Friday, February 14, 2020

China NHC: 1,716 HCWs Infected With Novel Coronavirus - 6 Deaths


A week ago, JAMA: Clinical Characteristics of 138 Hospitalized Coronavirus Patients, we saw a disturbing study that found that hospital (nosocomial) transmission was suspected in 41% of the cases they examined, and that HCWs made up 70% of those cases.
`Hospital-associated transmission was suspected as the presumed mechanism of infection for affected health professionals (40 [29%]) and hospitalized patients (17 [12.3%]).'
Since then, it has been widely reported that 500 HCWs have been infected in China, raising concerns over China's infection control, and sparking a debate over what constitutes `appropriate PPEs' for Healthcare workers (see CIDRAP's  Unmasked: Experts explain necessary respiratory protection for COVID-19).

Overnight China's NHC held a press conference - which has been widely covered by Chinese State Media - announcing that as of midnight February 11th, 1,716 medical workers have been infected with the novel coronavirus, and that 6 of them have died. 

This (translated) report from the China News Network follows. I'll return with more after the break:
1,716 confirmed cases and 6 deaths have been reported by medical staff across the country
February 14, 2020 15:33   China News Network
Client of Sino-Singapore Jingwei on February 14th.
On the 14th, the State Council Office held a press conference on the latest progress of epidemic prevention and control, especially the measures of caring for medical staff. Zeng Yixin, deputy director of the National Health and Health Commission, disclosed at the press conference that as of 24:00 on February 11, a total of 1,716 confirmed cases of medical personnel were reported across the country, accounting for 3.8% of the nationwide confirmed cases, of which 6 people died unfortunately, accounting for the national death. 0.4% of cases.
Zeng Yixin said that with the continuous change of the epidemic prevention and control situation, the number of confirmed cases of new coronary pneumonia is also increasing, and the number of infected medical staff is also increasing.
The National Health and Health Commission attaches great importance to this and has specially issued the "Technical Guide for the Prevention and Control of New Coronavirus Infection in Medical Institutions (First Edition)" and the "On Strengthening the Management of Outpatient Outpatient Clinics in Key Areas and Key Hospitals, and in Medical Institutions. "Notice of infection prevention and control work" and other related documents. On the basis of strengthening the implementation of various sensory control measures, special requirements have been put forward for the personal protection of medical staff and their concern for the health of medical staff.

Zeng Yixin pointed out that on January 20, 2020, after China ’s new crown pneumonia was included in the legal infectious diseases, medical institutions in various places began to report directly through the network of infectious disease direct reporting systems, so the statistics of medical personnel's incidence must be screened through the infectious disease network In the report data, the "crowd classification" field shows the report card as "medical staff" for statistical analysis. Further analysis is needed on whether the source of infection among medical staff is nosocomial or community-acquired.
As of 24:00 on February 11, a total of 1,716 confirmed cases of medical personnel were reported nationwide, accounting for 3.8% of the country's confirmed cases, of which 6 people died unfortunately, accounting for 0.4% of the national deaths. Among them, Hubei Province reported 1502 cases confirmed by medical staff, accounting for 87.5% of the cases diagnosed by medical staff across the country, and Wuhan City reported 1,102 cases confirmed by medical staff, accounting for 73.4% of cases confirmed by medical staff in Hubei Province. (Zhongxin Jingwei APP)

Although we see a lot of pictures showing HCWs in China wearing full PPE garb, there are reports - primarily on social media - suggesting that PPEs for many HCWs (particularly in Hubei) are not as sophisticated, or as plentiful, as those photo opportunities might suggest. 

The ability to protect the health and safety of healthcare workers will be paramount in any pandemic, for if their numbers fall - either through attrition by infection, or an unwillingness to work without proper protection - the healthcare system collapses.
And not just for pandemic cases.  But for everyone; heart attacks, strokes, trauma victims, chemotherapy & dialysis patients, etc.
While it pales in comparison to what we are seeing in China right now - in 2015 we saw a major outbreak of MERS-CoV in South Korea - one that affected 16 hospitals, where more than 180 patients, family members and staff were infected (see June 2015 WHO MERS Situation Assessment For Korea).

In the aftermath of that 3-month ordeal, researchers looked at the long-term physical and mental effects on the HCWs involved (see Study: Burnout & PTSD Among Nurses Working During A Large MERS-CoV Outbreak - Korea, 2015).
The study, published in the International Journal of Healthcare, followed up a subset of nurses from just one of the hospitals impacted by the MERS-CoV outbreak in Korea, and found at least half of those studied suffered from PTSD as a result of their experiences during the epidemic.
In the epilogue video (below) from 2018's Johns Hopkins Clade X Tabletop Pandemic Exercise, the butcher's bill read, in part: `. . . 20 months into the pandemic . . . half of all healthcare workers had either died, become disabled, or quit . . .' 

A little over two months ago (weeks before we'd heard of China's coronavirus epidemic), in HCWs Willingness To Work During A Pandemic, we looked at many of the issues involved in keeping HCWs (including vital support staff; lab workers, clerical, housekeeping, kitchen staff, etc.) safe and working during a prolonged pandemic.
Barriers frequently cited are a lack of sufficient & appropriate PPEs, the need for a vaccine (or an effective antiviral) to protect workers and their families, worries over inadequate hospital staffing and security, and fears of being `locked down' and unable to go home to care for families for weeks. 
I wrote in that blog:
Our battle against the next severe pandemic will likely be either won or lost in hospitals all across the nation. And while there are a lot of potential points of failure (lack of beds or ventilators, lack of IVs or meds, etc.), if we don't have the nurses, techs, EMTs and their support staff willing and able to work, it's pretty much game over.
Right now, there's no vaccine for the novel coronavirus, and no proven antiviral.  The only protection we have to offer to Healthcare workers dealing with COVID-19 cases are proper PPEs.  Without those, China's experience with HCWs infections will likely be repeated around the world. 
While there has been a lot of talk about fixing the global PPE supply problem in the 10 years since the last pandemic, we've only seen limited and uncertain progress (see Hong Kong Govt Scrambles To Acquire PPEs). 
Hopefully - for everyone's sake - we won't have to wait until this current crisis is over before we find solutions to providing the most basic of protective gear to our most important, and deserving, frontline assets.