As the novel coronavirus charges across the globe, no one faces more exposure than healthcare workers on the front lines.
Already, more than 3,330 healthcare workers have been infected and hundreds more remain under quarantine, decimating hospitals’ capacity to admit and treat patients.
"One hundred nurses and doctors can look after 100 ordinary beds and 16 ICU beds," one Chinese doctor estimated. "If they are sick, not only do they occupy 100 beds, but the staff taking care of 100 beds are gone. That means a hospital loses the capacity of 200 beds.”
The ripple effect is profound: Hospitals in China have been forced to reject patients not infected by COVID-19, including those seeking life-saving surgeries, chemotherapy, and kidney dialysis.
"Health workers are the glue that holds the health system and outbreak response together," said Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO).
For a host of reasons, healthcare workers are particularly vulnerable to COVID-19, and in China, at least 6 healthcare have workers have died from the disease, including doctors ages 29 and 34.
At one Wuhan hospital, two-thirds of the ICU staff were infected. At another, healthcare workers comprised 29% of patients infected in a one-month period. At yet another hospital, an estimated 130 of 500 medical staff were infected, and a quarantined nurse wrote that the floor where she is quarantined “is basically filled with colleagues.”
In Italy and the United Kingdom, too, healthcare workers have fallen ill with COVID-19. In the United States, 124 nurses at a California hospital have self-quarantined after possible exposure to a coronavirus patient, and at a nursing home, 25 staff have shown symptoms of the disease.
"If health care workers and nurses aren't protected, no one is protected,” warned Bonnie Castillo, president of National Nurses United, an American union.
Why Healthcare Workers Are So Vulnerable to COVID-19
It’s not just the sick and elderly who are highly susceptible to infection from the new coronavirus. Despite their relative youth and good health, medical workers remain at high risk.
In part, this is because medical staff in close contact with infected patients are exposed to more viral particles than the general public. Patients may cough and sneeze directly in front of them.
Staff may then infect one another or other hospital patients before they realize they are ill themselves.
At hospitals in Wuhan and Beijing, staff members who presumed themselves healthy are thought to have infected one another in tea rooms and meeting areas, according to David Hui Shu-Cheong, a respiratory expert at the Chinese University of Hong Kong.
What’s more, the long, gruelling shifts and severe stress faced by medical workers, particularly in China, are likely to compromise their immune systems, exacerbating their risk of infection.
Further elevating their risk is the shortage of protective gear, such as N-95 respiratory masks, goggles, and protective suits.
At one Wuhan hospital, medical staff fashioned protective gear out of plastic trash bags. At others, they’ve used tape to patch up torn surgical masks and reused goggles intended for one-time use.
Adding to their risk of infection is the high number of staff working outside their areas of expertise. Psychiatrists and orthopedists pitching in to treat COVID-19 patients may have insufficient training in the use of protective gear. For example, they might touch the outside of the mask when they remove it and then touch their face, inadvertently contaminating themselves.
Make-shift staff also have less experience implementing hospital protocols pertaining to infectious patients. Of course, protocols are continually changing, putting even highly trained staff at risk.
Initially, for example, nausea, vomiting, and diarrhoea were not recognized as red flags for COVID-19. As a result of this knowledge gap, one coronavirus patient who checked into a Wuhan hospital with abdominal pain was sent to the surgical ward, only to infect 10 medical staff and 4 other patients.
At a university hospital in the United States, a patient was not tested for the virus because she didn’t meet existing criteria, such as relevant travel history or exposure to another known patient. Testing guidelines have since been updated, but the patient may have already have exposed more than 100 healthcare workers.
As hospital protocols evolve, workers on the front lines will continue to bear the brunt of knowledge gaps.
Protecting Healthcare Workers from the COVID-19 Pandemic
Of course, improving hand hygiene and acquiring protective gear must be top priorities for hospitals. In addition, hospitals must isolate patients who are infected or thought to be infected.
As the U.S. Centers for Disease Control and Prevention states, “isolation of potentially infectious patients [is] essential to prevent unnecessary exposures among patients, healthcare personnel, and visitors at the facility.”
However, many hospitals in China are so overwhelmed that isolating all COVID-19 patients is not possible. Furthermore, hand-hygiene compliance, known to be “abysmally low” at hospitals worldwide, is likely to be even lower than usual given medical workers’ exhaustion and high stress in the current crisis.
Meanwhile, protective gear, much of it manufactured in China, remains in short supply around the globe.
In the United States, medical facilities were facing delays in receiving N-95 masks. And panicked consumers have been hoarding surgical masks needed by hospitals.
The U.S. Surgeon General, the country’s top healthcare official, implored Americans to stop buying masks.
“If healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!” he tweeted.
Given all these challenges, it is critical for hospitals to enhance standard protection strategies with medical-grade air dis-infection technology, such as Novaerus portable units.
Independent laboratory testing has proven Novaerus ultra-low-energy plasma technology highly effective against MS2 Bacteriophage, a commonly used surrogate for SARS-CoV, reducing the airborne load by 99.99%.
The same technology is used in hospitals and nursing homes to prevent the spread of viruses such as influenza, norovirus, and measles, as well as dangerous bacteria and fungi, such as MRSA, Clostridium difficile, and Aspergillus niger.
Novaerus units operate continually, are safe around the most vulnerable patients, and allow medical facilities to close the infection control loop: hands, surfaces, and air.
COVID-19 is thought to spread mainly from person-to-person via respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly inhaled into the lungs.
In addition, aerosol transmission has been added to the diagnosis and treatment plan issued by China’s National Health Commission as a possible route of coronavirus (COVID-19) infection.
This suggests that the virus is not only transmitted via airborne respiratory droplets but also via microscopic residue from evaporated droplets — aerosols that can remain suspended in the air for long periods and can be inhaled.
As the commission notes, the infection risk among healthcare workers is especially high with prolonged exposure, high viral concentrations, and in a closed environment. The ICU is a prime example of such an environment.
Despite its genetic similarity to the SARS virus, the novel coronavirus is proving to be considerably more contagious.
Like the common cold and seasonal influenza, the virus can trigger upper-respiratory infections, in the nose, pharynx, or larynx; at the same time, the virus can settle deep into the lower respiratory tract, causing deadly pneumonia.
“For a virus pretty closely related to SARS, it shows very effective person-to-person transmission, something nobody really expected,” noted Stephen Morse, a professor of epidemiology at Columbia University Mailman School of Public Health.
It’s already been established that a single hospitalized patient can infect 10 medical workers. The hospital setting is particularly hazardous for staff, as is the nursing-home setting.
At a long-term nursing facility in the United States, a healthcare worker in her 40s has been hospitalized for COVID-19, while two-dozen other staff members have shown symptoms of infection.
Residents are falling ill, too, and they are in the demographic — elderly and ill — most at risk from the coronavirus.
“Nursing homes will be extremely vulnerable to this epidemic, and it will be difficult to implement hygiene practices to prevent the spread,” warned Kevin Kavanagh, M.D., an American infection-control expert.
Novaerus portable air dis-infection units have been installed at nursing homes and hospitals worldwide, including in Wuhan, China, the city hit hardest by COVID-19. At no time has this technology been more critical than now: as the COVID-19 epidemic becomes a global pandemic.