UK guidance on personal protective equipment is “inadequate” and continues to put healthcare workers’ lives at risk from airborne transmission of Covid-19 and in the face of new variants, health organisations have warned.
A coalition of more than 20 organisations have written to Boris Johnson calling for the rules to be reviewed. In the letter to the prime minister, the organisations described measures to reduce airborne spread of coronavirus in high-risk health and care settings – which they described as “mission-critical to the pandemic response” – as “inadequate”.
They said: “The evidence is clear and lives continue to be put at risk.”
The coalition includes, among others, the Royal College of Nursing (RCN), British Medical Association, the Royal Pharmaceutical Society and the Royal College of Midwives.
Writing to the prime minister, they said the current infection prevention and control (IPC) guidance, which determines the selection and use of PPE across the UK “does not accurately depict the airborne risks when sharing health and care settings including working in patients’ homes and public buildings”.
They added that current policies “continue to emphasise the importance of fomite, droplet and direct spread but do not properly address airborne transmission”.
The organisations are calling for a rapid change in approach amid the risk of new variants, setting out five priorities, including changing the IPC guidance “to reflect and increase the level of respiratory protection as a precautionary principle for all health and care workers” looking after people with, or suspected to have, Covid-19.
Quick Guide
Vaccines: how effective is each one and how many has the UK ordered?
Pfizer/BioNTech
Country US/Germany
Efficacy 95% a week after the second shot. Pfizer says it is only 52% after the first dose but the UK’s Joint Committee on Vaccination and Immunisation (JCVI) says this may rise to 90% after 21 days.
The UK has ordered 40m doses.
Doses Clinical trials involved two doses 21 days apart. The UK is stretching this to 12 weeks.
Oxford/AstraZeneca
Country UK
Efficacy 70.4% 14 days after receiving the second dose. May have up to 90% efficacy when given as a half dose followed by a full dose. No severe disease or hospitalisations in anyone who received the vaccine. There have been concerns it is less effective against the South African variant of the coronavirus.
The UK has ordered 100m doses.
Doses Two, four to 12 weeks apart
Moderna
Country US
Efficacy Phase 3 trial results suggest 94.1%.
The UK has ordered 17m doses, to be delivered in March or April
Doses Two, 28 days apart
Novavax
Country US
Efficacy Phase 3 trials suggest 89.3%.
60m doses ordered by the UK, with distribution expected principally in the second half of the year
Doses Two
Janssen (part of Johnson & Johnson)
Country US
Efficacy 72% in preventing mild to moderate cases in US trials but 66% efficacy observed in international trials. 85% efficacy against severe illness, and 100% protection against hospitalisation and death.
30m doses ordered by the UK
Doses: One, making it unique among Covid vaccines with phase 3 results so far
Improved ventilation quality in all health and care settings and updated guidance reflecting the evidence on airborne transmission, taking into account a “truly multidisciplinary range of experts”, is also needed, the letter continues.
The letter also asks for the collection and publication of consistent data on healthcare workers who have contracted the virus “from likely occupational exposure” to help identify settings where staff are most affected.
Finally, they want all scientific evidence on airborne transmission in health and care settings to be published in an accessible form and research carried out “to fill any knowledge gaps”.
The letter, which is copied to the health ministers in all four nations of the UK, states: “We believe that given the rapid emergence and evolution of new variants of concern, a change in approach must be implemented at speed to protect patients and staff consistently across the UK.”
In response to a similar call in January, the Department of Health and Social Care stated that guidance on the safest levels of PPE was written by experts and kept under constant review based on the latest evidence and data.
Dame Donna Kinnair, the RCN general secretary, said current government guidelines appeared to take a “one size fits all, no evidence” approach, and members felt their concerns were not being listened to and they feel unprotected.
“Some nurses providing end of life care are working overnight in a patient’s home, with no ventilation, in close proximity to family members where the risk of coronavirus may be high given rates of infection in the community currently,” she said.
“The equipment they are provided with needs to match the risk they are facing and be available if required alongside fit testing and training on their use.”
