The authors say that health-care systems should ensure adequate availability of PPE and develop additional strategies to protect health-care workers from COVID-19, particularly those from Black, Asian, and minority ethnic backgrounds Frontline healthcare workers may have substantially higher risk of reporting a positive test for COVID-19 than people from the general population, according to an observational study of almost 100,000 healthcare workers in the UK and USA published today in The Lancet Public Health journal.
The study, based on self-reported data from users of the COVID Symptom Study smartphone app between 24 March and 23 April 2020, found the prevalence of COVID-19 was 2,747 per 100,000 app users among frontline care workers compared with 242 per 100,000 app users from the general community. After accounting for differences in testing for healthcare workers compared with the general community, the researchers estimate frontline workers are around 3.4 times more likely to test positive for COVID-19.
Professor Andrew Chan, senior author, from Massachusetts General Hospital, USA, said: "Previous reports from public health authorities suggest that around 10-20% of COVID-19 infections occur among health workers. Our study provides a more precise assessment of the magnitude of increased infection risk among healthcare workers compared to the general community. Many countries, including the US, continue to face vexing shortages of PPE. Our results underscore the importance of providing adequate access to PPE and also suggest that systemic racism associated with inequalities to access to PPE likely contribute to the disproportionate risk of infection among minority frontline healthcare workers." [1]
Gloves, gowns, and face masks are recommended for those caring for COVID-19 patients, but surging demand and supply chain disruptions have resulted in global shortages. Some areas have attempted to conserve PPE by reusing items or using them for longer periods of time, but data on the safety of such practices is scarce.
The latest study is based on data collected from the COVID Symptom Study smartphone app between 24 March and 23 April 2020. App users were asked to provide background information about themselves, such as age, race and whether they already have any medical conditions.
Participants were also asked if they worked in health care and, if yes, whether they had direct patient contact in their job. For the purposes of the study, frontline healthcare workers were defined as participants with direct patient contact, and this group was further subdivided according to whether they cared for patients with suspected or confirmed COVID-19 and the frequency with which they used PPE (always, sometimes, never). They were also asked to report if they had enough PPE when needed, if they had to reuse PPE, or if they did not have enough because of shortages. In addition, they were asked if they worked in inpatient care, nursing home, outpatient, home health, ambulatory clinic, or other, but they were not asked to give their specific role.
All participants were asked if they felt physically well at the outset of the study and again with daily reminders. If they reported not feeling well, they were asked about their symptoms. They were also asked if they had been tested for COVID-19 and what the result had been.
Some 2.6 million people from the UK (2,627,695) and 182,408 people from the USA were enrolled in the study. The researchers excluded 670,298 people who used the app for less than 24 hours and 4,615 people who tested positive for COVID-19 at the outset. This left 2,135,190 participants, of whom 99,795 people identified themselves as frontline healthcare workers. The participants reported symptoms for an average of 19 days.
Of those included in the study, there were 5,545 reports of a positive COVID-19 test over 34 435 272 person-days [2].
In secondary analyses, after accounting for pre-existing medical conditions, frontline healthcare workers who reported having inadequate PPE were 1.3 times more likely to report a positive COVID-19 test than those who said they had adequate equipment to protect themselves (inadequate PPE: 157 positive COVID-19 tests in 60,916 person days; adequate PPE: 592 ...
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