Following the very first tape-recorded death of an anesthetist from COVID-19 in the UK in November 2020, an evaluation of readily available information released in Anaesthesia (a journal of the Association of Anaesthetists) reveals that suddenly, in spite of their viewed increased direct exposure to COVID-19 clients and high-risk treatments, anesthetists and extensive care medical professionals seem at lower threat of being contaminated with SARS-CoV-2 and establishing COVID-19.
The analysis was performed by Professor Tim Cook, Consultant in Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK, and School of Medicine, University of Bristol, UK, and Dr Simon Lenanne, General Practitioner, Ross-on-Wye, Herefordshire, UK. The authors carried out the evaluation following the death on November 12, 2020, of anesthetist Dr. Krishnan Subramanian, who was aged 46 years and operated at the Royal Derby Hospital, UK.
“This very sad event is a moment for pause and reflection. Every death is a tragedy, and our first thoughts should be with Dr. Subramanian’s family, friends, and colleagues,” stated the authors.
Reviewing various research studies, the authors state that general, health care employees in patient-facing functions are at 2- to four-fold increased threat of infection and damage from COVID-19. Household members of health care personnel are likewise at increased threat. However, it stays unsure whether operating in a patient-facing health care function substantially increases the threat of death from COVID-19.
“Three separate studies from Oxford, Leicester, and Birmingham and including more than 20,000 healthcare staff indicate that those working in anaesthesia and intensive care had less than half the risk of infection than physicians dealing with COVID-19 patients on the wards. These studies also found significantly higher rates of infection in both front-line nurses and housekeeping staff compared to anesthetists and intensivists,” state the authors. “And in a study of Scottish of hospital admission of healthcare workers, working in ICU was again associated with approximately half the risk of working in ‘front door’ roles. Even household contacts of ‘front door’ healthcare workers had a higher risk of hospital admission than those working in ICU.”
The authors likewise performed an analysis to check out whether deaths of anesthetists were lower than anticipated among the basic population and among health care employees. Using information from The Royal College of Anaesthetists census, NHS Digital, the Office of National Statistics, and their own database of health care employee deaths the authors compared the anticipated and observed variety of deaths among UK anesthetists/intensivists with numerous comparator groups.
Overall deaths among anesthetists and intensivists were disproportionately low — varying in between less than a half to a quarter of anticipated deaths based upon the numbers operating in this speciality. The variety of deaths anticipated amongst anesthetists, based upon representation of anesthetists amongst medical professionals, and COVID-19 associated deaths amongst the basic population would be a number of times greater than the single death tape-recorded up until now (3 or 4 in overall).
The authors discuss: “This analysis indicates that, irrespective of the comparator group used, deaths among anesthetists and intensivists are notably lower than expected and certainly not high, as some would have predicted.”
The authors use a number of possible descriptions for the lower threat observed. These consist of much better individual protective devices or much better usage of it, operating in well-ventilated environments and the possibilities that both the clients who are confessed to ICU are less contagious than those on the wards, which the high threat treatments such as developing a client on a ventilator (consisting of intubation) are not as high threat as has actually been presumed.
The authors state: “This analysis highlights both the relative safety of anesthetists and intensivists from occupational harm from SARS-CoV-2 and the increased risks for others working on the wards, both in clinical and non-clinical roles.”
They conclude: “It is our opinion that those working in anesthesia and critical care should continue with current practices to maintain their own safety and that of their working environment. A more challenging question is whether some of the procedures that appear to keep anesthetists and intensivists safe such as high level protective respirators should be extended to general practice and the wards where other healthcare workers are more at risk.”
Dr Mike Nathanson, President of the Association of Anaesthetists, stated: “The whole profession was saddened to hear of the tragic death of Dr. Krishnan Subramanian. It is reassuring to see that, to date, we have lost no further anesthetists or intensivists to COVID-19 despite their involvement on the front line of battling this pandemic. The death of each healthcare worker has been in our minds, however. This analysis reminds us of the risks, and of factors that may explain why anesthetists and intensivists appear to have so far largely escaped the worst of this illness. We are not complacent, and we will continue to work for the wellbeing of the anesthetists and intensivists we represent.”
Reference: “Occupational COVID‐19 risk for anaesthesia and intensive care staff – low‐risk specialties in a high‐risk setting” by T. M. Cook and S. Lennane, 11 December 2020, Anaesthesia.
DOI: 10.1111/anae.15358
