Protecting healthcare workers from COVID-19: A comparative contextualized analysis [Added supplement: COVID-19 Variant Supplement]

This research focuses on measures to protect healthcare workers (HCWs) who are at substantially increased risk because of their direct contact with COVID-19 infected patients - and with considerable variation being experienced internationally in different settings. Although there is general agreement on many aspects of policy to protect HCWs, approaches have varied widely with very limited availability of contextualized evidence to guide local decisions. Often differences have been due to availability of specific personal protective equipment (PPE-e.g. N95 respirators, masks, gloves, gowns); sometimes differences have been due to operational necessities (e.g. whether exposed HCWs can continue to work while wearing PPE); sometimes variations in policies relate to availability of COVID-19 test kits or related reagents (e.g. criteria for testing or whether pre-return-to-work testing is implemented); approaches to exposure monitoring and contact tracing for HCWs also vary widely. It is critically important for policymakers to understand consequences of these variations, as well as scrutinize their scientific and contextual rationales. This proposal asks "What works to protect HCWs, in what contexts, using what mechanism, to achieve what outcome?" By building on a strong track record of interdisciplinary research in exactly this field, with well-established international networks with expertise in infection control and occupational health, and a long-history of relationship-building to facilitate this research, this team is extremely well-positioned to conduct this highly relevant research and provide world leadership in this area. It will be conducted through in-depth case studies conducted in Vancouver, Canada and Gauteng, South Africa as well an international cross-country comparative analysis based on surveys and experiences in protecting healthcare workers and a case-control study of workers with COVID-19 infection versus other workers in their same facilities.