Risk Stratification for Healthcare workers during the CoViD-19 Pandemic; using demographics, co-morbid disease and clinical domain in order to assign clinical duties

Abstract

Background: Healthcare workers have a greater exposure to individuals with confirmed SARS-novel coronavirus 2, and thus a higher probability of contracting corona virus disease (CoViD)-19, than the general population. It is critically important, therefore, for health systems to protect the lives of their staff especially those on the frontline. Urgent work is needed to identify how best to protect those most at risk in an evidence-based way in order to implement protective allocations. We wished to explore the predictive role of basic demographics in order to establish a simple tool that could help risk stratify healthcare workers. Objectives and Study question: To develop a risk stratification tool for use to assist staff allocation by examining reported demographics of hospitalisation and mortality in the UK from CoViD-19 compared to population demographics and historic admissions for viral pneumoniae. Setting: Secondary Care in the UK and worldwide. Participants: Patients and Health Care Professionals hospitalised and dying of CoViD-19. Methods: We undertook a review of the published literature (including multiple search strategies in MEDLINE with PubMed interface) and critically assessed early reports on medRxiv, a pre-print server (https://www.medrxiv.org/) (date of last search: April 30, 2020). We explored the relative risk of mortality from readily available demographics in order to identify the population at highest risk. Results: The only published studies specifically assessing the risk of healthcare workers had limited demographics available, therefore we explored the general population in the literature. Clinician Demographics. Mortality increased with increasing age from 50 years onwards. Male sex at birth, people of black and minority ethnicity groups had higher susceptibility to both hospitalisation and mortality. Co-morbid Disease. Vascular disease, diabetes and chronic pulmonary disease further increased risk. Those with pre-existing mental health issues may also be more likely to experience emotional trauma, depression and anxiety with consequences for self-harm too. Risk stratification tool. A risk stratification tool was compiled using a Caucasian female <50years with no comorbidities as a reference. A point allocated to risk factors associated with an approximate doubling in risk. This tool provides numerical support for healthcare workers when determining which team members should be allocated to patient facing clinical duties compared to remote supportive roles. Clinical Domain. Those working with aerosol generating procedures were at increased risk, however healthcare workers in any clinical domain are at higher risk than the general population. Conclusions. We have generated a tool which can provide a framework for objective risk stratification of doctors and health care professionals during the CoViD-19 pandemic.