How is it that 25% of confirmed cases of Covid-19 are health workers?

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While staff in areas such as ICU would be familiar with high-grade personal protective equipment, staff in other areas have had to be trained up to use it.  Photograph: Getty Images

One of the most worrying aspects of the crisis is the very large number of health workers who contracted Covid-19.

Currently, about 25% of confirmed cases are health workers. When you remove health workers who contracted the disease abroad – probably on vacation or leave in their home countries – that leaves 18 percent of the cases occurring in this crucial cohort of workers.

To paraphrase Oscar Wilde, losing a healthcare worker as a result of this disease is unfortunate; losing as much is like neglect. Irish figures seem high, even compared to Italy and Spain, where figures of 15 percent of staff falling ill were cited.

Doctor, currently in segregation after being infected, believes his hospital continued elective surgery “even when we knew it was a risk”

Authorities have so far refused to say whether health workers have died; if it hasn’t happened yet, it will be soon.

There are many different reasons why the numbers are so high, some common to other countries and some specific to Irish circumstances.

It must first be said that the coronavirus has proven to be a completely sneaky adversary. The role of asymptomatic transmission was largely underestimated at first, and the virus lives longer on surfaces than previously thought. It also hits people hardest with high viral loads, which may include primary care doctors and nurses.

A study in China found “widespread” levels of viral contamination in specialist departments and intensive care units, and on equipment ranging from keyboards to hand sanitizers, posing an obvious risk of infection to staff.

This underestimation of the danger helps explain why Ireland and so many other countries have failed to stop travel abroad, or at least quarantine incoming travelers, quickly enough. And why we haven’t implemented the tests quickly enough.

Self-isolation

The coronavirus was barely in the country when it passed hospitals in Cork and Limerick, infecting dozens of staff and forcing hundreds of others to isolate themselves.

One reason was the failure to test patients who clearly, in retrospect, had suspicious symptoms but did not meet the criteria for travel from abroad then in place.

As a result, a small number of patients who underwent general surgeries, emergency services, emergency services and after-hours services wreaked havoc among staff and other patients.

Yet even after this happened and was reported, normal activities continued in some hospitals for many days, with large numbers of people going to the outpatient clinic daily.

A doctor, currently in segregation after being infected, believes that his hospital continued elective surgery “even when we knew it was a risk.”

The doctor says that even patients with a history of fever and cough still had to show up in mid-March. When one arrived in the pre-theater for an operation but was canceled, the staff could not take a test for her because she was not abroad. These patients should have been treated as “potentials from the start,” said the doctor.

Protective gear

Personal protective equipment (PPE) helps reduce the risk of infection, but it must be properly donned and removed. While staff in areas such as the ICU are familiar with high-quality PPE, staff in other areas had to be trained to use it. It is also unclear how widespread the practice of wearing PPE for more common clinical engagements was.

Not all patients are able to comply with quarantine or hygiene rules, as noted by Dr. Emily O’Conor, president of the Irish Emergency Medicine Association. Some may be agitated or confused, or have cognitive or mental health issues.

The shortage of PPE has contributed to the problem of staff infection, says Dr. O’Conor. Some health facilities have reported lacking PPE or the appropriate level of PPE, which poses a major threat to the safety of personnel.

The head of a hospital told me on Thursday that he had one day of PPE despite the presence of Covid-19 patients in intensive care.

Doctors at St James’s Hospital in Dublin felt compelled to use an online call this week regarding their “urgent need” for masks and other equipment.

Official advice

A lack of guidance in other areas of medicine and care does not help. Independent dentists are irritated by the official advice they have received and the lack of PPE available.

Nursing homes and home care are also concerned about these deficits; at least four coronavirus outbreaks have occurred in nursing homes.

Absenteeism among doctors is the lowest in the public service, and many doctors say they have traditionally suffered from colds and minor ailments. However, the current crisis requires a culture change due to the enormous impact that infected staff can have on other staff and on patients.

“We are now rigid when it comes to sending personnel home in the event of illness. This is a drastic change that has a big impact on the lists, “says Dr. O’Conor.

Social distancing can be difficult in many hospitals, she says, especially in cramped emergency departments.

It is hoped that infection rates will drop among health professionals as those who contract illness abroad return to work, as new triage systems are put in place to ensure that Covid patients -19 are separated from all the others and that patients with the virus are cohorted in the same services, departments or hospitals.