Diagnosed and Undiagnosed COVID-19 in US Emergency Department Health Care Personnel: A Cross-sectional Analysis - 21/06/21

Doi : 10.1016/j.annemergmed.2020.12.007

Nicholas M. Mohr, MD, MS ^a,^⁎ , Karisa K. Harland, PhD, MPH ^a, Anusha Krishnadasan, PhD ^d, Patrick Ten Eyck, PhD ^b, William R. Mower, MD, PhD ^e, James Willey, MD ^c, Makini Chisolm-Straker, MD, MPH ^f, Stephen C. Lim, MD ^g, L. Clifford McDonald, MD ^h, Preeta K. Kutty, MD, MPH ^h, Elisabeth Hesse, MD, MTM&H ⁱ, Scott Santibanez, MD, MPHTM ⁱ, David A. Talan, MD ^a,^d,^e
for the
Project COVERED Emergency Department Network^{^∗}
All members are listed in the Appendix.
Monica Bahamon, MPH, Jestin N. Carlson, MD, MSc, Brian Driver, MD, Brett Faine, PharmD, MS, James Galbraith, MD, Philip A. Giordano, MD, John P. Haran, MD, PhD, Amanda Higgins, MS, Jeremiah Hinson, MD, Stacey House, MD, PhD, Ahamed H. Idris, MD, Efrat Kean, MD, Elizabeth Krebs, MD, MSc, Michael C. Kurz, MD, MS, Lilly Lee, SM, MD, Stephen Y. Liang, MD, MPHS, Juan Carlos C. Montoy, MD, PhD, Gregory Moran, MD, Utsav Nandi, MD, MSCI, Kavitha Pathmarajah, MPH, James H. Paxton, MD, MBA, Yesenia Perez, BS, Lynne D. Richardson, MD, Robert M. Rodriguez, MD, Richard Rothman, MD, PhD, Walter A. Schrading, MD, Jessica Shuck, BA, Patricia Slev, MD, Howard A. Smithline, MD, Kimberly Souffront, PhD, FNP-BC, RN, Mark Steele, MD, Amy Stubbs, MD, Morgan Swanson, BS, Josh Tiao, MD, Jesus R. Torres, MD, MPH, Stacy Trent, MD, MPH, Lisandra Uribe, BS, Arvind Venkat, MD, Gregory Volturo, MD, Kelli Wallace, MS, Kurt D. Weber, MD

^a Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
^b Institute for Clinical and Translational Science, University of Iowa Carver College of Medicine, Iowa City, IA
^c Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
^d Olive View–UCLA Education and Research Institute, Los Angeles, CA
^e Department of Emergency Medicine, University of California–Los Angeles Ronald Reagan Medical Center, Los Angeles
^f Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
^g Department of Emergency Medicine, University Medical Center, New Orleans, LA
^h Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
ⁱ Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, GA

^∗Corresponding Author.

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Abstract

Study objective

We determine the percentage of diagnosed and undiagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among a sample of US emergency department (ED) health care personnel before July 2020.

Methods

This was a cross-sectional analysis of ED health care personnel in 20 geographically diverse university-affiliated EDs from May 13, to July 8, 2020, including case counts of prior laboratory-confirmed coronavirus disease 2019 (COVID-19) diagnoses among all ED health care personnel, and then point-in-time serology (with confirmatory testing) and reverse transcriptase–polymerase chain reaction testing in a sample of volunteers without a previous COVID-19 diagnosis. Health care staff were categorized as clinical (physicians, advanced practice providers, and nurses) and nonclinical (clerks, social workers, and case managers). Previously undiagnosed infection was based on positive SARS-CoV-2 serology or reverse transcriptase–polymerase chain reaction result among health care personnel without prior diagnosis.

Results

Diagnosed COVID-19 occurred in 2.8% of health care personnel (193/6,788), and the prevalence was similar for nonclinical and clinical staff (3.8% versus 2.7%; odds ratio 1.5; 95% confidence interval 0.7 to 3.2). Among 1,606 health care personnel without previously diagnosed COVID-19, 29 (1.8%) had evidence of current or past SARS-CoV-2 infection. Most (62%; 18/29) who were seropositive did not think they had been infected, 76% (19/25) recalled COVID-19–compatible symptoms, and 89% (17/19) continued to work while symptomatic. Accounting for both diagnosed and undiagnosed infections, 4.6% (95% confidence interval 2.8% to 7.5%) of ED health care personnel were estimated to have been infected with SARS-CoV-2, with 38% of those infections undiagnosed.

Conclusion

In late spring and early summer 2020, the estimated prevalence of severe acute respiratory syndrome coronavirus 2 infection was 4.6%, and greater than one third of infections were undiagnosed. Undiagnosed SARS-CoV-2 infection may pose substantial risk for transmission to other staff and patients.

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	Please see page 28 for the Editor’s Capsule Summary of this article.
	Supervising editor: Donald M. Yealy, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: NMM and DAT conceived and designed the study, obtained research funding, interpreted analysis of data, and drafted portions of the manuscript. KKH, AK, PT, and WRM designed the study and developed data collection tools, analyzed the results, and wrote portions of the manuscript. LCM, PKK, EH, and SS designed the study, interpreted analysis of data, and critically revised the final manuscript. JW helped to develop data collection tools and drafted a portion of the manuscript. MC and SCL supervised data collection, interpreted analysis of data, and critically revised the final manuscript. All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. This project was funded by a cooperative agreement from the Centers for Disease Control and Prevention (U01CK000480) and the Institute for Clinical and Translational Science at the University of Iowa through a grant from the National Center for Advancing Translational Sciences at the National Institutes of Health (UL1TR002537).
	The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
	A podcast for this article is available at www.annemergmed.com.

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Vol 78 - N° 1

P. 27-34 - juillet 2021 Retour au numéro

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Moving Beyond the Centers for Medicare and Medicaid Services’ “Severe Sepsis and Septic Shock Early Management Bundle” Core Quality Measure
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Symptoms of Anxiety, Burnout, and PTSD and the Mitigation Effect of Serologic Testing in Emergency Department Personnel During the COVID-19 Pandemic
Robert M. Rodriguez, Juan Carlos C. Montoy, Karin F. Hoth, David A. Talan, Karisa K. Harland, Patrick Ten Eyck, William Mower, Anusha Krishnadasan, Scott Santibanez, Nicholas Mohr, Project COVERED Emergency Department Network, Monica Bahamon, Jestin N. Carlson, Makini Chisolm-Straker, Brian Driver, Brett Faine, Pharm D, James Galbraith, Philip A. Giordano, John P. Haran, Amanda Higgins, Jeremiah Hinson, Stacey House, Ahamed H. Idris, Efrat Kean, Elizabeth Krebs, Michael C. Kurz, Lilly Lee, Stephen Y. Liang, Stephen C. Lim, Gregory Moran, Utsav Nandi, Kavitha Pathmarajah, James H. Paxton, Yesenia Perez, Richard Rothman, Walter A. Schrading, Jessica Shuck, Patricia Slev, Howard A. Smithline, Kimberly Souffront, Mark Steele, Michelle St. Romain, Amy Stubbs, Morgan Swanson, Josh Tiao, Jesus R. Torres, Stacy Trent, Lisandra Uribe, Arvind Venkat, Gregory Volturo, Kelli Wallace, Kurt D. Weber

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Diagnosed and Undiagnosed COVID-19 in US Emergency Department Health Care Personnel: A Cross-sectional Analysis - 21/06/21

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