Covid: Science advisers call for better PPE for healthcare workers

Matt Butler in PPE

Healthcare workers have welcomed a change in scientific advice on how to protect them from coronavirus.

A document by the government’s scientific advisory group (Sage) says higher grade masks may be needed when caring for Covid patients.

Current guidance says that thinner surgical masks are adequate, outside of intensive care units.

The Department of Health said guidance “is kept under constant review” and protecting NHS staff was a priority.

Some doctors described it as a “crack of light” after more than a year of campaigning for improvements.

A long list of healthcare unions and professional bodies has been making increasingly desperate appeals for what are called FFP3 respirators.

These are designed to filter out infectious aerosols that may be lingering in the air, particularly in close proximity to patients.

Growing evidence of the risks of airborne transmission has led the government to emphasise the importance of ventilation – with the words “fresh air” now added to the public messaging.

And now a technical document released by Sage concludes that healthcare workers may need higher standards of respiratory protective equipment (RPE).

‘Crack of light’

It says that where there’s “an unacceptable risk of transmission”, and other measures have already been applied, “it may be necessary to consider the extended use of appropriate RPE (such as FFP3 masks)”.

Dr Matt Butler, a consultant in geriatrics in Cambridge, said: “This is huge, it’s the first time they’ve acknowledged this, it’s a crack of light.”

He has long argued that surgical masks don’t offer enough protection against aerosols, and that FFP3 masks should instead be issued to all medics caring for confirmed or suspected Covid patients.

As the guidance stands, they are only worn in intensive care units or where certain “aerosol generating procedures” are carried out.

The new scientific assessment has yet to be adopted by the authorities in charge of the rules on PPE.

But Dr Butler hopes that will follow, and that the lull in the numbers being admitted to hospital will allow stocks of the devices to be built up and for staff to be fitted for them.

“We’ve got a bit of reprieve until the next wave or peak, so now’s the time to get ready,” he said.

Shift in science

At least 23 hospital trusts have broken with the official guidelines by giving the Covid-facing staff FFP3 masks.

Dr Eilir Hughes, a GP in north Wales who helped to set up the FreshAirNHS campaign group, says the shift in scientific advice marks a significant moment.

“It feels like a door that was locked has now been opened, at least slightly, and it sounds like the science on airborne transmission is starting to be recognised.”

The Sage document points out that FFP3 masks are “intrusive and can be uncomfortable to wear”.

And it warns that they need to be properly worn and can give a false sense of security, with a risk of self-contamination as staff touch them or remove them.

This follows multiple official reviews which have concluded that there is no need to change policy on PPE.

Empower workers

The Royal College of Nursing’s professional lead for infection prevention and control, Rose Gallagher, said: “This is a step in the right direction.

“What we need is for the UK’s infection prevention and control guidance to reflect this change, so that health and care organisations feel confident they can apply it in line with local circumstances and risks.

“We have heard many reports from our members that their employers do not feel able to deviate from the letter of national guidance for fear of being criticised.

“We hope that this change will empower to them to find local solutions that offer a greater level of protection to nurses, midwives and patients.”

A Department of Health and Social Care spokesperson said: “The safety of NHS and social care staff has always been our top priority and we continue to work round the clock to deliver PPE that helps protect those on the frontline.

“Guidance on the appropriate levels and standards of PPE is written by experts and agreed by all four UK chief medical officers.

“Our guidance is kept under constant review based on the latest evidence.”