Frontline NHS staff are at risk of dying from Covid-19 after the protective gear requirements for health workers treating those infected were downgraded last week, doctors and nurses have are warned.
Hospital staff caring for the growing number of those seriously ill with the disease also fear that they could pass the infection on to other patients after catching it at work because of poor protection.
Doctors who are dealing most closely with Covid-19 patients – A&E medics, anaesthetists and specialists in acute medicine and intensive care – are most worried.
A doctor in an infectious diseases ward of a major UK hospital, who is treating patients with Covid-19, said: “I am terrified. I am seriously considering whether I can keep working as a doctor.”
Shortages of personal protective equipment (PPE) appear to be widespread across the health service and include GP practices as well as hospitals. Doctors are angry after Public Health England issued new advice which reduces the level of the PPE staff need to wear. Medics believe the change in advice was driven by the lack of equipment rather than a change in the clinical evidence about the risks from the virus.
Previously staff were told to wear full PPE comprising an FFP3 masks (which offer high levels of respiratory protection), visors, surgical gowns and two pairs of gloves each. But the new advice recommends only a standard surgical face mask, short gloves and a plastic apron. Staff have dismissed this as “totally inadequate” protection. FFP3 masks and visors appear to be in particularly short supply.
Dr Nick Fletcher, a consultant anaesthetist and intensive care specialist at St George’s hospital in London, said: “There is a high death rate for medical first responders. If they don’t have the protective kit this increases their risk of death.
“What we are going to have to use is likely not fit for purpose. There really needs to be a big effort to ensure PPE for medics and nurses is made an absolute priority.”
The World Health Organization is recommending that people take simple precautions to reduce exposure to and transmission of the coronavirus, for which there is no specific cure or vaccine.
The UN agency advises people to:
- Frequently wash their hands with an alcohol-based hand rub or warm water and soap
- Cover their mouth and nose with a flexed elbow or tissue when sneezing or coughing
- Avoid close contact with anyone who has a fever or cough
- Seek early medical help if they have a fever, cough and difficulty breathing, and share their travel history with healthcare providers
- Avoid direct, unprotected contact with live animals and surfaces in contact with animals when visiting live markets in affected areas
- Avoid eating raw or undercooked animal products and exercise care when handling raw meat, milk or animal organs to avoid cross-contamination with uncooked foods.
Despite a surge in sales of face masks in the aftermath of the coronavirus outbreak, experts are divided over whether they can prevent transmission and infection. There is some evidence to suggest that masks can help prevent hand-to-mouth transmissions, given the large number of times people touch their faces. The consensus appears to be that wearing a mask can limit – but not eliminate – the risks, provided it is used correctly.
One A&E consultant in London said: “It is staggering how trusts have downgraded protection for staff. Doctors and nurses treating patients with symptoms strongly suggestive of Covid-19 are now walking around with just a standard surgical mask and plastic apron for protection – in other words no protection at all.”
Meanwhile, it emerged that GP practices in about 20 parts of England have been supplied with face masks that expired in 2016 but purported to be useable until next year.
Pulse, a website for GPs, disclosed that stickers on batches of masks saying “best before 2016” had been covered over with new stickers bearing “2021” on them instead.
Dr Matt Mayer, chief executive of the local medical committee covering Berkshire, Buckinghamshire and Oxfordshire, told Pulse: “We are hearing from practices all over our area that the PPE being sent to them is inadequate. To now find that it is not just out of date, but that the expired date has apparently been deliberately concealed is staggering.”
Mayer demanded an investigation and that those responsible should face criminal charges if they had changed the use-by date deliberately.
Dr David Wrigley, the council deputy chair at the British Medical Association, the doctors’ trade union, said: “All healthcare staff … are under an enormous amount of pressure and face some increasingly difficult times ahead, so we need to look after them, so they can look after everyone else.”
Dr Sarah Wollaston, a former chair of the Commons health select committee, has voiced concerns over both the PPE shortages and delays in staff having a “fit test” so they can wear it.
“Frontline clinicians, care staff and patients deserve clear guidance on face masks and for that to then be consistently followed. If they make a difference in protecting clinicians and patients why are so many frontline staff not being supplied with fit-tested PPE?”, she tweeted.
Her daughter, an NHS doctor, “had been requesting fit testing for days but slots being rationed, now despite significant high-risk exposure, [she had been] told to return to work on Monday unless symptomatic, but still no PPE”.
A consultant in infectious diseases, who did not want to be named, said hospitals had been left ill-equipped because NHS chiefs had been caught by surprise by the virus’s emergence in Britain in January.
“There’s a massive gap between what doctors need and the availability of PPE and there is a threat to staff health. The trouble is that the NHS never saw such a big and difficult a problem as coronavirus coming.”
Dr Nick Phin, the deputy director of PHE’s National Infection Service, said: “The guidance is about ensuring that the right tools are available at the right time as the outbreak progresses and that the correct PPE is used for patient care to ensure the safety of healthcare workers. FFP3 masks are only needed for specific situations and we have updated the guidance to reflect this.”
