By Sanjeev Krishna and Yolanda Augustin
LONDON – Many rich countries have sometimes failed to provide their healthcare workers with enough personal protective equipment (PPE) during the coronavirus pandemic. But the UK government’s performance – which has repeatedly urged the public to “Clap for Our Carers” – has been particularly shameful.
Although the government vaccination campaign now dominates the headlines, we must not lose sight of the fact that at least 850 health and social care workers in England died from COVID-19 between March and December 2020. And these workers remain at risk.
Among the medical professionals who lost their lives is Peter Tun, a senior physician who manages COVID-19 patients at the Royal Berkshire Hospital in Reading, who pleaded for essential PPE supplies three weeks before he died of the disease last April. Similarly, Andrew Ekene Nwankwo, a locum nurse at Broomfield Hospital in Chelmsford, died of COVID-19 after desperately trying to buy his own PPE online. How many other UK healthcare workers would still be alive if the right equipment were available?
To date the UK has recorded more than 4.2 million COVID-19 cases and over 125,000 deaths. We do not know the exact number of infections faced by health professionals in patients. But one study estimated that they accounted for about 10% of all cases between April and June 2020, with healthcare workers six times more likely to become infected than the general population.
A separate study in late April 2020 found that healthcare workers in Birmingham had a seroprevalence rate – the presence of antibodies to the SARS-CoV-2 virus causing COVID-19, indicating a previous infection – that was four times higher than local population as a whole (24% vs. 6%). These figures do not include the first summit of the pandemic in the UK in late March and early April.
At the end of March 2020, one in four National Health Service doctors was sick or alone, according to the Royal College of Physicians. With the NHS facing a PPE supply crisis, the British Medical Association (BMA) reported that some doctors and nurses – like Nwankwo – were buying their own face masks to get to work.
Intensive care staff were getting rarer PPE, including the filtration of surface class 3 respirators (FFP3). Despite managing the sick COVID-19 patients, they had lower infection rates than healthcare workers in the ward. In contrast, Public Health England recommended that staff in other clinical areas should wear more basic fluid-resistant surgical masks unless they undergo “aerosol production procedures.”
Because coughing, the defining symptom of COVID-19, clearly produces aerosols, all staff caring for these patients were at risk of infection. In the Birmingham study, clinicians working in acute care had more than twice the seroprevalence rate of intensive care staff (33% versus 15%).
Black, Asian and minority ethnic (BAME) healthcare workers have been at even greater risk: they are twice as likely as their white colleagues to become infected with COVID-19, and are at greater risk of developing complications severe and dead.
And yet, even after a year of the pandemic and tens of thousands of healthcare worker infections, the UK’s PPE coverage remains inadequate. Meanwhile, many scientists and doctors fear the government’s decision to delay giving healthcare workers a second dose of COVID-19 vaccine could affect vaccine effectiveness. Frontline medical staff therefore remain at unnecessary risk of infection and death.
Groups representing healthcare workers have repeatedly urged the government to address the PPE shortage. In December 2020, Doctors Association UK, a union representing frontline medical staff, called for a public inquiry into COVID-related deaths among NHS employees linked to PPE deficiency. And after a third pandemic driven by a new, more transmissible coronavirus variant, hit the NHS in early January 2021, the BMA and the Royal College of Nursing renewed calls for Public Health England to update its PPE guidance.
BMA Council Chairman Chaand Nagpaul has also pointed out that PPE remains a problem for female doctors, because the equipment is designed for men. Women make up 75% of the NHS workforce, and some are often left with pressure sores after long shifts wearing masks that don’t fit.
The AGP Alliance, a coalition of healthcare organizations, urged the government to expand the list of aerosol production procedures to include nasal tube insertion, chest physiotherapy, cardiopulmonary resuscitation, and other procedures. The group called for all relevant healthcare workers to be given FFP3 respirators, face shields, and fluid repellents.
But mid-January this year, Public Health England and the UK Department for Health and Social Care said there were no plans to change the current PPE guidelines, and they have not yet announced any plans to revise this guidance.
Some NHS Trusts have taken matters into their own hands and issued FFP3 masks to all employees caring for confirmed or suspected COVID-19 patients. But protecting the UK’s vital medical staff should not be a matter of straw removal. The disconnected situation has fueled concerns that open healthcare workers may be causing COVID-19 to “re-seed” in communities, especially with a new and more contagious variant.
Cronyism in the acquisition of a pandemic-related state (which has given rise to the term “coronyism’) could be to blame. The government has allocated more than half of its £ 18 billion ($ 25 billion) in PPE contracts to date without competitive tender. Because Public Health England had only two weeks of PPE stocks when the pandemic first hit the UK, it was forced to pan out to buy supplies at inflated prices. Furthermore, a significant proportion of the equipment paid for was never delivered, and some supplies were not fit for purpose.
COVID-19 infections and deaths in the UK are now declining, mainly as a result of the introduction of a rapid government vaccine. But his incompetence regarding PPE means that those fighting on the frontline remain in the crossfire of the pandemic.
Copyright: Project Syndicate, 2021.
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