In response to Health Secretary Matt Hancock’s statement regarding his unlawful management of PPE during the pandemic: ‘I won’t apologise because to apologise would imply that I’d do something differently’ DAUK’s Dr Katie Sanderson spoke out:

This is a pandemic not an election

How are we going to learn from this if we can’t be honest about what happened? It’s grossly offensive to the families of healthcare workers who got COVID and died, and I think it should be retracted immediately. 

Can you imagine what it feels like if you are the son or daughter of a doctor who died after getting COVID at work to hear that?

Dr Katie Sanderson – LBC Radio

38% of doctors who should have had FFP3 masks were saying they didn’t have them
47% saying they did not have access to long sleeved gowns 
>20% didn’t have eye protection
>60% had not been fit tested, so even if they had an FFP3 mask, it may not be protecting them because it may not have fitted 

DAUK’s Dr Ellen Welch and Dr Katie Sanderson write in the BMJ.

For months now, it has been the norm in primary care to speak with patients calling to discuss their new coughs and fevers, and to be greeted with surprise and often outrage when a covid test and household isolation are suggested. “I know it’s not covid” or “I always get a cough at this time of year” are the commonest protestations, alongside the belief that an intact sense of smell invalidates all the other symptoms. After the well-rehearsed debate is over, what follows is typically an unconvincing agreement to follow the government advice, which inspires zero confidence that this will actually happen.

Meanwhile, on the wards, a similar narrative occurs while checking that the relatives of covid-19 patients are isolating. The response is often simply: “I can’t isolate”, with financial hardship acknowledged as the main influence. While we are sympathetic to this situation, there remains a profound lack of understanding about this disease, despite its omnipresence in our lives. The many patients dying of covid-19 in hospital invariably all ask: “How did this happen to me?”

The general public cannot be criticised for these misperceptions, since the guidance from the government throughout this pandemic has been confusing, ambiguous, and inconsistent, often changing at the last minute. The lack of financial support for those needing to self isolate has left some people unable to follow the guidance for fear of financial hardship or ruin. Instead of following the lead of countries like Australia, who isolated and tested anyone presenting with any upper respiratory symptoms (including rhinorrhoea and pharyngitis ), here in the UK clinicians have been forced to have daily disputes with patients about the nature of their cough, while ignoring patients who present with snotty noses and sore throats as these symptoms somehow aren’t included as covid-19 in the UK.

Read the full article here: https://blogs.bmj.com/bmj/2021/02/05/we-urgently-need-to-double-down-on-the-basics-if-we-are-to-find-a-way-out-of-lockdown/

The NHS has been urged to rethink safety for thousands of frontline staff after new research suggested that Covid patients’ coughing is putting them at far greater risk of catching the virus than previously thought.

The study found that coughing generated at least 10 times more infectious “aerosol” particles than speaking or breathing – which could explain why so many NHS staff have fallen ill during the pandemic.

The research has led to fresh demands that anyone caring for someone with Covid-19, or suspected Covid-19, should be provided with the most protective equipment – including FFP3 respirator masks – and that hospital ventilation should be improved.

Health workers are up to four times more likely to contract coronavirus than the general population, with infection rates among those on general hospital wards approximately double those of intensive care unit (ICU) staff – who do have access to the most protective PPE.

This access to higher-level PPE was based on the assumption thatICU wards are more dangerous because treatments such as continuous positive airway pressure (CPAP), used to support patients’ breathing, generated large amounts of aerosols – which linger in the air and can be breathed into the lungs.

Staff working in other hospital areas, GP surgeries and care homes are issued with looser-fitting surgical masks, which afford little protection against these tiny particles, but block larger virus-carrying droplets.

The new research, which has not yet been peer-reviewed, turns these assumptions on their head.

The research may also boost efforts to force a public inquiry into Covid-19 deaths among NHS staff and care workers. In December, Doctors’ Association UK (DAUK), which represents frontline medics, escalated its threat of judicial review against the government. “Inquiries must be initiated to investigate any factors that may have led to healthcare workers’ deaths,” a spokesperson said.

“We feel that there would be fewer infections among healthcare workers, and fewer deaths, if people had proper masks,” said Dr Katie Sanderson, a junior doctor and committee member of DAUK. “Acute medical wards and A&E, which is where most Covid patients are being cared for, have much lower standards of ventilation than intensive care units, and generally people are coughing all the time.

“This issue affects GPs as well, because most GP commissioners have refused to let GPs have access to proper masks.”

Read the article in full here: https://www.theguardian.com/world/2021/feb/03/covid-coughing-study-suggests-nhs-staff-at-far-greater-risk-than-thought

DAUK (working in partnership with Messly) logged >1500 reports nationally highlighting inadequate access to PPE; 220 reports frontline doctors being warned, threatened, disciplined, or made to feel bullied or unsupported for raising issues about PPE

COVID-related HCW death: 
Katie Sanderson (DAUK), “We know that the appalling death toll of 882 frontline health and social care workers will continue to rise if no action is taken. “The investigation of these deaths has been piecemeal and inconsistent.”

PHE guidelines on PPE: 
Jenny Vaughan, “We do not feel that the PPE currently mandated by Public Health England offers healthcare workers an acceptable level of protection, and we are calling for the guidance to be urgently revised to ensure that all staff exposed to covid-19 have access to high level respiratory protection.

“There is also a clear lottery among hospital trusts: some are defying Public Health England rules to give their staff the protection they deserve due to concerns about hospital spread of the virus.”

