Pregnancy, healthcare workers, and COVID-19
A statement from the Association of Anaesthetists
Thursday 21 January 2021
Healthcare workers in patient-facing roles are at increased risk of infection with COVID-19 . While the factors associated with this are not fully understood, personalised risk assessment should include risk due to working location and role (environmental risk) as well as the individual’s own risk factors (personal risk) [2, 3].
During their usual clinical duties anaesthetists and intensivists work closely with patients with COVID-19. They perform and are exposed to aerosol generating procedures. Anaesthetists and intensivists may be at a lower risk of infection with COVID-19 than other patient-facing healthcare workers , although the reasons for this difference are unclear, and it is likely their risk is still above that of the general population.
Pregnancy is associated with an increased risk of severe symptomatic COVID-19 . Guidance from the Royal College of Obstetricians & Gynaecologists, Faculty of Occupational Medicine and the Royal College of Midwives states: ‘Pregnant women of any gestation are at no more risk of contracting the virus than any other non-pregnant person who is in similar health’ and ‘For those women who are 28 weeks pregnant and beyond, there is an increased risk of becoming severely ill should you contract COVID-19’ . They go on to advise: ‘… social distancing is particularly important for all pregnant women who are 28 weeks and beyond, in order to lessen their risk of contracting the virus. For women with other medical conditions in addition to pregnancy, this should be considered on an individual basis’.
There is little data on the safety of COVID-19 vaccines in pregnancy. The Joint Committee on Vaccination and Immunisation states that: ‘Although the available data do not indicate any safety concern or harm to pregnancy, there is insufficient evidence to recommend routine use of COVID-19 vaccines during pregnancy’ and ‘for women who are offered vaccination with the Pfizer-BioNTech or AstraZeneca COVID-19 vaccines, vaccination in pregnancy should be considered where the risk of exposure to SARS-CoV2 infection is high and cannot be avoided, or where the woman has underlying conditions that put them at very high risk of serious complications of Covid-19’ .
Clinical managers should work with occupational health professionals to assess risk to pregnant colleagues and make appropriate and mutually agreed adjustments to working patterns and job plans. Based on the currently available evidence, we recommend that anaesthetists should not work in patient-facing roles in the third trimester of pregnancy.
If clinicians have concerns about their statutory employment rights in relation to changing work patterns because of pregnancy, they should approach their managers and Human Resources department. If a mutually agreed outcome is not achieved, they should consider contacting a trade union.
This guidance will be updated as more evidence becomes available, or if the advice on the use of vaccines changes.
- Cook TM, Lennane S. Occupational COVID-19 risk for Anaesthesia and Intensive Care staff – low risk specialties in a high-risk setting. Anaesthesia 2020 Early View https://doi.org/10.1111/anae.15358
- 2. Cook TM, El-Boghdadly K. COVID-19 risk tools should incorporate assessment of working environment risk and its mitigation. EClinicalMedicine 2020; 28: 100613
- Cook TM. Risk to health from COVID-19 for anaesthetists and intensivists – a narrative review. Anaesthesia 2020; B: 1494-1508 (https://onlinelibrary.wiley.com/doi/10.1111/anae.15220)
- Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living
systematic review and meta-analysis. BMJ 2020: 370: m3320
- Royal College of Obstetricians & Gynaecologists, Faculty of Occupational Medicine and the Royal College of Midwives. Occupational health advice for employers and pregnant women. (https://www.rcog.org.uk/globalassets/documents/guidelines/2020-09-10-occupational-health-statement-rcog-rcm-fom.pdf) (Accessed 09 January 2021
- Joint Committee on Vaccination and Immunisation: advice on priority groups for COVID-19 vaccination; 30 December 2020 (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/950113/jcvi-advice-on-priority-groups-for-covid-19-vaccination-30-dec-2020-revised.pdf) (Accessed 09 January 2021)