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November 3, 2020

CDC Highlights COVID-19 Hospitalization Risk Among Nurses

Author Affiliations
  • 1Consulting Editor, JAMA Health Forum and JAMA
JAMA Health Forum. 2020;1(11):e201363. doi:10.1001/jamahealthforum.2020.1363

Among health care workers caring for patients with coronavirus disease 2019 (COVID-19) during the first wave of the US pandemic, nurses and others in nursing-related positions, such as nursing assistants, were at highest risk of hospitalization with severe illness, according to a new report from the Centers for Disease Control and Prevention (CDC).

The findings, from a study of 6760 health care workers hospitalized in 13 states at some point during March 1 to May 31, were published last week as an early release from the CDC’s Morbidity and Mortality Weekly Report. Occupational status was determined by the COVID-19–Associated Hospitalization Surveillance Network (COVID-NET).

Nearly 6% of adults hospitalized with COVID-19 during this period were health care workers, of whom nearly 72% were female, 52% were Black, 27% were White, and nearly 9% were Hispanic or Latino. More than two-thirds of health care personnel hospitalized with COVID-19 worked in positions that generally involve direct contact with patients, and more than one-third were in nursing-related occupations.

Nurses comprised the largest proportion of health care personnel hospitalized with COVID-19 (about 28%), followed by certified nursing assistants (about 9%) and patient aides and caregivers (about 7%).

Nine of 10 health care workers hospitalized with COVID-19 had at least 1 underlying condition—most frequently obesity (in nearly 73% of those hospitalized), hypertension (in nearly 41%), and diabetes (in 31%). Many experienced severe illness; 1 in 4 were admitted to an intensive care unit for a median of 6 days, with nearly 16% requiring invasive mechanical ventilation, and about 4% dying during their hospitalization.

Although the COVID-NET surveillance network does not specifically collect information on patients’ exposure history, the authors note that because nurses are frontline workers, they might be at particular risk for exposure to the severe acute respiratory coronavirus 2 (SARS-CoV-2) because they have frequent and close contacts with patients, resulting in greater cumulative exposure time.

To decrease the risk for SARS-CoV-2 transmission in health care facilities, the CDC advises health care personnel to use medical masks (such as surgical or procedure masks) at all times, including in patient-care areas, in rooms used by staff members, and in other places where other health care workers might be present. In areas with moderate to substantial community SARS-CoV-2 transmission, the agency says that eye protection should be worn for all patient care encounters.

In addition, the report notes, an “N95-equivalent or higher-level respirator is recommended for aerosol-generating procedures and certain surgical procedures to provide optimal protection against potentially infectious respiratory secretions and aerosols.”

However, despite the recognized importance of personal protective equipment (PPE) for nurses and others who care for patients, there are ongoing concerns about shortages of PPE for health care workers, even as the United States experiences a surge of new hospitalizations across the country. A Government Accountability Office report released in late September said that shortages remain of certain types of PPE and testing supplies, the result of limited domestic production and high global demand.

Of more than 21 000 US nurses working in many health care settings who responded to a survey conducted July 24 to August 14 by the American Nurses Association, 42% reported widespread or persistent shortages of PPE. More than half of respondents to the survey said they were using single-use PPE, such as N95 masks, for 5 or more days, and 68% said that such reuse was required by their workplace’s policy.

Health care personnel in nursing homes, rural clinics, and small physician offices have an additional burden in obtaining PPE for staff: competition from larger and wealthier heath care facilities stockpiling equipment—in some cases, in response to new stockpiling laws and orders in states such as California, Connecticut, and New York. An analysis by AARP’s Public Policy Institute found that nursing homes in every state said they had a shortage of PPE, lacking a 1-week supply of N95 masks, surgical masks, gowns, gloves, and eye protection during the previous 4 weeks.

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Open Access: This is an open access article distributed under the terms of the CC-BY License.