Kendrick et al1 discuss the missed opportunities to protect the primary care workforce from exposure to SARS-CoV-2, such as: personal protective equipment (PPE) shortages; Public Health England (PHE) following World Health Organization interim guidance, which advocated that healthcare workers (HCWs) use fluid-resistant surgical masks (FRSM); and filtering facepiece respirators (FFP) being restricted to HCWs performing aerosol-generating procedures (AGPs). Royal College of General Practitioners (RCGP) guidance issued in March 2020 reflects the PHE position and states, ‘droplet and faecal spread seem to be the primary forms of transmission of coronaviruses’ and that it is not anticipated that FFPs ‘will be needed in most general practice situations’.2 However, FRSM only protect against splashes or large droplets of body fluids; unlike FFP, they do not prevent inhalation of aerosols.3 Kendrick and others note current evidence that, like other respiratory viruses, SARSCoV-2 is transmitted by aerosols1,4 and over distances exceeding 2 m; the SARS-CoV-2 therein remaining infectious for hours.3
An editorial published in an occupational medicine journal supports the view that: 1) underestimating the risk of aerosol transmission; and 2) inadequate supplies of FFPs left many HCWs inadequately protected against inhaling aerosols containing SARSCoV-2.3 Reviewed studies demonstrated that: 1) hospital patients, visitors, and HCWs were at increased risk of infection; 2) seropositivity was higher among staff working in supposedly low-risk areas; and 3) HCWs who perform AGPs or work in ICUs were protected, with lower prevalence of infections being attributed to better air exchange rates and provision of FFPs.3 This evidence together with higher infectivity around the time of symptom onset and the emergence of readily transmitted variants warrant that RCGP guidance should be reviewed and updated as a matter of priority. Practices should review their risk assessments and controls for managing airborne exposures. Practices must also consider personal susceptibility5 and ensure that individual HCW clinical vulnerability (personal risk factors such as age, ethnicity, sex, health, and immune status) is assessed so that each HCW is provided with the correct PPE that recognises both workplace and personal risks.
Competing interests
Paul J Nicholson is co-author of the editorial cited as reference 3.
REFERENCES
- 1.Kendrick D, Agius RM, Robertson JFR, et al. Was enough, and is enough, being done to protect the primary care workforce from COVID-19? Br J Gen Pract. 2021 doi: 10.3399/bjgp21X714953. [DOI] [PMC free article] [PubMed]
- 2.Royal College of General Practitioners COVID-19 — GP guide personal protective equipment. 2020 https://www.rcgp.org.uk/about-us/rcgp-blog/covid-19-gp-guide-personal-protective-equipment (accessed 16 Apr 2021).
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