Special report by web editor Chris Ingram:
The outcry over the lack of personal protective equipment (PPE) for nurses and doctors continues, along with the threats from NHS Trusts across the UK to their clinical staff of being sacked if they speak out or wear their own individually sourced PPE; has now taken a sinister turn in the minds of many NHS workers.
The World Health Organisation set the standards for PPE that doctors and nurses tending to Covid-19 patients should use, and which the majority of countries across the world battling against Covid-19 have adopted with success and reflected by the low level of deaths of their healthcare workers. especially in Germany, China, and South Korea.
However, in the UK, blighted by a Government decision to ignore and coerce changes to recommendations made to stockpile ventilators and clinical staff PPE in 2015, thereby creating a national shortage; downgrading the standard of PPE required to protect front-line workers was always going to be suspect. In effect a 4 year and 3 months notice for the need to prepare for a new pandemic, was ignored.
Not surprisingly, there is a link between Public Health England (PHE) effectively our Government's actions in downgrading PPE for clinicians and that of the current battle in the US.
In response to a national shortage of PPE, nurses have reported threats of sackings in the event they speak out or wear N-95 masks:
'The California Nurses Association and National Nurses United created a flyer for members which reads: "Kaiser has told nurses that if they're seen wearing their personal N95 masks, they could be fired 'on the spot' for insubordination." reports US based China Global Television Network (CGTN) on their news website:
'Health care workers "must have the ability to tell the public what is really going on inside the facilities where they are caring for COVID-19 patients," Ruth Schubert, a spokeswoman for the Washington State Nurses Association, told Bloomberg.
Last Monday [30th March], a group of nurses protested outside Kaiser Permanente's Oakland Medical Center asking for more PPE.
Of course in the UK, PHE England claimed that their changes, (coincidentally the same as that of Kaiser Permanante in the US), was based on 'the latest science' and 'backed by the World Health Organisation'. The latter claim being in direct opposition to that which the WHO has published without change, as their standard recommendation for PPE when treating suspected or confirmed cases of Covid-19.
So what is the difference and why the downgrade?
Well, the obvious answer to that is of course, the lack of PPE in hospitals in the first place!
But the more one looks into the difference between the two standards of PPE kit, the more the risk to NHS clinical staff is self evident.
Almost at the same time as the changes in the US, UK Government issued, via PHE England, new guidance for the use of PPE based upon false or flimsy evidential science at the least, was issued. The assumption is now that the virus is transmitted only by contact and via droplets expelled less than 2 metres from the mouth and nose of patients suffering from the virus, and that therefore distancing and simple water repellent face masks are required to protect NHS clinicians treating patients suspected of having or confirmed as having the Covid-19 virus. They claim that Aerosolised transmission is NOT the way it is spread, except when using certain procedures to treat the patient.
Therefore the new standard does NOT include the need for clinical staff to use N-95 standard face masks. It also does not include the need fro full long-sleeved gowns, and clearly shows that flimsy plastic aprons and short sleeved tops and disposable gloves are sufficient to protect nursing staff and doctors.
It also means that local 'risk assessments' are required to determine which of the two types of PPE is used for any given circumstance and patient. Given the speed and number of patients requiring urgent treatment, it is virtually impossible for clinical staff to risk assess before treating the patient. As the standard kit is only a water repellent face mask, flimsy apron, and short sleeved tunic; the risk to the treating nurse of becoming infected with the virus, is clearly one of small odds!
This new guidance of course allows for the NHS Trust to issue a dictate as majority have done, that only in a few circumstances is full WHO approved PPE required to be worn by staff, even in an ICU, according to reports from those brave enough to report to the media their plight and lack of PPE of both types.
Indeed, one nurse was forced to resign after being ordered not to wear her own sourced N95/FFP3 mask, under the threat of being sacked; following her return to work from having to self-isolate due to being couched on by a patient when she had no mask at all to wear due to their being a shortage in her NHS hospital.
As The Guardian newspaper reported:
'Tracy Brennan fought back against her superiors at Hillingdon Hospitals NHS Foundation Trust for forbidding her from wearing a surgical mask she had bought to protect herself – and the patients she was caring for – from contracting the deadly virus.
