A blind spot in the Covid-19 epidemic:
nosocomial transmission to healthcare workers
Press release from the National Academy of Medicine
April 14, 2020
More and more hospitals are reporting healthcare worker (HCW) infections in the departments treating Covid-19 patients, but also outbreaks of transmission in hospital wards that do not normally receive infected patients. Nosocomial transmission of the virus affects not only patients but also HCWs, sometimes in large numbers. The spread of Sars-CoV-2 in hospital wards is one of the blind spots of this epidemic in the absence of a systematic screening survey among HCWs in the most affected areas. At present, tests are only indicated for symptomatic HCWs, with the result that asymptomatic or pre-symptomatic forms are out of any control. Various international studies show that these inapparent forms are in the majority. These investigations are urgent for several reasons:
1-They may lead to reconsideration of procedures to protect HCWs, for example during acts of care that expose them to potentially infectious aerosols.
2-The screening of HCWs carrying the virus and their isolation during the contagious period are essential to avoid transmission to patients who are often frail and at risk of a severe form of the disease.
3-HCWs are not confined and have many contacts in the workplace and at home. If they do not know that they are virus carriers and contagious, they can represent a major source of contamination for their colleagues and relatives.
Since the instruction to wear a surgical mask applies only in the workplace, experience shows that people who are not aware of their infection find it difficult to comply with all day long, especially during breaks. In addition to the current lack of strict isolation of patients carrying the virus who are not, or no longer, subject to acute care hospitalization , nosocomial transmission of Sars CoV-2 contributes to maintaining the epidemic in France despite the containment efforts made by the population.
The French National Academy of Medicine recommends:
1. Systematic screening surveys of all HCWs, symptomatic or not, in hospitals treating Covid-19 patients, combining viral RNA detection by PCR and serum antibody testing;
2. Renewal of the PCR detection test in seronegative HCWs in the case of exposure;
3. The isolation of asymptomatic HCWs carrying Sars CoV-2 for a period of time identical to that of symptomatic HCWs, either at home if feasible, or in structures such as the “Covid-19 Hotel” type, in order to protect their relatives ;
4. The systematic screening of people “in contact” with infected HCWs, even in the absence of symptoms;
5. The updating of current HCW protection procedures according to the results of these investigations and the advancement of knowledge.
 Academy communiqué “For the opening of Covid-19 hotels”, 10 April 2020.