Protect pregnant healthcare workers in the UK from COVID-19
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We are writing on behalf of all pregnant healthcare workers in UK regarding our concerns surrounding lack of clarity about our working situation during the ongoing COVID-19 pandemic.
The Prime Minister, Boris Johnson and the Chief Medical Officer, Chris Whitty, have advised that pregnant women are shielded from contracting COVID-19 as much as possible because the risks are unknown(1), and Public Health England have advised that all at risk groups should, including pregnant women ‘be particularly stringent in following social distancing measures.’(2)
The way in which this advice has been interpreted by different NHS Trusts and even across departments within the same Trust has varied greatly, with many stating the Government advice does not apply to healthcare professionals because their work is deemed as ‘essential’. Currently, many pregnant healthcare workers remain in face-to face-clinical roles and are being unjustifiably exposed to COVID-19 in high risk settings.
As healthcare professionals, we are acutely aware of the need to support the NHS workforce as much as possible during this time of extreme strain on the health service. However, we also have a duty to maintain our own health so as not to put further pressure on the system, but also to protect the health and wellbeing of our unborn babies – this will always be paramount.
The updated guidance from the Royal College of Obstetricians and Gynaecologists at the time of this letter, suggests that pregnant women are not at an increased risk of contracting the virus compared with other members of the population(3). However, we are extremely concerned at the RCOG’s advice that healthcare workers who are less than 28 weeks gestation should remain within a clinical healthcare setting and continue to see patients, including those who are suspected of COVID-19 infection.
There is currently no evidence on the effects of the virus in the first or second trimesters of pregnancy, and very sparse data in those in the third. It appears that this advice is being given on the absence of evidence, rather than in the absence of risk. Whilst we are dedicated to our professional responsibilities and passionate about patient care, without an assurance of safety we are not willing for our unborn children to become the experiment.
The RCOG acknowledge that potential obstetric complications as a result of being infected with COVID-19 could include: fetal growth restriction/IUGR and preterm delivery.(3) Furthermore, the case series which have influenced current guidance are all small but included a high caesarean section rate (27/32 women), a high preterm delivery rate (47%), 1 still birth and 1 neonatal death, in addition to some evidence of increased risk of fetal compromise in infants of infected mothers(4). The fact that data is sparse means that there are many unknowns. We simply do not have enough data on effects of infection at any stage of pregnancy to be advocating exposure of pregnant healthcare workers.
RCOG advice for pregnant healthcare workers is not only contrary to the Public Health England advice(2), but also contradicts its own advice. The RCOG guidance states: ‘All pregnant women, regardless of gestation should observe the social distancing guidance available on the Government website’(3). They then go on to advise healthcare workers to carry on working largely as normal if they are in the first or second trimesters of pregnancy, without any evidence basis on which to satisfy safety concerns. To advise pregnant healthcare workers differently amounts to active discrimination.
It is not possible to follow social distancing measures when working within a healthcare setting and this poses an unjustifiable risk to pregnant healthcare workers
The legal charity Maternity Action(5), state that ‘as COVID-19 is an infectious disease, your employers duty to take health and safety action applies if there is ‘a level at work which is in addition to the level at which a new or expectant mother may be expected to be exposed outside of the workplace’ - a statement which is supported by UK legislation(6).
Since pregnant women have been advised to socially distance themselves at government level, it follows that a pregnant doctor entering any healthcare setting is at greater risk in comparison through the following routes:
1. Risk of infection from patients
· Any face-to-face patient contact carries a risk of transmission of the virus
· It is not safe to assume that asymptomatic patients are not carrying the virus. The Chief Medical Officer has already stated that there are believed to be cases who are asymptomatic or show minimal symptoms
· Patients may not be following self-isolation advice for family contacts and therefore could be incubating the virus
Some Occupational Health Departments have advised moving pregnant workers to areas within the hospital/practice building which are deemed ‘lower risk’ or have asked them to see patients who are not symptomatic. This is not appropriate for the reasons outlined above.
2. Risk from other staff
· Many healthcare staff are not being provided with adequate PPE when seeing suspected cases
· Healthcare workers are currently not required to self-isolate after having been exposed to known or suspected cases of COVID-19, as long as they remain asymptomatic.
· In a number of UK Hospital Trusts, healthcare workers are being told not to follow Public Health England advice with regards to self-isolation, and are being asked to continue working even if they have a household member with symptoms
· Contamination of keyboards/telephones/pens or other equipment, including sharing of toilet facilities.
Even where pregnant healthcare workers are moved to non-clinical roles and are removed from patient contact, they still have a significant risk of exposure through their colleagues via the above routes which promote incubation and spread of the virus. These points are of relevance also to those pregnant women who have a partner/spouse working within the healthcare system.
3. Risk through travel to the workplace
· Vulnerable groups (including pregnant women) have been advised to avoid public transport to minimise their risk of being infected
Many pregnant healthcare workers will not be able to reach work without using public transport, thereby exponentially increasing their risk to exposure of COVID-19.
