PPE in the NHS during COVID-19

A special episode of The Lancet Voice looks into the lack of personal protective equipment, or PPE, for healthcare workers in the NHS.

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Transcript

This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Jessamy: Hi, this is Jessamy. I'm a medical doctor. Hi, 

Gavin: this is Gavin. 

Jessamy: And we're discussing the really serious issue of personal protective equipment for healthcare workers. There are some terrifying situations for NHS staff who are currently on the front line, feeling scared and unsafe. And we've had the real honour of speaking to some of those healthcare workers about their experiences.

Gavin: Yeah, it's a really scary situation for a lot of these healthcare workers to be in. When you think they're on the front lines. facing a relatively unknown virus. We still, like we've said before, don't really know very much about it. But what we do know is that this personal protective equipment helps stop our healthcare workers getting the virus.

For them to be out there without the correct equipment is a very scary situation for them. 

Jessamy: Exactly. And we've learned from other countries that a high proportion of healthcare workers do get infected with this disease. And as we know, this is a disease that kills and it's not one that differentiates particularly between old or younger healthcare professionals.

There's a lot of stories of, young fit healthcare professionals becoming desperately unwell. 

Gavin: And, these are the people that we'll need. to to fight this disease on the front line. So they're the 

Jessamy: people 

Gavin: that need protecting right now. So 

Jessamy: they are our most crucial resource.

Gavin: Yeah, very much. Yeah, it was really interesting to speak to some health care workers about their experiences with the NHS's supply of PPE so far. And Later on, like Jessamy said, we'll be speaking with Richard Houghton, the editor of The Lancet, who's been collating some responses from clinicians around the UK on this topic as well.

Jessamy: First of all, we spoke to the editor of The Lancet, Richard Houghton, who's been contacted by frontline staff in the NHS, who have been talking to him about the situation and calling for more personal protective equipment. 

Gavin: So obviously, Richard, you've been talking to a lot of frontline doctors about their concerns about the lack of PPE in the NHS over the last few weeks.

What are some of the things that you've heard and what are some of the concerns that you would like to raise? 

Richard: We've been in touch with frontline health workers during the past week to 10 days to get their assessment of the access they have to personal protective equipment and the situation is dire up and down the country.

We are getting frequent reports of there being absolutely zero access to PPE. And even when there is access, there's certainly no access to WHO approved PPE. For some reason, the UK has not followed WHO or European CDC advice, with the result that the recommendation to have just surgical masks and thin plastic aprons and gloves that just cover the wrists is leaving our health workers massively exposed to infection.

Although we have heard in the last 48 hours about some of those blockages being relieved and PPE is making its way to some frontline services. Still, the fact is it's not WHO approved and when health workers raise that fact, the message we're getting is that hospital authorities and CCGs just won't budge.

They are saying that it's what NHS England and Public Health England have decided. And that's the end of the matter. That's not good enough. And we need to say that's not good enough. And messages even today, this morning, from GPs saying, and I'm quoting now we feel completely abandoned. We feel it's a completely negligent approach and not safe at all.

And then another, I can't tell you how distraught we feel. It's beyond words. And another, is anybody actually listening to the concerns and acting? We've got health workers who are literally risking their lives on the front line to suppress this outbreak, and our health authorities are not doing enough to protect those health workers.

If you go back to the papers we published on January the 24th and January the 31st, which were the first papers describing the clinical cases, of COVID 19 and also predicting the outbreak. PPE was specifically mentioned in both of those papers as being an urgent necessity that needed to be acquired and deployed at the front line.

And January the 24th, that was eight weeks ago, eight weeks ago, we had eight weeks to prepare. We could have used the whole of February to prepare for this, and we basically sat around twiddling our thumbs and hoping it would go away, and that everybody would get infected, and we'd build up herd immunity.

And so we ended up in the situation we're in. And These signals were, in these two papers. 

Gavin: So then Jesse, we spoke with Gerard O'Donohue, Nottingham University Hospital's, NHS Trust about his experience with the lack of personal protective equipment. 

Gerard: Hi I'm professor of otolaryngology at Nottingham University Hospitals NHS Trust.

We have. Very great concerns as a specialty because we feel we're very vulnerable and indeed the experience in Wuhan and indeed in Italy shows that individuals in the ENT specialty who do a lot of endoscopy, of course, in the course of our work are very vulnerable to this virus. And of course, those who work with us.

