SARS-CoV-2, surgeons and surgical masks

Table 1 Primary studies that reported coronavirus disease 2019 among surgeons

Ref.	Study country	Setting	Sample size	Age in years	Male: female	Comorbidity n (%)	Diagnostic TEST	Sample type	Risk of disease	Comment
Hunter et al[16]	United Kingdom	Hospital	1654	Mean 41.7	NR	NR	RT-PCR	Combined nose and throat swabs	Of 1654 HCWs tested, SARS-CoV-2 was detected in 240 (14%)
Jella et al[9]	United States	National data pool	4099	All were aged ≥ 60	NR	NR	NR	NR	For the top most states affected by COVID-19, elderly orthopaedic surgeons aged ≥ 60 years comprised up to 48%
Chow et al[12]	United States, Washington	Phone interview of HCWs with COVID-19	48	Median 43 (range 22-79)	11:37	23 (49.7)	Not specified	NR	Among 48 HCWs with COVID-19 interviewed, 31 (64.6%) worked a median of 2 (range: 1-10) d while being symptomatic	Facemask use by HCWs might prevent transmission from asymptomatic cases
Liu et al[13]	China	University hospital	30	21-59	10:20	NR	RT-PCR	NR	Of all 30 COVID-19 cases, 8 did not wear masks and 6 others wore irregularly
Hughes et al[46]	United States	CDC data pool	571,708 with occupational status known	41 (IQR: 30–53)	79:21	17,838 (44%) had at least one comorbidity	Not specified	NR	Of 571,708 100,570 (22%) were HCWs. Nursing and residential care facilities were the commonest job settings
Jella et al[8]	United States	National data pool	Not mentioned	All were aged ≥ 60	NR	NR	NR	NR	In the 10 states with the highest number of COVID-19 cases older neurosurgical workforce (≥ 60) accounted for 20.6%-38.9%
Ruthberg et al[10]	United States	National data pool	9578	All were aged >60	NR	NR	NR	NR	Of all, 3081 were (32.2%) ENT surgeons aged > 60 years; the proportion by state ranged from 25.9% to 58.8%
Durante-Mangoni et al[14]	Italy	Regional hospital	4 (details were known for only 3)	25-61 (of 3 cases)	2:1 (no details about the 4th case)	NR	RT-PCR	Nasal/or pharyngeal swab	Four nurses infected. No transmission between HCWs wearing surgical masks and inpatients	Masks were beneficial
Jørstad et al[47]	Norway	Regional hospital	6	NR	NR	NR	Not specified	NR	Five ophthalmic surgeons and a ward nurse had COVID-19
Ducournau et al[17]	37 countries (34)	Questionnaire survey	47	NR	NR	NR	Not applicable	NR	42 of 47 (89.4%) wore surgical mask, 12 of 47 (25.5%) wore N95 mask, 32 of 47 (68.1%) wore goggles	This study is about the compliance of surgeons with PPE
Canova et al[15]	Switzerl	Contact racing	21	Median 40 (range 18–62) yr	7:14	NR	RT-PCR	Nasopharyngeal swab	None wore a face mask	None were positive for virus
Guo et al[11]	Wuhan, China	Hospital	24 cases (and 48 controls)	36.1 (25-48)	23:1	1 (4.2%) had a comorbidity	RT-PCR and antibody tests	NR	Only 7 (29.2%) wore a facemask or respirator. Wearing respirator or mask all the time was protective (OR: 0.15, 95%CI: 0.04-0.55)	Orthopaedic surgeons are at risk of COVID-19 and masks are beneficial
Chan et al[48]	Honkong, China	University hospital	14 (10 nurses and 4 other staff)	NR	NR	NR	NR	NR	Fourteen neurosurgery staff contracted COVID-19 following exposure to a patient	Full PPE should be worn during high risk procedures
Ng et al[18]	Singapore	University hospital	41 HCWs exposed to an index patient	NR	NR	NR	RT-PCR	Nasopharyngeal swab	None of the exposed HCWs were RT-PCR positive; 85% wore a surgicalmask, and the rest wore N95 masks	Possibly masks and other standard measures are beneficial

CDC: Centers for Disease Control and Prevention (United States); 95%CI: 95% confidence interval; ENT: Ear, nose and throat (surgeons); HCW: Health care worker; IQR: Interquartile range; NR: Not recorded; OR: Odds ratio; PPE: Personal protective equipment; RT-PCR: Reverse transcriptase polymerase chain reaction.