Mild COVID outbreak impacts healthcare workers

In July, 94 fully vaccinated UC San Diego health workers had coronavirus infection with at least one symptom, nearly 19 times the five who became ill in June. And that number jumped to 176 in August, with another 18 tests positive but showing no outward signs of their illness.

While none of these workers fell ill enough to make it to hospital, all had to stay home until their symptoms resolved and they tested negative for cornavirus.

The fact that so many front-line healthcare workers are calling for mild cases of COVID-19 is simply unbearable, said Dr Francesca Torriani, an infectious disease specialist at the university, as many medical institutions are reporting a significant increase in demand for care in parallel with the current summer coronavirus outbreak. .

“We can’t afford to have people take time off work and stay home for 10 to 15 days with a mild infection,” Torriani said. “We need them to be available to work; we cannot afford to lose this vital workforce, even temporarily.

The current breakthrough case rate in the UC San Diego Health workforce gained international attention Wednesday with the publication of a letter to the editor in the prestigious New England Journal of Medicine.

A team of university researchers – Torriani is the corresponding author – examined administrative data on the immunization status of its workforce of more than 19,000 to calculate that the overall immunization effectiveness “exceeded 90% from March to June. , but fell to 65.5% in July. “

While the infection rate was still significantly higher among the unvaccinated, the jump was larger for those fully vaccinated, from 0.3 cases per 1,000 employees in June to 5.7 cases per 1,000 in July. . For unvaccinated workers, the rate fell from 4.9 to 16.4 per 1,000.

After reviewing the data, Dr David Dowdy, a researcher in infectious disease epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore, noted that the sudden increase in breakthrough cases among UCSD health workers was significantly higher than that reported nationally.

The doctor said that the decrease in vaccine protection alone is not likely to explain such a jump, nor is the increased infectivity of the current Delta variant.

“I think there’s probably a component of declining immunity, and there’s probably a component of the Delta variant, and there’s probably a component of people behaving in different ways,” Dowdy said.

In terms of behavior, he noted, it’s important to remember that transmission of the coronavirus occurs when people are close to each other for hours. Something as simple as a big retirement party could cause a temporary increase in infections in a group of people who all work for the same employer. And it’s also clear that UCSD employees are much more likely than the general population to be tested for the infection, as everyone is asked if they have any symptoms when they come to work every day.

However, understanding exactly why the rate of rupture cases is increasing at UCSD Health is less important now than finding a way to prevent the virus from continuing to erode the availability of the healthcare provider’s workforce. health.

Torriani said a recent request to administer recalls to frontline workers was denied by the state. Currently, only Americans with weakened immune systems are cleared by the United States Food and Drug Administration for third doses.

The Biden administration announcement on August 18, that boosters would be available for anyone whose second dose was at least eight months ago, starting September 20. independent body of health professionals that makes recommendations to the United States Centers for Disease Control and Prevention.

It’s unclear when the FDA will comment on the matter, which would then need ACIP’s approval.

However, the powerful committee did a preliminary review of the third-dose data in a meeting on Monday, considering current evidence for the vaccine’s declining efficacy, with many members expressing skepticism as the data clearly indicates that the vaccine is effective enough to prevent serious illness.

“Data to date does not show a remarkable reduction in the vaccine’s effectiveness in preventing hospitalizations and deaths,” said Dr. Beth P. Bell, committee member and professor of public health at the University. from Washington.

With so many millions of people still unvaccinated in the United States, and many more without access to the vaccine globally, the doctor said the evidence suggests that the country’s public health effort should remain focused on the getting more Americans unvaccinated to start their two doses. Classes.

“I really think we have to remember that, really, the most important thing we can do when it comes to vaccines is to keep working as hard as possible to encourage more people to get the primary series,” he said. Bell said.

But that comment referred to third doses for the 174 million Americans who are already fully immune. While ACIP members acknowledged on Monday that minor illnesses have “a strained health care infrastructure” and that “health workers with mild illness cannot work, so prevention mild illness is of greater importance as a public health goal, ”there was no rallying cry to immediately offer reminders to frontline workers.

While ACIP members acknowledged this week that many healthcare providers are moving ahead and giving third doses even though they are currently only allowed for the immunocompromised, officials have made it clear that immunization in outside the approved two-dose schedule carries a significant risk. As Noted in a recent publication from the American Academy of Pediatrics, those who receive off-label doses lose eligibility for federal government compensation if they experience a significant side effect. Doctors could lose their immunity against injury claims, their ability to continue providing coronavirus vaccines, and also payment for their immunization services.

Although she said she was aware some members of the San Diego County community were finding ways to get third doses, Torriani said UCSD plans to follow the rules.

“We cannot move forward without there being a formal OK,” she said.

Dowdy, the infectious disease expert for Johns Hopkins, said data from Israel, where many boosters have already been administered, shows it is reasonable to think health workers could benefit from a recall soon. , but how long exactly these effects would last. is unknown.

“It is quite reasonable that a month, a month and a half, two months after receiving this recall, you will be back to where you were before,” he said. “It is also reasonable that this immunity to booster shots lasts much longer; we really don’t know the answer.