Frontline healthcare workers in US, UK three times more likely to test positive for Covid-19 despite PPE: Study
Frontline healthcare workers have at least a three-fold increased risk of testing positive for Covid-19 even with adequate Personal {rotective Equipment (PPE) when compared to the general population, even after accounting for other risk factors. Those with inadequate PPE among healthcare personnel had a further increase in risk, according to a study, which was conducted by a team of researchers from Massachusetts General Hospital (MGH), King's College London, Harvard
Medical School and Harvard TH Chan School of Public Health, among others.
The study also found that healthcare workers from Black, Asian, and minority ethnic (BAME) backgrounds were more likely to test positive. The authors recommend that healthcare systems should ensure adequate availability of PPE and develop additional strategies to protect healthcare workers from Covid-19, particularly those from Black, Asian and minority ethnic backgrounds.
Using the Covid-19 symptom study smartphone application, the authors looked at data from 2,035,395 individuals and 99,795 frontline healthcare workers in the US and the UK. The prevalence of Covid-19 was 2,747 cases per 100,000 frontline health-care workers compared to 242 cases per 100,000 people in the general community. In the US, the highest infection rates were reported in New York, New Jersey and Los Angeles while the UK reported the same in areas around London and the Midlands.
A little over 20% of frontline healthcare workers reported at least one symptom associated with coronavirus infection compared to 14.4% of the general population — fatigue, loss of smell or taste and hoarse voice were especially frequent. According to the analysis, BAME (Black, Asian and Minority Ethnic) healthcare workers were at an especially high risk of Covid-19 infection, with at least a five-fold increased risk of infection compared to the non-Hispanic White general community.
While frontline healthcare workers, who reported inadequate availability of PPE such as masks, gloves and gowns, had an especially elevated risk, the study shows that adequate availability of PPE did not seem to completely reduce risk among healthcare workers caring for patients with Covid-19. Frontline healthcare workers who worked in inpatient settings (where providers most frequently reported PPE reuse) and nursing homes (where providers most frequently reported inadequate PPE) had the greatest risk.
Differences were also observed in PPE adequacy according to race and ethnicity, with non- Hispanic White healthcare workers more frequently reporting reuse of or inadequate access to PPE, even after adjusting for exposure to patients with Covid-19. "Overall, frontline healthcare workers had at least a three-fold increased risk of Covid-19, after accounting for differences in testing frequency between frontline healthcare workers and the general community. Black, Asian, and minority ethnic healthcare workers appeared to be disproportionately affected," says the study published in The Lancet Public Health.
The analysis shows that 5,545 new reports of a positive Covid-19 test were reported by those who used the app between March 24 and April 23. “We recorded 5,545 incident reports of positive Covid-19 testing over 34,435,272 person-days. In the UK, 1.1% of healthcare workers reported being tested compared with 0.2% of the general community (healthcare workers to community testing ratio 5.5), whereas 4.1% of US healthcare workers were tested versus 1·1% of the general community (testing ratio 3.7),” the findings state.
According to Professor Sebastien Ourselin, senior author from King's College London, the findings have a tremendous impact on healthcare workers and hospitals. "The data is clear in revealing that there is still an elevated risk of SARS-CoV-2 infection despite the availability of PPE. In particular, we note that the BAME community experiences elevated risk of infection and in some cases lacks access to adequate PPE, or frequently reuse equipment," Ourselin tells MEA WorldWide (MEAWW).
"Although it is clear that healthcare workers on the front line of the fight against COVID-19 have an increased risk of infection, our country continues 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," says senior author Dr Andrew T. Chan, chief of the Clinical and Translational Epidemiology Unit at MGH and director of Cancer Epidemiology at the MGH Cancer Center.
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. “The work is important in the context of the widely reported higher death rates among healthcare workers from BAME backgrounds. Hopefully, a better understanding of the factors contributing to these disparities will inform efforts to better protect workers,” says joint first author Dr Mark Graham from King's College London.
The findings also underscore the possibility for healthcare workers to perpetuate infections or contribute to community spread, particularly when asymptomatic or mildly symptomatic, and justify calls to increase testing to reduce hospital-based transmission, says the team. "Further intervention studies investigating modifiable risk factors for healthcare worker-related Covid-19 infection, ideally accounting for differential exposure according to race and ethnic background and care location, are urgently needed to support our observational findings," the authors recommend.