Australian doctors, nurses and other healthcare workers are nearly three times more likely to contract coronavirus (COVID-19) than other Australians, according to a study of the early pandemic period from UNSW Sydney’s Kirby Institute, published in the International Journal of Nursing Studies. As Australia does not have a system for publicly reporting COVID-19 in healthcare workers, researchers conducted a study to estimate Australia’s numbers using publicly available data.
Led by the Head of Global Biosecurity at the Kirby Institute, Professor Raina MacIntyre, researchers identified 536 cases of COVID-19 among Australian healthcare workers up to the beginning of July. This indicates that more than one in 20 of Australia’s COVID-19 cases were potentially acquired on the job, in the health system.
To conduct the analysis, researchers searched government reports, websites and media reports to create a comprehensive line listing of Australian healthcare worker infections and nosocomial outbreaks (outbreaks starting in hospitals) between 25 January and 8 July 2020. Researchers calculated rates of infections and odds ratios for healthcare workers per state by comparing overall cases to estimated healthcare worker cases.
Notably, the period selected for study had a low COVID-19 community prevalence, taking place prior to the second wave in Victoria. “Even without counting more than 3500 health workers infected in the second wave, these numbers from early in the pandemic suggest some system failures to protect our first line health responders,” Professor MacIntyre said. “The safety of health workers should be urgently addressed.”
The data for this study was based on open-sourced reporting of healthcare worker cases, which vary depending on each state’s individual data publishing policies, and researchers used media reports, which have not been verified. Professor MacIntyre pointed out that in most cases, there were multiple media reports about each outbreak, often with quotes from health officials. “This means we have likely underestimated the true number of healthcare worker infections, so this study presents a minimum estimate,” she said.
There is also a potential effect of testing rates on the identification of COVID-19 cases. Researchers accounted for this by representing the daily testing rates in conjunction with the daily healthcare worker infections reported. “A large proportion of healthcare worker infections did not have source of infection reported, and we were unable to obtain further data, nor verify reported sources,” Professor MacIntyre said. “These limitations highlight the need for formal reporting, proper outbreak investigation and contact tracing during hospital outbreaks.”
Significance and recommendations
The researchers believe their findings should inform work health and safety procedures in Australian hospitals, with efforts for national reporting on COVID-19 among healthcare workers accelerated. Researchers also call for hospital workers to be rostered in cohorts to minimise the impact of outbreaks, for better ventilation in hospitals and for improved personal protective equipment guidelines.
The study also highlights that outbreaks in hospital settings have serious consequences, with a hospital in Tasmania closing to quarantine contacts of hospital staff. Ashley Quigley, first author and a Masters student at the Kirby Institute, noted that for every health worker outbreak, hundreds of staff can be furloughed. “There are flow-on effects from a depleted workforce while hundreds to thousands of health worker contacts are quarantined,” Quigley said.
Professor MacIntyre noted that despite the country’s low daily notification counts, continuing hospital outbreaks can occur and threaten economic recovery, citing a recent community cluster in Victoria that was linked to a hospital outbreak long after the second wave. “Controlling health system outbreaks and protecting health workers is key to ensuring safe reopening of society. Several countries such as Taiwan, China and Singapore have demonstrated low health worker infections,” Professor MacIntyre said. “We should learn from them and the precautionary approach they have used to protecting health workers.”
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