Just before the ICU unit where I work dealt with its first case of Covid-19, I was tested to ensure the FFP-3 masks I would need fitted safely. This involved walking up and down while a bitter chemical was sprayed to ensure there were no leaks in this suffocating face-covering. These masks are in short supply internationally, yet I’ve seen celebrities posing for selfies wearing them. Two weeks down the line and I am well into the routine of donning and doffing my personal protective equipment.
As a doctor working in intensive care, I am fortunate to be provided with a surgical cap, goggles, mask, long-sleeved gowns, two pairs of gloves and an apron. However, we hear from many people across the UK who are still waiting for theirs. It is hot work and we stay in the same gear to do the ward round, wiping ourselves with disinfectant between patients to minimise the risk of transferring other infections between them. Some colleagues have died. These healthcare workers are no longer only those working in another country, but people we have worked with before, people in our own hospitals, our friends. The danger we feel is very real.
Access to personal protective equipment is one of the biggest concerns of staff working in the health service right now. The anxiety they feel around this issue is hardly surprising when the world we work in has changed so dramatically in just a month. We have worked hard to prepare our hospitals, as we watched the crisis in northern Italy unfold, and have managed to vastly increase our ventilator capacity in those few weeks. The usual array of conditions with which we are faced – strokes, trauma, liver disease and so on – have been quickly replaced, mainly by patients suffering with Covid-19.
I work with an organisation called EveryDoctor which campaigns for the working rights of doctors and patient safety. We have been hearing concerns from people – not only doctors – about their access to PPE, and launched a campaign earlier this week demanding goggles, masks, gowns and gloves in line with World Health Organization recommendations for all healthcare staff. More than 35,000 staff have signed our petition.
We welcome government guidance issued yesterday to help clarify previous advice that had left many confused. Now all staff working within close proximity of patients with coronavirus are recommended to wear goggles. Previously, hardly anyone had been recommended to wear eye protection. Government advice regarding masks continues to reflect and, in areas deemed high-risk due to frequent use of aerosol-generating procedures, even exceeds the advice from the WHO. However, we are concerned that Public Health England has not gone far enough.
For example, WHO advises the use of long-sleeved gowns for anyone directly caring for patients with suspected or confirmed coronavirus. PHE continues to advise the use of a flimsy plastic apron. The most common form of transmission of the virus is through contact. GPs on home visits along with other workers undertaking care in the community, such as paramedics and district nurses, must enter people’s homes with these aprons, and it is suggested that they scrub their arms up to the elbows, which can be impractical. We know the virus is carried on clothing, and anyone who has worn these aprons knows that their underlying clothes are not protected when reaching over to listen to the chest or feeling the tummy of an unwell person.
Moving beyond arguments in favour of gowns, we are hearing from members and other allied health professionals that people working on the front line do not even have access to the level of PPE prescribed by the government. GPs are going out to DIY stores to buy their own masks and goggles. Cleaners are being told they do not need masks despite working in high-risk areas, and nurses are being bullied by managers for raising concerns.
While PPE is a vital element of our protection, it is also part of broader infection-control measures within and outside of the NHS. Evidence suggests healthcare workers are as likely to contract coronavirus in the community as we are to at work, and so it is vital that we all continue to follow the strict social distancing and hand-hygiene advice recommended by PHE.
Our health service is the backbone of the fight against Covid-19. Each day we go to work at no insignificant risk to ourselves and the people we live with. The guidance around how to use PPE must of course be evidence-based, and we are glad the government has now shared its evidence with us. But we must also feel protected. We are intelligent, we can engage with the uncertainties of knowledge in a new and emerging infection, but we demand the highest protection in the work we do.
Each day we hear of new shortages of gowns, visors, goggles and masks. We avoid going back into sealed-off bays to assess patients we would normally have reviewed on multiple occasions in order to protect our stocks. These patients deserve better. Our staff deserves better. We need every single person working in our health system to have access to appropriate protective equipment. Not tomorrow, or in a week as the government promised a week ago, but now. Our lives depend on it.
• Dr Jessica Potter is a respiratory specialist registrar working in London and member of EveryDoctor
