key: cord-1047754-yz567xmf
authors: Wang, Yinchu; Chow, Angela
title: Dancing with COVID-19 after the Hammer is Lifted: Enhancing Healthcare Worker Surveillance
date: 2020-08-01
journal: J Infect
DOI: 10.1016/j.jinf.2020.07.037
sha: 349351511b1ac98ef1d1e8f450cc7c290342b27f
doc_id: 1047754
cord_uid: yz567xmf

nan

Li et al. reported health care worker (HCW) deaths from coronavirus disease (COVID-19) (1) . HCWs are at risk of COVID-19 from nosocomial transmission and community acquisitions (2) . Since the first imported case of COVID-19 from Wuhan, China, on January 23, 2020, the number of locally acquired COVID-19 cases has increased in Singapore. To break the chain of disease transmission, Singapore implemented the "Circuit Breaker" measures between April 7, 2020 and June 1, 2020 (3) . The measures included the closure of non-essential workplaces and schools, suspension of religious activities, movement restrictions, mandatory use of face masks in public areas, and safe distancing measures (3) .

Since the lifting of the measures on June 2, 2020, hospitals have resumed non-COVID-19related clinical services including clinically indicated elective surgeries and chronic disease clinics. Furthermore, with the gradual resumption of economic activities and essential travel, an increase in the community transmission of COVID-19 can be expected.

Early identification of COVID-19 infected HCWs can detect viral transmission, determine the effectiveness of control measures, and prevent onward transmission to patients and coworkers in healthcare settings (1, 4, 5) . At the 1600-bed Tan Tock Seng Hospital (TTSH) and its co-located 330-bed National Centre for Infectious Disease (NCID), the designated center for emerging infectious disease outbreaks including COVID-19, a comprehensive staff sickness surveillance system has been implemented for >10,000 HCWs (6). The system initially comprised an online temperature and sickness reporting platform and the medical screening for COVID-19 in unwell HCWs working in COVID-19 related work areas at the TTSH"s Emergency Department or NCID"s COVID-19 Screening Center (SC). In preparation for the easing of "Circuit Breaker" measures, the HCW sickness surveillance system was enhanced to include SARS-CoV-2 swab testing for all HCWs with fever or symptoms of acute respiratory infection (ARI) from May 6, 2020 regardless of exposure risk. In addition to NCID"s SC, TTSH"s Occupational Health Clinic (OHC) also performed SARS-CoV-2 swab testing for all HCWs with fever or ARI symptoms. HCWs who had attended a primary care clinic near their homes were required to be tested for SARS-CoV-2 either at the clinic or the OHC. We compare the epidemiology of sick HCWs and describe the effectiveness of the enhanced HCW ARI surveillance program in COVID-19 detection, in the last month of the "Circuit Breaker" and the first month after the lifting of the "Circuit Breaker".

We present data from May 6, 2020 to June 30, 2020 corresponding to the 4 weeks before 

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