Covid-19: Coroners needn’t investigate PPE policy failures in deaths of NHS staff, new guidance says
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1806 (Published 04 May 2020) Cite this as: BMJ 2020;369:m1806Find out more about our #properPPE campaign
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Dear Editor,
Although there is concern related to, for instance, provision of protective equipment and the possible impact on care, I would have thought that the apparent profound loosening of safeguards by the Chief Coroner surrounding the certification of death would have attracted even more notice. After all, many were instituted after the activities of Dr Harold Shipman. When I worked in the Tameside area where he was practising , he was known as as a caring competent GP and his murderous activity not known.
Potentially the new guidance would make it all too easy for a doctor with less than professional sympathy for the old or infirm under their care to usher them to their demise in the present circumstances.
No-one thought that a doctor would do such a thing, but history shows otherwise, and hence the checks and guidance for sound practice that were instituted. More than ever the patients should be able to trust their physicians in the present atmosphere of irrational fear engendered by our Government.
Yours sincerely
Dr J Aniskowicz
Competing interests: No competing interests
Dear Editor
The BMJ rightly questions the decision that in England, Coroners do not have to investigate PPE failures in NHS staff deaths from Covid-19 [1]. This should set the alarm bells ringing for a much wider range of workers beyond the NHS who may have been exposed to SARS-CoV-2 without appropriate PPE. It is to be hoped the medical press will speak up for these often very vulnerable workers too.
The risks to a range of workers from SARS-CoV-2 occupational hazards in the UK and elsewhere emerged at almost the same time. However, they have produced different levels of awareness, investigation and action. In this respect, the risk recognition from SARS-CoV-2 hazards and possible morbidity and mortality of workers has come in waves. With the first wave came a relatively belated recognition of the COVID-19 risks run by those treating or in contact with COVID-19 patients doctors, nurses, other health professionals, cleaners etc and emergency workers. Their risks were compounded by major problems with PPE and testing. In the second wave came those in social care and home care who were initially provided with even less PPE and less testing than for health care workers. In the third wave came key workers such as those in transport and service sector such as food retail. In the fourth wave there already are construction workers and, with the likely incremental loosening of the lockdown across the UK, other manufacturing workers where PPE requirements, physical distancing and testing may well prove the most demanding but with significantly lower levels of risks than those faced by health care workers.
Occupational diseases can take decades to emerge. Then there may be much scientific and legal wrangling about causation often based on the need for a doubling of relative risks to be established before an ‘industrial’ diseases is prescribed. Covid-19 has emerged in a very short period of time as an ‘occupational disease’ but gaining official recognition and establishing workplace exposures as its cause may well still prove highly problematic. The task may be easier for health care workers than other occupational groups. For that reason, it is critical that the health and safety need of the third and fourth wave of exposed workers are addressed and appropriate preventive action taken supported by the necessary research.
At the moment this appears to be a neglected area in publications as the table below indicates.. A few scoping reviews covering safety and Covid-19 have mentioned the safety of grocery store staff, public transport and taxi drivers as well as health and social care but little other information is currently available [2]. Yet trade unions and non-governmental organisations for several weeks have been raising the lack of PPE and the general lack of health and safety precautions for the third and fourth wave workers exposed to SARS-CoV-2 [3, 4].
Table. Search results for papers on health and safety of non-health workers and COVID in major data bases – all record searched with no date limitations ( searched 9 May 2020)
Source HCWs Social care/
Care
Home/nursing home Transport
Workers Bus
Drivers/
Ticket collectors Ferry workers Train drivers/
Railway workers Taxi drivers Factory workers/
Manufacturing workers
Pubmed 28 0/0/0 0 0/0 0 0/0 0 0/0
Science Direct 201 0/0/1 0 1/0 0 0/0 2 1/0
Web of Science 6 0/0/0 0 0/0 0 0/0 0 0/0
[HCW – Health Care Workers]
Search terms uses the employment category and then refined by “safety covid”. Web of Science Core Collection.
1 Dyer C. Covid-19: Coroners needn’t investigate PPE policy failures in deaths of NHS staff, new guidance says. BMJ 2020;369:m1806. oi: https://doi.org/10.1136/bmj.m1806 published 04 May 2020
2 Haghani, M., Bliemer, M.C.J., Goerlandt, F., Li, J, The scientific literature on Coronaviruses, COVID-19 and its associated safety-related research dimensions: A scientometric analysis and scoping review, Safety Science 2020, doi: https://doi.org/10.1016/j.ssci.2020.104806 online 7 May 2020. In press, page proof.
3 International Transport Workers Federation (2020) Charter on Public Transport Worker health and safety and COVID-19. https://www.itfglobal.org/en/news/keep-public-transport-workers-safe-cov... (accessed 5th May 2020)
4 Watterson A. Commentary and debate: COVID-19 in the UK and occupational health and safety: predictable not inevitable failures by government, and trade union and non-governmental organization responses. New Solutions. A Journal of Environmental and Occupational Health Policy. Preprint Research gate . Online May 2020.
Competing interests: No competing interests
Dear Editor
I feel a bit vindicated when I read a few article in this issues. A friend of mine, a consultant anaesthetist, told me that during the early days of the pandemic, he was told not to scaremongering other colleagues by raising concerns about PPE. It has been highlighted many times that staff were more concerned that they could infect their family when they go home. He felt that it would be difficult to challenge them because the guidance coming from the NHS England. This clearly indicates that the front life staff and their family are considered expendable! By the way my friend is one of the BAEMs. There you are they are expendable! Less likely to challenge the management.
Secondly , in the early days of news briefing , the question was put to the panel regarding the number of deaths in black and ethnic minority group. Deliberate obfuscation. Did not get the answer. Thirdly in this issues , it was highlighted the lack of minority representative in the politically appointed news briefing NHS panel. Finally it is the gagging order from the top not to investigate the lack of PPE related deaths in these patients. What a way of brush it under the carpet.
I had a suspicion right from the beginning. It is well known that the PPE guidance from NHS England is based on availability. Not based on the science. The politically appointed SAGE and NERVTAG members are confidential. Finally very reluctant to disclose the CIGNUS 2019 simulation out come.
It beggars believe what we are witnessing
Competing interests: No competing interests
Re: Covid-19: Coroners needn’t investigate PPE policy failures in deaths of NHS staff, new guidance says
Dear Editor,
We are concerned that we may gathering inaccurate data on death related to COVID-19.
Where a death occurs in a person who has tested positive for Covid-19, the cause of death is being recorded as COVID-19 infection. Covid infection may just be coincidental, and the death might have occurred due to another condition such as an acute myocardial infarction, a subarachnoid haemorrhage or other pathology. We need to be mindful of this factor impacting our count of Covid deaths.
In the absence of a post-mortem recording a death as a Covid-19 death, it raises the question about the accuracy of the data.
Competing interests: No competing interests