Supporting vulnerable physicians at high risk from COVID-19 during the pandemic: a call for action

Abstract

Because of its high infectivity and risks for devastating sequalae, coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) continues to be a challenge for healthcare workers (HCWs). The potentially overwhelming burden of disease also greatly stresses healthcare system capacity and requires extraordinary organizational planning. Anesthesiologists are particularly vulnerable to the risk of viral transmission that can occur through aerosol and droplet transmission, and less commonly from contaminated surfaces, as was seen in the previous severe acute respiratory syndrome outbreak. Airway management that anesthesiologists and others perform requires close contact with infected patients and risks viral exposure during aerosol-generating medical procedures such as endotracheal intubation and extubation. Initial efforts during the COVID-19 pandemic were largely targeted at organizational planning for infection prevention and control (IPAC) training and availability of personal protective equipment (PPE). Nevertheless, many HCWs have conditions that elevate their risk for severe complications or death if they develop COVID-19. Concrete recommendations addressing these HCW vulnerabilities, and increasing measures for protection, have been lacking. Recommendations from the Government of Canada identifying vulnerable populations were directed at the general population, and did not specifically address protection of HCWs at elevated risk. Vulnerable populations have generally been defined as individuals at risk of more severe COVID-19-related adverse outcomes due to pre-existing conditions including advanced age (i.e., increasing risk with each decade, especially [ 60 yr of age); other chronic medical conditions (e.g., lung disease, heart disease, high blood pressure, diabetes, kidney disease, liver disease, stroke, or dementia); immunocompromised states, including those with an underlying medical condition (e.g., cancer, human immunodeficiency virus infection) or when taking medications that impair the immune system (e.g., chemotherapy, steroids); and obesity (body mass index C 40 kg m. In the United Kingdom (UK), the ‘‘extremely clinically vulnerable’’ were identified as those in the community who have a specific set of conditions, including solid organ transplant recipients, specific cancers, severe respiratory conditions, people with rare diseases at risk of infection, those on certain immunosuppressive therapies, and concomitant pregnancy with immune suppression or heart M. Singh, MBBS MD MSc (&) Department of Anesthesiology and Pain Management, Women’s College Hospital, Toronto, ON, Canada e-mail: [email protected]