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Federal Register / Vol. 86, No. 116 / Monday, June 21, 2021 / Rules and Regulations infectious materials. 9 Although only 16% of all surveillance forms indicated whether the case was healthcare personnel, 19% of the reported cases occurred in healthcare personnel.
Twelve states indicated whether the case was healthcare personnel for at least 80% of all reported cases. An estimated 11% of COVID19 cases from those 12 states were healthcare personnel. Based on reported known contact with confirmed COVID19 cases in the 14 days before illness onset, work exposures likely caused 55% of those infections. Between 8% and 10% of infected employees were hospitalized, 2%5% of the infected employees were admitted to the ICU, and 0.3%0.6% of those employees died.
CDC continues to provide general updates for COVID19 cases and deaths among healthcare personnel. However, information on healthcare personnel status was reported for only 18.21% of total cases and death status reported for only 79.57% of healthcare personnel cases as of May 24, 2021 CDC, May 24, 2021a. CDC reports 491,816 healthcare personnel cases 10% of the 4,856,885
cases that included information on healthcare personnel status and 1,611
fatalities 0.4% of healthcare employee cases as of May 24, 2021 CDC, May 24, 2021a. Independent reporting by Kaiser Health News and the Guardian in their ongoing investigative reporting database found 3,607 fatalities among healthcare personnel in the United States as of April 2021Kaiser Health News and the Guardian, April 2021; February 23, 2021. The reporters for this effort consider even their own countwhich is higher than the official CDC count to be an undercount due to various reporting issues, such as a lack of reporting requirements for long-term care employees for a significant portion of the initial COVID19 surge.
Hartmann et al., 2020 analyzed case interview data from February through May 2020 to assess the burden of COVID19 on healthcare employees in Los Angeles County, CA, where it is mandated that all positive cases be reported to the County Department of Public Health, and all cases are interviewed. Healthcare employees were defined as any person working or volunteering in healthcare settings including hospitals and skilled nursing facilities, medical offices, mental health facilities, and emergency medical services EMS. The definition also includes healthcare employees 9 The term healthcare personnel is consistent with OSHAs use of the terms healthcare employees and healthcare workers to include healthcare support workers.

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providing care in non-healthcare settings such as schools, senior living facilities, and correctional facilities.
Healthcare employees included both staff who interacted directly with patients and staff who do not provide direct clinical care to patients. Through May 31, 2020, 5,458 COVID19 cases among healthcare employees were reported to the County Health Department, representing 9.6% of all cases during this time period. Of those healthcare employees, 46.6% worked in a long-term care setting, 27.7% worked in a hospital, and 6.9% worked in medical offices. Healthcare employees from all other settings represented less than 4% of total healthcare employee cases. Nurses represented 49.4% of all healthcare employee cases; no other group of healthcare employees represented more than 6% of the total reported healthcare employee cases. Of note is that some healthcare associated employees who are expected to have less close contact with patients represented a greater percentage of cases than some healthcare employee that are expected to have close and direct patient contact. For example, employees in administration 4.3%, environmental services 3.2%, and food services 2.9% represented a higher percentage of infected healthcare employees than physicians 2.7%. When asked about known exposures, 44% of those who tested positive reported exposure to a COVID19-positive patient or co-worker in their health facility, 11% reported exposure to a COVID19-positive friend or family member or recent travel, and 45.1% had unknown exposures. At the time of the interviews, 5.3% of COVID
19-positive healthcare employees in Los Angeles County reported requiring hospitalization because of COVID19, and as of May 31, 2020 there were 40
0.7% deaths.
Fell et al., October 30, 2020
reviewed exposure and infection data for healthcare personnel in Minnesota between March and July of 2020. After the first confirmed case of COVID19 in Minnesota on March 6, 2020, the Minnesota Department of Health MDH
requested that healthcare facilities provide a list of exposed healthcare personnel. Healthcare personnel included EMS personnel, nurses/
nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractors, and those who do not provide direct patient care but could be exposed to infectious agents in a healthcare setting e.g., clerical, food services, environmental services, laundry, security, engineering and
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facilities management, administrative, billing, and volunteer personnel. Cases in laboratory personnel are also reported. The facilities were asked to determine if each exposure was highrisk, defined as when the healthcare personnel has close, prolonged contact with a confirmed COVID19 case or their secretions/excretions while not wearing PPE, or close, prolonged contact with persons with COVID19 in their household or community. MDH
and the 1,217 participating healthcare facilities assessed 17,200 healthcare personnel for 21,406 exposures to COVID19 cases, of which 5,374 25%
were classified as higher-risk. It was reported that 373 of 5,374 personnel 6.9% with high-risk exposures tested positive for COVID19 within 14 days of the exposure. The report stated that only symptomatic personnel were encouraged to get tested for COVID19, and therefore it is possible that asymptomatic cases occurred and were not detected. Of those 373 personnel who tested positive for COVID19, 242
were exposed to a patient, resident of a congregate setting, in a congregate setting outbreak, or to another healthcare personnel. Twenty-one percent of exposures to a confirmed COVID19 case took place in acute or ambulatory care settings, 24% of exposures were to residents in congregate living or long-term care settings, and 25% of exposures were in congregate setting outbreaks. An additional 25% of exposures to confirmed COVID19 cases were exposures to co-workers, and 5% were exposures to household/social contacts.
The Fell study October 30, 2020 also demonstrated that high risk exposures can occur to healthcare employees in positions throughout the healthcare facility. Available data for 4,669 87%
of the higher risk exposures in the Fell et al., study indicated that the highest percentages of high-risk exposures were in nursing assistants or patient care aides 1,857; 40% and nursing staff 1,416; 30%. The proportion of highrisk exposures represented by personnel such as administrators 247; 5% and environmental services staff 155; 3%
were similar to those reported by medical providers, such as physicians or nurse practitioners 220; 5%.
Healthcare personnel working in congregate living or long-term care settings, including skilled nursing, assisted living, and group home facilities, were more likely to receive a positive COVID19 test result within 14
days of a higher-risk exposure than were healthcare personnel working in acute care settings. The study authors note the
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