Healthcare Worker Infections in China: Harbinger or Outlier?

February 13th, 2020

By Gary Evans, Medical Writer

In one of the first reports of the clear risk of the emerging coronavirus to healthcare workers, an outbreak in a hospital in Wuhan, China, resulted in 40 infections in clinical staff caring for patients.

The World Health Organization recently designated a new name for the virus, changing it from 2019-nCoV to COVID-19.

No U.S. healthcare workers have been infected as of Feb. 13, 2020. There were 15 cases of the new coronavirus in the United States, with 13 of them infected travelers returning from Wuhan. Two cases of transmission to close contacts have occurred. China had 59,804 cases, including 8,030 cases in serious condition and 1,367 deaths. There are at least 37 cases of COVID-19 in some 28 other countries.

In the recently published report of the outbreak at Zhongnan Hospital of Wuhan University, about one-fourth of the healthcare workers contracted the coronavirus from a single patient. That transmission is reminiscent of the “super spreader” phenomenon seen with severe acute respiratory syndrome (SARS) in 2003 and Middle East respiratory syndrome (MERS).

“One patient in the current study presented with abdominal symptoms and was admitted to the surgical department,” the researchers report. “More than 10 healthcare workers in this department were presumed to have been infected by this patient.”

Workers on general wards, the emergency department, and the intensive care unit also were infected when caring for patients between Jan. 1 and Jan. 28, 2020. The clinical outcomes for the healthcare workers were not reported in the paper.

The total number of healthcare workers infected in China is not clear, but a coronavirus expert says COVID-19 should not be a threat to clinicians on the level of SARS.

Hospital Infection Control & Prevention interviewed Allison McGeer, MD, director of infection control at Mount Sinai Hospital in Toronto, Canada. McGeer dealt first hand with SARS in 2003, and has consulted on hospital outbreaks of MERS, which is an ongoing threat in Saudi Arabia.

HIC: What is your impression of the report from China of 40 healthcare workers being infected?

McGeer: It’s hard to tell a lot from one event. I think this hospital is one of the hospitals that has had more transmission to healthcare workers than others. The good news, relatively speaking, is that it remains clear that the proportion of cases in this outbreak that are healthcare workers is much smaller than SARS. It is not the same kind of hospital issue that SARS was. This hospital appears to be the exception. The key issue is that healthcare workers are now protected because there are protocols in place. The risk of outbreaks of any infectious disease is always higher from unsuspected cases. At the beginning of an outbreak, they are all unsuspected.

HIC: It appears at least 10 patients were infected by an unsuspected case.

McGeer: The challenge of this virus – if there is community spread – is that it is going to be much more difficult to separate [COVID-19] from everything else that causes fever and respiratory symptoms. That could present a very significant challenge to protecting healthcare workers. Say a case comes to a hospital – for a reason that is completely unrelated to novel coronavirus – but happens to be incubating it and develops illness in the hospital. Your go-to diagnosis in a post-op patient who develops fever is not novel coronavirus.

For more on this story, see the March issue of Hospital Infection Control & Prevention.