Healthcare worker acute respiratory illness cluster in 2020: Could it be from COVID-19?

To the Editor—Since the emergence of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in China, >45,000 confirmed cases including >60 healthcare workers (HCWs) have been reported in Singapore.1,2 Healthcare workers (HCWs) are at increased risk of nosocomial COVID-19 infection.3 In 2003, almost one-third of ward-based HCWs at Tan Tock Seng Hospital (TTSH) in Singapore were infected with the severe acute respiratory syndrome (SARS) from an index patient.4 After the SARS nosocomial outbreak, web-based staff sickness surveillance systems have been established at TTSH for the early detection of HCW clusters of acute respiratory infection (ARI).5–7 Additionally, a risk-based approach to the use of personal protective equipment (PPE) by HCWs, with full PPE donned in high-risk areas and minimally surgical masks in low-risk areas were implemented.7 During the COVID-19 pandemic, a team of public health-trained personnel maintained close monitoring of staff sickness reporting to identify ARI clusters among the 12,000 HCWs working at the 1,600-bed TTSH and its collocated 330-bed National Centre for Infectious Diseases, the national referral centre for COVID-19 response. SARS-CoV-2 virus was not detected in any of the HCW ARI clusters in 2020. Since start of the pandemic, despite an increase in ARI clusters detected, SARS-CoV-2 has not been detected. Close surveillance of staff absenteeism due to ARI and epidemiological investigations of HCW ARI clusters with screening for respiratory viruses and SARS-CoV-2 are crucial as COVID-19 pandemic emergency responses relax, economic activities resume, and travel bans are lifted. Because it is unlikely that COVID-19 infections will taper off soon around the world, countries should consider having all HCWs wear surgical masks at all times in healthcare settings.