Blog
About

7
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Characteristics of health worker fatality in China during the outbreak of COVID-19 infection

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Dear Editor, Since December, 2019, an outbreak of a novel coronavirus pneumonia (COVID-19) occurred in Wuhan (Hubei, China) 1 . Recent paper in this journal also described the clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by COVID-19 2 . During nearly two months of fighting against the epidemic, health workers were under great physiological and psychological pressure in China 3 . For example, due to wearing protective clothing, many health workers avoided drinking water and wore adult diapers for a long time, so that some of them fainted under hypoxia and hypoglycaemia 4 . Previous studies showed that stress could increase the risk of infection 5 as well as induce ventricular arrhythmia, and thus sudden cardiac death 6 . As a result, the medical staff in the front-line fighting against the novel coronary pneumonia were facing high risks of virus infection and sudden death. In 2003, more than 1000 health workers were attacked by severe acute respiratory syndrome (SARS) and 124 deaths were observed in China. As of Mar 16, 2020, 24 health workers had died during the outbreak of COVID-19 infection in China. We retrieved information on 24 deceased cases of health workers based on official reports from governmental institutes, as well as reports from news sites. Information available on public data included gender, age, cause of death, location city, date of disease onset, date of admission, date of death, and hospital levels they worked. We grouped cases into three groups based on the cause of death, which included COVID-19 infection, sudden death, and traffic accident groups. Mann-Whitney U test was applied to compare continuous variables because the data was non-normal distribution, and Fisher exact test was used for categorical variables because the data number was limited. 13 (54.2%) cases died of COVID-19 infection, 8 (33.3%) suffered from sudden death including cardiac arrest, myocardial infarction, and other non-confirmed diseases, and 3 (12.5%) died in traffic accident during work time or after work (Table 1 ). The basic information of all the deceased health workers was listed in Fig. 1 A. The median age was 50.5 years (IQR: 36.25-56.5), ranging from 26 to 69 years. A total of 72314 patient record showed that 81% of dead cases were aged 60 years or older, and 12.7% were aged 50 to 59 years 7 . The median age of deceased medical staff was obviously younger than that of general population, because medical staff were mostly in employment who were younger than 60 years. Up to 83.3% of deceased medical workers were males, and no sex difference occurred among COVID-19 infection group, sudden death group, and traffic accident group. In the group of infection, 11 deceased cases (84.6%) were males. Zhang reported that the overall case fatality rate of male patients (rough estimate: 2.8%) was significantly higher than that of female patients (rough estimate: 1.7%) 7 . In the group of sudden death, 7 cases (87.5%) were males. Previous study revealed that, at 45 years of age, lifetime risks for sudden cardiac death were 10.9% for men and 2.8% for women 8 , which was similar to the results in our study. Above data suggested that males had higher risks of death due to COVID-19 infection and sudden death than females. Table 1 Demographics of deceased medical workers in China by Mar 16, 2020. Table 1 Characteristic Total (n=24) COVID-19 infection (n=13, 54.2%) Sudden death (n=8, 33.3%) Traffic accident (n=3, 12.5%) Z/χ2 (P /Fisher P) Age, Median (IQR) -yrs 50.5(36.25-56.5) 51(38.0-58.0) 50(36.25-56.5) / -0.399(0.690) Male, No. (%) 20(83.3) 11(84.6) 7(87.5) 2(66.7) 1.180(0.579) Hubei resident, No. (%) 11(45.8) 11(84.6) 0(0.0) 0(0.0) 17.293(0.000*) Wuhan resident, No. (%) 9(37.5) 9(69.2) 0(0.0) 0(0.0) 11.684(0.001*) Community hospital, No. (%) 11(45.8) 3(23.1) 5(62.5) 3(100.0) 6.644(0.022*) Onset to admission, Median (IQR)-days / 2(1-5.5) (n=9) / / / Admission to death, Median (IQR)-days / 26(21.25-36.5) (n=12) / / / Onset to death, Median (IQR)-days / 30.5(25-35.25) (n=10) / / / Fig 1 A) Death date, demographics, and death cause of medical workers in China by Mar 16, 2020. Infection with COVID-19 marked with blue, sudden death marked with purple, and traffic death marked with red. B) The new number of deceased medical workers with confirmed COVID-19 infection at admission per 5 days (marked with blue), new number of medical workers with sudden death per 5 days (marked with purple), and new number of medical workers with traffic accident per 5 days (marked with red). Fig 1 Transmission of COVID-19 occurred in the hospital setting. In the group of COVID-19 infection, there were more medical staff working in Hubei province (84.6%) and Wuhan city (69.2%), which was consistent with the result of 63% of infected medical staffs were in Wuhan in recent report 9 . Due to serious situation of COVID-19 infection in Hubei, more nosocomial infection and death happened in Hubei than other provinces. As of February 11, 2020, 3019 cases had been observed among health workers, of whom there have been 1716 confirmed cases. Among health workers infected, 14.8% of confirmed cases were classified as severe or critical, and 5 deaths were observed 9 . Among all the deceased medical staff with COVID-19 infection, the median of period from disease onset to hospital admission was 2 days (IQR: 1-5.5), and the median of period from admission to death was 26 days (IQR: 21.25-36.5) (Table 1). Based on the admission date of staff with COVID-19 infection and the death date of staff with sudden death, the new number of deceased health workers per 5 days was listed in Fig. 2. Attacked infection mostly occurred on January, and the sudden death mainly happened from Jan 23 to Feb 10, 2020. Furthermore, there were more health workers suffering from sudden death or traffic accident, who worked in community hospitals. Sudden death due to huge work and lack of rest happened since Jan 23, 2020, when comprehensive measures for epidemic prevention and control were taken nationwide. Massive work including temperature measure, door to door visit, medicine delivery, patients transfer, disinfection, and etc., had been completed by community or village medical workers. Some village doctors even lived and ate in the village clinics. On Feb 22,2020, Chinese government took a series of measures to protect and support health workers in front line, such as improving the quality of life, strengthening personal protection, arranging rest in turns, and relieving mental stress. Afterwards, the incidence of accidental death decreased significantly. In summary, there were more males in the fatality of health workers, more sudden death happening to community health workers, and more death due to COVID-19 infection occurring in Hubei health workers during the outbreak of COVID-19 infection in China. Declaration of Competing Interest None.

