Personal Protective Equipment (PPE) use for support staff

The use of PPE will depend on Local public health and/or government authority policy, and in particular may be influenced the prevalence of COVID-19 in the community.

For rugby, the primary concern is that dose contact creates transmission risk. To assess this risk, we can evaluate the probability of encountering an infected person in a group of people who are together for the purposes of training for and playing the sport.

This probability will vary in different countries, but is a function of two factors:

1. how many active cases are present in that community or region in question (the prevalence);
2. The size of the group to which the person is exposed, with increases in size increasing the risk of exposure and thus transmission.

For example, if the prevalence of active cases is low (as is the case in New Zealand and Australia), then the probability of exposure to an active case and thus transmission is very low. In contrast, countries, regions, communities, or clubs where prevalence of cases is higher have a naturally increased probability of encountering such an active case within a group of people of any size.

We therefore advise every Union, Competition and Club to assess its own prevalence, and resultant probability of exposure to an active COVID-19 case. This probability may then be used to inform the requirements for PPE, with higher probability of exposure or encountering a case necessitating a more stringent requirement for PPE in medical staff.

World Rugby has developed a calculator to assist in assessing the likelihood (given disease prevalence) that an infected individual would be encountered in a random group of 50 people drawn from a given community (an arbitrary figure to represent a typical rugby squad - this figure may be altered to determine how exposure risk is affected). On June 25th, for example, the probability of a random exposure to an infected person in the UK is 12.1%, in Italy it is 9.0%. Over time, as the active case numbers decline in these countries, the probability decreases, and is expected to be 8.6% and 5.6% on August 22nd, for the UK and Italy, respectively.

Using source data for active cases or estimated active infections, you may calculate the probability of an infected person being found in a random sample of 50 people for your country/region here:

The figures used in the examples above are estimates, and the calculated probability will vary depending on the ability to accurately identify the prevalence in the source community. However, this probability calculator may help provide a guide to planning for PPE use in competition and at training. The UK is a good example of a country which is emerging from lockdown, starting to commence elite sporting activity, but still has high rates of community transmission. The elite sports groups in the UK have prepared a document outlining the PPE required for use in their jurisdiction, it is attached here. Where a country has a high disease prevalence the use of level I, 11 or 111 PPE (figure 3) may be required.

Figure 3: Illustration of Personal Protective Equipment (reproduced and adapted with permission from Hodgson et al. Pitch side emergency care and personal protective equipment: a framework for elite sport during the COVID-19 pandemic)

Care should be taken to protect not only players, but also match officials and staff. The following guidelines should be considered at facilities and in match situations.

For countries with lower disease prevalence, level 1 PPE may be sufficient for doctors and physiotherapists on the side-line and on the pitch with increasing probability suggesting more stringent PPE level use.

Unions, Competitions and Clubs should liaise with public health and/or government authorities to discuss the disease prevalence and determine the level of PPE that is most appropriate and ensures compliance with local policy.

At Club facitilities:

• The use of masks by all (players, support staff and coaches) at facilities when not training is encouraged. In the medical treatment area, a combination of social distance where practical and mask use will help to mitigate risk of prolonged contact between staff and players. Unions Competitions and Clubs should be guided by local public health and/or government authorities - where mask use is mandatory in public transport, use in the team facility is likely to be strongly advised.
• During matches the following should be considered; Mask use for side-line medical staff may be advisable particularly if medical staff are not full-time and work in practice away from the facility.
• Where community disease transmission and high disease prevalence is present when teams return to play, and staff have a higher risk of either exposing others, or being exposed to infected or symptomatic persons:

• • World Rugby recommends that all efforts are made (screening and testing) to prevent symptomatic players taking to the pitch. If measures are in place to the satisfaction of local public health authorities it may be agreed (with them) that level of PPE protection is sufficient.
  • In situations where government advised distancing may not be maintained a surgical mask is advised.
  • Where COVID-19 prevalence is high, both staff and players have a higher risk of exposing others or being exposed to infected persons.

1. 1. 1. Unions, Competitions and Clubs should assess this remaining compliant local health and/or government regulations but may use the prevalence-probability calculator to guide their assessment of the risk in order to inform their PPE decisions.

• • Airway management, such as the use of airway adjuncts, or any form of mechanical ventilation are aerosol generating procedures and extra care needs to be taken to avoid staff exposure. In this situation where community transmission is high Unions, Competitions and Clubs should consider having a dedicated member of the immediate care team ready to don level III PPE to deal with this, where this is practically possible.
  • The team doctor and physiotherapist managing an unconscious player should assess airway breathing and circulation and maintain inline stabilisation. If the player requires extraction and or airway management, this should be performed by the dedicated immediate care team member in level III PPE.