Change downgrading of PPE guidance by Public Health England for COVID-19.

Change downgrading of PPE guidance by Public Health England for COVID-19.

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Irem Ishlek started this petition to Boris Johnson (Prime Minister) and

The NHS is facing the greatest public health challenge in its history - and one that it is not well equipped for.

It is clear that the NHS is working tirelessly to meet the mounting pressures and demands of the COVID-19 outbreak, with an exponentially increasing number of people testing positive for the virus each day. Inevitably, this is leading to crippling pressures on our hospitals, with colossal structural and managerial changes made to accommodate for the increasing needs on a daily, almost hourly basis.

As someone who works for the NHS, I am deeply concerned about the level of personal protective equipment (PPE) that Public Health England (PHE) have recommended for staff managing patients with COVID-19. To clarify, this currently comprises donning a surgical mask, a thin plastic apron and short latex gloves for attending suspected/confirmed cases, except when performing aerosol generating procedures, such as intubation, when a respirator (i.e. FFP3 mask), is advised to confer maximal respiratory protection. This has been recently downgraded from donning FFP3 masks, visors, long-sleeved gowns and gloves in all patients tested positive for the virus, irrespective of procedure.

The proposed argument by Public Health England is that an ‘adequate’ level of protection is established with surgical masks, aprons and gloves, but this is by no means absolute. There is still a considerable risk of viral transmission when using this suggested PPE –  especially from lacking full protective gowns and eye protection. Surgical masks provide some protection against droplet transmission, and guidance suggests that droplet transmission is a main mode of infection for COVID-19, but there are growing concerns amongst staff that this may not be enough.

There is a clear discrepancy on PPE wear internationally without any clear explanation. The World Health Organisation advises (as of 19th March 2020) the use of visors and long-sleeved gowns when in close contact with all cases of COVID-19 to reduce contact and droplet transmission, which the current PHE guidance does not implement.

41% of cases of coronavirus in a Wuhan hospital were due to hospital-transmission, without adequate PPE and infection control precautions (Wang et al., JAMA 2020). COVID-19 is extremely infectious, and we must minimise the risk of hospital-related transmission in this phase of the pandemic.

In the same vein, supplies for adequate PPE are reportedly running low nationwide. NHS staff are struggling to find protective wear within their trusts, resulting in dangerous rationing of equipment (as reported in ‘NHS staff ‘at risk’ over lack of protective gear’, BBC News, 18th March). There is a growing sense of fear that the government have so far failed to arrange adequate PPE provision – and protect its NHS staff and public - to get us through this outbreak safely.

It is not myself, or the likes of my colleagues, that I am most concerned about. The reality is, a majority of NHS staff will probably get through this pandemic relatively unscathed. The real risk we pose is being silent vectors of the disease to our most vulnerable if appropriate measures are lacking: our patients, our children, our elderly. Those who we care about the most. We are so proud to be serving the NHS during an incredibly difficult time, however we need to be safe – and infection free – to continue giving our best level of care, without harm. We need appropriate PPE and adequate PPE supplies to protect our public.

I therefore urge PHE to change their downgrading of the level of PPE required to safely manage patients with confirmed or suspected COVID-19 infection. To support this, I additionally petition for government to incentivise businesses to accelerate PPE manufacturing, thereby increasing the availability of PPE supply, for NHS Trusts and their healthcare professionals. Finally I am calling the government and PHE to publicise and inform all NHS staff (and the public) the scientific evidence and rationale behind adopting surgical masks over FFP3, to assure that optimal respiratory protection is being advised in light of the current evidence available.

Transparency is key for us to beat this pandemic. The curve cannot be flattened without optimal protection, before it is too late.

 

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