Estimating the burden of COVID-19 on the Australian healthcare workers and health system during the first six months of the pandemic

Abstract

Introduction: There are no publicly available national data on healthcare worker infections in Australia. It has been documented in many countries that healthcare workers (HCW) are at increased occupational risk of COVID-19. We aimed to estimate the burden of COVID-19 on Australia HCW and the health system by obtaining and organizing data on HCW infections, analyzing national HCW cases in regards to occupational risk and analyzing healthcare outbreak.

Methods: We searched government reports and websites and media reports to create a comprehensive line listing of Australian HCW infections and nosocomial outbreaks between January 25^th and July 8^th, 2020. A line list of HCW related COVID-19 reported cases was created and enhanced by matching data extracted from media reports of healthcare related COVID-19 relevant outbreaks and reports, using matching criteria. Rates of infections and odds ratios (ORs) for HCW were calculated per state, by comparing overall cases to HCW cases. To investigate the sources of infection amongst HCW, transmission data were collated and graphed to show distribution of sources.

Results: We identified 36 hospital outbreaks or HCW infection reports between January 25^th and July 8^th, 2020. According to our estimates, at least 536 HCW in Australia had been infected with COVID-19, comprising 6.03% of all reported infections. The rate of HCW infection was 90/100000 and of community infection 34/100,000. HCW were 2.69 times more likely to contract COVID-19 (95% CI 2.48 to 2.93; P < 0.001). The timing of hospital outbreaks did not always correspond to community peaks. Where data were available, a total of 131 HCW across 21 outbreaks led to 1656 HCW being furloughed for quarantine. In one outbreak, one hospital was closed and 1200 HCW quarantined.

Conclusion: The study shows that HCW were at nearly 3 times the risk of infection. Of concern, this nearly tripling of risk occurred during a period of low community prevalence suggesting failures at multiple hazard levels including PPE policies within the work environment. Even in a country with relatively good control of COVID-19, HCW are at greater risk of infection than the general community and nosocomial outbreaks can have substantial effects on workforce capacity by the quarantine of numerous HCW during an outbreak. The occurrence of hospital outbreaks even when community incidence was low highlights the high risk setting that hospitals present. Australia faced a resurgence of COVID-19 after the study period, with multiple hospital outbreaks. We recommend formal reporting of HCW infections, testing protocols for nosocomial outbreaks, cohorting of workforce to minimize the impact, and improved PPE guidelines to provide precautionary and optimal protection for HCW.

Keywords: COVID-19; Healthcare worker; Healthcare worker infections; Occupational risk.

Fig. 1

The left y-axis shows the daily number of HCW COVID-19 cases nationwide. The right y-axis shows the total number of confirmed daily COVID-19 cases nationwide. Date of COVID-19 confirmation is used as a proxy for onset.

Fig. 2

The left y-axis shows the total number of confirmed HCW COVID-19 cases nationwide. The right y-axis shows the number of daily COVID-19 tests nationwide. Date of COVID-19 confirmation is used as a proxy for onset. a – Only overseas return travelers were tested. March 17^th, QLD and ACT started regularly reporting testing data; b - March 25^th, indicates a nationwide change in testing criteria to include people who did not recently travel from overseas; c - May 1^st, indicates a change in reporting from people tested to number of tests performed in WA; d - May 26/27^th: indicates a change in reporting from people tested to number of tests performed in NSW and VIC.

Fig. 3

Frequency distribution of sources of COVID-19 infection among reported HCW outbreaks/cases. Risk is stratified based on occupational risk level as defined above.