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COVID-19: Risk of severe complications among the United States health workforce
20 March 2020Tim Dall
For the 330 million people in the United States, forecasts of
the number infected range as high as 214 million under a worst-case
scenario, with much lower projections under alternate modeling
assumptions regarding prevention strategies such as social
distancing and other key factors driving outcomes.
Health workers are on front lines to diagnosis and treat people
with COVID-19 and thus are at high risk for infection.
Reports from Italy suggest that as much as 20% of their health
workforce might have been infected with COVID-19, and that younger
health workers are experiencing severe complications of COVID-19 at
higher rates than their peers in the general population.
In the U.S., reports are coming in of health workers being
diagnosed with COVID-19 and their colleagues being
quarantined.
Is it clear that older people and people with pre-existing
conditions such as pulmonary disease, cardiovascular disease,
diabetes, history of cancer, and other chronic conditions that
compromise the pulmonary or immune systems are at increased risk
for the severe complications that lead to hospitalization and
mortality. In the U.S., 74 million adults are age 60 are over, with
close to 90% of them having at least one pre-existing condition and
60% having two or more pre-existing conditions that put them at
high risk for severe COVID-19. Combining these figures with data on
younger adults having pre-existing conditions, about 158 million
(62%) adults are at elevated risk for severe complications.
When we look at the estimated 14.6 million health care workers
in the U.S., about 2 million (13%) are age 60 or older; when
combined with younger adults having pre-existing conditions, a
total of 5.5 million (43%) health workers are at risk for severe
COVID-19 complications. Among health care workers with greater
exposure to COVID-19 are those working in critical care units,
emergency departments, and hospitals in general. About 27% of
critical care physicians and pulmonologists and 24% of emergency
physicians are age 60 and older. For physicians overall, nearly
550,000 (57%) are either over age 60 or have one or more relevant
pre-existing condition. Of the 3.3 million registered nurses, 1.7
million (52%) are age 60 and older or have at least one
pre-existing condition. These statistics underscore the need to
keep health workers safe by providing them appropriate preventive
clothing and supplies, and raise questions about strategies to call
on retired doctors and nurses to increase surge capacity.
At the other end of the health spectrum are home health aides,
nurse aides and other health occupations where a large portion are
younger and healthier. While this subset of the health workforce
has less to fear about COVID-19 affecting their personal health,
these younger and healthier workers potentially could contract
COVID-19, and while asymptomatic, inadvertently infect the older,
vulnerable population they serve in the community, residential care
facilities, nursing homes, and hospitals. This concern highlights
the need for testing—even among health workers not showing
symptoms of COVID-19.
While the immediate priorities are to protect the health of
everyone (the population as well as health workers), challenges
like COVID-19 expose weaknesses and failings of the health care
system which create impetus for change. Long-term changes in care
use and delivery might include the following:
Changes in public awareness leading to improved hygiene and
social distancing could reduce future prevalence of communicable
diseases such as influenza. In Japan, it appears that the number of
influenza cases this year is lower than in a typical year likely as
a result of people observing better hygiene and social distancing.
Such changes can put less stress on the health care system.
Improvements in testing in the U.S. are building on ideas and
successes in other countries like South Korea. While testing
capabilities in the U.S. are still ramping up, improvements in
testing might include increased use of drive-through testing, free
testing, and processing test results on-site with results delivered
in hours rather than days with off-site test processing.
Improvements in testing are beneficial to the population at large,
as well as to health workers at risk for contracting COVID-19 as
well as infecting others.
Barriers to using telemedicine likely will continue to decline.
Heretofore, growth in use of telemedicine has been hampered more by
reimbursement policies than by technological limitations, despite
telemedicine being seen as a way to improve access to under-served
populations. The current crisis will heighten awareness that
telemedicine is an important tool to help protect the health of
both patients and providers.
Hopefully countries, communities and individuals will continue
to share resources and best practices such that health care systems
will emerge stronger than before.
