key: cord-0883125-aobzf7hr
authors: Plaat, F.; Campbell, J.
title: Is spinal anaesthesia an aerosol-generating procedure? Transmission of SARS-CoV-2 from patient to anaesthetist
date: 2020-06-15
journal: Br J Anaesth
DOI: 10.1016/j.bja.2020.06.015
sha: 50912895c7c547028cc5430898d72b82d1b50c12
doc_id: 883125
cord_uid: aobzf7hr

nan

Editor -The recently published study by Zhong and colleagues 1 from Zhongnan Hospital in Wuhan found that 57.1% of anaesthetists who had performed spinal anaesthesia on patients with confirmed COVID-19, wearing a surgical mask, hat, gloves and gown ('Level 1 PPE'), subsequently tested positive for the virus. In contrast, only 2.7% of those wearing fully encapsulating protective suits, two pairs of gloves and using self-contained positive pressure breathing apparatus ('level 3 PPE') became infected. The majority of these patients were women undergoing Caesarean section. Is this evidence that the guidelines on PPE for anaesthetists produced by the Royal College of Anaesthetists in conjunction with the Obstetric Anaesthetists' Association are wrong? 2 This guidance suggests that PPE for aerosol-generating procedures (FFP3 mask, gown, gloves and eye protection but not including the positive pressure breathing apparatus) should be used only if general anaesthesia is planned or there is a chance it will be necessary.

Regional anaesthetic techniques are not classified as aerosol-generating procedures. According to the authors, the anaesthetists had no contact with COVID-19 positive patients 'beyond the operating theatre', and none of the anaesthetists who subsequently tested positive had infected family members. However, at the time of the data collection (beginning of January until middle of February 2020) Wuhan was the epicentre of the COVID-19 outbreak with an estimated 75,815 cases in the city by January 25th and a doubling time of 6.4 days 3 . In addition, the authors stated that a substantial proportion of anaesthetists had symptoms consistent with COVID-19 at the time they administered spinal anaesthesia: 35% had cough, 25% had headache, 22.7% had sore throat and one had fever.

These findings have not been commented on, but they must call into question the authors' conclusion that wearing Level 3 PPE reduces the risk of transmission of COVID-19 to anaesthetic staff during administration of spinal anaesthesia. We were surprised that the anaesthetists with symptoms of COVID-19 were providing clinical care and not self-isolating. We believe that the study does not provide sufficient evidence to change the current guidelines that anaesthetists performing regional anaesthetic techniques, which are non-aerosol generating, can be cared for using Level 1 PPE.

The authors have no conflicts of interest to declare.

Is spinal anaesthesia an aerosol-generating procedure? Transmission of SARS-CoV-2 from patient to anaesthetist

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Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study