She said that later that day, while taking blood, a patient coughed into her unprotected face but, despite relaying details of the incident, she was still refused permission to wear her mask.
Brennan wrote: “With a heavy heart and sadness, I feel I have no alternative but to hand this letter in as my formal resignation and will be unable to work my notice due to not being allowed to wear sufficient personal protective equipment (PPE) for the duties I perform.”
The response from the NHS Trust was the usual dismissive statement of "We take the safety of our employees seriously...." that all employers spew out when confronted about health and safety issues, with out actually addressing the specific incident raised:
"A spokesman for the Hillingdon trust said: “Our trust takes the safety of all our staff extremely seriously and we follow national guidelines, as set out by Public Health England. We regularly update staff on the types of PPE and the rules for its use ... We are also providing extra support to our staff during the current emergency both for their physical and their mental health and wellbeing.”
In the case of Tracy Brennan, the 'extra support to our staff' bit didn't exist.
Claims made by the Health Secretary Matt Hancock that all those 'needing' PPE have got it and that the new guidelines determine who needs it, belies the fact that WHO standards for PPE is BNOT being met and that only those dealing with patients on ventilators will get the full PPE.
Referring back to the UK, CGN reports on what is now the international record of our NHS: mismanagement of the virus, and no adherence to the duty of care by the NHS when it comes to it's employees, the doctors and nurses who are on the front-line:
'It's also been the case in the UK where medical workers have said they are being put at risk during the outbreak. A frontline doctor told the BBC that they feel like "cannon fodder" without adequate protective equipment like masks.
Doctors told The Independent on Tuesday that they are not allowed to speak publicly about the shortage of PPE when treating COVID-19 patients. Some claim that hospital managers and National Health Service (NHS) bodies have threatened their careers, warning them not to make any comments on social media and to avoid talking to journalists.'
But some have ignored the threats.
Their report adds:
'NHS England, according to the Independent, confirmed that it has been controlling media communication. However, the body clarified that the act was "part of its national emergency incident planning to ensure the public received clear and consistent information."
At least two doctors have had their jobs terminated, and one in London said they were not even allowed to wear protective kit bought by themselves or stop working, according to The Independent, which added that it has received a series of emails and messages warning staff not doing so.
For those who spoke out about their concern for the equipment shortage, punishment, as revealed by The Guardian includes threatening emails, the possibility of disciplinary action and being sent home from work. This has raised disagreement from experts.
Dr. Samantha Batt Rawden, president of Doctors' Association UK (DAUK), said it is "unacceptable."
"Doctors have a moral duty to make their concerns regarding COVID-19 public if these cannot be resolved locally," she told The Guardian.
Dr. Rinesh Parmar, chairman of the DAUK told The Independent "We are seeing draconian measures used to gag doctors and nurses on the frontline. The NHS will only benefit if we learn from each other's experience. If we are unable to share our learning then patients will be put at risk."
However, "Once a major incident occurs it is vital that the public receive fast, authoritative, open, clear and consistent information from their NHS, which is why, in line with longstanding emergency preparedness, resilience and response protocols, official communications are therefore always coordinated nationally," an NHS spokesperson said, according to The Independent.'
The UK news media in print has reported on the scandal in the NHS, but TV news media, especially the BBC, is lacking in bringing the Government to account for their failings in preparedness and dealing with the Covid-19 virus as it presents in the UK.
Along with the lack of testing of NHS clinical workers on the front line which is risking their lives, and has cost over 20 NHS doctors and nurses treating patients with Covid-19 their lives; the lack of PPE and the downgrading of the standards of that which is used, is clearly a disgrace.
The absurdity of sacking nurses and doctors given the shortage of both to the tune of 40,000 and 10,000 respectively; is also a national disgrace and one which is clearly determined by NHS England who, headed by Simon Stevens, an ex-president of United Health (Europe) whose practices in the UK clearly reflect that of American Healthcare company Kaiser Permanente, often quoted by the now Chair of the Commons Committee on Health and Social Care, Jeremy Hunt when he was the Secretary for Health and Social Care.
Source: PHE / WHO / The Guardian / The Independent / CDC / CGTN / unionsafety / Covid-19 Health Data.org