Read the full article here: https://www.bmj.com/content/372/bmj.n442?utm_source=twitter&utm_medium=social&utm_term=hootsuite&utm_content=sme&utm_campaign=usage

Dr Katie Sanderson of DAUK spoke to CNN this morning regarding the growing trend of Covid deniers. She explained:

“The reason it is so upsetting people saying covid is a hoax is because you know that it will cause some people to behave in a way where they take risks they wouldn’t otherwise have taken. They get COVID and they potentially become very, very unwell. And that’s preventable.”

“And you just sometimes wonder, what do these people want? Do they want people to be dying in hospital car parks, dying in the streets, dying in corridors before they will accept that this is this is serious? It sort of beggars belief.”

DAUK’s Dr Katie Sanderson, talked to BBC Today about what it was like in March compared to today. She talks about the more hopeful situation dealing with Covid patients now due to the increased knowledge on the ground compared to previously, but also highlights her fears for another spike in cases in January. She reiterates how important it is to be sensible, and how every death now feels preventable due to the ongoing roll out of the vaccine.”
#protectthefrontline

Dr Katie Sanderson, part of the DAUK committee, talks to Sky News about her concerns about the next few weeks as a frontline hospital doctor.

“We’ve all got to think really carefully about what we do over the next couple of weeks, otherwise we are not going to be able to offer good quality medical care to everybody who needs. It’s not just about looking after patients who have coronavirus. We want to be able to do our best by everybody, but we can’t control how you behave.”

DAUK committee member, Dr Katie Sanderson on LBC radio speaks up on the importance of social responsibility during the current COVID outbreak, particularly following government guidance to stay home.

“I suppose what we want people to understand as an association of doctors working on the front line in acute medicine, in intensive care, in A&E, in general practice across London and the Southeast is that every individual decision really, really matters because every new infection is somebody who could potentially end up in hospital.”

” We’ve got to take all the pressure out of the system that we possibly can. What you choose to do over the next few days just makes such a big difference to the chance of us giving medical care to everybody who needs it over the next few weeks.”

Dr Katie Sanderson, committee member of DAUK and junior doctor working in London spoke out on the care of COVID patients during the second wave.

“I found it much scarier this time. We are much better at looking after these patients. I think we know how to treat them much better. The volume of people turning up who are really unwell is just unremitting and the concern is how are we going to manage over the next few weeks – looking after people well takes time.”

“There’s a finite number of staff available. And so I suppose every new admission just means less time for everybody else.”

Medical leaders have urged Public Health England to strengthen its guidance on personal protective equipment (PPE) to reflect the more transmissible forms of SARS-CoV-2 that healthcare staff are being exposed to.

Current guidance says that higher grade FFP3 masks should be provided to staff who are involved in aerosol generating procedures, but other staff looking after patients with covid-19 are only required to wear fluid resistant surgical masks.

In a letter to Public Health England sent on 13 January, BMA council chair Chaand Nagpaul said that, in light of the identification of the new variant of SARS-CoV-2, increased spread of the virus, and growing evidence of aerosol transmission, Public Health England should review its recommendations on PPE usage “so that a more precautionary approach is adopted to the provision of respiratory protective equipment (RPE) to ensure staff are protected from aerosol transmission.”

He wrote: “There are significant and growing concerns about the role of aerosol transmission of covid-19 in healthcare settings, and the need for wider use of RPE (for example, FFP3 respirators) outside of those procedures designated as aerosol generating. We are therefore calling on [Public Health England] to support the wider use of RPE in other high risk settings across primary and secondary care.”

Nagpaul mentioned evidence indicating lower infection rates among staff in areas where higher grade RPE is currently recommended.1 He also pointed out that the World Health Organization modified its guidance in December to advise that where respirators were available, they should be considered for wider use.2

The Doctors’ Association UK also called on Public Health England to review its guidelines on PPE for healthcare workers. The organisation said that there were 44 000 NHS staff currently absent because of covid-19, with many becoming unwell because of the new, more transmissible variant.

Katie Sanderson, spokesperson for the association, said, “Healthcare workers in the UK continue to become infected with covid-19 at work at rates that could be mitigated by access to better personal protective equipment.”

Jenny Vaughan, vice chair of the Doctors’ Association UK, said that the organisation was “calling for a full review of the PPE guidelines including wider access to FFP3 masks. So many NHS staff are getting sick because of the new, more transmissible variant. The covid-19 virus has changed, and yet the same guidelines we introduced in March have not been updated.”

Ensuring greater protection was especially vital for staff who were more at risk from covid-19, such as doctors from an ethnic minority background, the medical bodies said.

The interventions follow a similar call from Fresh Air NHS, a group of frontline healthcare workers who recently wrote an open letter to UK politicians urging them to recognise the importance of airborne transmission of SARS CoV-2 and to ensure that measures were in place to protect staff and patients.3

Yvonne Doyle, medical director at Public Health England, “NHS staff are under immense pressures and their safety has always been our highest priority. The NHS Infection Prevention Control group has reviewed the latest evidence and has advised that PPE should continue to be worn as laid out in the current [infection prevention and control] guidance, with FFP3 masks required for staff undertaking clinical aerosol generating procedures. This is supported by [the World Health Organization]. Emerging evidence and data on variant strains and transmission will be continually monitored and reviewed.”

Read the full article here: https://www.bmj.com/content/372/bmj.n146

References

1. ↵Shields  A, Faustini  SE, Perez-Toledo  M, et al. SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study. Thorax2020;75:1089-94. doi:10.1136/thoraxjnl-2020-215414. pmid:32917840Abstract/FREE Full TextGoogle Scholar
2. ↵WHO. Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus outbreak. 1 Dec. 2020, https://www.who.int/publications-detail-redirect/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak.
3. ↵Wise  J. Covid-19: Doctors and nurses demand better PPE for wider range of procedures. BMJ2021;372:n30.doi:10.1136/bmj.n30 pmid:33408072FREE Full Text