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Corresponding author at: Johns Hopkins University School of Medicine, Department of Medicine-Infectious Disease, 5200 Eastern Avenue, Baltimore, MD 21224, United States of America.
First responders are at high risk of repeated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure, work in close proximity with team members, and interface with vulnerable populations. Individuals working in a firehouse are often sharing living and dining quarters, making risk levels comparable to that of household contacts. While several hospitals have offered testing to first responders, the extent of transmission in this population and the adequacy of passive outreach is unclear.
2. Methods
We tested 9 individuals from a single firehouse within 2 days of an index case and subsequently tested 33 additional fire/emergency medical services (EMS) personnel around Maryland. All individuals were screened over phone for COVID-19-associated symptoms (fever, cough, sore throat, myalgias, dyspnea on exertion, diarrhea, headache, loss of taste/smell, shortness of breath at rest, chest pain, new onset confusion/irritability, and cyanosis), risk factors (older age, heart disease, diabetes, lung disease, and pregnancy), and knowledge of a close contact with a confirmed COVID-19 case. Drive-through testing using nasopharyngeal swabs and a SARS-CoV-2 RT-PCR test was conducted at Johns Hopkins.
3. Results
Of the 9 fire/EMS personnel tested from the initial firehouse, 4 tested positive (44.4%). Overall, of the 42 individuals tested, 10 (23.8%) tested positive for SARS-CoV-2. All reported symptoms, with cough and headache being the most common, regardless of test result (Table 1). No one reported any shortness of breath, chest pain, confusion/irritability, or cyanosis. Most of those tested were able to identify a close contact with a COVID-19 positive individual, the most common being work exposure with a coworker or transport of a COVID-19 positive patient. Among those who tested positive, the median symptom duration prior to calling was 1.0 days, and ranged from 0 to 18 days (Fig. 1).
Table 1Demographics and symptoms reported by emergency services personnel tested, N = 42.
The high prevalence (44%) of positive tests at a single firehouse following identification of an index case, and the overall prevalence of 23.8%, suggests uncaptured transmission among first responders. Only symptomatic first responders reached out to Johns Hopkins Ambulatory Care; thus the number of true SARS-CoV-2 cases are likely higher, given the documented rates of infection among asymptomatic or pre-symptomatic individuals [
There is growing recognition of the insufficiency of symptom-based screening in higher risk population given the possibility of pre-symptomatic transmission [
]. While most personnel were screened within a day or two of overt symptom onset, there were a substantial proportion of individuals with symptoms starting up to weeks prior to testing. This suggests more active efforts in screening and testing of first responders may be warranted.
A single paramedic team in Maryland responded to up to 4450 calls in 2018 [
]; these first responders are in constant and repeated exposure, and have significant contact with vulnerable communities. Active monitoring of first responders [
Interim U.S. guidance for risk assessment and public health management of healthcare personnel with potential exposure in a healthcare setting to patients with coronavirus disease 2019 (COVID-19) | CDC.
Interim U.S. guidance for risk assessment and public health management of healthcare personnel with potential exposure in a healthcare setting to patients with coronavirus disease 2019 (COVID-19) | CDC.
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