Modern Australian

why health-care workers in Australia are inadequately protected against coronavirus

  • Written by Alicia Dennis, Associate Professor MBBS, PhD, MPH, PGDipEcho, FANZCA, University of Melbourne

In Victoria, more than 1,100 health-care workers have now been infected with SARS-CoV-2, the coronavirus that causes COVID-19. Some 11% of active cases are workers in the health-care sector.

Health-care workers are reported to be among those fighting for life in Victorian intensive care units.

While we don’t know what proportion of the Victorian health-care workers currently infected with COVID-19 acquired it at work rather than in the community, it’s almost certain a portion of these infections were contracted in the workplace.

Early experience from China found the proportion of health-care workers who contract COVID-19 can be up to 29% in settings with inadequate personal protective equipment, or PPE.

Lessons from China also show workplace transmission of SARS-CoV-2 can be reduced to negligible numbers with sufficient supply, and correct use of, airborne precaution PPE.

Right now, Australia is sitting somewhere in the middle. National guidance needs to be urgently updated to reflect safest practice and acknowledge what we’re learning about the airborne spread of the virus.

Read more: Supplies needed for coronavirus healthcare workers: 89 million masks, 30 million gowns, 2.9 million litres of hand sanitiser. A month.

What is PPE?

PPE is a crucial part of controlling exposure to hazards in all workplaces.

It includes items such as masks, respirators, face shields, gowns and gloves.

PPE is categorised into three tiers, corresponding to the type of hazard.

Level 1: standard and contact precaution PPE

This PPE limits exposure to standard contact hazards. Examples include face coverings and administrative controls such as hand hygiene, cough etiquette and physical distancing.

Level 2: droplet precaution PPE

This PPE prevents exposure to contact and droplet hazards. Examples include surgical masks, eye shields or goggles, long-sleeved gowns, and gloves.

Level 3: airborne precaution PPE

This PPE aims to prevent exposure to contact, droplet and airborne hazards. It includes N95/P2 respirators or powered air-purifying respirators with a P2 filter, eye shields or goggles, fluid-resistant gowns, double gloves, disposable head and neck wear, and protective footwear.

Construction worker wears fluorescent vest, mask and hat. We’ve heard a lot about PPE in the context of coronavirus. But PPE isn’t just for health-care settings. Shutterstock

Current Australian guidelines

The national guidance on the use of PPE in hospitals during the COVID-19 outbreak has been written by the Infection Control Expert Group and endorsed by the Australian Health Protection Principal Committee.

The guidance doesn’t recommend universal airborne precaution PPE for health-care workers dealing with patients suspected or confirmed to have COVID-19. It only recommends level 3 protection for highly specialised procedures such as intubating a patient.

Read more: Is the airborne route a major source of coronavirus transmission?

A preprint in the Medical Journal of Australia has criticised the current guidance, noting it’s not aligned with increasing scientific evidence regarding airborne transmission of SARS-CoV-2 and is therefore inadequate to protect health-care workers.

Inadequate national guidance has led to an inconsistent and non-standardised approach to airborne precaution PPE across all health-care settings.

In the absence of strong national safety guidance, some hospitals and jurisdictions are making independent improved safety recommendations to their staff.

Why we need level 3

Transmission of SARS-CoV-2 occurs by direct contact with droplets and contaminated surfaces — but emerging data suggests it can also be spread by the airborne route.

An analysis of health-care worker deaths in the United Kingdom found none among wearers of level 3 PPE, suggesting airborne precaution PPE was protective.

why health-care workers in Australia are inadequately protected against coronavirus Surgical masks don’t offer as much protection against COVID-19 as respirator masks. Shutterstock

Importantly, surgical masks are primarily designed to protect the environment from the wearer. They’re not designed to protect the wearer from respiratory pathogens.

A recent review found N95 respirators offered significantly better protection against viruses including COVID-19 than surgical face masks, while one study found N95 respirators provided 8-12 times more protection than surgical masks against small viral particles.

Read more: Rising coronavirus cases among Victorian health workers could threaten our pandemic response

In Australia, N95 is synonymous with P2 respiratory protection and refers to the filtration efficiency (so N95 means 95% of particles are filtered). But it’s the total inward leakage — what goes through and around the facemask — that’s the critical factor in determining the level of protection the wearer achieves.

To ensure total inward leakage is minimised, respiratory masks used under level 3 PPE must meet certain standards, including fit testing and the training of wearers in their use.

We need immediate action

SARS-CoV-2 is a highly contagious virus with the potential to cause significant ill health and death. In health-care settings, it should be classified as a lethal biohazard and managed accordingly.

