ABSTRACT
Background. Appropriate staffing is essential to provide safe patient care. During the COVID-19 pandemic, healthcare workers (HCWs) are missing work days due to illness or high-risk exposure (HRE) to an infected person. To avoid staffing shortages, we implemented a SARS-CoV-2 test-based strategy among asymptomatic HCWs after HRE to facilitate early return to work. Methods. In July 2020, our institution implemented a SARS-CoV-2 RT-PCR testbased strategy among HCWs within 7 days of HRE. HCWs were defined as any paid or unpaid persons directly or indirectly involved in patient care. HRE was defined as close contact < 6 feet with an infected household member without use of mask and lasting for ≥ 15 minutes. Contact with a patient or coworker was not considered high-risk due to universal masking and eye protection use. HCWs underwent SARS-CoV-2 RT PCR testing of a nasopharyngeal swab at least once (1-2 days post-exposure) or twice (5-7 days post-exposure). HCWs with symptoms at baseline were excluded. HCWs who were asymptomatic during evaluation were considered as truly asymptomatic (TA). Saved work-days (SWD) were calculated based on number of days saved due to testing strategy compared to the Centers for Disease Control and Prevention's recommended 14-day quarantine. HCWs were allowed to return to work within 7 days of HRE if they tested negative, or after completing 10-day isolation period ± improvement in symptoms from symptom onset if they tested positive. Results. Between 07/01/2020 to 12/31/2020, 450 unique asymptomatic HCWs underwent SARS-CoV-2 testing. Of those, 84% were women and median age was 36 years, 347 tested negative and 103 tested positive. Of those positives, 33% of HCWs tested positive on day 2 after HRE with 141 SWDs (average 2 days/person). Only 37% were TA positives. Of those negatives, 94% were TA SARS-CoV-2 negative with 2620 SWDs (average 7.5 days/person). There were no healthcare outbreaks related to HCWs allowed to return to work following this strategy. Asymptomatic healthcare workers commonly tested positive for SARS-CoV-2 on day 2 from household exposure compared to other days Conclusion. Test-based strategy among asymptomatic HCWs with HRE reduced loss of workdays and helped limit staffing shortages. Majority of positive HCWs developed symptoms after positive SARS-CoV-2 testing, which may support allowing most fully vaccinated HCWs with no COVID-like symptoms to continue to work unless symptomatic.
ABSTRACT
Background. Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 virus affected healthcare workers (HCWs) adding additional burden on staffing shortages. COVID-19 vaccination (mRNA 1273 and BNT162b2) has been shown to protect against severe disease, death and reduced risk of asymptomatic infection and transmission from fully vaccinated individuals. Here, we present the impact of COVID-19 vaccination (CoVac) on risk of developing COVID-19 based on test results among unvaccinated and vaccinated HCWs. Methods. Our academic medical center with 11,785 HCWs on its Jackson campus initiated non-mandatory CoVac among HCWs with BNT162b2 on December 16, 2020. Individuals ≥ 2 weeks after 1st dose of vaccine were defined as partially vaccinated and those ≥2 weeks from 2nd dose of vaccine were defined as fully vaccinated. Per facility policy, all symptomatic HCWs (irrespective of vaccination status) were recommended to undergo SARS-CoV-2 RT-PCR testing. Asymptomatic HCWs were also tested upon household exposure, however, this policy was changed on March 9th 2021 to allow fully vaccinated asymptomatic HCWs to work without need for quarantine or testing. Universal masking policy among HCWs remained effective at our center during study period. Results. Between the launch of COVID-19 vaccination on December 16, 2020 and April 30, 2021, 5,855 HCWs received one dose of vaccine, and 5,687 received both doses. A total of 1,329 unique HCWs underwent COVID-19 testing between January 4, 2021 and April 30, 2021. Of those, 217 (16.3%) tested positive for SARSCoV-2 infection;204 were unvaccinated, 7 were partially vaccinated, and 6 were fully vaccinated (figure 1). Of the 6 fully vaccinated employees, 1 was asymptomatic (testing for travel purposes), 4 had mild symptoms, and one elderly employee required hospitalization with oxygen supplementation and had a complete recovery. No facility outbreaks were reported related to asymptomatic, work exposed, fully vaccinated HCWs. Unvaccinated healthcare workers were more likely to test positive for SARS-CoV-2 compared to partially and fully vaccinated healthcare workers. Conclusion. COVID-19 vaccination protected HCWs by reducing risk for developing COVID-19. Vaccinating healthcare workers is a crucial infection prevention measure to reduce disease burden, avoid staffing shortages and create a safe environment in the healthcare facility to prevent transmission to other staff and at-risk patients.