Infection rules for NHS staff leave them at risk from airborne Covid, warn experts

Pressure is growing on the government to change its stance on coronavirus infection rules which it is feared may leave NHS staff and patients at risk from airborne transmission.

Experts told The Independent the current guidance from Public Health England (PHE), which effectively says staff working on general wards can rely on just surgical masks for protection, was “outdated and potentially misleading” and put NHS staff at risk.

At the start of the pandemic the emphasis on stopping infection was focused around droplets containing the virus both in the air over short distances and on surfaces. Increasingly scientists have begun to warn the virus can also spread through much smaller aerosols which can remain airborne for a lot longer and over further distances.

On Friday, the World Health Organisation updated its information on how Covid spreads to acknowledge the risk of aerosols and last month papers released by the government’s Scientific Advisory Group for Emergencies (Sage) said health workers may need to use better protection for longer.

According to the Health and Safety Executive there were nearly 20,000 notifications of suspected workplace infections involving staff in a health or care setting in the 12 months to April this year, with 271 deaths. This is likely to be a substantial underestimate and only includes cases where there is reasonable evidence staff were infected at work.

Some hospitals have already gone further than the official guidance and started supplying staff with higher grade respirator masks, but this is not universal. Unions including the British Medical Association have called for better protection for NHS staff.

Dr Nathalie MacDermott, a paediatric expert in infectious diseases from King’s College London, said she considered the guidance to have been “substantially lacking since the beginning” of the pandemic.

She said: “I think it needs to be changed. From the beginning it was making an assumption that it couldn’t back up. With a new pathogen you should be taking every measure possible to prevent transmission in the workplace by giving people the highest level of PPE until such time as you can demonstrate that’s not required. But at no point have they demonstrated that and at the same time they have simply dismissed all research that demonstrates their guidance is substandard.”

Dr MacDermott, who was part of the international response to the Ebola outbreak in Africa in 2014, said she believed the guidance was “actively putting NHS staff at risk”, and added: “I think it has been all along, and I think that one of the reasons there’s reticence to change it now is because that would be acknowledging that they have put people at risk.”

Recent papers discussed by Sage found 15 per cent of people being treated for Covid-19 in hospital had developed their symptoms seven days after admission, suggesting they caught it on the wards. Some estimates have suggested at least 8,000 Covid deaths could be linked to catching the virus in hospital.

Dr Julian Tang, a clinical virologist and honorary associate professor at the University of Leicester, told The Independent there was a “battle royale” developing between traditionalists who opposed the idea of aerosol transmission and those who believed airborne spread was the predominant way infection passed between people.

He outlined weaknesses in the current PHE guidance which focused on droplets and surface contacts with aerosols only in areas like an intensive care unit.

“When you talk and breathe, you produce aerosols and droplets of a wide range of sizes, and the smaller aerosols can be inhaled even more effectively at close-range.

“So whilst surgical masks may block the larger droplets, the aerosols produced at close range can bypass the surgical mask to cause infection. This is why the categories in the PHE guidance are outdated and potentially misleading.”

He said if staff were given the filter masks known as FFP3 or other respirators “fewer would be infected from such patients”, adding: “But if the effectives of masks was acknowledged and acted upon earlier, more lives could have been saved.”

He pointed to countries in southeast Asia which had done better than Western nations after adopting universal masking early in the pandemic.

A Department of Health and Social Care spokesperson said there were no planned updates for the guidance yet. They added: “The safety of the NHS and social care workforce has always been our top priority and we continue to work tirelessly to deliver PPE that protects staff on the frontline.

“PPE recommendations included in the infection prevention and control guidance are agreed by an expert group of clinicians and scientists from across all four nations of the UK, based on the latest clinical evidence. Our experts are acutely aware of the risks of airborne transmission and the guidance is kept under constant review.”

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