As community-spread of the novel coronavirus is increasingly recognized, many health care providers all over the country will be encountering patients, in all care settings, who may be infected. While many encounters may occur with the appropriate personal protective equipment (PPE) donned, as cases increase there will increasingly be situations in which health care providers may be exposed without full PPE.
Currently, these unprotected encounters are being managed by having health care providers be quarantined for the 14-day incubation period of the virus. If this policy continues it will be disastrous and further cripple what will already be an over-extended health care system coping with a surge of patients. This approach is not sustainable.
Public health officials will continue to find cases as they ramp up testing and additional transmission will occur in communities. It is likely that we will soon reach a point where most health care providers encounter known COVID-19 cases. Some fraction of these encounters may occur without the full use of PPE. We cannot establish a precedent that requires health care workers with no signs of infection to stay out of work, lest we find ourselves without enough staff to treat infected people.
It will be very challenging to respond to a surge of critically ill patients with existing numbers of doctors and nurses. While we must do the utmost to ensure that health care workers have the PPE they need to protect themselves while evaluating and treating patients, it is crucial that policies regarding health care providers are guided by sound science keeping in mind the full context of this pandemic.
Every day, health care providers are exposed to myriad infectious threats that range from influenza to RSV to MRSA to HIV without the donning of PPE. Most of these exposures do not result in disease transmission. High consequence exposures to HIV or tuberculosis result in an employee being monitored for the development of systems and tested if warranted. They are not quarantined.
The novel coronavirus has an incubation that averages about a week and extends up to two weeks. Contagiousness is a function of symptoms with a coughing or sneezing patient being more contagious than those with no or minimal symptoms.
Health systems should monitor health care workers for signs of infection, possibly have them wear a surgical mask with non-COVID-related patient encounters, and isolate them if they develop symptoms. This approach – which is consistent with what is done with other exposures – should be applied to the novel coronavirus.
But quarantining well health care workers from hospital settings sets a precedent that will ensure we don’t have enough health care workers to effectively and safely treat COVID19 patients.
Dr. Jennifer Nuzzo is a Senior Scholar at the Johns Hopkins Center for Health Security and an Associate Professor in the Department of Environmental Health and Engineering and the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.