For the 330 million people in the United States, forecasts of the number infected range as high as 214 million under a worst-case scenario, with much lower projections under alternate modeling assumptions regarding prevention strategies such as social distancing and other key factors driving outcomes. Health workers are on front lines to diagnosis and treat people with COVID-19 and thus are at high risk for infection. Reports from Italy suggest that as much as 20% of their health workforce might have been infected with COVID-19, and that younger health workers are experiencing severe complications of COVID-19 at higher rates than their peers in the general population. In the U.S., reports are coming in of health workers being diagnosed with COVID-19 and their colleagues being quarantined. Is it clear that older people and people with pre-existing conditions such as pulmonary disease, cardiovascular disease, diabetes, history of cancer, and other chronic conditions that compromise the pulmonary or immune systems are at increased risk for the severe complications that lead to hospitalization and mortality. In the U.S., 74 million adults are age 60 are over, with close to 90% of them having at least one pre-existing condition and 60% having two or more pre-existing conditions that put them at high risk for severe COVID-19. Combining these figures with data on younger adults having pre-existing conditions, about 158 million (62%) adults are at elevated risk for severe complications.
When we look at the estimated 14.6 million health care workers in the U.S., about 2 million (13%) are age 60 or older; when combined with younger adults having pre-existing conditions, a total of 5.5 million (43%) health workers are at risk for severe COVID-19 complications. Among health care workers with greater exposure to COVID-19 are those working in critical care units, emergency departments, and hospitals in general. About 27% of critical care physicians and pulmonologists and 24% of emergency physicians are age 60 and older. For physicians overall, nearly 550,000 (57%) are either over age 60 or have one or more relevant pre-existing condition. Of the 3.3 million registered nurses, 1.7 million (52%) are age 60 and older or have at least one pre-existing condition. These statistics underscore the need to keep health workers safe by providing them appropriate preventive clothing and supplies, and raise questions about strategies to call on retired doctors and nurses to increase surge capacity.
At the other end of the health spectrum are home health aides, nurse aides and other health occupations where a large portion are younger and healthier. While this subset of the health workforce has less to fear about COVID-19 affecting their personal health, these younger and healthier workers potentially could contract COVID-19, and while asymptomatic, inadvertently infect the older, vulnerable population they serve in the community, residential care facilities, nursing homes, and hospitals. This concern highlights the need for testing—even among health workers not showing symptoms of COVID-19.
While the immediate priorities are to protect the health of everyone (the population as well as health workers), challenges like COVID-19 expose weaknesses and failings of the health care system which create impetus for change. Long-term changes in care use and delivery might include the following:
Changes in public awareness leading to improved hygiene and social distancing could reduce future prevalence of communicable diseases such as influenza. In Japan, it appears that the number of influenza cases this year is lower than in a typical year likely as a result of people observing better hygiene and social distancing. Such changes can put less stress on the health care system. Improvements in testing in the U.S. are building on ideas and successes in other countries like South Korea. While testing capabilities in the U.S. are still ramping up, improvements in testing might include increased use of drive-through testing, free testing, and processing test results on-site with results delivered in hours rather than days with off-site test processing. Improvements in testing are beneficial to the population at large, as well as to health workers at risk for contracting COVID-19 as well as infecting others. Barriers to using telemedicine likely will continue to decline. Heretofore, growth in use of telemedicine has been hampered more by reimbursement policies than by technological limitations, despite telemedicine being seen as a way to improve access to under-served populations. The current crisis will heighten awareness that telemedicine is an important tool to help protect the health of both patients and providers. Hopefully countries, communities and individuals will continue to share resources and best practices such that health care systems will emerge stronger than before.
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