To the Editor:
Liu and Fleisher recommend that both patients and healthcare providers wear facemasks to prevent the spread of COVID-19 as a new normal in hospitals.1 We agree, and recommend adding risk stratification of those involved with airway management to mitigate further any transmission or adverse effects of COVID-19 on vulnerable healthcare providers.
Liu and Fleisher noted that the close proximity between patients and healthcare providers combined with the highly transmittable SARS CoV-2 virus places healthcare providers at a high risk of infection, especially those healthcare providers involved in airway management. El-Boghdadly et al. reported that 10% of healthcare providers either tested positive for SARS CoV-2 or were self-isolated due to COVID-19 symptoms within 30 days of performing their first tracheal intubation on a COVID-19 patient.2 To identify healthcare providers most at risk, we used Centers for Disease Control guidance.3
Procedurally, we request SARS CoV-2 testing for patients having elective surgery. For any patients arriving without testing, we determine which are at high risk for being SARS CoV-2–positive. These patients include those with cough, fever, or contact with a COVID-19–positive person, or those coming from nursing homes or prisons. Then we exclude the highest-risk healthcare providers from airway management of these patients or those known to be SARS CoV-2–positive.
We calculate healthcare providers risk using a point scale: 4 points for age >70 yr, immunocompromised, or pregnant; 2 points each for age 60 to 70 yr, diabetes, or medical conditions involving the heart, lungs, and kidneys; and 1 point for age 50 to 60 yr or primary caregiver for a family member at risk or a child under 6 months old. Eleven percent of 149 anesthesia healthcare providers returned surveys of 4 or greater points. Healthcare providers not returning surveys are treated as having scores of 0.
We collected these data through a voluntary survey of all anesthesia healthcare providers. Department members self-identified their risks, with no documentation required. Faculty anesthesiologists returned their surveys to the department chair, residents to the program director and nurse anesthetists to their chief. These department leaders relayed the summary results to the charge anesthesiologists, who use the results to make daily work assignments. We handle data that healthcare providers report as private information, not available outside this small departmental group. Healthcare providers with a summative score of 4 or greater have received no clinical assignments involving airway management of high-risk patients.
This combination of wearing face masks, testing patients, and risk-stratified assignments of healthcare providers has led to no known transmission of COVID-19 within the institution. We plan to study the effects of these mitigation practices over time on worker morale, practice efficiency, and disease prevention, and modify the program as needed. We may also modify our risk calculation scale as more information about COVID-19 accumulates.
Dr. Johnstone’s son-in-law is CEO of Lab Corps, which does COVID-19 testing. He and Lab Corps are not associated with West Virginia University.