As well, speech and language therapists, for instance, who look after tracheostomy patients and laryngectomy patients. These professions are also very vulnerable, so we really want to increase awareness of the need for proper protective equipment. Not just surgical masks, which really do nothing to protect against the aerosols that contain the virus.

We feel that one of the important lessons from Wuhan is the importance of protecting healthcare staff very early in the course of this disease. We don't want to learn the same lessons that needed to be learned from Wuhan and Italy. We need to keep our healthcare workers healthy as much as we can.

We owe it as a moral duty to them that they are protected as good as they can be. And we want to make sure that Trusts throughout the country are making this an absolute priority that nobody need die or get sick needlessly because this equipment was not available. 

Jessamy: There's a lot of confusion I think about which different masks people should wear, be wearing and which different clothing.

When you're talking about kind of proficient protection, what are you talking about? 

Gerard: We are talking really about the, in, in exposure prone procedures, that would be for instance examining the throat, examining the nose and so on of a patient who may have either declared a COVID disease or they may have, of course, they may be just asymptomatic carriers.

But we need to have masks that lower the risk of viruses getting through. Now there are a number of these. Available and for instance anesthesiologists who are very much at the forefront of critical care that's needed for these patients have a very high spec mask, which is available and a visor as well as protective clothing.

And that is deemed adequate and the WHO has made its own guidelines on this. However in routine care, for instance, on hospital wards, one doesn't see that being used. The surgical masks are not designed. to lower the ingress of viruses to the mucous membranes. And therefore they offer very little protection.

Besides, once they've been worn for even an hour or even less, their efficacy reduces. So you need really masks that are highly effective at reducing the viral load that the individual is confronted with. I 

Jessamy: mean, how can we quickly access these masks? 

Gerard: If there is sufficient political will to get these things done and provided it will happen.

We have a lot of talk about making respirators and so forth, which of course is wonderful, but the likelihood of being able to do that in 10 days is almost an impossibility for any company. And of course, providing respirators without skilled nursing staff is futile. They just end up as scrap metal in the hospital.

We really need to concentrate on personnel, their safety, their skills, and keeping them active and working and safe when they go to work. It's really crucial that they, that we do that. So anything we invest in improving the safety of the healthcare workforce will pay handsome dividends in the longer term.

Jessamy: And finally, we spoke with the local London GP about his experiences and how he's been affected by the lack of personal protective equipment. 

Azim: So my name is Azeem Majeed. I'm Professor of Primary Care at St. Peter's College, London. I'm also an NHS GP in Clapham and South London. and a public health specialist, so I have a dual training in both public health and general practice.

What we call PPE for short Personal Protective Equipment. The NHS and most of the SNR sent out actually wasn't particularly good or useful, and so I think a lot of doctors are concerned they're seeing patients without full protection and therefore at risk of infection themselves. There's a lot of frustration amongst primary care professionals and other professionals in secondary care.

They're not being tested if they're symptomatic, which means then they're off work for 14 days which then causes problems for for workload. So I know across the country, there are many practices that have got now are now short of staff because so many are either sick. or in self isolation.

So I think the rapid testing of NHS staff is very important because it allows the staff to be tested and if negative they can return to work very quickly rather than being off for 14 days. I think that's one area which I welcome today's announcement and hope that is put in place very quickly. So I want to thank all our NHS staff and patients and the public for all that they've done.

But I think we do need to prioritise the staff, the health and NHS staff, because those people are needed in the next few months to manage people, whether it's in primary care, secondary care, tertiary care, intensive care. We need those staff for the next few months, to really prioritise their health and wellbeing.

Gavin: It's really important our NHS staff get as much support as possible. And, I think what's really important, Jessamyn, is that this supply of personal protective equipment is vitally important to their ability to not only practice medicine at the time, but to continue to practice medicine ongoing in this crisis.

Jessamy: Yeah, I think we really need some kind of resolution. The WHO guidance on Personal protective equipment is drastically different to the UK guidance on personal protective equipment. We need to learn from our mistakes or from the kind of lessons that were learned in China and in Italy, where, you know, up to 10 percent of healthcare workers were getting infected with COVID 19.

Now, obviously that has huge implications for the workforce, but also for people's personal. health and for their well being. So this is something that desperately needs to be sorted out. And Gerard O'Donoghue's point that where there's a will, there's a way, is one which, needs heeding. 

Gavin: If you have any feedback, thoughts, or comments on the lack of PPE in the NHS during the COVID 19 outbreak, please do send us an email on podcastsatlanta.

com and we'll get back to you. Thanks so much for listening.