Dutch Hospital Staff Show ‘Insidious Nature’ of Coronavirus

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When a handful of Dutch health workers fell ill days after the Netherlands’ first Covid-19 case, it prompted mass screening at two hospitals. What scientists found surprised them.

Some 1,353 hospital staff in Breda and Tilburg, who recently suffered typical winter coughs and sniffles, were tested for the coronavirus. Of those, 86 — or 6.4% — were positive. Barely half had a fever, and the majority reported working while they were mildly ill.

The “unexpected high prevalence” indicated hidden community spread, Marion Koopmans, Jan Kluytmans, and colleagues said in a report on Friday. The research is the first to describe clinical effects of the pandemic-causing disease among health-care workers and “confirms the insidious nature” of the coronavirus.

It shows “how mild this infection can be,” Koopmans, head of the viroscience department at the Erasmus University Medical Center in Rotterdam, said in a phone interview. “And, therefore, how easily it can fly under the radar.”

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Dutch hospitals will probably reach full capacity in intensive care units Sunday because of the pandemic, the Trouw newspaper said, citing numbers from a medical association. The government is in talks with Germany about transferring critically ill patients to its eastern neighbor.

Doctors have begun asking elderly patients if they become infected whether they would prefer to be cared for at home, rather than add to the demand on intensive care units — a move that’s sparked panic among older citizens, the Telegraaf newspaper reported.

‘Rapid Increase’

“We are experiencing a rapid increase of cases in our community, and now in the hospital,” Kluytmans, a co-author of the paper and a consultant microbiologist in Breda and professor of the epidemiology of health-care associated infections in Utrecht, said in a phone interview on March 12.

The hospitals where Kluytmans works had five patients in intensive care units in mid-March, compared with none the previous week.

“There is a spectrum of disease that’s still not fully recognized,” he said. “In the beginning phase, there was a strong focus on more severe cases, which we do see also. But now we see that there’s much more.”

Didn’t Meet Criteria

Staff, who volunteered to be tested for the virus and were among more than 9,700 employees at Breda and Tilburg’s major hospitals, didn’t meet the internationally recommended criteria used to define a Covid-19 case at the time of the study, the researchers said.

Even if a history of travel to China or northern Italy were excluded from the criteria, 40% of infected health workers identified in the screening still wouldn’t have otherwise been detected, they said.

Given the need to swiftly identify and isolate people infected with the virus to stop its spread, the researchers recommend a broader case-definition be applied to identify suspected Covid-19 in health-care workers.

Fever should be seen as one of the possible symptoms, and not as a required symptom, the Dutch researchers said. They also suggested adding severe muscle aches and general tiredness to the case-definition used to identify potentially-infected health workers.

Follow-Up Study

A follow-up study will assess how many health-workers generated antibodies against the coronavirus, said Koopmans, who is a member of the World Health Organization’s emergency committee on Covid-19. The findings will help determine their level of protection against reinfection.

The shortage of personal protective equipment is one of the most urgent threats to the outbreak response, WHO Director-General Tedros Adhanom Ghebreyesus told reporters on Friday.

“When health workers are at risk, we are all at risk,” Tedros said.

— With assistance by Ruben Munsterman

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