Protect our healthcare workersBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1324 (Published 02 April 2020) Cite this as: BMJ 2020;369:m1324
All rapid responses
As an ex-Army medic, I have felt disquiet in the past over health workers being described as “frontline staff.” The “front line” has always for me conveyed a tangible risk of harm or death, as in the armed forces, police or fire brigade. No longer – NHS staff are now being infected with, and dying of, COVID-19 infections directly acquired from patients. Experience from other countries suggests that some staff, such as anaesthetists, ITU staff and ENT surgeons, are at greater risk. Early data from other countries indicates that high level PPE can mitigate the risk of transmission of high viral loads. In the UK, many doctors, nurses and other staff are deeply concerned they are not being offered the correct level of protection. They are now dying, some not having had appropriate PPE, although whether that was a contributory factor we do not yet know.
Returning to the military theatre, during the 2003 Gulf War and its aftermath, many British soldiers believed that they had been sent to battle with inadequate equipment. There were particular concerns over body armour and communications. Belief was widespread that the then Chancellor, Gordon Brown, had resisted requests for funding this equipment. This claim was later repeated by retired senior officers (https://www.bbc.co.uk/news/uk-11190527), but roundly denied by Mr Brown. However, the lack of trust and the belief that the “military covenant” had been broken by the Blair/Brown government was tangible. The average soldier might not have argued with going to fight in a (hopefully just) war, but was unhappy to have extra and avoidable risk of injury or death laid upon him or her without good reason. Many soldiers and their families believed that comrades had died (as in the six Military Policemen killed in Basra in 2003) due to penny pinching (https://news.sky.com/story/iraq-rmp-ambush-red-cap-families-may-sue-mod-...).
We risk this perception in the war against COVID-19
There is huge will to help among NHS staff, but a great deal of unhappiness over the perception of a lack of both PPE and testing. The rapid diagnosis of politicians with COVID-19 stands in stark contrast to the absence of testing for the great majority of front line clinical staff with symptoms. PPE is provided on a seemingly haphazard basis – many in my own hospital have been purchasing their own masks from overseas. A Scottish Health Board has issued guidelines for protection of operating theatre staff in contradiction of Intercollegiate surgical guidelines. NHS workers feel they are accused of using "too much" PPE by managers and politicians. Whether there is a real increased risk or not, in the absence of any high level evidence it is hard to see why healthcare leaders should resist providing equipment and testing which those at risk believe may save their lives.
Again to return to military philosophy, and with the help of my military historian colleague Dr Jonathan Boff, it is often the case that soldiers will put themselves at greater danger if they believe that the cause is just and that their commanders are honest and share their fate. Good training, good kit, motivation and discipline are essentials. The NHS should understand this, and should be at pains to show it is protecting and valuing its staff in such crises.
The quotation in the title is a slight misquotation of Sir Colin Campbell, Commanding Officer of the 93rd Regiment (Sutherland Highlanders) at the battle of Balaklava. In 1854 the original “Thin Red Line” of the Highlanders was facing an overwhelming cavalry charge, Sir Colin Campbell did say to his men: “Needs be you must die where you stand.” The reply came: "Aye, Sir Colin. If needs be, We'll do that." Some died, but the battle was saved. Great leadership and a shared sense of purpose can make humans endure the impossible.
We will weather COVID-19; the NHS should be stronger in many ways afterwards. I hope that those in charge will in future crisis listen attentively to those who put themselves and their families at risk. Increased trust will lead to better cohesion, which must in future benefit our patients.
Consultant Urologist and Honorary Senior Lecturer in Surgery
King’s Colllege Hospital and King’s College London
Dr Jonathan Boff FRHistS
Senior Lecturer in Modern History
University of Birmingham
Competing interests: No competing interests
Re: Protect our healthcare workers. ''Take back control: improve your Covid 19 personal protection equipment with a self-assembled, reusable, cheap viral filter and repurposed full-face snorkel mask combination''.
The global health COVID-19 (C19) pandemic places health workers and their clients at mutual risk of transmission, creating an existential requirement for personal protection equipment (PPE). Suppressing respiratory droplet transmission and protecting eyes, nose and mouth simultaneously during clinical procedures is usually achieved with a cumbersome combination of an eye shield and disposable filtering face piece class 3 (FFP3) respirator mask. Even if you can obtain both items of PPE in the face of mass worldwide increase in demand when supply chains are exhausted, it is difficult to ensure maintenance of an effective seal throughout arduous clinical shifts.
