ONE in six working age adults hospitalised with Covid in Scotland during the first wave were healthcare workers or people they lived with, according to new research.

Patient-facing NHS staff aged 18 to 65 were also three times more likely to be admitted to hospital with the infection than the general population, even taking account of factors such as age, sex, ethnicity and underlying health conditions.

Members of their households were nearly twice as likely to be hospitalised.

The research, by Glasgow University, found that those in “front door” roles, such as paramedics and A&E department staff, were most at risk.

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Of the 243 healthcare workers hospitalised with Covid between March 1 and June 6, one in eight were admitted into critical care and six died.

Among the 141 household members the figures were higher, with one in five needing critical care and 18 (13%) dying.

Writing today in the British Medical Journal (BMJ), the researchers call on governments, healthcare managers and occupational health specialists to consider the findings amid a resurgence of the virus.

They said: "Our findings from the 'first wave' in Scotland show that healthcare workers in patient facing roles—especially those in “front door” roles—are, along with their households, at particular risk."

It comes as doctors told the Herald of concerns that frontline staff are being advised not to self-isolate if Test & Protect identifies them as a "close contact" of an infected case, as long as they were wearing a facemask at the time of potential exposure.

A close contact is defined as anyone who was within one metre for any length of time or within two metres for 15 minutes or more of an infected individual in the 48 hours before they developed symptoms.

Official Test & Protect guidance states that close contacts should self-isolate as a precaution for 14 days, regardless of symptoms.

However, clinicians say exemptions are being routinely made for NHS staff if they were wearing a fluid-resistant surgical mask at the time they were in proximity to a colleague or patient who later tested positive.

These type of masks are estimated to provide a four-fold reduction transmission by an infected person.

However, it is unclear to what extent they protect wearers from contracting the virus, and Test & Protect guidance makes no mention of any exemption.

The Scottish Government said NHS staff "are recommended to pause the Protect Scotland app while wearing full PPE" - which would include goggles and gowns.

A spokeswoman added: “If a member of staff is requested to self-isolate as a close contact of someone who has tested positive, then we expect this to be facilitated by an employer unless a risk assessment carried out by the Health Protection team determines that the risk they have been exposed to the virus has been appropriately mitigated against through appropriate infection prevention and control measures or the wearing of appropriate PPE throughout the period of close contact."

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One A&E-based doctor who spoke to the Herald anonymously said they are concerned that few checks are actually being made, and that a "blanket approach" was being taken in the NHS that differed to hairdressers or hospitality workers.

They said: "While the assessment relies on the premise that fluid resistant surgical masks are good enough, this is shaky

"Jason Leitch has never said they're good enough to let people off the hook in other settings

"There are likely to be higher levels of virus circulating in hospitals while people are infectious, having procedures done and while we concentrate them there."

They said they fear rules are being "fudged" to avoid NHS staff shortages.

"I worry staff are going to be forced to go back to work and end up reinfecting patients," they said.

"In my hospital we've made no attempt to improve ventilation in the emergency department.

"We haven't tried to space out staff areas or create new ones for people to have breaks.

"Changing rooms are all in the one place - tiny spaces.

"Scrubs are not provided laundered by the hospital, so people are carrying them in and out, maybe going on public transport with them."

A second medic, with a background in infectious disease, said they also knew of colleagues being advised against self-isolation if they had been wearing surgical masks at the time of potential exposure.

"The problem is it’s very invisible as to who is actually giving the advice," they said. "It may also vary from ward to ward."

It comes as NHS Greater Glasgow and Clyde confirmed it has had to close 17 wards to new admissions following a number of Covid outbreaks.

Last week, the president of the Royal College of Surgeons Edinburgh said its members - who work across the UK - are worried

about cases transmitting between staff members due to a lack of social distancing infrastructure in non-patient areas and because most frontline staff are not being routinely tested for the virus.

Dr Lewis Morrison, chair of BMA Scotland, said health chiefs "have a moral obligation" to safeguard the health of their staff.

He said: "That means assuring the right level of and guaranteed supply of the PPE required in the many different environments we deliver care in, commensurate with the level of risk staff know they are being exposed to.

"It also means working environments and practices with infection control as a number one priority, through frequent effective cleaning, proper ventilation and assuring social distancing.

"It also necessitates a proper risk assessment for all staff with clear advice and action to ensure those more at risk are kept safe."