Coronavirus disease 2019 (COVID-19) among healthcare workers: A call for a low-threshold in-hospital screening

To the Editor—A recent large study have shown that only 3% of healthcare workers (HCWs) infected with the novel severe acute respiratory coronavirus virus 2 (SARS-CoV-2) have been exposed to an inpatient with coronavirus disease 2019 (COVID-19) prior to the onset of symptoms, suggesting that most HCWs acquire infection in the community, perhaps due to contact with presymptomatic or asymptomatic carriers, rather than in hospital settings.¹ The high prevalence of infection (11%–20%) among HCWs supports this assertion,^2,3 despite the reportedly low risk of nosocomial infection associated with SARS-CoV-2.^1,4,5

Wee et al⁶ recently reported their experience with syndromic surveillance of HCWs for COVID-19. The surveillance was based on symptoms of acute respiratory illness (ARI) and fever. Pointing to community as well as in-hospital secondary transmission, these researchers detected 14 cases of COVID-19 among HCWs with 4 clusters; most were linked via transmission outside of hospital.⁶ However, although syndromic surveillance, based on fever and ARI symptoms, was shown to be effective during the outbreak of severe acute respiratory syndrome (SARS),⁷ it may not be as effective in containment of COVID-19 infection because of different patterns of clinical presentations. Indeed, in the study by Wee et al,⁶ heat maps did not pick up the cluster with suspected intrahospital spread. Moreover, in a study by Tostmann et al² employing a low-threshold screening for SARS-CoV-2, most HCWs with SARS-CoV-2 infection had mild clinical presentations, frequently not including fever or respiratory symptoms. Using the same clinical data, these researchers developed a model, excluding fever and cough, to predict COVID-19 among HCWs with a fair discriminative ability.²

Early identification and control of COVID-19 among HCWs is of paramount importance particularly in the postoutbreak period to prevent in-hospital secondary transmission to other HCWs and inpatients. The concern of transmitting infection into the healthcare system has been highlighted in a recent study in which HCWs were linked to transmission of COVID-19 into long-term healthcare facilities.⁸ Considering that as many as 50% of all SARS-CoV-2 infections are asymptomatic,⁹ it would seem appropriate, when resources are available, to perform routine SARS-CoV-2 nasopharyngeal screening for all HCWs. The prediction model described by Tostmann et al,² rather than fever and ARI symptoms, can be used to guide a targeted screening strategy in settings with limited availability of testing materials.

Financial support

No financial support was provided relevant to this article.

Conflicts of interest

All authors report no conflicts of interest relevant to this article.