Thread by @doctimcook

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio This is an interesting take.
To be clear, every harm or death of a healthcare worker from COVID is a tragedy

However despite anaesthetists/intensivists proximity to the airway it's far from clear that this raises risk of death compared to other HCWs
…-publications.onlinelibrary.wiley.com/doi/10.1111/an…

1/n

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio Rather than emphasising increased risk the editorial by @emirakur with @DrSimonLennane highlighted the international evidence showing lower than expected mortality among anaesthetists/intensivists and our co-workers
…-publications.onlinelibrary.wiley.com/doi/full/10.11…

2/n

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane Three analyses of HCW deaths were published in the @HSJnews

They're all here
hsj.co.uk/tim-cook/30082…

The notable findings were
- a marked excess of deaths in non-white frontline staff
- the absence of impact on anaesthesia/ICM

3/n

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane @HSJnews In the first published in April
Among 106 health and social care staff deaths
- 63% non-white (vs 21% of workforce)
- 94% docs non-white (vs 44%)
- zero anaesthesia/ICM staff (despite 14% of all hospital docs)

4/n
hsj.co.uk/exclusive-deat…

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane @HSJnews Updated in May
166 UK HCW deaths.... still
-63% non-white (vs 21% of workforce)
-94% docs non-white (vs 44%)
-zero anaesthesia/ICM docs (despite 14% of all hospital docs)
-One ICM nurse sadly died

5/n
hsj.co.uk/workforce/at-l…

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane @HSJnews In terms of infection risk its harder to see the clear picture

@IntubateCovid reports 10% of COVID intubators report COVID symptoms w/in 21d
-but only 1.5% PCVR +ve w/in 14d
-no comparator group that didn't intubate
-shows association not causality

6/n
…-publications.onlinelibrary.wiley.com/doi/full/10.11…

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane @HSJnews @IntubateCovid A series of surveillance studies show lower risk for anaesthesia/ICM vs other specialties or hospital staff

Oxford study n >10,000 shows anaesthesia lower and ICM lower risk

medrxiv.org/content/10.110…
7/n

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane @HSJnews @IntubateCovid SAFER study - UCLH
Shows ICM lowest incidence of PCR+ve or sero+ve amongst medics
medrxiv.org/content/10.110…

8/n

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane @HSJnews @IntubateCovid Recent Birmingham study
Housekeeper 7 ward medics 2x risk of ICM
thorax.bmj.com/content/thorax…
9/n

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane @HSJnews @IntubateCovid so.....
-anaesthesia/ICM are probably doing something right
-and, importantly, should continue

Big questions are
-why is risk low?
-should ward staff be replicating ICU precautions (eg wearing airborne PPE or at least FFP3 masks w/in 2m of patient)?

10/n

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane @HSJnews As an aside
Here is the distribution of medical deaths by specialty

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane @HSJnews @IntubateCovid ...and of course hospital workers as a group are clearly at increased risk of SARS-CoV-2 exposure by dint of their jobs

11/n

@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane @HSJnews @IntubateCovid So we need to keep hospitals safe from COVID
to protect staff & patients

We should risk assess based: individual risk, occupational risk & mitigation
Amongst HCWs & with current precautions anaesthesia/ICM does not seem to be an increased risk.

…-publications.onlinelibrary.wiley.com/doi/10.1111/an…

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