Transmission of 2019-nCoV to Health-Care Workers in the Early Epidemic
39 Pages Posted: 25 Feb 2020More...
Background: A large outbreak of pneumonia associated with 2019 novel coronavirus (2019-nCoV) occurred in Wuhan City, Hubei Province, China in December 2019. We have reported the first case of health-care worker infection in Wuhan Union Hospital to public at the earlier stage of the outbreak. Now this report summarizes the initial epidemiological and clinical findings on the basis of the identification of nosocomial 2019- nCoV infection of health-care workers in our 5000-bed tertiary general hospital. We aim to pay tribute to the front-line medical staff fighting against 2019-nCoV pneumonia and provide reference information to protect global health-care workers from 2019-nCoV infection in the epidemic.
Methods: In this retrospective, single-centre study, we analyzed the firstbatch of 48 hospitalized cases of confirmed 2019-nCoV infection from the health-care workers of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, China, between January 16, 2020 to January 30, 2020. Included cases were the hospitalized health-care workers with positive symptoms, typical CT findings, and confirmed 2019- nCoV infection by real-time RT-PCR. Data on demographic characteristics, exposure history, clinical features and subjected to preliminary epidemiological assessment. We also investigated the attack rate of 2019- nCoV in the infectious isolation wards and designated fever outpatient clinics.
Findings: Of the 48 first-batch hospitalized health-care workers with confirmed 2019-nCoV infection (including 17 physicians [35·4%], 28 nurses [58·3%] and three health-care assistants [6·3%]), 32 (66·7%) were female, with an median age of 36 years (IQR 31-41). The median duration from symptom onset to admission was estimated to be 6 days (IQR 5-10). The 48 infected employees were variously from the departments of surgery (23 [47·9%]), internal medicine (16 [33·3%]), pediatrics (2 [4·2%]), gynecology (2 [4·2%]) and other departments (5 [10·4%]) including the radiology unit, clinical laboratory and pharmacy department. 18 out of 48 individuals had direct contact with a patient with confirmed 2019-nCoV infection. Only six of the workers working in high-risk departments were aware of the possibility of exposure to infected patients. During the exposure period, 46 workers protected themselves by only wearing surgical masks; one wore N95 mask and only one physician wore an isolation gown, fit-tested N95 mask, gloves, cap, eye shield and shoe covers. Among the 189 physicians and nurses working in three isolation wards and one fever outpatient clinic, one nurse was infected with 2019- nCoV. Symptoms were of mild nature in most cases. Empirical therapy most commonly included administration of antibiotics, oseltamivir, arbidol, and inhalation of recombinant human interferon α-2b. Oxygen supplementation was used, via a nasal cannula in 21 patients (43·7%) and via a face mask in one patient (2·1%). None of the 48 cases required respiratory support with mechanical ventilation. As of February 8, 30 (62·5%) of 48 patients have been discharged and no fatalities occurred. The median hospital stay of the 30 patients lasted 11 days (IQR, 6·8-16·3). The median time to negative results among the 30 discharged patients was 10·5 days (IQR 7-15·3).
Interpretation: Our findings confirmed 2019-nCoV could easily spread through direct personal contact in a hospital setting and provided compelling evidence that health-care facilities worldwide need to be prepared for possible transmission of this novel coronavirus. Medical workers engaging in daily interaction with their fellow workers should be personally under effective protection against the infection. The health-care workers developing any possible associated symptoms should seek prompt medical attention and be duly isolated, thereby minimizing secondary transmission of 2019-nCoV in health-care associated outbreaks. Adequate protection against exposure to infected patients can effectively protect health-care workers from 2019-nCoV infection.
Funding Statement: This study was supported by the State Project for Essential Drug Research and Development, China (no. 2019ZX09301001).
Declaration of Interests: The authors declare no competing interests.
Ethics Approval Statement: The study was approved by Wuhan Union Hospital Ethics Committee and written informed consent was obtained from subjects involved before they were enrolled and when data were collected retrospectively.
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