          Related collections

          Most cited references 9

          • Record: found
          • Abstract: found
          • Article: not found

          [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China].

          (2020)
          Objective: An outbreak of 2019 novel coronavirus diseases (COVID-19) in Wuhan, China has spread quickly nationwide. Here, we report results of a descriptive, exploratory analysis of all cases diagnosed as of February 11, 2020. Methods: All COVID-19 cases reported through February 11, 2020 were extracted from China's Infectious Disease Information System. Analyses included: 1) summary of patient characteristics; 2) examination of age distributions and sex ratios; 3) calculation of case fatality and mortality rates; 4) geo-temporal analysis of viral spread; 5) epidemiological curve construction; and 6) subgroup analysis. Results: A total of 72 314 patient records-44 672 (61.8%) confirmed cases, 16 186 (22.4%) suspected cases, 10567 (14.6%) clinical diagnosed cases (Hubei only), and 889 asymptomatic cases (1.2%)-contributed data for the analysis. Among confirmed cases, most were aged 30-79 years (86.6%), diagnosed in Hubei (74.7%), and considered mild (80.9%). A total of 1 023 deaths occurred among confirmed cases for an overall case-fatality rate of 2.3%. The COVID-19 spread outward from Hubei sometime after December 2019 and by February 11, 2020, 1 386 counties across all 31 provinces were affected. The epidemic curve of onset of symptoms peaked in January 23-26, then began to decline leading up to February 11. A total of 1 716 health workers have become infected and 5 have died (0.3%). Conclusions: The COVID-19 epidemic has spread very quickly. It only took 30 days to expand from Hubei to the rest of Mainland China. With many people returning from a long holiday, China needs to prepare for the possible rebound of the epidemic.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Mental health care for medical staff in China during the COVID-19 outbreak