The safest approach is to consider all people with confirmed or suspected COVID-19 in hospital, being transported to hospital or being tested for COVID-19 as being able to spread the virus via the airborne route. As such, the use of airborne precaution PPE with a correctly fitted N95/P2 respirator is essential.

Read more: Health-care workers share our trauma during the coronavirus pandemic – on top of their own

There’s also an urgent need for a national registry of health-care worker infections, containing data about the category of health-care worker, where the infection was acquired, severity of disease, hospitalisation, intensive care and death numbers.

This will give us a better understanding of the scope and specifics of the problem, and inform policy and prevention strategies.

Finally, adequate supply of airborne precaution PPE must be available throughout Australia to protect health-care workers from COVID-19.

Authors: Alicia Dennis, Associate Professor MBBS, PhD, MPH, PGDipEcho, FANZCA, University of Melbourne

Read more


Each budget used to have a gender impact statement. We need it back, especially now

Jeremy Dorrough/UpshotCOVID-19 has left women, more than men, economically disadvantaged through unemployment, underemployment, lowered incomes, less secure work, greater household and family demands, and increased risk of domestic violence.But you’re...

The budget must address aged care — here are 3 key priorities

Australia’s aged care system has produced a litany of failures: unpalatable food, poor care, neglect, abuse and, most recently, the tragedies of the pandemic.This should not come as a surprise...

Have our governments become too powerful during COVID-19?

Dean Lewins/AAPIn the fight against the coronavirus, the Australian government has enacted a series of measures that have expanded executive powers. These include the use of smartphone contact-tracing technology, mandatory...

a love letter to our iconic flowers

ShutterstockSpring has arrived, and all over the country the hills and riversides are burnished with the green and gold of Australian wattles, all belonging to the genus Acacia. It’s a...

New tricks? When COVID forces a bridge club online, what becomes of their community?

ShutterstockPhysical distancing measures during the first COVID-19 outbreak led to the closure of libraries, theatres, gyms, cafes and community centres across Australia. Venues like these are known as “third places”...

the Persian polymath who shaped modern science, medicine and philosophy

A miniature of Avicenna.Wikimedia CommonsOver a thousand years ago, Nuh ibn Mansur, the reigning prince of the medieval city of Bukhara, fell badly ill. The doctors, unable to do anything...

5 ways school libraries support student well-being

ShutterstockStudents in Australia and around the world have experienced significant challenges this year, including the COVID-19 pandemic and natural disasters. Globally, as many as one in five young people may...

Australia's biggest corporate fine isn't the end of it for Westpac

Paying a record A$1.3 billion fine for breaches of the Anti-Money Laundering and Counter-Terrorism Financing Act is one thing, making sure it couldn’t happen again is another.The fine agreed to...

could our entire reality be part of a simulation created by some other beings?

Unsplash, CC BY-SAIs it possible the whole observable universe is just a thing kept in a container, in a room where there are some other extraterrestrial beings much bigger than...

are consumers willing to pay more for climate-friendly products?

Shutterstock/Alliance ImagesCC BY-NDClimate Explained is a collaboration between The Conversation, Stuff and the New Zealand Science Media Centre to answer your questions about climate change.If you have a question you’d...

Wellington’s older houses don’t deserve blanket protection — but 6-storey buildings aren’t always the answer

www.shutterstock.comThe proposed blueprint for how Wellington will develop over the next 30 years puts its finger straight on one of the key issues affecting urban growth and change: residential character...

Faster public health response might have saved some aged care residents' lives: Brendan Murphy

Federal Health Department Secretary Brendan Murphy has admitted some COVID deaths in aged care might have been prevented if there had been a quicker public health response.Murphy, Chief Medical Officer...

News Company Media Core

Content & Technology Connecting Global Audiences

More Information - Less Opinion

Popular articles from Modern Australian

6 Stunning Ways to Spruce Up Your HouseHome renovations in hot climatesThree of the best detective games for mystery loversAuto Wrecker in NewcastleExperience the Excitement of a Day at the Races How Do You Know If You Need A Hearing Aid?Fitness Tips: 3 Ways to Stay in Shape At HomeWear a Mask and protect yourself in StyleWellness expert:  Cutting up your fruit cuts the goodness out of themRegain Your Natural Smile Getting Porcelain Crowns in MelbourneIs Photography Still Important In 2020?Thinking of Hiring a Boat? Check these Facts FirstDo You Know that Certain Serious Athletic Injuries Can Turn into Medical Malpractice?Most In-Demand Suburbs for Property Buyers in Australia Post Covid-19What Is Selective High School?