The Role of PPE in Healthcare-Related COVID Infection

Data published last week in The Lancet Public Health showed frontline healthcare workers were at a significantly greater risk of coronavirus 2019 (COVID-19) infection, particularly in earliest stages of the virus outbreak in the US and UK.

What’s more, the team observed risks greater among those with worse quality personal protective equipment (PPE), minority backgrounds, or both.

Investigators, led by senior author Andrew Chan, MD, MPH, of Massachusetts General Hospital, conducted an assessment of data from the COVID Symptom Study smartphone app, which requires users provide background information including their age, race, and medical history.

Chan and colleagues conducted their assessment between March 24 and April 23—a full month marked by heightened spread of coronavirus in both the US and UK. The trial enrolled 2.63 million UK participants and more than 182,000 US participants.

COVID-19 was reported in 2747 per 100,000 app users among the frontline workers, versus just 242 per 100,000 app users from the general community. With consideration to differences in healthcare setting testing capability, investigators estimated frontline workers are about 3.4 times more likely to test positive for COVID-19 than the general population.

In a secondary analysis with consideration to user response on PPE use, investigators found frontline healthcare workers who reported to have inadequate PPE were 1.3 times more likely to report a positive COVID-19 test than those with adequate PPE.

Healthcare workers who reported reusing PPE were almost 1.5 times more likely to report a positive COVID-19 test than those with adequate equipment.

The greatest healthcare worker COVID-19 risk was observed in those with confirmed COVID-19 without adequate PPE—at a nearly six-fold greater rate than healthcare workers with adequate PPE who were not exposed to positive patients.

Caring for a COVID-19-confirmed patient was associated with a 5 times greater risk of confirmed infection than those not exposed to such patients—even with adequate PPE.

In a post-hoc analysis, healthcare workers from Black, Asian, and minority ethnic backgrounds reported greater risk of positive COVID-19 tests than non-Hispanic white colleagues.

Even after accounting for medical history and prior conditions, Chan and colleagues observed a nearly five-fold greater risk of COVID-19 positivity in minority healthcare workers than someone from the general community. For non-Hispanic white healthcare workers, the risk was just 3.5 times greater than the general community.

In an interview with Contagion, Chan discussed the value of the study, which helped better define the absolute risk of frontline healthcare worker and immediate COVID-19 patient exposure among caregivers who may not be optimally protected from the virus.

He also discussed how the matter highlights an even greater series of crises in US healthcare: the burdens of limited PPE, and the history of health disparity.

“I think it does highlight that the PPE crisis in our country is really not equally felt, and that there are disparities in PPE access that I think highlight that there are structural inequities in our system,” Chan said. “And I think we need to be conscious of those as we think forward about addressing this problem for healthcare workers, especially those from minority backgrounds.”