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March 12, 2020

Supporting the Health Care Workforce During the COVID-19 Global Epidemic

Author Affiliations
  • 1Northwestern Memorial HealthCare, Chicago, Illinois
  • 2Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois
  • 3Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Harvard Medical School, Boston, Massachusetts
JAMA. 2020;323(15):1439-1440. doi:10.1001/jama.2020.3972

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread internationally. Worldwide, more than 100 000 cases of coronavirus disease 2019 (COVID-19, the disease caused by SARS-CoV-2) and more than 3500 deaths have been reported. COVID-19 is thought to have higher mortality than seasonal influenza, even as wide variation is reported. While the World Health Organization (WHO) estimates global mortality at 3.4%, South Korea has noted mortality of about 0.6%.1-3

Vaccine development and research into medical treatment for COVID-19 are under way, but are many months away. Meanwhile, the pressure on the global health care workforce continues to intensify. This pressure takes 2 forms. The first is the potentially overwhelming burden of illnesses that stresses health system capacity and the second is the adverse effects on health care workers, including the risk of infection.

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    6 Comments for this article
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    Important Practical Advice
    Shlomo Monnickendam, University of Tel Aviv | Maccabi Healthcare Services
    Thank you for this timely, much needed practical advice. You addressed the concerns I have as a (older) primary care physician, especially how to deal with patients with "simple" colds and what to do in order to protect my family.
    CONFLICT OF INTEREST: None Reported
    Importance of Viral Load in Mortality of Health Workers
    Babak Tf Tf, Assistant Professor of Medicine | Isfahan University of Medical Sciences
    Until this time in our University Hospital, specially linked for coronavirus in the center of Iran,  we fortunately have had a low mortality among medical staff & health personnel despite the experience of other hospitals in Iran. I think type of exposure to virus load is an important factor because in spite of our national self-protecting guideline and recommendations of the government there is a notable difference in health worker mortality in the north compared to southern parts. We had a surge of infections in the North part of Iran about 1 week ago, and during this week our local morbidity and mortality may rise. If so, I think the load of viral shedding is an important factor for health personnel.
    CONFLICT OF INTEREST: None Reported
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    Contingency planning
    Packard Day, Ph.D. |
    Using the Great Influenza pandemic of 1918-19 as a template, let me suggest that hospitals/healthcare agencies should begin immediately to plan for how they will reinforce their existing palliative care work force.

    For example, using Great Influenza as a worst case scenario, imagine an RN force that experiences attrition of 1/3 of its numbers due to general sickness, death, or overwork. Now imagine another 1/3 that fails to show up for work and is thereby lost due to personal fear, panic, selfishness, or anxiety. The remaining 1/3 of RNs are then left to care for a new patient cohort
    that has increased 50X in size from the hospital’s ordinary influx of ER traffic.

    What to do? What is the plan? Admittedly, the potential numbers are daunting, but it is far better to try to answer these questions now than it is to wait until reality demands immediate action.
    CONFLICT OF INTEREST: None Reported
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    Droplet Not Airborne, Still?
    Dvora Inwood, MA, BA | Arena.io, Healthcare Staffing
    Is this guidance still correct in light of the possibility that COVID-19 may be more airborne than previously thought? Is there any way the general public can support efforts that health systems are struggling with when it comes to supply chain/FDA approval? We heard about the debacle with university tests sitting unattended at FDA for approval weeks into the situation. The general public will want to mobilize and help in whatever way the acute care sector wants, we just have not had traditionally clear communication from that sector as to what is needed. Perhaps articles like this can serve that purpose as well as internal communication purposes among healthcare professionals?
    CONFLICT OF INTEREST: None Reported
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    Comforting
    Sharon Argenbright, MSN RN | Group Homes
    This thoughtful piece provides me comfort. I know these precautions like the back of my hand. I've got this. Now if we could just get the equipment through the pipeline, stat, and reinforce Doctors Adams and Walls' message over and over: we can do this. Thank you for your sensitivity to what it is the front line is living through.
    CONFLICT OF INTEREST: None Reported
    Suggestion How to Further Protect Medical Personnel
    Nailya Bulatova, MD, PhD, Professor | The University of Jordan, School of Pharmacy, Department of Biopharmaceutics and Clinical Pharmacy, Amman, Jordan
    Although I am not personally involved in care of patients with COVID 19, I have watched the process of donning and then removal and disposal of personal protective equipment recommended by a number of professional bodies (e.g., NHS), which led me to the thought that one additional step may be recommended before the PPE removal. Simply having a shower with warm water mixed with liquid soap which can neutralize the virus effectively could be an easy and non-expensive measure, when resources are limited, that can protect healthwork force from being infected. Or, it could be using a chamber with a disinfectant mist as advertised by some companies from Vietnam or Turkey, for example. But it is essential to apply this before the PPE removal.
    CONFLICT OF INTEREST: None Reported
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