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Covid-19: Delving into healthcare worker infection rates

The high percentage of Covid-19 infection among healthcare staff in Ireland is an issue of increasing concern. More than one-fifth of Covid-19 cases among healthcare workers are linked to outbreaks in nursing homes, shows recent data from the Health Protection Surveillance Centre (HPSC).

The Report of the profile of Covid-19 cases in healthcare workers in Ireland, which included data up to 13 June, states that 1,755, or 21.5 per cent, of the 8,180 cases among healthcare workers were linked to nursing home outbreaks.

Almost 9 per cent, or 730 cases, were linked to hospitals, while 4.3 per cent were connected with residential institutions. Around 60 per cent of cases in healthcare workers were not linked to an outbreak, according to the report published on 22 June.

The number of female healthcare workers to contract the virus was “disproportionately high”, at 74 per cent. This compared to 49.4 per cent of cases among females who were not healthcare workers.

The report said the high rate among females was most likely due to some specialties such as nursing being “female-dominated”.

Almost 32 per cent of all Covid-19 cases nationally were in healthcare workers, with seven deaths (six confirmed and one probable case) recorded to date.

Just 16 of the new cases were confirmed among healthcare workers between 7-13 June, the lowest weekly figure since 14 March.

Of the 8,180 cases among healthcare workers, almost 35 per cent had an underlying health condition. Cases among healthcare workers peaked around mid-April and have been declining since that time.

Some 32 per cent of cases were among nurses, followed by 26 per cent in healthcare assistants. Doctors made up 6 per cent (500) of cases among healthcare workers.

Information on healthcare workers in each of the nine HSE community healthcare organisations (CHOs) reveals that staff in CHO 7 were worst affected, with 21 per cent of cases in this area alone.

CHO 7 covers Kildare, West Wicklow, Dublin West, Dublin South City and Dublin South West.

Healthcare workers in HSE East made up the bulk of Covid-19 cases. Around 58 per cent of all cases nationally among healthcare workers occurred in the region.

The age range of healthcare workers with Covid-19 was 31-to-50 years. The age range in ICU was 44-to-60 years. Of those who have died from Covid-19, the age range was 30-to-68 years. Some 309 healthcare workers had been hospitalised with the virus and 44 were admitted to ICU.

Testing

As exclusively reported online by the Medical Independent (MI), a proposed Covid-19 testing strategy specifically for healthcare professionals is being developed in consultation with the national public health emergency team (NPHET).

The strategy was presented to the NPHET by Dr Lorraine Doherty of the HPSC and contains a range of proposed measures to manage Covid-19 infection risk in healthcare workers. These include: Repeat testing of certain healthcare staff; blanket testing of healthcare workers in hospitals with high incidence of the virus; a serology testing exercise in hospitals with a high incidence of the virus; and testing of healthcare staff moving from high infection rate areas to lower infection areas.

The HSE has already commenced a new mass testing exercise for nursing home staff, where they are being tested weekly for four weeks to determine if this would help stop the spread of Covid-19 in residential settings and to see if such an approach would be useful in other healthcare settings.

Last month, the Irish Nurses and Midwives Organisation (INMO) told the Oireachtas Covid-19 committee that Ireland had the world’s highest rate of infection in healthcare workers. It called for an investigation into the matter, as well as additional measures, such as regular testing in high-risk settings.

Responding to questions from MI on what the HSE was doing to better protect healthcare workers from Covid-19 infection risks, HSE Chief Clinical Officer Dr Colm Henry said the adequate provision of personal protective equipment and prioritised testing had been a consistent feature of the approach to date.

“Testing is not a control measure in itself. It informs control measures in order to protect healthcare workers, protect from transmission of the virus to patients, and break the chain of infection of the virus. We’ve learned a lot about testing of healthcare workers in the past weeks. The blanket exercise in nursing homes showed a low level [of infection among healthcare workers] though,” Dr Henry told MI.

Changeover

Concern has been raised about the risks of the NCHD changeover in July.

This will involve NCHDs changing employment to different hospitals all over the country, with many moving from hospitals which have had high numbers of Covid-19 cases to hospitals with no current cases. Dr Henry acknowledged this issue was under consideration in relation to the proposed testing strategy.

“I’ve had engagement with the colleges on this and have listened carefully to their concerns, and that has been reflected in the testing strategy from Dr [Lorraine] Doherty,” he said.

Some hospitals have had a high number of Covid-19 cases among their staff. For example, by mid-May, in excess of 300 staff at the Mater Misericordiae University Hospital in Dublin had tested positive for Covid-19 and a further 1,500 had self-isolated following contact tracing to protect patients, fellow staff and the public.

As of 20 May, there had been 53,017 appointments offered to healthcare workers for a Covid-19 test as part of community testing, show figures supplied to MI. This included people referred by their GP and those who had a test as part of the large-scale testing exercise in nursing homes.

Speaking at a HSE media briefing on 24 June, HSE CEO Mr Paul Reid urged caution on comparing healthcare worker infection rates globally. He said Ireland had adopted a “wide” definition of healthcare workers that included caterers, porters and support staff, for example. Mr Reid said some other countries only included doctors and nurses in their data.

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