Doctors step up push for PPE as frontline fears continue

by Keith Cooper

The UK’s ability to protect doctors from COVID-19 infection is laid bare as BMA research reveals ongoing supply issues, and calls for Government action grow more urgent.

Location: UK
Published: Wednesday 15 April 2020

Doctors have stepped up their campaign for adequate personal protective gear for staff as ministers refuse to tap EU supply routes, and reports of poor access to basic equipment continue to stream in.

Hundreds of doctors have posted often alarming reports of the risks they are forced to take with the lives of their patients and themselves for want of access to PPE (personal protective equipment) in recent weeks. Fifty from across the UK – in London, Cardiff, Oxford and Norfolk, among others – raised concerns through the BMA’s open-access portal over the bank holiday weekend alone.

Following this continuing concern, the association has this week launched its second snapshot survey to assess and track the extent of PPE supply issues across the UK. Its inaugural survey of almost 2,000 doctors earlier this month found more than 55 per cent of hospital doctors often or sometimes felt pressured to be involved in risky ‘aerosol-generating procedures’ without adequate protection. More than half also reported a shortage or no supply at all of FFP (filtering face piece) masks.

Since that survey doctors have continued to report poor access to PPE, confusion over the official guidance on what sort to wear, and how standards, intended to keep them safe, are lowered when supplies run low.

'No eye protection for the last three weeks,' one junior doctor said. 'No facilities to clean clogs. PPE equipment is in short supply – and often locked away. A group of trainees at their hospital had clubbed together to spend £4,000 on PPE to keep safe.

Doctors in one hospital were provided with ‘a bucket of Milton to dip our hands in’ after running out of hand cleansing gel.

'The infection control advice from our hospital changes weekly, depending on supplies,’ another said. 'Initially, we were advised to wear full PPE for all interactions with suspected or confirmed COVID-19 patients...subsequently our airtight masks were removed and we were given surgical masks. Instead of being cautious, they have opted to be reckless with our safety, and deny this is a decision based on monetary and supply factors.'

The protection of doctors from the risk of infection is the BMA’s ‘first priority’, its council chair Chaand Nagpaul has said. The association has successfully pressured the Government and Public Health England to strengthen its guidance to match that of the World Health Organization.

This guidance now specifies that PPE should be worn for all direct patient contact – not just for those with suspected or confirmed COVID-19.

A research team led by highly respected Oxford professor of primary care Trisha Greenhalgh concluded this week following a ‘rapid review’ of research on the use of PPE during the COVID-19 pandemic, that there was ‘no direct evidence’ of their efficacy, that it remained in short supply, and ‘does not always meet the minimum standards recommended by national and international bodies’.

This new NHS guidance should be the ‘minimum’ on offer, Dr Nagpaul said in a letter to NHS England chief executive Simon Stevens this week, raising concerns about the apparent disproportionate impact of COVID-19 on people from BAME (black, Asian and minority ethnic) backgrounds.

'We also need to ensure that there is sufficient supply of effective PPE to meet different needs,2 the letter added. 'Some doctors, such as Sikh and Muslim doctors, wear beards for religious reasons and we have heard they are facing difficulties in getting alternative respirators like PAPR (powered, air-purifying respirator) hoods when FFP3 masks cannot be fitted.'

The association has ‘spearheaded’ an urgent call for Government to take whatever action is necessary to massively scale up production of PPE within the UK amid a global shortage. This call was made in a joint statement with other trade unions Unite, Unison, the Royal College of Nursing and trade organisations Make UK, ADS Group, and the British Printing Industries Federation.

Similar calls have been made by the BMA in letters to the business, energy and industrial strategy secretary Alok Sharma. Health secretary Matt Hancock has been urged to explore overseas suppliers which have been successfully pursued by other countries, such as Ireland’s chartering of 10 Aer Lingus aeroplanes to collect £180m of PPE directly from China.

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The BMA also wrote to NHS England director for acute care Keith Willett to recommend tapping into EU supply chains, as they remain open to the UK. Cabinet Office minister Penny Mordaunt indicated last month that the Government would not use these supply sources: ‘We have chosen other routes,’ she told Parliament. Downing Street has denied media reports that it missed three opportunities to bulk buy supplies through the EU.

The BMA has also backed the Daily Mirror’s campaign, Protect Us, which demands PPE for all NHS staff, carers, cleaners, porters, transport workers and anyone else at risk.

But Dr Nagpaul said: 'No avenue should go unexplored, and no stone unturned, in the effort to secure the equipment which the NHS will require to rise to the challenge of this pandemic and to save doctors and patients’ lives.'