By Stephanie Stephens

Frontline healthcare workers are at increased risk of reporting a positive COVID-19 test.

It's scientific confirmation of what may seem obvious to many. American and British authors of a new report in The Lancet Public Health said that few studies exist to inform policymakers about risk among healthcare workers and the effect of personal protective equipment (PPE) on disease burden—topics frequently discussed. These workers are approximately 3.4 times more likely to test positive, they said.

Previous studies have suggested that between 10 and 20 percent of infections occur among healthcare workers.

The new study was based on cross-sectional data with limited information on individual-level risk factors, the authors wrote, adding that they found no population-scale investigations during their search. It combined researchers from Harvard Medical School and King's College London.

Both mask use and PPE are needed to reduce transmission, but efforts such as extended use or reuse, or disinfection protocols to conserve PPE due to shortages, offer little in the way of scientific consensus on best practice, they added.

Even PPE Doesn't Reduce All Risk

The prospective, observational cohort study looked at more than 2 million people and included almost 100,000 frontline workers, and it recorded 5,545 positive COVID-19 tests. Data was self-reported from the COVID-19 Symptom Study smartphone app accumulated between March 24 (UK) and March 29 (US) to April 23, acknowledged to be around pandemic "peak" time.

"We noted that frontline healthcare workers had at least a threefold increased risk of reporting a positive COVID-19 test and predicted COVID-19 infection, compared with the general community, even after accounting for other risk factors," said the authors.

Frontliners in inpatient settings, sites of reported PPE reuse, and nursing homes, sites of reported PPE shortages, had the greatest risk—but even adequate PPE didn't completely eliminate risk.

One finding of note: Higher risk was reported among Blacks, Asians, and minorities with direct contact with COVID-19 patients, who also reported they had inadequate PPE or had to reuse it. Their risk of testing positive was almost twice that of white healthcare workers, and the study found the risk of a positive test to be at least three times greater than that of the general public.

The authors cited limitations of shortened details for some exposures due to the need for survey brevity; self-reported findings; and a cohort that wasn't a random sampling of the population, and said that future studies would reflect a greater targeted outreach of under-represented populations.

Case and Death Counts Sketchy

When it comes to how many COVID-19 cases and deaths have occurred among healthcare workers, the water gets muddy.

For example, the Centers for Disease Control and Prevention (CDC) reported 600 deaths among healthcare workers out of 124,813 cases thus far, adding that of all the cases reported, death status was available for only 68.4 percent. The WHO says it believes 10 percent of all cases globally are healthcare workers.

Two other different sets of statistics were cited: The Centers for Medicare and Medicaid Services with at least 767 deaths among nursing home staff, and National Nurses United, with at least 1,289 deaths among all healthcare workers.

Neither the CDC nor the Department of Health and Human Services responded to the investigative publication's questions about data and deaths.

As a Lancet Public Health opinion comment reiterated, "If we are ever to outpace COVID-19, there must be accountability at every level, from the community to top government officials. By combining a centralized mechanism for supply chain oversight, with universal masking and data transparency at local levels, it is possible to afford healthcare workers the protection they deserve."