BOHS advises workplace health professionals that healthcare and education workers need better RPE amid concerns over mutant COVID-19 risks.

Surveillance on mutations occurring in the COVID-19 virus has reported a number of mutations. Data – COG-UK Consortium. Over recent weeks, there has been particular concern over a UK mutation (VUI-202012/01-the first “Variant Under Investigation” in December 2020) which has become the dominant strain in new infections in the UK. What have we learnt about the new variant in the UK?. Also, the dominant strain in Southern Africa, B.1.351, has caused concerns because of increased mutations and the higher levels of infectiousness and is subject to some preliminary analysis in The Lancet.

Aside from the questions about how far the mutations will affect the effectiveness of vaccines, it is logical to question whether these mutations impact on the preventative measures we need to take to keep people safe.

At present, the information about how these mutations might affect the infectious process is limited. Key differences relate to the relationship between the mutations and their interaction with the body’s cells. There is no direct information about how this may impact on pathways to transmission. There is evidence that there is an increased risk of infection in children.

BOHS regularly reviews the guidance it issued on managing risk in the context of the pandemic. The Risk Matrix the Society issued last year remains its definitive statement of appropriate precautionary measures to protect against the risk of COVID-19 infections in the workplace.

It provides guidance as to relevant measures to be taken for different occupational groups, based on an analysis of the likely pathways to exposure and the frequency of infection according to national statistics.

Having reviewed our guidance in January 2021, the Society confirms that taking the precautions outlined in the Risk Matrix remains an appropriate and proportionate approach to reducing risk of exposure.

However, the Society underlines its recommendation that the evidence shows that for all health and social care staff potentially in contact with COVID-19 patients, the recommended respiratory protection should be a FFP3 respirator. Powered respirators offer better comfort and fit for those working long shifts and are recommended for those in intensive care situations, where aerosol generating procedures are likely and where factors make finding appropriate face fit for respirators difficult.

BOHS understands that FFP3 is not being offered to all healthcare staff at risk of infection with COVID-19. It is also concerned that Fluid Resistant Surgical Masks (FRSM), which are designed to reduce the risk of exhaled particles infecting patients are being offered as PPE by some healthcare settings. BOHS reaffirms that the literature on the matter identifies that FRSM is not designed to be PPE and offers only very limited reduction in exposure risk to the wearer.

In the light of the new variants, BOHS underlines the importance of observing good ventilation and full air changes in line at least with the WHO standards. For healthcare workers, including dentists, who may be exposed to locations which have been used for aerosol-generating procedures, there is a risk of static areas of air not being ventilated. These minimum standards may not affect the protections needed and a precautionary approach, such as that laid out in the SOP for emergency dental practitioners in Wales may be appropriate to observe.

Another area of concern lies in relation to education providers who are in face-to-face contact with children, including teachers, teaching assistants and other support staff in schools. There is no direct evidence that teachers have been at greater risk than the general population. However, it does appear that the new mutations pose a higher risk of infection for children. Previously, infection rates and symptoms have been lower in children which might logically account for the reason why, despite longer exposure to individuals in a hard-to-regulate, face-to-face environment, infection levels have not been higher in education staff.

BOHS believes it may be prudent to consider reviewing the protection measures in place in schools. The Society has previously indicated in its Risk Matrix that consideration of the issuing of FFP2 respirators to staff in contact with children may be appropriate as part of the range of protective measures.

In other contexts, the Society considers its guidance is still appropriate but will continue to monitor the situation and advise its members appropriately.

BOHS guidance on COVID-19 can be found at Covid-19 Technical Information.