By Alistair Smout
LONDON (Reuters) – It was when the government changed its guidance last week to say medical workers treating coronavirus patients could use plastic aprons instead of protective gowns that British doctor Asif Munaf concluded he was not going to get the protection he needs.
“Aprons are not water repellent, and these aprons show a huge part of the chest,” Munaf, a registrar central England, told Reuters, comparing them to frocks worn by servers in school cafeterias.
“You can’t be protected by an apron. A plastic apron doesn’t do anything. So when that was mentioned on Friday, I was very disheartened really, and I knew supplies weren’t going to come over the weekend,” he said. “They are not sufficient for doctors or nurses on the frontline.”
A shortage of personal protective equipment, or PPE, has become a political issue in Britain, with the government forced to defend its guidelines, which doctors say no longer comply with international recommendations to keep them safe.
Munaf says that he has worn full protective gear once in three weeks while working shifts at the COVID-19 wards. Gear was more readily available in emergency wards and Intensive Treatment Units (ITU), but supplies were dwindling, he said.
A British Medical Association (BMA) survey released on Saturday found that around 80% of doctors said they do not feel fully protected at work.
“As the weeks have progressed, the reality on the ground has been one of shortages, non-availabity at times, and therefore a lot of worry and concern amongst the profession,” Chaand Nagpaul, Chair of the Council of the BMA, told Reuters.
While those doing the riskiest procedures feel adequately supplied with the right masks and gloves, gowns are the problem: more said there were shortages or no supply of long-sleeved disposable gowns than said they had adequate equipment.
Public Health England, which issued the guidelines for National Health Service doctors, says it adheres to World Health Organization advice. The WHO says that while aprons are an alternative to gowns, they “should be avoided when performing aerosol-generating procedures”, referring to the riskiest work frontline doctors do.
But the new PHE guidance from Friday specifically says aprons can be used even for high-risk AGPs.
Nagpaul said that the shortage of full-sleeve gowns was a key concern and that, while guidance for doctors in general met standards outlined by the WHO, gowns were the exception.
He said that the BMA had not been given any notice of last Friday’s guidance change, and it had been very concerning.
“Remember, prior to this, the government had been repeatedly announcing that the issues were not one of not having the supplies, but there were problems with, operationally, delivery of large stocks that were centrally kept,” he said.
“It’s been the gowns that has been the issue in recent days. So when on Friday we learnt that this new guidance had been issued, it took us by surprise and worried us immensely because we had banked on getting those supplies.”
On Friday, health minister Matt Hancock said that Britain was “tight on gowns” but would aim for the delivery of gowns to the right places over the weekend. He did not refer to the change in policy, which followed later that day without a public announcement.
Foreign Secretary Dominic Raab, who is deputising for Prime Minister Boris Johnson while he continues to recover from COVID-19, on Wednesday defended the government’s record on procuring and distributing PPE.
“We’ve delivered 1 billion items of personal protective equipment and 10s of millions have been distributed via the devolved administrations,” he told parliament, saying 69 health workers had died from COVID-19.
“We recognise though that we have got to strive even harder in this incredibly difficult and competitive international environment to source the equipment.”
England’s Chief Medical Officer Chris Whitty said that Britain was “close to the line” on PPE supplies but had enough at a national level, even if there were local shortages.
“We have broadly… managed a very difficult situation without yet getting to the point where we’re no longer able to cope with it. But to promise now that in 2 or 3 days this is all going to be sorted… I think would be a mistake.”
Rinesh Parmar, an intensive care doctor based in the West Midlands and chair of the Doctors’ Association UK, a campaign group, said it was clear Britain had not learnt lessons about how to protect medical staff treating COVID patients from hard hit countries such as Italy and Spain.
“If we had, we would have stronger, more robust guidance that would fall in line with the World Health Organization recommendations.”
(Reporting by Alistair Smout; editing by Guy Faulconbridge)