key: cord-0919329-jwwazskv
authors: Begley, J. L.; Brazil, V.
title: Assessing the risk of nosocomial infection posed by COVID‐19 tracheal intubation: the first intubateCOVID results
date: 2020-07-22
journal: Anaesthesia
DOI: 10.1111/anae.15219
sha: 5296405083f6b4278102541db66dcfa1e54d9d78
doc_id: 919329
cord_uid: jwwazskv

nan

need to self-isolate due to respiratory symptoms) is pragmatic and reflects the actual impact of absence on the hospital workforce. However, many readers would be more interested in knowing to what extent performing tracheal intubation directly exposes them to the risk of contracting COVID-19. Our discussions with colleagues suggest that many have inferred a high risk of infection from this study, although the authors did not make this claim.

If the risk of contracting the virus were associated with performing tracheal intubation per se, we would expect to see certain signals in the data, which we did not.

Specifically:

• If the virus was contracted during tracheal intubation, we would expect to see a peak of onset at around 5 days with a significant reduction in new cases after 12 days, consistent with the known incubation period [2] ; however, no such distribution was seen (their Fig. 4 ),

• There was no increase in risk associated with the absence of personal protective equipment (PPE) (their Table 2 ),

• There was no increase in risk associated with intubating a patient's trachea with confirmed COVID-19 vs. a patient with merely suspected disease (their Table 4 ), and • There was no association between the number of tracheal intubations performed and the primary outcome (their Supplementary Fig. S1 ).

Additionally, we would expect to see the infection rate of participants being significantly higher than other clinicians working in similar parts of the hospital. At this stage, there is not a sufficient pool of data against which to make this comparison, but it is possible that the infection rate among participants is no higher than in the general hospital workforce [3] , or indeed a community's other essential workers [4] . While pragmatic from a workforce- We conclude that it is unlikely a significant proportion of the primary outcome cases were caused by performing tracheal intubation. If any conclusion is to be drawn from this study regarding nosocomial transmission during tracheal intubation, we suggest the results are reassuring that the current approach to airway management in COVID-19 appears to be safe for clinicians.

Cabrini Hospital, Malvern, Australia Email: begley@doctorbegley.com.au

Bond University, Gold Coast, Australia

No competing interests declared.

Risks to healthcare workers following tracheal intubation of patients with COVID-19: a prospective international multicentre cohort study

The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application

©2020 Association of Anaesthetists

COVID-19: PCR screening of asymptomatic health-care workers at London hospital

The plight of essential workers during the COVID-19 pandemic