OSH protection for health care professionals April 16 th 2020 COVID-19 pa pandemic: Exp Experie iences fr from The he Hos ospitals ls San Santi i Paolo aolo an and Car arlo of of Mila ilano Prof. Claudio Colosio, Dr. Federica Masci, Dr. Stefan Mandić - Rajčević & Occupational Health Unit Team
Co Contents • The situation in Lombardy • The epidemics in our Hospital • Our colleagues/patients: data collection and analysis • Clinical findings • Some conclusions
Sit ituation report: It Italy, Lo Lombardy, Mil ilan National Trend PCM-DPC dati forniti dal Ministero della Salute AGGIORNAMENTO 12/ 04/2020 ORE 17.00 POSITIVI AL nCoV INCREMENTO Regione DIMESSI/ CASI TOTAL I Totale DECEDUTI CASI TOTAL I TAMPONI Ricoverati Terapia Isolamento GUARITI attualmente (rispetto al giorno con sintomi intensiva domiciliare precedente) positivi L ombardia 11.969 1.176 18.120 31.265 17.166 10.621 59.052 205.832 + 1.460 Emilia Romagna 3.491 335 9.846 13.672 3.862 2.564 20.098 + 463 96.704 Piemonte 3.429 381 8.695 12.505 2.426 1.729 16.660 + 652 66.555 Veneto 1.428 249 9.052 10.729 2.492 856 14.077 + 309 198.442 Toscana 983 238 4.941 6.162 578 495 7.235 + 277 78.640 L iguria 1.032 144 2.157 3.333 1.412 749 5.494 + 118 21.983 Marche 949 114 2.051 3.114 1.489 700 5.303 + 92 21.057 L azio 1.268 201 2.348 3.817 749 279 4.845 + 122 68.954 Campania 526 82 2.449 3.057 305 242 3.604 + 87 35.448 Trento 322 61 1.699 2.082 678 293 3.053 + 83 17.797 Puglia 609 71 1772 2.452 277 260 2.989 + 85 30.973 Friuli V.G. 160 28 1.138 1.326 910 195 2.431 + 38 29.988 Sicilia 552 53 1.425 2.030 223 163 2.416 + 52 36.098 Abruzzo 346 54 1.342 1.742 206 212 2.160 + 40 20.594 Bolzano 183 45 1.287 1.515 378 205 2.098 + 141 23.246 Umbria 129 39 519 687 580 52 1.319 + 10 18.672 Sardegna 109 26 768 903 137 73 1.113 + 22 10.663 Calabria 165 14 616 795 62 66 923 18.211 + 8 Valle d'Aosta 109 16 463 588 221 112 921 + 19 3.510 Basilicata 61 12 204 277 20 18 315 + 3 4.355 Molise 27 4 171 202 40 15 257 + 11 2.471 TOTAL E 27.847 3.343 71.063 102.253 34.211 19.899 156.363 + 4.092 1.010.193 ATTUAL MENTE POSITIVI 102.253 TOTAL E GUARITI 34.211 TOTAL E DECEDUTI 19.899 CASI TOTAL I 156.363 LAST UPDATE 12.04.2020
Su Surveillance pr prot otocol for or healt healthcare pr prof ofessionals • “ C lose contact” = any person who had a face to face talk without PPP or spent more than 15 minutes in a indoor environment without PPP with a Coronavirus infected person (PATIENT, COLLEAGUE, GENERAL POPULATION) • Worker who have recently traveled from or live in an area with ongoing spread of COVID-19, were at the beginning considered at higher risk • Protocol: Nasopharyngeal swab for real-time RT PCR (rRT-PCR) detection of 2019-Novel Coronavirus (2019-nCoV) The worker is admitted to work only if the reported body temperature before the start of the shift is < 37.5 (temperature monitoring is managed by the department coordinator) A check point has been set up
Ho How w to o man manage close con ontacts 1. Without symptoms: NFS; remains at work waiting for the results, In the meanwhile, mandatory use of PPP (surgical mask and, where necessary, gloves); in family: use of PPP, lives separately from the other members. Takes meals separated. If Swap positive: mandatory QUARANTINE 14 DAYS. 2. With Symptoms: if at work, NFS, precautionary quarantine (same precautions as in point 1). If swab negative: re- entry after recovery. If positive mandatory quarantine 14 days after recovery. 3. With symptoms, at home: when fever is less than 37.5°C NFS. Positive vs negative: as points 1-2 Re-entry at work: only after having performed two swabs, both negative. Otherwise to repeat weekly this approach, remaining in mandatory quarantine
Ho How w to o man manage ab absent fr from om work ork at t the the re-entry ry duri during g epi epidemic ics perio period 1. Telephone interview to collect information regarding possible contacts and symptoms. 2. If duration of absence critical (14 days or more) and/or presence of one or more of the following symptoms: fever, cough, dyspnea, anosmia, ageusia, conjunctival hyperemia, diarrhea: clinical diagnosis of Covid 19 or contact with a covid patient: readmission at work only after 14 days without symptoms and after two NPSs. 3. If duration non critical, absence short, no contacts, symptoms non typical: NPS and readmission at work with the same precautions as in point 1 of previous slide.
