Dancing with COVID-19 after the Hammer is Lifted: Enhancing Healthcare Worker Surveillance

Abstract

Li et al. reported health care worker (HCW) deaths from coronavirus disease (COVID-19) ( 1 ). HCWs are at risk of COVID-19 from nosocomial transmission and community acquisitions ( 2 ). Since the first imported case of COVID-19 from Wuhan, China, on January 23, 2020, the number of locally acquired COVID-19 cases has increased in Singapore. To break the chain of disease transmission, Singapore implemented the 'Circuit Breaker' measures between April 07, 2020 and June 01, 2020 ( 3 ). The measures included the closure of nonessential workplaces and schools, suspension of religious activities, movement restrictions, mandatory use of face masks in public areas, and safe distancing measures ( 3 ). Since the lifting of the measures on June 02, 2020, hospitals have resumed non-COVID-19related clinical services including clinically-indicated elective surgeries and chronic disease clinics. Furthermore, with the gradual resumption of economic activities and essential travel, an increase in the community transmission of COVID-19 can be expected.Early identification of COVID-19-infected HCWs can detect viral transmission, determine the effectiveness of control measures, and prevent onward transmission to patients and co-workers in healthcare settings ( 1 , 4 , 5 ). At the 1600-bed Tan Tock Seng Hospital (TTSH) and its co-located 330-bed National Centre for Infectious Disease (NCID), the designated center for emerging infectious disease outbreaks including COVID-19, a comprehensive staff sickness surveillance system has been implemented for > 10,0 0 0 HCWs ( 6 ). The system initially comprised an online temperature and sickness reporting platform and medical screening for COVID-19 in unwell HCWs working in COVID-19-related work areas at the TTSH's Emergency Department or NCID's COVID-19 Screening Center (SC). In preparation for the easing of "Circuit Breaker" measures, the HCW sickness surveillance system was enhanced to include SARS-CoV-2 swab testing for all HCWs with fever or symptoms of acute respiratory infection (ARI) from May 06, 2020 regardless of exposure risk. In addition to NCID's SC, TTSH's Occupational Health Clinic (OHC) also performed SARS-CoV-2 swab testing for all HCWs with fever or ARI symptoms. HCWs who had attended a primary care clinic near their homes were required to be tested for SARS-CoV-2 either at the clinic or the OHC. We compare the epidemiology of sick HCWs and describe the effectiveness of the enhanced HCW ARI surveillance program in COVID-19 detection, in the last month of the "Circuit Breaker" and the first month after the lifting of the "Circuit Breaker".We present data from May 06, 2020 to June 30, 2020 corresponding to the 4 weeks before (period A) and after (period B) the lifting of the 'Circuit Breaker' on June 02, 2020. A total of 997 sickness episodes from 874 HCWs (434 in period A and 440 in period B) were included ( Figure 1 ). The median age was 31

An Effective Mechanism for the Early Detection and Containment of Healthcare Worker Infections in the Setting of the COVID-19 Pandemic: A Systematic Review and Meta-Synthesis

“…Table 1 shows the main characteristics of the 38 studies, including the basic publication information, study type, relevant effective monitoring measures in the COVID-19 context (syndromic surveillance, testing, contact tracing and exposure management), and summary results. With duplicates (repeated count), 11 of the included studies discussed syndromic surveillance measures [6,11,[21][22][23][24][25][26][27][28][29]; 28 studies discussed approaches of testing [3,6,11,22,23,26,27,; 16 studies discussed measures of contact tracing and exposure management [6,11,17,18,[22][23][24][25][26]28,36,47,[50][51][52][53].…”

“…Comprehensive e-surveillance systems, web-based self-service applications, and online databases have been developed to facilitate reporting. Empirical data show that these digital tools are highly effective [21,24,26]; in this regard, they allow healthcare workers to easily and efficiently report their daily temperatures and/or any COVID-19-related symptoms via mobile device. The same online platforms can also be used to schedule testing appointments, redistribute workforces, and assist in epidemiological investigations [24,54].…”

The utilization of HCWs surveillance as an early warning of COVID-19 epidemic activity in the community

“…This study's results may not be applicable in populations with heterogeneous immunity to the virus from natural exposure or immunization unless the emerging new variants might escape the natural or vaccination immunity. The ongoing COVID-19 pandemic is not expected to abate soon and the investment in building robust surveillance systems and infection prevention and control will stand as safeguard for transmission in health care and an extension of the disease spread in the community ( 9 , 10 ).…”

Staff and patient surveillance in hospitals: Good sentinels for the emergence of new SARS-CoV-2 variants

“…Dear Editor, Wang et al highlighted the importance of enhanced surveillance amongst healthcare workers (HCWs) to prevent nosocomial transmission of Coronavirus disease 2019 (COVID-19) as lifting of lockdowns and safe management measures occurred after the initial COVID-19 wave in 2020. 1 The arrival of the Delta variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Singapore led to increased community cases and a cluster at Tan Tock Seng Hospital (TTSH), a 1600-bed acute general hospital colocated with the national COVID-19 referral center (National center of Infectious Diseases) in April 2021. 2 Subsequently, TTSH enhanced its measures against COVID-19.…”