Running Title:Medical Staff Infected with COVID-19
Liang
Wang1*,
Chengcao Sun 2, Deijia Li 2*
- Department
of Radiology, Zhongnan Hospital of Wuhan University, Wuhan
University,
China.
- School of Health Sciences, Wuhan
University, Wuhan, China
*Correspondence: Liang Wang, Department of Radiology, Zhongnan
Hospital of Wuhan University, Wuhan University, 169th Donghu Rd, Wuhan
430071, China (martinwang@whu.edu.cn); Deijia Li, PhD, Occupational and
Environmental Health, School of Health Sciences, Wuhan University, 185th
Donghu Rd, Wuhan 430071, China
(djli@whu.edu.cn).
The
COVID-19 first identified in Wuhan, China brings an ongoing outbreak
with global impact.(Huang et al., 2020; Zhu et al., 2020) According to
the data from Chinese Centre for Disease and Prevention (CDC), 3019
suspected cases of COVID-19 in medical staffs were released, with 1716
cases confirmed and 5 dead. More attention should be paid to the medical
staffs infected with COVID-19 and proactive steps should be taken to
decrease infection risk.
Zhongnan Hospital of Wuhan University has been established as the
largest COVID-19 designated hospital in Wuhan. From January 15 to March
30, 6 suspected COVID-19 cases (medical staff) were enrolled from the
department of radiology. The symptoms of 6 suspected cases at onset and
present were collected including fever, dry cough, myalgia, diarrhea,
headache and generalized weakness. CT imaging results were approved by
at least two high-level radiologists. Throat swab samples from 6 cases
were collected for real-time reverse transcriptase polymerase chain
reaction (RT-PCR) analysis to confirm COVID-19 infection.(Wang et al.,
2020) To corroborate the outcome, each case repeated a least 5 times and
the parallel control group was demanded. This study was approved by the
institutional review board of Zhongnan Hospital of Wuhan University.
Oral informed consent was obtained before enrolling participants.
Patient 1, a 30-year-old man, was in good health condition before
infection. Fever (highest temperature reached 38.0℃), myalgia and cough
(mainly dry) started on Jan 18, 2020(Table 1). He was admitted to travel
to a residential area near Huanan Seafood Market, which was noted as the
epidemiological infection source by Huang. etc.(Huang et al., 2020) The
chest thin-section CT showed ground glass opacity in one lung lobe on
Jan 18. The patient soon underwent a RT-PCR test to examine the
COVID-19 RNA of and the result showed
positive. Three days after symptom onset, he was transferred to
isolation ward and received standard treatment. Patient 1 was discharged
from the hospital 2 weeks later. Patient 2, a 34-year-old man, had close
contract with patient 1 before the epidemiological alarm of COVID-19. On
Jan 23, he developed an unreasonable generalized weakness. CT results
showed nodular areas of ground-glass opacity, bearing some resemblance
to Patient 1. Low-dose spiral CT screening covered all the medical
staffs in the department. Patient 3 developed
flu-like
symptoms (38.0℃) and chest radiography showed ground glass nodules.
Patient 4 and Patient 5 were asymptomatic, but their CT images showed
solitary solid nodules and RT-PCR tests presented the infection of
COVID-19. On
Feb
2, Patient 6 developed an acute onset of fever(37.8℃), dry cough,
myalgia and diarrhea. CT images manifested a local high density nodule;
however RT-PCR tests were negative. No new suspected case was detected
from Feb 2 to March 30.
The suspected cases of medical staffs infected with COVID-19 described
an epidemiological and clinical pattern with
atypical
presentation. In January 2020, some cases in medical staffs were
identified, who admitted to close contact with patient without medical
protection or visit to the epidemiological infection areas before
symptom onset. The subsequent cases were admitted to have close contact
with the primary cases including having a meal together, taking a car
and discussing a case before the city lockdown alarm. In the meantime,
all the suspected cases had a history of exposure to infected patients
in workplace with N95 masks, eye shields and biohazard suits.
Nevertheless, it is hard to perform case investigation, contact tracing
and quarantine of exposed persons of COVID-19 infection in medical
staffs.
Flu-like and gastrointestinal symptoms have been noted as the common
symptoms of hospital patients (Wang et al., 2020), however, 40% medical
staff cases developed no fever, dry cough or diarrhea. For some cases,
depending solely on symptoms and CT imaging might lead to a
false-negative result. CT imaging of mild or asymptomatic patients
presented solid nodule instead of ground-glass opacification or
consolidation.(Shi et al., 2020) This may be due to the ultra-early
diagnosis of COVID-19 infection in medical staffs. Encouragingly, the
additional detected cases declined significantly in medical staffs from
Feb 2 to Mar 30; this is possibly attributed to the low-dose spiral
chest CT screening and the isolation of suspected cases in medical
staff.
Compared to SARS, COVID-19 shows higher infectivity and more difficulty
to identify mild and asymptomatic cases.(Wu & McGoogan, 2020; Xu et
al., 2020) Therefore, vigilant control measures are warranted beyond
SARS.(Wang,Wang,Chen, & Qin, 2020) The contaminated zone and
semi-contaminated zone has been strictly divided and the contract
between staffs without medical protection is forbidden. It is meaningful
to expand the samples and set a control group to study the COVID-19
infection in health care workers. In such cases, we suggest that medical
staffs should present themselves for evaluation, to emphasize the
importance to take appropriate precautions including the low-dose CT
screening, the preventive viral nucleic acid detection and hotel
isolation of health care workers in designated hospital. The best
approach for interrupting transmission is not known, but it seems
reasonable to take stringent protective measures and stress hospital
infection control.