Ask Dr. Tessa: Health-Care Clients

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Email her your question at askdrtessa@ascpskincare.com.
 

Q. Am I more susceptible to contracting coronavirus if I treat health-care workers?

Health-care providers have heroically stepped up to treat patients impacted by this disease, at a time when they feared they may run out of personal protective equipment (PPE) to safeguard their own safety.

Some health-care workers have reported feeling a degree of stigma (avoidance, rejection, denial of services) which could cause additional psychological suffering during what is probably the most challenging point in their career. Fear of certain groups perceived to be at high risk is very common in disease outbreaks. Many of my close friends are health-care providers and I worried deeply about their safety when their health-care institutions began caring for COVID-19 patients.

Here are a few reasons why I have stopped worrying as much:

• Hospitals and health-care facilities that care for COVID-19 patients have rapidly adopted a suite of strategies1 to minimize the risk of transmission to their health-care providers. To name a few: placement of patients with confirmed or suspected COVID-19 in airborne infection isolation rooms during aerosol-generating procedures, ventilation systems that provide air movement from a clean to contaminated flow direction, use of telemedicine, training, and use of personal protective equipment (PPE).  
• Asymptomatic health-care workers who have a high-risk exposure (prolonged contact with someone with confirmed or suspected COVID-19 without proper PPE) are generally required2 to self-isolate for 14 days and report any symptoms to their employer.  
• If a health-care worker has developed suspected or confirmed COVID, they cannot return to work until they are 72 hours after the resolution of fever without the use of fever-reducing medications and improvement of respiratory symptoms and at least 10 days must have elapsed since symptoms first appeared. Many are also required to have a negative SARS-CoV-2 RNA test, which detects infection from the virus, from two consecutive samples taken 24 hours apart.

While we are still very early in understanding the risk of transmission of SARS-CoV-2 to frontline health-care workers, it is reasonable to expect that the risk was highest in the early days of the epidemic before strict infection control standards were in place in health-care institutions. The Morbidity and Mortality Weekly Report (MMWR)3 from the Centers for Disease Control and Prevention (CDC) describes a detailed study of 121 health-care workers that treated the first US case of community-acquired SARS-CoV-2 in Solano County, California, in late February 2020. Treatment of this patient occurred across two hospitals, before transmission-based precautions were in use, thus no provider used PPE. All 121 were monitored for 14 days since their last exposure and only three tested positive for COVID. A similar report from a Swiss hospital4 found that of 21 health-care providers who cared for an early COVID-19 case without PPE, no health-care providers tested positive for the virus. The limited research available to date certainly does not allow us to conclude that health-care workers are not at high risk. Reports from Wuhan China5 have informed risk mitigation strategies around the globe. It is a situation that will continue to be monitored and infection control practices are being adjusted in real time as new research emerges.

Bottom line is that health-care workers are a highly monitored population who are knowledgeable about potential symptoms of COVID-19 and the importance of self-isolation, should symptoms occur. I would encourage you to provide services to health-care workers while taking the same precautions you do for your other clients. These should include conducting a health intake update administered during a pre-session interaction and doorway health screening upon client arrival as recommended in the ASCP Back to Practice Guidelines. Use of masks by both yourself and your client is also essential.

REFERENCES:

1. Centers for Disease Control and Prevention, “Summary for Healthcare Facilities: Strategies for Optimizing the Supply of N95 Respirators During the COVID-19 Response,” accessed June 2020
2. Centers for Disease Control and Prevention, “Criteria for Return to Work for Healthcare Personnel with Suspected or Confirmed COVID-19 (Interim Guidance),” accessed June 2020
3. Amy Heinzerling, et al., “Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient – Solano County, California, February 2020,”  MMWR 69 (2020): 472–76
4. Canova Vera, “Transmission Risk of SARS-CoV-2 to Healthcare Workers – Observational Results of a Primary Care Hospital Contract Tracing,”  Swiss Medical Weekly 150 (2020)
5. Li Ran, “Risk Factors of Healthcare Workers with Corona Virus Disease 2019: A Retrospective Cohort Study in a Designated Hospital of Wuhan in China,” Clinical Infectious Disease, (2020)
    

ASCP DISCLAIMER:

Please be sure to always work within your scope of practice as determined by your state and to adhere to all local and federal rules and regulations regarding COVID-19 protocols. To learn more about returning to your practice or to access free resources to assist you with reopening, access the ASCP Back-to-Practice Guide!

BACK-TO-PRACTICE GUIDE
 

About the Author:

Dr. Tessa Crume is an Associate Professor in the Epidemiology Department at the Colorado School of Health at the University of Colorado Anschutz Medical Campus. Her research focuses on the development and utilization of public health surveillance systems to understand the burden of disease. She has been an academic researcher since 2011, before which she worked for a decade as an applied epidemiologist at the state and federal level, analyzing surveillance data and evaluating public health impact. Dr. Crume has taught the core epidemiology class at the Colorado School of Public Health for nine years.

HAVE A QUESTION FOR DR. TESSA?

Email her your question at askdrtessa@ascpskincare.com.