Risk to health from COVID-19 for anaesthetists and intensivists - a narrative review

Healthcare workers are at an increased risk of infection, harm and death from COVID-19. Close and prolonged exposure to individuals infectious with SARS-CoV-2 leads to infection. A person's individual characteristics (age, sex, ethnicity and comorbidities) then influence the subsequent risk of COVID-19 leading to hospitalisation, critical care admission or death. While relative risk is often reported as a measure of individual danger, absolute risk is more important and dynamic, particularly in the healthcare setting. Individual risk interacts with exposure and environmental risk-factors, and the extent of mitigation to determine overall risk. Hospitals are a unique environment in which there is a significantly increased risk of infection for all healthcare workers. Anaesthetists and intensivists particularly are at high risk of exposure to SARS-CoV-2 infected patients due to their working environments and exposure to certain patient groups. However, the available evidence suggests that the risk for this group of individuals is not currently increased. This review examines factors associated with increased risk of infection with SARS-CoV-2, increasing severity of COVID-19 and death. A risk tool is proposed that includes personal, environmental and mitigating factors, and enables an individualised dynamic 'point-of-time' risk assessment.