OSH protection for health care professionalsApril 16th 2020

COVID-19 pandemic:Experiences from The Hospitals Santi Paolo and Carlo of Milano

Prof. Claudio Colosio,Dr. Federica Masci,

Dr. Stefan Mandić-Rajčević & Occupational Health Unit Team

Contents

•The situation in Lombardy•The epidemics in our Hospital•Our colleagues/patients: data collection and analysis•Clinical findings•Some conclusions

Situation report: Italy, Lombardy, Milan

LAST UPDATE 12.04.2020

National Trend

PCM-DPC dati forniti dal Ministero della Salute

Ricoverati

con sintomi

Terapia

intensiva

Isolamento

domiciliare

Totale

attualmente

positivi

Lombardia 11.969 1.176 18.120 31.265 17.166 10.621 59.052 + 1.460 205.832

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

Liguria 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

Lazio 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 + 8 18.211

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

TOTALE 27.847 3.343 71.063 102.253 34.211 19.899 156.363 + 4.092 1.010.193

102.253

34.211

19.899

156.363

ATTUALMENTE POSITIVI

TOTALE GUARITI

TOTALE DECEDUTI

CASI TOTALI

Regione

AGGIORNAMENTO 12/ 04/ 2020 ORE 17.00

POSITIVI AL nCoV

DIMESSI/

GUARITIDECEDUTI CASI TOTALI

INCREMENTO

CASI TOTALI (rispetto al giorno

precedente)

TAMPONI

Surveillance protocol for healthcare professionals

• “Close 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

How to manage close contacts

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°CNFS. 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

How to manage absent from work at the re-entry during epidemics 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.

Index case: San Carlo Hospital

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

TOTAL WABS : ~1200DAILY ANAMNESIS: ~50TOTAL POSITIVE CASES: 73TOTAL ISOLATED (AWAITING CONF.): 4TOTAL ACCIDENT AT WORK REPORTED: 12TOTAL SICK WORKERS (NOT OCCUPATIONAL INFECTION) : 3

The epidemic in our hospitalsInitially

Worker to worker transfer (red)

Most asymptomatic

LaterLower „close contact“ rate,

lower worker to worker transfer

Data collection – worker submit online

Relatively good compliance (66% to 73%), lower as the time passes, but allows to

analyse the symptoms

Body temperature in the first week

Day (0) of the positive swab

Most COVID-19 positive workers remain afebrile during the follow up-period

Other symptoms: cough and dyspnea

Most workers with no or light symptoms

And some new symptoms?

Anosmia and dysgeusia are commonly reported

and persist for a long time

ACTIVITIES PERFORMED AT APRIL 15

Total employees: 5.000 Total swabs performed: 2800Total positive subjects: 185Total recoveries: 74% of positive swabs in contacts: 8-9%% of positive swabs collected without any strategy (“all workers tested”): < 1%

Considerations• 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

Critical issues

Duration of the diseaseRange: 12-46 daysAverage: 21.5 days12-15 days: 6.8%16 days: 11.5%17 days: 6.8%

12-17 days: 25%

Future perspectivesOur group is experimenting:• Follow up study: symptom questionnaire

administered to positive workers

Future perspectives

Our group is experimenting:

•COVID-19 IgG and IgM study

• Telemedicine: monitoring not criticalworkers’ health

Thank you for your attention

claudio.colosio@unimi.it