Frontline healthcare workers more likely to test positive for COVID despite PPE

April 28, 2020

A new study published in Lancet Public Health has found that front-line healthcare workers with adequate personal protective equipment (PPE) have a three-fold increased risk of a positive SARS-CoV-2 test, compared to the general population.

Those with inadequate PPE had a further increase in risk. The study also found that healthcare workers from Black, Asian and minority ethnic (BAME) backgrounds were more likely to test positive. 

Using the COVID Symptom Study App, researchers from King’s College, London and Harvard looked at data from 2,035,395 individuals and 99,795 front-line healthcare workers in the UK and US. The prevalence of SARS-CoV-2 was 2747 cases per 100,000 front-line healthcare workers compared with 242 cases per 100,000 people in the general community. A little over 20 percent of front-line healthcare workers reported at least one symptom associated with SARS-CoV-2 infection compared with 14·4 percent of the general population; fatigue, loss of smell or taste, and hoarse voice were especially frequent. 

BAME health-care workers were at an especially high risk of SARS-CoV-2 infection, with at least a fivefold increased risk of infection compared with the non-Hispanic white general community. 

Professor Sebastien Ourselin, senior author from King’s College London said:

“The findings of our study have tremendous impact for healthcare workers and hospitals. The data is clear in revealing that there is still an elevated risk of SARS-CoV-2 infection despite availability of PPE.”
“In particular we note that the BAME community experiences elevated risk of infection and in some cases lack access to adequate PPE, or frequently reuse equipment.” 

Researchers say their study not only shows the importance of adequate availability and use of PPE, but also the crucial need for additional strategies to protect healthcare workers, such as ensuring correct application and removal of PPE and avoiding reuse which was associated with increased risk.  

Differences were also noted in PPE adequacy according to race and ethnicity, with non-Hispanic white health-care workers more frequently reporting reuse of or inadequate access to PPE, even after adjusting for exposure to patients with COVID-19.  

Joined first author Dr. Mark Graham from King’s College London said:

“The work is important in the context of the widely reported higher death rates amongst healthcare workers from BAME backgrounds. Hopefully a better understanding of the factors contributing to these disparities will inform efforts to better protect workers.”  

Dr Claire Steves, lead clinical researcher from King’s College London said:

“I’m very pleased we have now introduced masks and social distancing where possible for all interactions in hospitals – to protect ourselves and the population we serve.  We need to ensure this is reinforced and sustained throughout the health service - including in healthcare settings outside hospitals, for example in care homes. 
“Additional protective strategies are equally as important, such as implementing social distancing among healthcare staff.Stricter protocols for socializing among healthcare staff also need to be considered.” 
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