ACEP COVID-19 Field Guide

Authors: Joel Lange, MD; and Aisha T. Terry, MD, MPH, FACEP

An at-risk population that is often overlooked is law enforcement personnel (LEP). As essential workers, they are unable to properly socially isolate on a daily basis and often come into contact with others at risk and with special populations. Officers and other LEP have an amplified risk due to a lack of adequate screening and proper personal protection, such as face masks, of those they encounter, whereas these protections are typically in place for hospital workers. Already, cities across the US are seeing increasing numbers of officers who are infected with COVID-19 or requiring quarantine due to high-risk exposures. This section explains the epidemiology and guidelines in place for testing and the use of personal protective equipment (PPE). However, there is significant variability between agencies and geographic locations; therefore, this section highlights more universal recommendations. 

Epidemiology 

While data are minimal about the prevalence and rate of exposure to LEP, this population is at a higher risk than normal of contracting and coming into contact with the virus. Cities such as New York City (NYC) are reporting rates as high as 1 out of every 6 officers that are out of work with illness or require quarantining, rates far exceeding those of the general population.^1,2 However, rural communities are also reporting an extreme uptrend in officers unable to work due to exposure or illness. Due to their smaller nature, rural agencies are reporting that they cannot afford to lose as high of a percentage of LEP as seen in cities such as NYC.³ 

One organization that is tracking the infection rates is the National Police Foundation. This foundation has self-reporting of agencies and has data on over 100,000 police officers in 43 states. However, this website is based on self-reporting of 118 agencies and, therefore, likely self-selects for a higher prevalence of cases. Of the reporting agencies, 9.7% (9,954 of 102,353) of LEP were seriously exposed to the coronavirus, leading to 6.1% (6,261 of 102,353) of LEP unable to work, in order to self-quarantine or due to illness. This increased exposure then results in the increased diagnosis of COVID-19. This source currently reports that 2,232 LEP have been diagnosed with COVID-19. This gives a total prevalence of 0.25%, when correcting for total law enforcement, compared to 0.17% for the general population (relative risk 1.47).² 

The specific risk of this disease to law enforcement is highly correlative with the disease prevalence in the regions they serve. New York State, for instance, has an exposure rate of 14.1% (5,499 of 39,000 reporting), resulting in 13.8% (5,382 of 39,000) unable to work and 5.01% (1,954 of 39,000) of officers having a COVID-19 diagnosis.²

Testing recommendations 

The CDC has recommendations for both testing of suspects with COVID-19 and for testing of LEP with exposure to COVID-19. There is a universal recommendation that any person whom an LEP arrests, transports, or books who displays symptoms of COVID-19 be evaluated by EMS or an EMT or transported to a health care facility or emergency department. If there is strong suspicion of COVID-19, then all individuals should don appropriate PPE prior to engaging with the individual. 

If an LEP comes into contact with a known or highly suspected COVID-19–infected person during apprehension or other circumstances, they should immediately clean and disinfect their duty belt and gear prior to reuse. According to the CDC, symptomatic first responders should be triaged as Priority 2 for testing and identified as high risk (falling behind only hospitalized patients and symptomatic health care workers).⁴

At this time, there is no specific recommendation for testing LEP. However, due to their higher risk of contracting the virus, it is not unreasonable to implicate similar testing guidelines and work restrictions as used for health care personnel in any given geographical area. These guidelines are based on the confirmed diagnosis of an infected person and the degree to which the LEP was protected (ie, the amount of PPE worn). The CDC recommendations on this topic can be found online in “Evaluating and Testing Persons for Coronavirus Disease 2019 (COVID-19).”⁵

Personal protection and other recommendations

The International Criminal Police Organization (INTERPOL) has published recommendations for LEP in accordance with international best practices and the WHO. These recommendations for LEP and the use of PPE are largely similar to those of the general population, but they urge that if more strict precautions are given by local health officials, then those recommendations should supersede the INTERPOL recommendations.^2,5-7 In general, all LEP should wear a face mask at all times, wear a pair of disposable gloves, and maintain social distancing of at least 1 meter or 6 feet. However, when coming into contact with a person or persons suspected of having COVID-19, then PPE should be elevated to N-95 masks or other higher level respiratory protection and eye protection (goggles or face shield); gowns are also advised, if available, if the LEP will be interacting physically with people of suspicious status. This elevated precaution should also be taken when working with large groups, or in settings where one knows they will interact with many people at a given time. 

INTERPOL also gives recommendations for cleaning clothes and work equipment, avoiding touching eyes and exposed skin until after thorough hand washing, and taking a shower after a shift. There are also universal recommendations for self-monitoring for symptoms of fever, cough, and generalized malaise and for the encouragement of reporting.⁷ 

While proper use of PPE has been stressed to law enforcement agencies throughout the US, 40.2% of agencies report having a severe shortage of adequate equipment.² Particulate respiratory masks, disposable gowns, and hand sanitizers are cited as the most needed items. These shortages are typically relative to prevalence, such that 52.6% of New York State’s agencies report a shortage.² 

References

1. Southall A. Virus's toll on N.Y. Police: 1 in 6 officers is out sick. New York Times. 2020 Apr 3.
2. Coronavirus (COVID-19): resources for law enforcement. National Police Foundation website.
3. Phillips K. 'It would cripple us completely': coronavirus takes toll on rural police agencies. USA Today. 2020 Apr 12.
4. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Interim U.S. guidance for risk assessment and public health management of healthcare personnel with potential exposure in a healthcare setting to patients with coronavirus disease (COVID-19).” CDC website. 2020 Apr 15.
5. Evaluating and testing persons for coronavirus disease 2019 (COVID-19). CDC website. 2020 Apr 27.
6. INTERPOL issues international guidelines to support law enforcement response to COVID-19. INTERPOL website. 2020 Mar 26.
7. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. What law enforcement personnel need to know about coronavirus disease 2019 (COVID-19). CDC website. 2020 Mar 14.