As in previous times of crisis, the C19 pandemic has accelerated the development of innovative solutions to PPE shortages. Of particular interest to us was the report of modification of readily available full-face snorkel masks to administer prolonged continuous positive airway pressure (CPAP) to avoid mechanical ventilation in C19 respiratory collapse.
With a comfortable soft silicone shield achieving a tight seal for prolonged use and an integral, isolated eye compartment to avoid misting, the full-face snorkel mask has been modified to create a PPE device to protect eyes, nose and mouth simultaneously. A multidisciplinary team of engineers and doctors at the University of Oxford have designed a 3D printed adapter to connect a disposable heat and moisture exchange filter (HMEF) to a specific design of snorkel mask for PPE use during the C19 pandemic. 
There are many different designs of full-face snorkel masks available worldwide, not all of which will accept the Oxford adaptor, which requires 3D print technology to create. To increase the worldwide availability of this reusable full-face snorkel mask PPE upgrade we have developed a simple means of sealing the HMEF (Inter thermTM) viral filter to the snorkel using readily available 3M Microfoam Medical Tape. Latex free and hypoallergenic, this elastic foam tape allows multidirectional stretching, readily conforms and secures to irregularly contoured sites even when washed repeatedly. The HMEF filter is used in CPAP and mechanical ventilation with a viral efficiency of 99.99 % [3,4] for up to 24 hours according to the manufacturer, though other reports recommended use for up to 96 hours .
The senior author further adapted the sealed full face PPE SNORKEL MASK by inserting a pair of prescription glasses, having removed the temple arms, into the eyes chamber and securing them with Microfoam Tape, enabling him to carry out a demanding clinical procedure lasting 90 minutes in an intensive care setting. The attendant nursing staff had no difficulty in hearing requests for assistance from the surgeon who confirmed that the modified mask provides a good comfortable seal with an excellent visual field.
We recommend this inexpensive, readily available, reusable, comfortable full-face SNORKEL MASK/ HMEF filter upgrade as an addition to PPE device considerations during the C19 pandemic, whilst acknowledging that the device is not tested for this purpose and further research is warranted.
1-Coronavirus: Grassroots project adapts snorkelling masks for use against COVID-19. DW news. 02 April 2020. https://p.dw.com/p/3aLBy
2-Doctors create pioneering reusable facemasks to solve PPE shortage. The Telegraph. 11 April 2020.
3-Heat and moisture exchanging filters (HMEFs). Airway management. https://www.intersurgical.com/products/airway-management/intertherm-rang...
4-Breathing Filters, HMEs and HMEFs. Information sheet. Accessed from https://us.intersurgical.com/content/files/76142/-151123555.
5-Thomachot L, Boisson C, Arnaud S, Michelet P, Cambon S, Martin C. Changing heat and moisture exchangers after 96 hours rather than after 24 hours: a clinical and microbiological evaluation. Crit Care Med. 2000;28(3):714–720. doi:10.1097/00003246-200003000-00019
Competing interests: No competing interests
Data from countries like Italy and China suggests that the frontline health care workers such as doctors and nurses put themselves at serious risk of being infected with Covid-19 in this pandemic. You have rightly explained 'a profound loss of trust in authority. Repeated assurances ......not yet matched the reality' as correctly the recent survey by the BMA also reveals that over half of doctors in the community and hospital settings have not received PPE and they have to compromise their own health.
It is unfortunate that the rhetoric of the Government has changed recently as the current health secretary suspected inappropriate use and also doubted the contracting of the infections during the work or not for those frontline health care workers who died infected with Covid-19. These are most unfortunate comments from the captain of the ship where the sailors are fighting for their own safety let alone saving the lives of the passengers on board.
Three out of four of my family are doctors and my own daughter has now been infected with Covid-19. Where we put the analogy from the airline passenger that put your oxygen mask first and then put on to your child. Is it not now the foremost priority for the establishment that the frontline doctors, nurses and health care workers are to protect them first and build their confidence so that they can do the job that they love most to save as many lives as possible?
It is also immensely important, as your article has highlighted, that the large proportion of the doctors and health care staff would carry an immense psychological stress now and in the future like our soldiers who fight in the war zone. Perhaps a large proportion of the medics would suffer from psychological trauma in fighting this pandemic when we are able to win this battle.
