Risks of COVID-19 from patients. An Inside Lyme Podcast.

Welcome to my next Inside Lyme podcast. – Forty health care workers and 17 patients were presumed to have been infected with COVID-19 in a Chinese hospital. I will be discussing the risk of COVID-19 from patient to health care worker and patient-to-patient transmission.

You may be wondering why I am discussing COVID-19 during an Inside Lyme podcast. I am concerned for my children, grandchildren, and my patients. I would like to share my understanding of COVID-19 through my eyes as a clinical epidemiologist.

I have learned that the best way to understand an infection is through a discussion of actual cases.

What are the risks of COVID-19 for health care workers?

Wang and colleagues described 40 health care workers who “were presumed to have been infected in hospital.” wrote Wang and colleagues in the Journal of the American Medical Association. These 40 workers were hospitalized at Zhongnan Hospital of Wuhan University in Wuhan, China in January 2020.

The 40 hospitalized health care workers were from three departments. ”31 (77.5%) worked on general wards, 7 (17.5%) in the emergency department, and 2 (5%) in the ICU.” wrote Wang and colleagues.

Ten of the health care workers contracted COVID-19 from a single patient. “One patient in the current study presented with abdominal symptoms and was admitted to the surgical department. More than 10 health care workers in this department were presumed to have been infected by this patient.” wrote Wang and colleagues.

Patient to patient risk of COVID-19

The authors also described patient-to-patient transmission. 17 patients were already hospitalized for other reasons. “Of the hospitalized patients, 7 patients were from the surgical department, 5 were from internal medicine, and 5 were from the oncology department.” wrote Wang and colleagues.

The authors traced the transmission from one patient to three others. One patient had a fever and atypical abdominal symptoms during hospitalization. That patient was isolated. “Subsequently, the other 3 patients in the same ward had fever, presented with abdominal symptoms, and were diagnosed as having nCoV infection.” wrote Wang and colleagues.

One of the reasons for the spread may have been patients who presented with atypical presentations such as diarrhea and nausea wrote Wang and colleagues.

The authors granted that the COVID-19 cases were suspected and presumed. “hospital-related transmission/infection could not be definitively proven but was suspected and presumed based on timing and patterns of exposure to infected patients and subsequent development of infection.” wrote Wang and colleagues.

This study should encourage further research on the risk of COVID-19 to hospitalized patients and health care providers.

One of the reasons for the spread may have been patients who presented with atypical presentations such as diarrhea and nausea wrote Wang and colleagues.

The authors granted that the COVID-19 cases were suspected and presumed. “hospital-related transmission/infection could not be definitively proven but was suspected and presumed based on timing and patterns of exposure to infected patients and subsequent development of infection.” wrote Wang and colleagues. The authors also did not describe the level of personal protective equipment

This study should encourage further research on the risk of COVID-19 to hospitalized patients and health care providers.

What can we learn from these cases?

1. Patient to hospital care workers of COVID-19 can take place.
2. Patient to patient transmission of COVID-19 can take place.
3. The spread of COVID-19 may be increased through atypical presentations e.g., diarrhea.

What questions does these cases raise?

1. 1. What is the risk to health care workers strictly following personal protective protocols?
   2. What is the risk of patient-to-patient transmission of COVID-19 with Personal protective equipment?
   3. Was fecal transmission a factor in the patient to health care worker and patient to patient transmission? I discussed this potential risk in a recent podcast called COVID-19 Podcast: Fecal Transmission of COVID-19 in children?