What risk do aerosol‐generating procedures pose to health‐care workers?

• Published in: Journal of Paediatrics and Child Health Vol. 56; no. 10; pp. 1639 - 1640
• Main Authors: Ross, Kirsty A, Almuzam, Sulaiman, Britton, Philip N, Howard‐Jones, Annaleise R, Isaacs, David, Kesson, Alison, Nayda, Claire
• Format: Journal Article Web Resource
• Language: English
• Published: Australia John Wiley & Sons Australia, Ltd 01.10.2020; John Wiley & Sons, Inc; Blackwell Publishing Ltd
• Subjects: Aerosols; Health Personnel; Human exposure; Humans; Infectious Disease Transmission, Patient-to-Professional; Medical personnel; Occupational health
• ISSN: 1034-4810; 1440-1754
• DOI: 10.1111/jpc.15127

Definitive transmission data on SARS‐CoV‐2 is still accumulating, but its behaviour under experimental conditions has similarities to SARS‐CoV‐1.3 Community transmission parameters are also comparable to other droplet‐based respiratory viruses. [...]data on transmission dynamics of SARS‐CoV‐1 may be reasonably extrapolated to SARS‐CoV‐2, whilst awaiting robust studies on the latter. A systematic review suggested that certain procedures capable of generating aerosols were associated with an increased risk of SARS‐CoV‐1 transmission from infected patients to HCWs.4 The review did not, however, enable authors to conclude with certainty that HCWs caring for patients undergoing AGPs were at higher risk of contracting infection compared to those caring for patients not undergoing AGPs.4 While there remains a gap in evidence on the infectivity of SARS‐CoV‐2 associated with AGP's, there are case reports that support limited airborne transmission and experimental evidence that supports similar aerosol characteristics between SARS‐CoV‐1 and SARS‐CoV‐2.3, 5, 6 COVID‐19 During the current pandemic there are some reassuring early observations. Small studies from Italy, Singapore and the UK show either no transmission of disease to HCWs wearing PPE (despite performing AGPs on infected patients) or no increased risk of transmission of infection to HCWs performing AGPs compared to HCWs with no patient contact.9, 11, 12 Transmission Dynamics in the Health‐care Setting Data from the 2003 SARS epidemic demonstrated that – with appropriate use of PPE, patient risk stratification and re‐organisation of workflow processes where AGPs were performed – risk of transmission of infection to HCWs was low.13 Available information, including a systematic review and meta‐analysis by Chu et al., suggests that the current systems, processes, PPE and training implemented in our workplace settings are effective at protecting HCWs from SARS‐CoV‐2.1, 14, 15 The notion that viral shedding of SARS‐CoV‐2 may peak at or just prior to symptom onset and the observation that hospital care tends to be needed a week or so into symptomatic disease suggests that hospitalised patients undergoing AGP's may not be the cohort of patients that pose the greatest risk in the health‐care setting.16 AGPs aside, based on current published information, it appears that the rate of HCW workplace acquisition of SARS‐CoV‐2 is no greater than the HCW community acquisition. First experience of COVID‐19 screening of health‐care workers in England.