In Index cas ase: : San an Carl arlo Hosp ospital TOTAL WABS S : ~1200 DAILY ANAMNESIS: ~50 TOTAL POSI OSITIVE CASE SES: 73 73 TOTAL ISOLATED (AWAITING CON ONF.): 4 TOTAL ACCIDEN ENT AT WOR ORK REPORTED: 12 TOTAL SICK WOR ORKERS (NO NOT OC OCCUPATIONAL INF NFEC ECTION) : 3 Case INDEX (from emergency unit): absence from work cause of sickeness (not accident at work) 40 swab 5 positive cases (MDs and nurses) INVESTIGATION IN PROGRESS
Th The ep epid idemic ic in in ou our ho hospit itals ls Initially Later Worker to worker Lower „close transfer (red) contact“ rate, Most lower worker to asymptomatic worker transfer
Data a col ollectio ion – wor orker su submit it on onli line Relatively good compliance (66% to 73%), lower as the time passes, but allows to analyse the symptoms
Bo Body temperature in n the the first week Day (0) of the positive swab Most COVID-19 positive workers remain afebrile during the follow up-period
Oth Other r symp ymptoms: cou ough and and dy dyspnea Most workers with no or light symptoms
And And som ome ne new w symp ymptoms? Anosmia and dysgeusia are commonly reported and persist for a long time
ACTI CTIVITIES PER ERFORMED AT T APRIL RIL 15 Total employees: 5.000 Total swabs performed: 2800 Total positive subjects: 185 Total recoveries: 74 % of positive swabs in contacts: 8-9% % of positive swabs collected without any strategy (“all workers tested”): < 1%
Con onsid iderations • 90% positive healthcare workers are asymptomatic • General symptoms: Dry cough, dyspnea, sore throat, fever, diarrhea: BUT also: anosmia, dysgeusia, conjunctival hyperemia • Our workers positive to COVD 19 did not need intensive therapy working age patients have not fatal outcome • In closed populations, such as hospitals, the risk comes mostly from within the population (workers->workers) • To avoid virus spreading is important to identify immediately the contacts and adopt preventive measures within 5 days: • no meetings • surgical mask FFP 2 e FFP3 only for operator protection during maneuvers that create aerosols (e.g. bronchoscopy) Surgical mask: stops inlet and outlet droplets
Crit ritic ical is issues Duration of the disease Range: 12-46 days Average: 21.5 days 12-15 days: 6.8% 16 days: 11.5% 17 days: 6.8% 12-17 days: 25%
Fut Future pe perspectiv ives Our group is experimenting: • Follow up study: symptom questionnaire administered to positive workers
Fut Future pe perspectiv ives Our group is experimenting: • COVID-19 IgG and IgM study • Telemedicine: monitoring not critical workers ’ health
Th Thank you ou for or you our atten entio ion claudio.colosio@unimi.it
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