It is now more than ever important to be more understanding, compassionate and supportive to these frontline staff who go out everyday to do their job and risk their own lives and potentially risk infecting close family members when they come back from work.
Competing interests: No competing interests
Protection for our healthcare workers is priority. Also for patients in surgery and pre-op evaluation.
A recent report from Wuhan, China, found that in post-surgical patients who developed Covid 19, 44.1% of them required ICU and 20.5% of the total died (Published: April 04, 2020DOI:https://doi.org/10.1016/j.eclinm.2020.100331).
This underscores the importance of the pre-op evaluation in detecting those who could require specific covid 19 testing or who have a limited respiratory reserve and should postpone the surgery.
For many years, in my pre-op evaluations I have included an index which I have validated and is very useful in identifying those patients who are not good candidates for elective surgery. It correlates very well with the standards classifications ASA and Revised Cardiac Risk Index, also with the functional reserve, respiratory reserve and evolution, trans- and post-op.
The patients do an air exchange with 4 deep inhalations and exhalations. Then stay in inspiratory apnea for as long as possible, under control of SpO2 and heart rate.
To calculate the Index, the average SpO2 is multiplied by the time in seconds of apnea durations and divided by the heart rate.
An index of 80 or more is very good. Between 50 and 80 is normal. Fewer than 50 is insufficient.
This index can be very useful in this time of Covid 19 to identify high risk patients.
I propose to do a multicentric study and share our experiences.
Prof. Enrique Sánchez Delgado, MD
Internal Medicine - Clinical Pharmacology and Therapeutics
Hospital Vivian Pellas, Managua, Nicaragua
Competing interests: No competing interests
Nations and Governments must prioritize healthcare over border politics
We are in an unprecedented situation. COVID-19 has brought nations and economies to a halt. While most people are locked down in their homes, healthcare workers are at the forefront more than ever. Doctors, nurses and paramedical staff are at more risk of contracting COVID 19 as they are in direct contact with the infected patients.  Healthcare workers are putting their best efforts into triage and detection of those who are suspected cases and treating those who are affected. There is a panic and hue and cry about the shortage of medical staff, Personal protective equipment ( PPE), and ventilators.
We must understand that healthcare workers are a part of the large overall healthcare system; they are the functional arm. Most of our healthcare system decisions are made by top administrators and politicians who hardly have any in-depth knowledge regarding difficulties and challenges faced by these workers who are at extreme risk. It is not rocket science that we need more and more funding for our health budget. Health should be the topmost priority of every nation to protect its citizens. Surprisingly, what we observe is that most nations including those claiming to have the best healthcare systems spend a meager budget on healthcare. 
Current healthcare expenditure (% of GDP) of the USA, Switzerland and France, who are amongst the top spenders, is 17.07, 12.25 and 11.54 respectively. Most countries spend a minuscule amount of their budget on healthcare despite facing major healthcare issues. Even for those spending more, the costs of healthcare are marginally higher. Political leaders are busy with their domestic election processes or economic and defense deals. Global military expenditure stands at $ 1.7 trillion annually.  Over the past two decades military expenditure has increased 75%. It is expected that by 2030 the military spending of the USA, China and India will stand at over $ 1 trillion, $ 736 billion and $ 213 billion respectively. Our governments must set priorities.
We call on all governments to keep healthcare the top most priority. It is for all of us collectively. We need sufficient funds to take of our sick. And we need much more for those who take care of the sick. We can’t afford to make our healthcare workers vulnerable to sickness. Healthcare workers are facing tremendous physical and mental exhaustion due to the pandemic. The dearth of beds and lack of proper equipment like ventilators and PPE amplify their anxieties. Remember they are humans, they can break down and they have families too.
1) Editorial. COVID-19: protecting health-care workers. The Lancet March 21, 2020DOI:https://doi.org/10.1016/S0140-6736(20)30644-9
2) The World Bank. Current Health Expenditure. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS. Accessed on 2020-03-23.
3) European Commission. An official website of the European Union. World military expenditure and weapons trade. https://ec.europa.eu/knowledge4policy/foresight/topic/changing-security-... . Accessed on 23 March 2020.
Competing interests: No competing interests
We are hugely concerned about the high reported variability in availability and use of PPE  and are particularly concerned about the ENT profession and have published the findings of survey of use by ENTS on the ENT-UK website. There results paint a very worrying picture and are summarised here:
• Full PPE for Aerosol-Generating Procedures (AGPs) in COVID-19 pandemic readily available to only 36% of respondents.
