Covid-19: doctors’ leaders warn that staff could quit and may die over lack of protective equipmentBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1257 (Published 26 March 2020) Cite this as: BMJ 2020;368:m1257
The BMA has called the shortage of personal protection equipment (PPE) across the NHS “totally unacceptable” and warned the government that without proper kits some doctors treating patients with covid-19 may die.
Chaand Nagpaul, the BMA’s Chair of Council, has called for the government to be transparent about the level of supplies it has.
The Royal College of GPs has also raised concerns about the protective kits being provided to primary care staff and has called for guidance on how and when they should be using PPE during patient consultations.
Reports from BMA members suggest that, in general, supplies of PPE were not getting through to frontline NHS staff, or if they were it was in small amounts, was rationed, or was not offering enough protection
In response to a call for doctors’ experiences of getting PPE, one told the BMA, “Coughed on by covid patients all day today. No visors available. Tomorrow I’m borrowing my nine year old’s safety specs she got in a science party bag. I wish this was actually a joke.”
Nagpaul said, “A construction worker wouldn’t be allowed to work without a hard hat and proper boots. Even a bee keeper wouldn’t inspect a hive without proper protective clothing. And yet this government expects NHS staff to put themselves at risk of serious illness, or even death, by treating highly infectious patients without wearing proper protection. This is totally unacceptable.”
While the government has said that shipments of PPE are being delivered to GPs and hospitals, this was not the reality for thousands of its members, he said. “We know from international data that healthcare workers are at higher risk of becoming infected and dying. They are worried about the risks to themselves and their families.”
Rinesh Parmar, chair of the Doctors Association UK, said that some trusts are running so low on PPE that there is a risk that staff may quit.
“We would like to see eyewear made more readily available for those who need it. We remain concerned about reports that departments are being territorial over their PPE. Patient and staff safety must be paramount,” he said.
He told the Guardian, “If doctors feel there is a widespread lack of PPE then some may feel they have no choice but to give up the profession they love.”
Chair of the Royal College of GPs, Martin Marshall, has also raised concerns in a letter to the secretary of state for health and social care, Matt Hancock. Marshall is demanding clarity for GPs around how and when to use PPE when seeing patients during the pandemic.
“Our members are telling us that their confidence to carry out patient consultations is being impacted by uncertainty over the quality of PPE being supplied to their surgeries. This is particularly relevant for aprons and eye protection, which many believe to be providing inadequate protection. We note that the World Health Organization recommends that GPs use eye protection for consultations, yet most practices do not yet have proper access to it and there are outstanding concerns around the use of aprons and whether clinicians should have full body cover when seeing patients,” wrote Marshall.
He called for clearer guidance to reduce the rising anxiety among GPs and their teams.
Change in guidance
Questions are also being raised over the rationale for last week’s change in Public Health England’s advice on protective equipment.
Nagpaul told The BMJ, “We are concerned that the level of protection now recommended by PHE is not the same as that recommended by WHO, the European Centre for Disease Control, the Centers for Disease Control and Prevention, and most other nations.”
PHE had told doctors seeing any patient with confirmed covid-19 to wear full PPE, including a FFP3 respirator, disposable eye protection, and, preferably, a visor, long sleeved gown, and gloves.1 On 18 March it changed that advice,2 saying that an apron rather than a gown was sufficient for staff providing basic care and in “close contact” with patients.
“The basic protection offered to GP practices in England is a fluid resistant mask, gloves, and a plastic apron only partially covering clothing, which could harbour and spread infection to others,” said Nagpaul. “The basic minimum recommended by WHO and other nations includes a full gown or scrubs and eye protection where appropriate.”
PHE also changed its recommendation on FFP3 respirators, saying these are now only needed if staff are carrying out “aerosol generating procedures on a patient with confirmed or suspected covid-19” or if they are in an area where such procedures are happening, such as an intensive care unit. This is in line with WHO guidance published on 20 March.3 Doctors from the UK and abroad have raised concerns over the advice, however, noting that doctors in Wuhan used respirators and full PPE on covid-19 wards.4
TheBMJ asked PHE what evidence underlay its changed recommendations.
Nick Phin, deputy director of the National Infection Service at PHE, said, “The guidance, jointly developed with the NHS and the devolved administrations, ensures that any healthcare worker treating a suspected or confirmed case of covid-19 is protected against the virus.”
A spokesman added that the advice was based on the “best evidence available” from previous pandemics.
A Department of Health and Social Care spokesperson said, “We are working around the clock to give the NHS and the wider social care sector the equipment and support they need to tackle this outbreak.
“Over the past two days, more than 15 million facemasks have been delivered to the frontline and yesterday’s deliveries included 24.6 million gloves and 1.9 million eye protectors.
“The full weight of the government is behind this effort and we are working closely with industry, social care providers, the NHS, and the army so all our NHS and care staff have the protection they deserve.”
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