Perspectives on personal protective equipment in acute care facilities during the COVID-19 pandemic

Ng-Kamstra et al.(1) provide two references(2,3) to support their conclusion that, despite “complex and extensive” protective measures, “thousands of health care workers acquired the virus” in China. They then go to imply that such protective measures would not be effective if adopted in Canada. One of the two references(3) describes the difficulties experienced during the early stages of the pandemic in China; the other(2) actually reports success in preventing Chinese HCW infections - quite the opposite of Ng-Kamstra et al.’s characterization.

Specifically, Wang et al.(3) report that by February 24 there were 2,055 HCWs infected comprising 2.6% of all confirmed infections in China. Most of these infections occurred between January 18 – February 5. Wang et al. attributed the early infections to inadequate personal protection, intense workloads and extended shifts, shortages of personal protective equipment, and inadequate training. On January 20th the Chinese government designated the level of protective measures to control the SARS-CoV-2 virus as those prescribed for a Class A infectious disease (i.e. cholera and plague), even though COVID-19 was classified as a Class B infectious disease(4). A later report(5) put the confirmed number of HCW infections at 2,457 workers (3% of all confirmed cases up to March 26) including 17 deaths.

The protective measures listed in the Handbook(2) which Ng-Kamstra et al. characterized as being “complex and extensive”, are credited in the Foreword as preventing any of the HCWs (who worked in the institution that produced the Handbook) from being infected.

From January 24 to March 8 the government of China recruited 42,600 HCWs to assist the 100,000+ HCWs in Hubei province. These HCWs used the protective measures similar to those described in the Handbook. A number of publications report that, as of April 16 (when the last recruits finished their work in Hubei), none of those HCWs had been infected. (5)

It is instructive to contrast the Chinese experience with that of Ontario. At present (data as of July 29) 6,438 HCWs have been infected comprising 16.5% of the confirmed COVID-19 cases9 in Ontario – many more “thousands of healthcare workers” than were infected in China.

Clearly the HCW infection experience has been worse in Ontario and, contrary to Ng-Kamstra et al.’s assessment, Canadians have a lot to learn from the Chinese experience.