A. Trent, MD MPH, Lisandra Uribe, BS, Arvind Venkat, MD, Gregory Volturo, MD, James Willey, MD

a Department of Emergency Medicine, Orlando Health, Orlando, FL 
b Department of Emergency Medicine, Ronald Reagan UCLA Medical Center, the David Geffen School of Medicine at UCLA, Los Angeles, CA 
c Olive View-UCLA Education and Research Institute, Los Angeles, CA 
d Department of Emergency Medicine, University of Iowa, Iowa City, IA 
e Department of Emergency Medicine, University of California-San Francisco, San Francisco, CA 
f Division of Healthcare Quality Promotion Centers for Disease Control and Prevention, Atlanta, GA 
g Division of Preparedness and Emerging Infections Centers for Disease Control and Prevention, Atlanta, GA 

∗Corresponding Author.
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Abstract

Study objective

In the early months of the coronavirus disease 2019 (COVID-19) pandemic and before vaccine availability, there were concerns that infected emergency department (ED) health care personnel could present a threat to the delivery of emergency medical care. We examined how the pandemic affected staffing levels and whether COVID-19 positive staff were potentially infectious at work in a cohort of US ED health care personnel in 2020.

Methods

The COVID-19 Evaluation of Risks in Emergency Departments (Project COVERED) project was a multicenter prospective cohort study of US ED health care personnel conducted from May to December 2020. During surveillance, health care personnel completed weekly electronic surveys and underwent periodic serology and nasal reverse transcription polymerase chain reaction testing for SARS-CoV-2, and investigators captured weekly data on health care facility COVID-19 prevalence and health care personnel staffing. Surveys asked about symptoms, potential exposures, work attendance, personal protective equipment use, and behaviors.

Results

We enrolled 1,673 health care personnel who completed 29,825 person weeks of surveillance. Eighty-nine (5.3%) health care personnel documented 90 (0.3%; 95% confidence interval [CI] 0.2% to 0.4%) person weeks of missed work related to documented or concerns for COVID-19 infection. Health care personnel experienced symptoms of COVID-19 during 1,256 (4.2%) person weeks and worked at least one shift whereas symptomatic during 1,042 (83.0%) of these periods. Seventy-five (4.5%) participants tested positive for SARS-CoV-2 during the surveillance period, including 43 (57.3%) who indicated they never experienced symptoms; 74 (98.7%; 95% CI 90.7% to 99.9%) infected health care personnel worked at least one shift during the initial period of infection, and 71 (94.7%) continued working until laboratory confirmation of their infection. Physician staffing was not associated with the facility or community COVID-19 levels within any time frame studied (Kendall tau’s 0.02, 0.056, and 0.081 for no shift, one-week time shift, and 2-week time shift, respectively).

Conclusions

During the first wave of the pandemic, COVID-19 infections in ED health care personnel were infrequent, and the time lost from the workforce was minimal. Health care personnel frequently reported for work while infected with SARS-CoV-2 before laboratory confirmation. The ED staffing levels were poorly correlated with facility and community COVID-19 burden.

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Plan


 The Project COVERED Emergency Department Network includes the following: Monica Bahamon, MPH, Jestin N. Carlson MD, MSc, Makini Chisolm-Straker, MD, MPH, Brian Driver, MD, Brett Faine, Pharm D, MS, Brian M. Fuller, MD, James Galbraith, MD, John P. Haran, MD, PhD, Amanda Higgins, MS, Jeremiah Hinson, MD, Stacey House, MD, PhD, Ahamed H. Idris, MD, Efrat Kean, MD, Elizabeth Krebs, MD, MSc, Michael C. Kurz, MD, MS, Lilly Lee SM, MD, Stephen Y. Liang, MD, MPHS, Stephen C. Lim, MD, Juan Carlos Montoy, MD, PhD, Robert M. Rodriguez, MD, Gregory Moran, MD, Utsav Nandi, MD, MSCI, Kavitha Pathmarajah, MPH, James H. Paxton MD, Yesenia Perez, BA, Lynne D. Richardson, MD, Richard Rothman, MD, PhD, Walter A. Schrading MD, Jessica Shuck, BA, Patricia Slev, MD, Howard A. Smithline, MD, Michelle St. Romain, MD, Kimberly Souffront, PhD, FNP-BC, RN, Mark T. Steele, MD, Amy Stubbs, MD, Morgan B. Swanson, Josh Tiao, MD, Jesus R. Torres, MD, MPH, Stacy A. Trent MD MPH, Lisandra Uribe, BS, Arvind Venkat, MD, Gregory Volturo, MD, and James Willey, MD.
 Supervising editor: Steven M. Green, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors.
 Author contributions: KDW interpreted analysis of results, drafted portions of the manuscript, and takes responsibility for the manuscript. WRM and AK designed the study, developed data collection tools, analyzed the results, and drafted portions of the manuscript. MM and DAT conceived and designed the study, obtained research funding, interpreted analysis of data, and critically reviewed the manuscript. JCM and RMR critically reviewed the manuscript. PG interpreted analysis of results and drafted portions of the manuscript. KKH and PT designed the study, developed data collection tools, and analyzed the results. KW designed the study, developed data collection tools, and supported implementation of the project. LCM, PKK, and EH designed the study, interpreted analysis of data, and critically revised the final manuscript. KDW takes responsibility for the paper as a whole.
 Data sharing statement: The deidentified data upon which this manuscript is based has been posted on Open Science Framework (osf.io) and can be accessed from the following doi: dr2kj/.
 All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
 Funding and support: By Annals' policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Funded by a cooperative agreement from the Centers for Disease Control and Prevention (CDC) (U01CK000480) and the Institute for Clinical and Translational Science at the University of Iowa through a grant from the National Center for Advancing Translational Sciences at the National Institutes of Health (UL1TR002537).
 Please see page 41 for the Editor’s Capsule Summary of this article.
 A podcast for this article is available at www.annemergmed.com.
 Readers: click on the link to go directly to a survey in which you can provide 5ZKYX27 to Annals on this particular article.


© 2024  American College of Emergency Physicians. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 84 - N° 1

P. 40-48 - juillet 2024 Retour au numéro
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