            In December, 2019, an outbreak of a novel coronavirus pneumonia occurred in Wuhan (Hubei, China), and subsequently attracted worldwide attention. 1 By Feb 9, 2020, there were 37 294 confirmed and 28 942 suspected cases of 2019 coronavirus disease (COVID-19) in China. 2 Facing this large-scale infectious public health event, medical staff are under both physical and psychological pressure. 3 To better fight the COVID-19 outbreak, as the largest top-class tertiary hospital in Hunan Province, the Second Xiangya Hospital of Central South University undertakes a considerable part of the investigation of suspected patients. The hospital has set up a 24-h fever clinic, two mild suspected infection patient screening wards, and one severe suspected infection patient screening ward. In addition to the original medical staff at the infectious disease department, volunteer medical staff have been recruited from multiple other departments. The Second Xiangya Hospital—workplace of the chairman of the Psychological Rescue Branch of the Chinese Medical Rescue Association—and the Institute of Mental Health, the Medical Psychology Research Center of the Second Xiangya Hospital, and the Chinese Medical and Psychological Disease Clinical Medicine Research Center responded rapidly to the psychological pressures on staff. A detailed psychological intervention plan was developed, which mainly covered the following three areas: building a psychological intervention medical team, which provided online courses to guide medical staff to deal with common psychological problems; a psychological assistance hotline team, which provided guidance and supervision to solve psychological problems; and psychological interventions, which provided various group activities to release stress. However, the implementation of psychological intervention services encountered obstacles, as medical staff were reluctant to participate in the group or individual psychology interventions provided to them. Moreover, individual nurses showed excitability, irritability, unwillingness to rest, and signs of psychological distress, but refused any psychological help and stated that they did not have any problems. In a 30-min interview survey with 13 medical staff at The Second Xiangya Hospital, several reasons were discovered for this refusal of help. First, getting infected was not an immediate worry to staff—they did not worry about this once they began work. Second, they did not want their families to worry about them and were afraid of bringing the virus to their home. Third, staff did not know how to deal with patients when they were unwilling to be quarantined at the hospital or did not cooperate with medical measures because of panic or a lack of knowledge about the disease. Additionally, staff worried about the shortage of protective equipment and feelings of incapability when faced with critically ill patients. Many staff mentioned that they did not need a psychologist, but needed more rest without interruption and enough protective supplies. Finally, they suggested training on psychological skills to deal with patients' anxiety, panic, and other emotional problems and, if possible, for mental health staff to be on hand to directly help these patients. Accordingly, the measures of psychological intervention were adjusted. First, the hospital provided a place for rest where staff could temporarily isolate themselves from their family. The hospital also guaranteed food and daily living supplies, and helped staff to video record their routines in the hospital to share with their families and alleviate family members' concerns. Second, in addition to disease knowledge and protective measures, pre-job training was arranged to address identification of and responses to psychological problems in patients with COVID-19, and hospital security staff were available to be sent to help deal with uncooperative patients. Third, the hospital developed detailed rules on the use and management of protective equipment to reduce worry. Fourth, leisure activities and training on how to relax were properly arranged to help staff reduce stress. Finally, psychological counsellors regularly visited the rest area to listen to difficulties or stories encountered by staff at work, and provide support accordingly. More than 100 frontline medical staff can rest in the provided rest place, and most of them report feeling at home in this accomodation. Maintaining staff mental health is essential to better control infectious diseases, although the best approach to this during the epidemic season remains unclear.4, 5 The learning from these psychological interventions is expected to help the Chinese government and other parts of the world to better respond to future unexpected infectious disease outbreaks.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk.

              We examined the psychological impact of the 2003 outbreak of severe acute respiratory syndrome (SARS) on hospital employees in Beijing, China.
                Bookmark

                Author and article information

                Contributors
                Journal
                J Infect
                J. Infect
                The Journal of Infection
                The British Infection Association. Published by Elsevier Ltd.
                0163-4453
                1532-2742
                8 April 2020
                8 April 2020
                Affiliations
                [a ]Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
                [b ]Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education, Orthopaedic Department of Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
                Author notes
                [* ]Correspondence authors: Lin Sun, No. 600 South Wanping Road, Shanghai, China xiaoshifu@ 123456msn.com xiaosuan2004@ 123456126.com
                [1]

                Contribute equally

                Article
                S0163-4453(20)30158-4
                10.1016/j.jinf.2020.03.030
                7141456
                © 2020 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                Categories
                Article

                Infectious disease & Microbiology

                Comments

                Comment on this article