• In 1 in 5 Trusts (22%), dedicated PPE was unavailable, even For Aerosol-Generating Procedures.
• FFP2/N95 masks were available to only 27% of respondents and 30% did not know whether or not they were available in their Trust.
• 95% of responding ENT surgeons predict that PPE will run out during the crisis.
Unconfirmed COVID-19 disease and Nasendoscopy & Laryngoscopy
Adequate PPE was available to only 28% of colleagues; just over 30% are offered surgical masks only
COVID-19 positive disease and Nasendoscopy & Laryngoscopy
Full PPE was only routinely available in 37%; occasionally offered in 36%; a surgical mask was available in 21%.
Training for the COVID-19 crisis
• 40% of respondents have either not attended a ‘donning and doffing’ course or stated that a course was unavailable.
• Most colleagues would defer or refuse to undertake an AGP in a COVID-19 positive without PPE.
• 80% of respondents do not know how to manage accidental contamination with COVID19 infected fluids.
Trust operational management for COVID-19
• Engagement with the Trust COVID-19 response team was described as peripheral (47%) or non-existent (8%).
• Only 16% of colleagues had established dedicated interdisciplinary teams and protocols for undertaking AGPs.
• Pre-treatment screening areas for potentially positive COVID-19 patients had been set up in only 40% of Trusts; 30% of respondents were unaware of their Trust’s arrangements.
• 60% of Trusts had created distinct isolation zones for COVID-19 patients.
• 58% were aware of their Trust having an agreed protocol for COVID-19 patients.
In our opinion these data show the reality in ENT AGP based services and may reflect the reality in many other surgical specialities. It is appalling that ENT and other medical, nursing, scientific and caring staff have to work in a situation where only one third of staff have proper PPE available, and we call as a priority that not only does NHS strategically work with the supply chain to enable the availability of PPE but also with Trusts and professional bodies to ensure that PPE is available and USED. If PPE is not used for ANY reason this is slaughter of a profession by neglect and inaction.
1 Covid-19 Personal Protective Equipment (PPE) Upated 3 April 2020 https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infec... Accessed 3 April 2020
2 O'Donoghue G, Swift A. Synopsis of PPE survey results for the COVID-19 pandemic. Key findings from 258 ENT Surgeons throughout the UK (survey period 23-30 March 2020). https://www.entuk.org/sites/default/files/files/Summarised_results_of_PP...
Funding: The survey was supported by ENT UK for administration and collection of data
No other external funding
The contributions of Mr Andrew Swift and Dr George Garas as well as the membership of ENTUK is acknowledged for their help and support.
Competing interests: Prof O’Donoghue is a Trustee of ENT UK. Prof A Davis has no conflict of interest to declare
Even with appropriate PPE, infections with Covid-19 will occur. It is very clear however that the greatest risk factor for serious illness and death comes with increasing age. Also it appears with being male (1).
Compared with those in their 20s or 30s, those of us in our 50s or 60s have a likelihood of death from Covid-19 that is an order of magnitude higher.
In Italy it is published that of 74 doctors who have died most were in their 60s, and only 4 were women (2).
In light of this evidence the NHS should endeavor to ensure that only younger doctors, nurses and other staff should be "patient facing". Older staff should recognise their inherent risks and be prepared to let the next generation take the frontline whenever possible.
Competing interests: I am an older, male GP.
Healthcare workers are acutely aware of regional and international differences in PPE guidance and practice as discussed. The discordance between high level guidelines such as those issued by larger organisations and hospital level guidance is a major source of anxiety and may even foster mistrust of future guidance.
It is not the disagreement between guidance that is the greatest source of anxiety but the communication of these decisions . Those issuing guidance need to be as transparent as possible in explaining every aspect of their decision making. In the event of pragmatic guidance being issued due to a specific resource shortage, it is essential to share this as part of the decision-making process. Healthcare workers are highly educated and socially engaged - they understand the realities of the unprecedented global situation and will do their best within these constraints to care for their patients. Simply suggesting that a certain geographical region should have a different PPE approach without justification is deeply unsettling for front-line staff.
There may be an impression among healthcare workers that any resource related PPE recommendations would be too politically embarrassing to disclose and might thus be obscured from those on the ground. Indeed, discussions surrounding healthcare logistics and PPE are no longer the purview of medical journals but now appear in the mainstream media daily. Troublingly, discussions surrounding PPE are increasingly politicized and sensitive.
