TITLE: A pediatric pulmonologist’s cumulative risk of acquiring Covid-19 in outpatient practice
Julian Allen, M.D. and Tryce Scully, M.S.
Corresponding Author:
Julian Allen, M.D.
Professor of Pediatrics
Perelman School of Medicine at the University of Pennsylvania
Pulmonary Division
Colkett 11th floor
The Children’s Hospital of Philadelphia
3401 Civic Ctr. Blvd
Philadelphia, PA 19104
Email: allenj@email.chop.edu
Key Words: Covid-19, risk, N95 mask, surgical mask, infectious disease transmission
Running Title: Cumulative risk of acquiring Covid-19
A pediatric pulmonologist’s cumulative risk of acquiring Covid-19 in outpatient practice
To the Editor:
Pediatric pulmonologists, and, indeed, general pediatricians, are exposed to the causative virus of Covid-19 , SARS-CoV2, in their daily outpatient practices from both symptomatic and asymptomatic patients. This risk naturally increases with multiple exposures over time. To describe how risk could be affected by disease prevalence, transmissibility, patient volume, and personal protective equipment (PPE), we have developed a simple equation for the probability of a practitioner remaining Covid free over a specified time interval. We were unable to find similar calculations in the literature, although analogous concepts have been explored in considering communicable disease risk to patients from multiple exposures to practitioners and other patients in healthcare settings (1).
In our analysis, we assume that R, the risk of each patient encounter= average prevalence in population (P) x transmission rate/encounter (T) x PPE mitigation factor (M).
If 1-R = probability of remaining Covid- free after one encounter, and total encounters (E) over one year = encounters/day x patient days/week x weeks/year, then to calculate Cumulative Covid-free probability (CFPc) :
CFPc = (1-R)E
CFPc = (1-PTM)E
For example, if one makes the following assumptions for the clinical practice of one practitioner over a year:
Daily population prevalence (P) of 2% over the exposure period = 0.02 (2)
Transmission rate (T) of 1 in every 100 close encounters = 0.01 (3)
PPE mitigation factor (M) = 1.0 for no mask, 0.33 for a surgical mask, and 0.04 for an N95 mask (4)
Encounters/year (E) = 12 patients seen/day x 3 Patient days/week x 46 Patient Weeks/year = 1656
then, the probability of remaining Covid free for a year if the practitioner wears a surgical mask can be calculated as
CFPc = (1 – 0.02x0.01x0.33)1656 = 0.999931656 = 0.89, or 89%.
Similarly, the probability is 72% with no mask, and 98% with an N95 mask. The equation can be used to construct a Kaplan Meier -like plot for remaining Covid free (Figure)