We are not doing enough to protect healthcare workers from COVID-19

Key Research Questions: 1) Among countries who are past their initial peak of COVID-19 cases, what proportion of total cases were in healthcare workers (HCW), and what is the estimated proportion of the total number of HCWs who developed COVID-19 from presumed occupational exposure?2) Is there any evidence that household members of HCWs are at elevated risk of COVID-19 disease, and if so, are there guidelines for mitigating that risk? Key Messages from the Evidence Summary• Alberta based data synthesized from the WHS dashboard indicated a current absolute occupational risk of documented COVID-19 infection in healthcare workers to be 0.01%, with an overall HCW risk of 0.14%, on the basis of detailed case investigation.This is compared with the overall current 0.1% risk in the community in Alberta.The elevated HCW non-occupational risk as compared with the general population may be explained in part by higher rates of testing in the HCW population (15% tested versus 2.9% of the general population tested), and by differences in travel patterns amongst HCWs compared with other populations prior to recognition of the pandemic and the implementation of travel restrictions.• This new AHS surveillance is very valuable, because as yet there is no peer-reviewed published data, from any region within Alberta, reporting the proportion of healthcare workers infected and the mechanisms by which this occurred.The current Alberta data is notable for presenting the population denominators, as well as the outcomes of investigation of whether acquisition of COVID-19 was occupational.The data are also broken down by age and clinical versus non-clinical staffing categories. Context• It is critical to understand the risk of transmission of COVID-19 virus (SARs-CoV-2) to HCWs, to develop evidence informed policies and practices to protect them while performing their work.• This update was issued to include data from a comprehensive Workplace Health and Safety dashboard, as well as any accrued local data pertinent to Alberta, which will track COVID-19 infections and SARS-CoV2 testing in Alberta Health Services (AHS) and Covenant Health and Alberta Precision Laboratories (APL) staff (including clinical, clinical support, and non-clinical staff as well as physicians working within the facilities.• An updated literature review, and partial re-analysis of data from high and low risk countries (using government surveillance data) is provided, and compared with current Alberta data.• In the absence of reliable risk data, the perception of personal COVID19 risk in HCW is at risk of being driven by preferential media reporting of cases in HCWs.This risk perception is substantiated by a recent informal social media based poll of over 500 physicians across Canada which reportedly indicated that 86% felt they had a greater than 50% chance of acquiring COVID19 during the coming months(1).• Detailed assessment and transparent reporting of HCW occupational risks will support HCWs and employers in ensuring appropriate risk reduction strategies are in place.The importance of this may be highlighted during a pandemic. COVID-19 Risk to Healthcare Workers • 3• Calgary has the preponderance of COVID-19 hospitalized cases within Alberta at this time.There has been no evidence of aerosol generating medical procedures as cause for COVID-19 infection on any of the four Calgary "Designated COVID-19" acute care wards (one at each of the four adult acute care hospitals in Calgary).On these wards, interim data reveals that there have been an estimated 5544 person hours of HCW exposure to 132 inpatients, using recommended PPE [gowns, gloves, medical masks, and face shield or goggles in routine care and the addition of N95 respirator for any aerosol generating medical procedures (AGMPs).These data support that the virus is not airborne in the setting described and that precision of execution of IPC precautions and PPE use protects HCWs.