As ever, openness and transparency are essential. If healthcare workers feel they are being given guidance that is informed by resources shortages but under the pretense of being data-driven this will undermine the essential trust between expert bodies and front-line staff. Maintaining trust in each other is fundamental to our success in this epidemic.
Competing interests: No competing interests
The lack of personal protective equipment (PPE) against covid-19 for frontline healthcare staff is indeed scandalous. Remedies are urgently required, both for the UK and in countries with far fewer resources. Regrettably, a simple yet important potential means of protection has been overlooked through lack of familiarity with the evidence and mis-interpretation of its implications: the prophylactic use of oropharyngeal washing.
Over a decade ago randomised controlled trials (RCTs) found evidence for the effectiveness of gargling with both povidone-iodine (PVP-I) and (chlorinated) tap-water in preventing general upper respiratory tract infections (URTIs) and influenza-like illnesses in particular. Yet despite point estimates all indicating efficacy, their lack of statistical significance was taken to imply lack of effectiveness, a widespread inferential error . A more sophisticated analysis  shows the findings of both studies are consistent with substantial efficacy concealed by inadequate statistical power.
Subsequent studies of other agents – notably tea-derived compounds – have led to similar outcomes: point estimates consistent with efficacy but lacking statistical significance. The role of inadequate statistical power rather than a lack of efficacy in these findings is supported by a meta-analysis of five studies which pointed to a statistically significant risk reduction of around 30 per cent. The appropriate response to the evidence from human studies is thus not that gargling with active agents does not work, but that large-scale RCTs should be performed[5,6].
In relation to covid-19, the obvious rejoinder is that these trial findings are irrelevant as they concern prophylaxis against influenza and the common cold. Given that SARS-CoV-2 was only recently identified, the lack of directly-relevant studies is hardly surprising. However, there exists in vitro evidence for inhibitory effects of both PVP-Iand tea-derived compounds against the closely-related coronavirus SARS-CoV-1. Biological plausibility of prophylactic gargling against covid-19 comes from the exploitation of ACE2 as the host cell receptor for infection by SARS-CoV-2. This receptor appears to be highly enriched in the oral cavity, which has accordingly been identified as a high-risk infectivity site. The salivary glands may be an early target for SARS-CoV-2, with implications for community-wide spread of infection.
None of the above constitutes compelling evidence; that can only come from well-designed large-scale studies. It is regrettable that repeated calls for such studies in relation to familiar viral infections have gone unheeded. Given the urgency of the present situation and the low risk of adverse effects, large-scale studies of prophylactic naso- and oropharyngeal washing involving those virucidals already investigated and also novel agents (eg ) should be started as soon as practicable. A draft protocol for healthcare workers and patients has recently been formulated. The use of similar forms of prophylaxis by the general population also merits urgent consideration, given its potential to reduce infection risk among both individuals and the community at large.
1. Satomura K, Kitamura T, Kawamura T, Shimbo T, Watanabe M, Kamei M, Takano Y, Tamakoshi A, Investigators GC. Prevention of upper respiratory tract infections by gargling: a randomized trial. American Journal of Preventive Medicine. 2005 29(4): 302-307.
2. Kitamura T, Satomura K, Kawamura T, Yamada S, Takashima K, Suganuma N, Namai H, Komura Y. Can we prevent influenza-like illnesses by gargling? Internal Medicine. 2007 46(18): 1623-1624.
3. Altman DG, Bland JM. Statistics notes: Absence of evidence is not evidence of absence. BMJ. 1995 311(7003): 485.
4. Matthews RAJ . Beyond ‘significance’: principles and practice of the Analysis of Credibility. Royal Society Open Science. 2018 5(1): 171047.
5. Ide K, Yamada H, Kawasaki Y. Effect of gargling with tea and ingredients of tea on the prevention of influenza infection: a meta-analysis. BMC Public Health. 2016 16(1): 396.
6. Furushima D, Ide K, Yamada H. Effect of tea catechins on influenza infection and the common cold with a focus on epidemiological/clinical studies. Molecules. 2018 23(7):1795.
7. Eggers M, Koburger-Janssen T, Eickmann M, Zorn J. In vitro bactericidal and virucidal efficacy of Povidone-Iodine gargle/mouthwash against respiratory and oral tract pathogens. Infectious diseases and therapy. 2018 7(2): 249-259.
