Frontline Provider COVID-19 Underlying Sero-Prevalence Study (FLIPCUP)

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Public Summary

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread internationally and in the US. As of the beginning of April, more than 1 million cases of coronavirus disease 2019 (COVID-19, the disease caused by SARS-CoV-2) and more than 56,000 deaths have been reported worldwide. In the US, 239,000 cases of COVID-19 have been reported, 32,649 hospitalized, and 5,784 deaths. Mortality has varied by country and region. Front line health care providers have been exposed to COVID, with a number of important consequences: 1) the providers become ill, sometimes requiring hospitalization, and resulting in death; 2) Asymptomatic carriers may exposed patients and family members to COVID; 3) infected providers cannot continue to provider care, resulting in the need for sick call and additional coverage. Being a health care provider is considered a risk factor for contracting COVID. In China, an estimated 3000 health care workers have been infected and at least 22 have died, including young healthcare workers with no comorbidities. Transmission to family members is widely reported. Despite recognition that transmission occurs mostly via symptomatic individuals, there are reports of asymptomatic individuals who transmitted the disease to multiple family members. In Italy, 20% of healthcare workers were infected, and recently 29% of HCW in Detroit were infected. Thus far, 42/700 healthcare workers have been infected at UCSF health, and we believe that ED providers will represent a disproportionate number of cases. ED providers are at high risk for COVID-19 infection. The ED clinical environment is challenging for providers due to the undifferentiated nature of patient presentations. Patients may present with cardinal symptoms of COVID infection but may present with vague or non-specific symptoms. Nonspecific conditions with similar presentations, such as pneumonia and other respiratory infections, obstructive pulmonary disease, and heart failure require different treatments and personal protective equipment precautions. As COVID positivity can be difficult to predict, and COVID PCR test results may take hours to days, emergency providers are managing suspected COVID patients without the benefit of definitive testing. Furthermore, emergency providers are called upon to perform a number of high-risk procedures, such as performing nasopharyngeal or oropharyngeal swab testing, non-invasive positive pressure ventilation, and endotracheal intubation. We seek to assess the seropositivity of ED providers (nurses, physicians, staff) over 6 4 months using a point of care serology test. during the pandemic and identify independent predictors of infection. This has implications for providers, health systems, and public health as we provide emergency and safety net care for San Francisco and the greater Bay Area. Better understanding of the incidence of infection may allow for development of interventions to reduce COVID infection, rational approaches to staffing.