Saturday 28th March 2020
Protecting healthcare workers during a pandemic
Whilst much of the nation has been instructed to stay at home for the sake of others during this pandemic, healthcare workers have been rallied to march to hospitals and clinics en masse. The increasing cohort of healthcare workers include some 25,000 additional final year nursing and medical students who are being fast tracked to work in hospitals. (1) 11,000 retired medics and nurses will also been joining the National Health Service to serve the growing number of patients in hospitals. With this huge influx of troops to the frontlines there is a need for greater cognisance of healthcare worker safety. To keep all staff safe will require ensuring adequate personal protective equipment, proper rest facilities and helping staff to cope with the psychological stress of the new working environment.
In Italy 20% of healthcare workers have been infected with COVID-19. (2) Only in the past several days has the UK government announced that it will begin testing healthcare workers for COVID-19. The lack of testing for staff has been described as “illogical” by the head of the British Medical Association. (3) Previously staff had been instructed to self-isolate only if they developed symptoms of COVID-19 or if someone that they lived with developed symptoms of fever, persistent cough or shortness of breath. However no formal testing has been undertaken to provide clarity for staff on whether or not they have indeed been infected with the coronavirus. This has produced unnecessary anxiety for staff regarding whether they themselves, or their families, were are risk from the infection. This also kept perfectly healthy healthcare workers away from the frontlines, where they have been needed, due to a family member or flatmate being unwell.
The guidance has been confusing and, at times, frustrating. Earlier this month, I visited Berlin for a holiday to celebrate my upcoming wedding with my friends. This holiday occurred prior to the huge rise of COVID-19 cases in the UK and Germany. On the last day of the trip one of the individuals in our party became unwell. I was notified of his symptoms, which sounded remarkably like COVID-19. I called my local occupational health department on my return to the UK and I informed them that I had been in close contact for four days with an individual who had likely contracted the virus. I was instructed to come to work until I had symptoms. I found this approach a little irresponsible, given that I have countless interactions with staff and unwell and potentially immunocomprised patients who I might unknowingly infect. I should have been offered testing at the time. I am currently still within the 14 day incubation period for COVID-19 and have no idea whether I am infectious and what risk I am potentially posing to myself or others.
(Not) All the gear, no idea
Personal Protective Equipment or ‘PPE’ has been an area of contention for healthcare staff recently. On 15th March the WHO declared the COVID-19 virus to be spread by direct contact with respiratory droplets, thus changing the requirements for PPE when dealing with COVID-19 patients. Currently aprons, two pairs of gloves and fluid resistant face masks are required for basic interactions with these patients. If the patient is undergoing an aerosol generating procedure additional requirements of FFP 3 masks and eye visors are required. The definition of an aerosol generating procedure is highly contested at the moment with local guidelines differing from national policy. Some examples of aerosol generating procedures are: invasive ventilation, non-invasive ventilation and high-flow oxygen. Yet some other interventions such as nebulisers, which are used to clear respiratory secretions and help patients to breathe, have contested guidance. This is an area of potential conflict, confusion and increased risk for staff given the lack of ongoing clarity.
In addition, there is currently a national shortage of eye visors and FFP 3 face masks. These vital parts of equipment are used to protect staff in the highest risk areas such as intensive care units. However there are stories such as those on the British Medical Association website of staff having to source protective equipment from DIY stores or building sites. (4)
Doctors need social distancing too
Ensuring adequate rest facilities for doctors has been a bone of contention in our hospitals for many years. In the hospital that I currently work in there is one rest room for all the junior doctors in the hospital. On any one day there are approximately 100 or more junior doctors working in my hospital. These doctors have to share the same 10 meter by 6 meter doctor’s mess that contains a sink, a microwave, a 1 meter circular dining table with three functioning dining chairs and a sofa for approximately 6-8 people. The room has no window but there is an A3 picture of a window overlooking the ruins of a castle by the sea. Escapism at its finest.
Previously during meal times doctors would head to the canteen and congregate in groups to eat lunch and dinner. However with the introduction of social distancing the canteen has gone from having well over 100 seats to now having eight seats. It makes for a comical dining experience. It is now the most exclusive dining experience in South East Scotland.
The hospital has recently banned eating meals in the doctors’ offices on the wards for infection control purposes. However, this new declaration in addition to the scarcity of canteen seating has had the unfortunate effect of pushing the entire hospital’s junior doctor population to our tiny doctor’s mess. Social distancing is impossible to maintain. Seating, cutlery and fresh air is at a premium in the mess. It is a cacophony of noise and smells. And a prime breeding ground for an outbreak of COVID-19 amongst the entire junior doctor population of this hospital over the coming weeks.
I sit on the Lothian Trainees Management Forum as the representative for all first year junior doctors in South East Scotland. I raised the issue of adequate rest spaces with the Medical Director and Directors of Medical Education, as did several other members of the management forum yet the question was ignored on three separate occasions within the same conference call on Wednesday. Whilst I understand the directors see this as small fry and an opportunity for junior doctors to push the agenda of better rest facilities for staff, an ongoing and contested issue, I see this as potentially significant safety issue for the junior doctor populace. I see no bigger issue that an entire hospital’s population of doctors having to self-isolate in the next two weeks, just as the peak of the pandemic is predicted to hit. Who will man the frontlines then?
On Thursday, I wanted to take a picture of the packed and bustling doctor’s mess. Individuals were sitting on the floor, social distancing rules thrown out the (A3 picture of a) window. I wanted to use this to fortify my case for better rest facilities for the coming weeks at the management forum. I was however urged not to by one of my colleagues, the president of the doctor’s mess, in fear of the doctor’s mess being shut down. Where would we go then? No canteen, no doctor’s offices, no doctor’s mess. I shudder at the thought.
I want to finish with a powerful and moving interview done with an intensive care doctor who called into a national radio show. He finishes the interview by talking about how nurses and doctors could be repaid for risking their lives at work to help patients during the pandemic.
“All I want, rather than people saying thank you when this is
finished, is for these people to be given a coffee room to sit in.
To be given a kettle, coffee, milk. Maybe a Christmas dinner
that’s paid for or given to them by the hospital rather than
making our own.” (5)
The full length video can be found here.