COVID-19–Associated Hospitalizations Among Health Care Personnel — COVID-NET, 13 States, March 1–May 31, 2020

During March 1–May 31, 2020, HCP accounted for approximately 6% of adults hospitalized with COVID-19 for whom HCP status was documented in COVID-NET. The median age of hospitalized HCP (49 years) was substantially lower than that previously reported for hospitalized adults (62 years) (3). More than two thirds (67.4%) of HCP hospitalized with COVID-19 were generally expected to have direct patient contact, and over one third (36.3%) were in nursing-related occupations. Similar to the proportion of underlying conditions among all hospitalized adults reported to COVID-NET during March–May,** approximately 90% of hospitalized HCP reported at least one underlying condition, with obesity being the most common and reported for over two thirds (72.5%) of patients. A high proportion of hospitalized HCP had indications of severe disease: approximately one in four were admitted to an ICU, and approximately 4% died. The proportion of HCP with these severe clinical outcomes was similar to that of adults aged 18–64 years hospitalized with COVID-19 during March–May.††

Findings from this analysis are comparable to those reported among HCP with COVID-19 in China, which found that nursing-related occupations accounted for the largest proportion of COVID-19 cases among HCP (4). COVID-NET does not specifically collect information on exposure history; however, nurses are frontline workers and might be at particular risk for exposure because of their frequent and close patient contact, leading to extended cumulative exposure time. Nursing-related occupations also account for a large proportion of the U.S. health care workforce: in 2019, registered nurses alone represented approximately one third of health care practitioners (5). This has implications for the capacity of the health care system, specifically nursing staff members, to respond to increases in COVID-19 cases in the community. To decrease the risk for SARS-CoV-2 transmission in health care facilities, CDC recommends that HCP use face masks (i.e., medical masks, such as surgical or procedure masks) at all times while they are in health care facilities, including patient-care areas, staff member rooms, and areas where other HCP might be present (2). In addition, in areas with moderate to substantial community transmission of SARS-CoV-2, CDC recommends that HCP wear eye protection for all patient care encounters. 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 (2).

Similar to the distribution of the U.S. health care workforce overall, a majority of hospitalized HCP in this report were female (5). However, compared with previously reported demographic characteristics of U.S. HCP with COVID-19, HCP identified by COVID-NET were older, and a larger proportion were Black (6). Given that COVID-NET conducts surveillance specifically for hospitalized patients, these differences might reflect the association between increased age and severe outcomes associated with SARS-CoV-2 infection as well as disproportionate effects among Black populations (1,3,7,8).

These results are consistent with previously reported data suggesting that underlying conditions, including obesity, diabetes, and cardiovascular disease, are risk factors for COVID-19–associated hospitalization and ICU admission (3,9,10). Among the approximately 90% of HCP in this analysis with at least one underlying condition, obesity was most commonly reported. A recent study found that obesity was highly associated with risk for death among COVID-19 patients who sought health care, even after adjusting for other obesity-related underlying conditions (10). The findings in this report highlight the need for prevention and management of obesity through evidence-based clinical care as well as policies, systems, and environmental changes to support HCP in healthy lifestyles to reduce their risk for poor COVID-19–related outcomes.§§

The findings in this report are subject to at least five limitations. First, HCP status is determined through medical chart review, and although chart abstractions will be completed on all sampled cases, abstraction was pending at the time of analysis for approximately 14% of sampled cases hospitalized during March–May. Thus, the proportion of identified HCP among all adults hospitalized with COVID-19 from March–May might represent an overestimate or underestimate of HCP in this population. Second, because of small sample sizes for some variables, some estimates might be unstable, as evidenced by wider confidence intervals. Third, although COVID-NET collects HCP status, data on the degree, frequency, and duration of contact with patients are not collected. HCP were stratified by presumed level of patient contact, based on general understanding of health care professions; the level of patient contact for some HCP might have thus been misclassified. Fourth, COVID-NET does not collect data regarding exposure history. It is unknown whether HCP were exposed to SARS-CoV-2 in the workplace or community, highlighting the need for community prevention efforts as well as infection prevention and control measures in health care settings. Finally, laboratory confirmation is dependent on clinician-ordered testing and hospital testing policies for SARS-CoV-2; as a result, COVID-19–associated hospitalizations might have been underestimated.

Findings from this analysis of data from a multisite surveillance network highlight the prevalence of severe COVID-19–associated illness among HCP and potential for transmission of SARS-CoV-2 among HCP, which could decrease the workforce capacity of the health care system. HCP, regardless of any patient contact, should adhere strictly to recommended infection prevention and control guidance at all times in health care facilities to reduce transmission of SARS-CoV-2, including proper use of recommended personal protective equipment, hand hygiene, and physical distancing (2). Community mitigation and prevention efforts in households and congregate settings are also necessary to reduce overall SARS-CoV-2 transmission. Continued surveillance of hospitalized HCP is necessary to document the prevalence and characteristics of COVID-19 among this population. Further understanding of exposure risks for SARS-CoV-2 infection among HCP is important to inform additional prevention strategies for these essential workers.