key: cord-0780591-2nu25q5x authors: Turner, M. C.; Marshall, S. D. title: Can gendered personal protective equipment design account for high infection rates in female healthcare workers following intubation? date: 2020-07-12 journal: Anaesthesia DOI: 10.1111/anae.15206 sha: 0feee1ba274ac16cc75111a2eb91ecf3799685d7 doc_id: 780591 cord_uid: 2nu25q5x nan As one of the significant findings outlined in the paper, it was surprising to us that this was not given more prominence in the discussion or the infographic associated with the article. Whereas it is clear that this association does not necessarily amount to causation, a hazard ratio of 1.36 (p = 0.04) is substantial enough to compel further exploration. It is unlikely that the finding of increased reporting in women can be attributed to a female predisposition to SARS-CoV-2 infection as this has not been demonstrated elsewhere in the literature. In sex disaggregated data of over 1.3 million cases reported world-wide, there are no marked gender differences in rates of COVID-19 infection in the general population in 18 countries, with an overall rate of 51.2% female [2] . Why then is the post-intubation healthcare worker infection rate so notably skewed towards women? El-Boghdadly et al. propose that 'biological differences' may be a factor in this disparity, without elaborating further. We postulate that one biologically relevant difference could be body habitus and the gendered design of personal protective equipment (PPE). Personal protective equipment has been noted in other sectors, such as mining and engineering, to be designed for the male body shape [3] . It stands to reason that this may also be the case in the health sector, and studies by the Royal College of Nursing and ergonomists are underway to investigate. The COVID-19 outbreak has brought these issues to the attention of the UK media, where anecdotes of sex disparity in the appropriate fit of PPE have been proffered from various NHS sources [4, 5] . Stories abound within healthcare about 'unisex' (for which read: inadequately sized) PPEgowns so large that they drag on the floor and trip up the wearer, gloves that are not available in small enough sizes, visors that are dislodged by breasts when the intubator looks down, and ill-fitting facemasks and goggles that fail to seal when applied to smaller female faces. Such PPE, whereas not being fit for purpose when worn, may also prove more difficult (and therefore more dangerous) to doff. Women comprise over three-quarters of healthcare workers in the UK and many other countries. Failure to adequately protect a large sector of the workforce is ethically unsound, a health and safety issue, and a looming potential class action lawsuit. Urgent research is needed to ascertain the extent of the problem, and immediate action is required to ensure sex equity in PPE provision. Great Ormond Street Hospital for Children, London, UK Email: maryann.turner@gmail.com Monash University, Melbourne, Australia No competing interests declared. Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study COVID-19: Emerging gender data and why it matters Trades Union Congress. Personal protective equipment and women: Guidance for workplace representatives on ensuring it is a safe fit Unions say coronavirus crisis has brought 'into sharp focus' the problem of women being expected to wear PPE designed for men Sexism on the COVID-19 frontline: 'PPE is made for a 6ft 3in rugby player'. Guardian 24