In summary, we believe:
· there is not enough evidence on the effects of COVID-19 in pregnancy at any gestation to justify exposing pregnant healthcare workers within the workplace
· that we are actively being discriminated against by being advised differently to other expectant mothers
· that it is not possible to follow social distancing measures whilst working within any healthcare setting
We want to ensure that in line with Government advice:
· we are able to practice social distancing at any gestation to minimise our risk and should not be differentiated from the rest of the pregnant population
· That in practicing social distancing we are able to: a) work remotely or from home, or if this is not possible b) that we will be suspended from work on full pay for the full suggested 12 week period (or for as long as social distancing measures are deemed appropriate for the at risk population).
As a consequence of such measures, we want to ensure:
· we are not financially penalised and will receive written assurance that our pay is unaffected
· we will be included in fair discussions surrounding how our training and career progression will be affected by these measures
We ask for clear, unequivocal guidance for all pregnant women which will be applied in a coordinated and uniform manner by all healthcare services, and that does not discriminate healthcare workers from the rest of the population. In light of the anxiety and confusion that pregnant healthcare workers have faced thus far, we respectfully ask for these concerns to be addressed as a matter of urgency.
In support of Pregnant UK Healthcare Professionals
Dr Henrietta Cavanagh, ST6 Obstetrics and Gynaecology, GMC 7044582
Miss Susan Hendrickson, ST6 Plastic Surgery, GMC 7169608
Dr Ruth Wood, MRC Clinical Research Training Fellow (Neurology), GMC 7073637
Miss Eleanor Davidson, ST7 Orthopaedics, GMC 7016716
Dr Shier Ziser Dawood, Foundation Year 2 Doctor, GMC 7601473
Dr Natalie Smith, ST5 Obstetrics and Gynaecology, GMC 7169790
Dr Roshini Joseph, Foundation Year 2 Doctor, GMC 7605996
Dr Kathryn Selby, ST5 Geriatrics/General Medicine, GMC 7254646
Dr Leila Hummerstone, GPST3, GMC 7131902
Mrs Tricia Campbell, Leadership Fellow HEE NE, 7085105
Dr Lyndsey Brandwood, GP, GMC 7017174
Dr Jennifer Akhurst, GP, GMC 7016648
Dr Laura Yell, ST2, Obstetrics and Gynaecology, GMC 7490075
Dr Kirsty Harris, Obstetrics and Gynaecology, GMC 7495637
Dr Avni Hindocha, ST4 Paediatrics, GMC 7427060
Miss Annemarie Brunswicker, ST6 Cardiothoracic Surgery
Dr Hannah Buglass, GPST3, GMC 7411065
Dr Holly Brooker, ST6 Emergency Medicine, GMC 7082166
Dr Emily Hale, ST4 Paediatrics, GMC 7271370
Dr Kathryn Blackmore, ED Consultant, GMC 7071664
Dr Saoirse Lyons, ST3 Aneasthetics/ITU, GMC 7410215
Dr Oluwakemi Oyefeko, GPST1, GMC 7538765
Dr Sakinah Said Ali, ST3 Paediatrics, GMC 7202834
Dr Fiona Baxter, ST8 Paediatrics, GMC 7036799
Dr Kimberly Tan, ST3 Ophthalmology, GMC 7447505
Dr Anna Butterworth, IMT1 Oncology, GMC 7527942
Dr Anna Leslie, Core Medical Trainee, GMC 7419078
Miss Sarah Dawson, ST6 Ophthalmology, GMC 7135093
Dr Katie Smith, GPST1, GMC 7563600
Dr Nicola Gray, GP, GMC 7334273
Dr Emma Badger, ST2 Obstetrics and Gynaecology, GMC 7408668
Dr Rachael Black, ST5 Obstetrics and Gynaecology, GMC 7266545
Dr Hannah Willis, GPST3, GMC 7408877
Dr Gemma Haverson, GPST3, GMC 7457203
Dr Sian Louise Goddard, Clinical Fellow GUM/HIV, GMC 7040379
Dr Ling Zhang, GP, GMC 7072548
Dr Emma Telford, ST3 Paediatrics, GMC 7039007
Dr Ariella Wagerman, Foundation Year 2 Doctor, GMC 7601443
Dr Julie Gray, GP, GMC 6157542
Dr Hannah Smith, ST5 Obstetrics and Gynaecology, GMC 6160787
Dr Megan Ashwood, GPST2, GMC 7138596
Dr Hannah Wilkin-Crowe, ST3 Emergency Medicine, GMC 7403240
Dr Alison Williams, GP, GMC 6167069