8. Chen CN, Lin CP, Huang KK, Chen WC, Hsieh HP, Liang PH, Hsu JT. Inhibition of SARS-CoV 3C-like protease activity by theaflavin-3, 3'-digallate (TF3). Evidence-Based Complementary and Alternative Medicine. 2005; 2(2):209-215.
9. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, Li T, Chen Q. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. International Journal of Oral Science. 2020 12(1):1-5.
10. To KK, Tsang OT, Yip CC, Chan KH, Wu TC, Chan JM, Leung WS, Chik TS, Choi CY, Kandamby DH, Lung DC. Consistent detection of 2019 novel coronavirus in saliva. Clinical Infectious Diseases. 2020 Feb 12. Accessed 3 April 2020
11. Ramalingam S, Graham C, Dove J, Morrice L, Sheikh A. A pilot, open labelled, randomised controlled trial of hypertonic saline nasal irrigation and gargling for the common cold. Scientific reports. 2019 9 : 1015
12. Kirk-Bayley J, Challacombe S, Sunkaraneni S, Combes J. The use of povidone iodine nasal spray and mouthwash during the current covid-19 pandemic may protect healthcare workers and reduce cross infection. SSRN Preprint 3563092. Accessed 3 April 2020
Competing interests: No competing interests
Could I share a recent experience in relation to spreading infection in the community in the UK. Details have been altered to protect the identity of the healthcare workers and patients.
A GP received a call from the ambulance service in attendance with an elderly patient with mild dyspnoea and a temperature of 35.9C. The crew suggested treatment with prednisolone, mucolytics and antibiotics although the patient had no history of respiratory disease. The GP considered, in view of the other comorbidities, a cardiac cause should be ruled out, and attended without any PPE. On chest percussion the patient seemed to feel warmer than the reported 35.9C and temperature was confirmed as 36.9C about 4 hours after the initial call. The patient's main problem was shoulder pain and analgesia were organised for this through the community pharmacy.
Two days later the GP received another call from an ambulance in attendance. the patient had spiked a temperature of 38.4C the previous afternoon and breathing was laboured with a respiratory rate of 40 and a severe cough. Carers were present who had attended in the morning without PPE, ambulance staff in attendance was wearing a surgical mask, non-sleeved aprons and gloves but no face or eye protection. Carers had been given face masks some hours after entering the patient's residence, but were not trained to use them and were observed to contaminate the inside of the mask before applying it to their face. Some had been febrile the week previously, but without any of the other qualifying symptoms were back at work. The GP had experienced hay-fever like symptoms (occasional sneezing and itchy eyes for two days) in the previous week, had been checking their temperature twice a day, maximum 36.8, and no cough or chest symptoms.
While squatted to speak to the relatives the friendly cats of the patient repeatedly rubbed themselves on the back of the shirt of the GP. The previous week district nursing service had stopped visiting another terminal patient who was in great discomfort, due to the lack of PPE, the medication prescribed for pain two days previous was not in the house for either patient due to restrictions in the community pharmacy and it would not have been possible to ensure the patient was kept comfortable at home, necessitating admission to hospital and no doubt further contamination of attending staff and equipment.
It is clear to the UK GP that containment and prevention is not feasible. The GP had a change of clothing in their car just for such a situation of the second attendance, but in hindsight would have been heavily contaminated two days prior on the first home visit. With all other GPs in self-isolation, who would be in attendance for patients if this GP were to go home to await symptoms that never materialise in at least 30% of the COVID cases, and how many happy returns of such self-isolation could we expect in the months to come?
The GP in question had already resigned to be contaminated with the virus likely sooner than later, just like they have been for every influenza, parainfluenza, adenoviral, pertussis, pneumonia, streptococcal infection that has circulated in the community in the last 25 years. This is not an act of heroism, it is the job. The bitter pill is that after 20 years of institutional bullying and unilateral changes to contracts (the latest imposed change: cancelling Easter for primary care) the sudden praising words from authorities to keep staff plodding at the coalface ring hollow and disingenuous. Where were those praises when junior doctors and nurses had to go on strike?
It would be better if we could all be honest with each other and admit we are just doing the best we can given the circumstances, that PPE is not going to be adequate, that staff cannot be protected, that we aim for least harm, but above all that we do not lose sight of our humanity by branding patients as "frail elderly" not deserving of diagnosis, treatment or palliation.
Competing interests: No competing interests