Coronavirus Disease 2019 Infections Among Emergency Health Care Personnel: Impact on Delivery of United States Emergency Medical Care, 2020

Abstract

ObjectiveIn the early months of the COVID-19 pandemic and prior to vaccine availability, there were concerns that infected emergency department (ED) healthcare personnel (HCP) 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 U.S. ED HCP in 2020. MethodsThe COVID-19 Evaluation of Risks in Emergency Departments (Project COVERED) project was a multicenter prospective cohort study of U.S. ED HCP conducted from May to December 2020. During surveillance, HCP completed weekly electronic surveys and underwent periodic serology and nasal RT-PCR testing for SARS-CoV-2, and investigators captured weekly data on healthcare facility COVID prevalence and HCP staffing. Surveys asked about symptoms, potential exposures, work attendance, personal protective equipment (PPE) use, and behaviors. ResultsWe enrolled 1,673 HCP who completed 29,825 person-weeks of surveillance. Eighty-nine (5.3%) HCP documented 90 (0.3%; 95% CI 0.2-0.4%) person-weeks of missed work related to documented or concerns for COVID-19 infection. HCP experienced symptoms of COVID-19 during 1,256 (4.2%) person-weeks and worked at least one shift while 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%-99.9%) infected HCP 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 two-week time shift, respectively). ConclusionDuring the first wave of the pandemic, COVID-19 infections in ED HCP were infrequent, and the time lost from the workforce was minimal. HCP frequently reported for work while infected with SARS-CoV-2 prior to lab confirmation. ED staffing levels were poorly correlated with facility and community COVID-19 burden.