Dr Alison Marriott, GPST1, GMC 7554361
Dr Juliet Baby, GPST2, GMC 7482220
Dr Helen Arnold, Endocrinology SpR, GMC 7284416
Dr Hayley Austin, GPST1, GMC 7486036
Dr Ailie MacPhee, Registrar in Emergency Medicine, GMC 7148979
Dr Nicholas Jennings, GP, GMC 7409492
Dr Meena Murugan, CT3 Psychiatry, GMC 7265399
Dr Siyamini Sivananthan, Paediatric Registrar, GMC 7140357
Dr Rachael Lockyer, GP, GMC 7285054
Dr Beth Goundry, Speciality Doctor in Palliative Medicine, GMC 7082563
Ms Kirsty Milne, Orthopaedic Registrar, GMC 7264803
Dr Sarah Wilson, ST3 Paediatrics, GMC 7494812
Dr Livia Soriano, ST5 Dermatology, GMC 7293907
Dr Olga Khan, ST1 Paediatrics, GMC 7488669
Dr Tracey Williamson, GP, GMC 7072544
Dr Rachael Trenaman, ST5 Care of the Elderly, GMC 7138816
Dr Louise Polson, GPST1, GMC 7561499
Dr Miriam Rodriguez, GPST3, GMC 7421036
Dr Rebecca Hepworth, GPST2, GMC 7274588
Dr Aung Win Tin, Consultant Clinical Oncologist, GMC 7039666
Dr Jennifer Lane, GP, GMC 6159431
Dr Susan Travers, Foundation Year 2 Doctor, GMC 7605158
Dr Danielle Robinson, GP and Sexual Health Specialty Doctor, GMC 7016016
Dr Elizbeth Cope, GP, GMC 7040630
Dr Lianne Thomas, ST5 Dermatology, GMC 7266839
Dr Emma David, ST3 GP, GMC 7414433
Mrs Antonia Di Benedetto, Urology Consultant, GMC 7434675
Dr Farhana Lalani, GP, GMC 7411624
Dr Adrienn Zarandi, Speciality Doctor, Obstetrics and Gynaecology, GMC 7431654
Dr Barbara Zawisla-Boksz, CMT2, GMC 7515258
Dr Elisabeth Hoyles, ST5 Radiology, GMC 7137916
Dr Sehrish Khan, Cardiology SpR, GMC 7050197
Dr Giovanna Sheiybani, Gastroenterology/GIM SpR, GMC 7130266
Dr Harriet Cosh, GPST1 Paediatrics, GMC 7519486
Dr Ellen Farmer, GP, GMC 7284974
Dr Rebecca Wiltshire, ST6 Obstetrics and Gynaecology
Dr Fiona Lyall, Radiology Registrar, GMC 6144271
Dr Sheena Patel, Urology Speciality Registrar, GMC 7016463
Dr Qainaat Husnoo, GPST2, GMC 7503527
Dr Kate Robson, GPST2, GMC 7492345
Dr Nizrun Shaffraz Nisthar, GPST3, GMC 7132580
Dr Shari Sapuan, Paediatric Trainee/Clinical Research Fellow, GMC 7080016
Dr Harriet O’Neill, Dermatology Registrar, GMC 7138769
Dr Hannah Fosker, ST5 Psychiatry, GMC 7284363
Dr Katherine Patel, GPST2, GMC 7461121
Dr Katie Hoyles, Histopathology Trainee, GMC 7155739
Dr Yvonne Mangan, Oncology SpR, GMC 7429056
Dr Mieran Sethi, Dermatology SpR, GMC 7049848
Dr Lauren Barnfield, ST4 Obstetrics and Gynaecology, GMC 7280637
Dr Fiona Ramsden, Consultant Anaesthetist, GMC 6073340
Dr Laura Sparks, GPST3, GMC 7455754
Dr Emily Robinson, ST4 Haematology, GMC 7458556
Dr Zoe Hazelwood, GPST3, GMC 7493657
Dr Daria Mudrak, GPST3, GMC 7459537
Dr Bobbie Drinkwater, GPST3, GMC 7074950
1. PM statement on coronavirus: 16 March 2020. www.gov.uk (2020). Available at: https://www.gov.uk/government/speeches/pm-statement-on-coronavirus-16-march-2020 (Accessed: 22nd March 2020)
2. Public Health England. Guidance on social distancing for everyone in the UK. www.gov.uk (2020). Available at: https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults (Accessed: 22nd March 2020)
3. Royal College of Obstetricians and Gynaecologists. Coronavirus (COVID-19) Infection in Pregnancy. (2020). Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-03-21-covid19-pregnancy-guidance-2118.pdf (Accessed: 22nd March 2020)
4. Mullins, E., Evans, D., Viner, R. M., O’Brien, P. & Morris, E. Coronavirus in pregnancy and delivery: rapid review. Ultrasound Obstet. Gynecol. (2020). doi:10.1002/uog.22014
5. Wood, K. Coronavirus (Covid-19) and rights at work during pregnancy - Maternity Action. (2020). Available at: https://maternityaction.org.uk/2020/03/covidmaternityblog/ (Accessed: 22nd March 2020)
6. The Management of Health and Safety at Work Regulations. (Queen’s Printer of Acts of Parliament, 1999).
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