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Medical COVID Exposure Risk Outside of Work Increasing for Clinicians
2020.11.03 06:58
I would like to share one interesting article on Medscape this morning as following;
COVID Exposure Risk Outside of Work Increasing for Clinicians
Jennifer Garcia
November 02, 2020
Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.
One-third of COVID-19 exposures among health care providers (HCPs) in Minnesota is due to family or community exposure, not patient care, according to a study conducted by the Minnesota Department of Health (MDH) and published online October 30 in Morbidity and Mortality Weekly Report. And nonwork exposures were more likely to lead to COVID-19 infections.
Between March 6 and July 11, 2020, researchers with the MDH evaluated 21,406 incidences of HCP exposure to confirmed COVID-19 cases. Of those, 5374 (25%) were classified as higher-risk exposures, meaning the provider had close contact for 15 minutes or more, or during an aerosol-generating procedure.
Two-thirds (66%) of the higher-risk exposures occurred during direct patient care and 34% were related to nonpatient care interactions (eg, coworkers, social and household contacts). Overall, 6.9% (373) of the HCPs with a higher-risk exposure received a positive SARS-CoV-2 test result within 14 days of the exposure. Notably, HCPs with household or social exposure had the highest positivity rate across all exposure types at 13%.
"Since the time period covered in this report, we've seen a significant increase in the proportion of HCPs who have had higher-risk exposures outside of work due to the household or social contacts," said lead author Ashley Fell, MPH, from the Minnesota Department of Health.
"HCPs with household or social exposures are also more likely to test positive than HCPs with higher risk exposures within the healthcare setting, which is an important message for both HCPs and the community at large that more COVID-19 spreading in our communities poses a greater risk to our HCPs and health care system," Fell told Medscape Medical News.
When evaluating personal protective equipment (PPE) use among exposed HCPs, researchers found that 90% of providers in acute or ambulatory care were wearing a respirator or medical-grade face mask at the time of exposure, compared with just 68% of HCPs working in congregate living or long-term care facilities.
Further, investigators found that an HCP with a positive SARS-CoV-2 test working in a congregate living or long-term care facility resulted in the exposure of a median of three additional HCPs (interquartile range [IQR], 1-6) compared with a median of one additional HCP exposure in acute or ambulatory care (IQR, 1-3).
The researchers also found that, compared with HCPs in acute or ambulatory settings, HCPs working in long-term care or congregate living settings were more likely to return to work following a high-risk exposure (57% vs 37%) and work while symptomatic (4.8% vs 1.3%).
When asked whether these findings apply to HCPs in other states, Andrew T. Chan, MD, from Massachusetts General Hospital, Boston, noted: "These data are not surprising and confirm what many of us have been seeing in our own areas.
"Clearly, the risk of contracting COVID-19 is particularly high for front-line health care workers in long-term care facilities and nursing homes," Chan said.
"Furthermore, the infection control practices in these care settings are often not as rigorous, and together these factors are probably contributing to higher risks of infection," he said.
The authors acknowledge potential study limitations including misclassification of HCP risk for exposure or misclassification of community exposure as workplace exposure.
"We also recognize that HCPs, like the rest of the community, are experiencing COVID fatigue and that facilities have to constantly be innovative and vigilant to help HCPs maintain rigorous safety precautions with their patients and around their colleagues," Fell concluded.
The authors and Chan have disclosed no relevant financial relationships.
MMWR Morb Mortal Wkly Rep. 2020;69:1605-1610.
Stay safely,
BB Lee
Some more information on Medscape for the issue of the mutation as following;
Common SARS-CoV-2 Mutation May Be Making COVID-19 More Contagious!!!!!
Damian McNamara November 04, 2020
Most SARS-CoV-2 virus strains feature a specific mutation that makes them more transmissible, to the point that these strains now predominate globally, new evidence shows.
In contrast to a greater variety of strains early in the pandemic, now 99.9% of circulating SARS-CoV-2 strains in the study feature the D614G mutation on the spike protein. In addition, people infected with a D614G strain have higher nasopharynx viral loads at diagnosis.
It's not all bad news. This single-point mutation was not associated with worse clinical COVID-19 severity. Also, the mutation isn't expected to interfere with the efficacy of any of the antibody cocktails, small molecule therapies, or vaccines in development.
Furthermore, "as bad as SARS-CoV-2 is, we may have dodged a bullet in terms of how quickly it mutates," study author Ilya Finkelstein, Ph.D., told Medscape Medical News. This virus mutates much slower than HIV, for example, giving researchers a greater chance to stay one step ahead, he said.
The study was published online on October 30 in the journal mBio.
Molecular Sleuthing
The research was possible because colleagues at the Houston Methodist Hospital system sequenced the genome of 5085 SARS-CoV-2 strains early in the outbreak and during a second wave of infection over the summer, Finkelstein said.
The unique data source also includes information from plasma, convalescent plasma, and patient outcomes. Studying a large and diverse population in a major metropolitan area like Houston helps create a "molecular fingerprint" for the virus that will continue to be very useful, said Finkelstein, a researcher, and director of the Finkelstein Lab at the University of Texas Austin.
D614G was the most common genetic substitution the researchers found, appearing in 82% of SARS-CoV-2 strains during the first wave from March 5 to May 11. The proportion with this mutation jumped to 99.9% by the second wave, defined as May 12 to July 7 in the study.
The jump in mutation frequency "occurred very rapidly, in a matter of just a few months," the researchers note.
The presence of the mutation during the first wave was independently associated with mechanical ventilation days, the overall length of stay, and ICU length of stay. However, it was not associated with any significant differences in patient outcomes.
The D614G mutation is now so common worldwide that these viruses are considered reference strains. Researchers believe D614G predominates because it increases the spike protein's ability to open cells for the virus to enter.
BB Lee