Royal College of Physicians says NHS staff’s lives are still at risk despite ministers’ pledges

Doctors working in the riskiest areas of the UK’s hospitals with Covid-19 patients are finding it harder to get protective kit, despite ministerial pledges to solve the problem, research reveals.

The Royal College of Physicians has condemned the apparently worsening availability of personal protective equipment (PPE) as “truly terrible” and warned that frontline staff’s lives are at risk as a result.

Among doctors performing aerosol-generating procedures (AGP), in which patients with the disease release droplets from their mouth, 37% cannot always access a visor to wear while 31% have not been able to obtain a full-length surgical gown. Both are key elements of the full PPE NHS staff are advised to wear when participating in an AGP, such as a patient being intubated before being ventilated.

A survey undertaken by the college, to which 2,129 hospital doctors responded last week, found medics are finding it harder generally access to any sort of PPE. Just over a quarter (27%) said they could not get the kit they needed to keep them safe while treating people with Covid-19, up from 22% who said the same when the RCP conducted the same survey at the start of April.

Quick guide Will there be a second wave of coronavirus? Show Hide In recent days the UK has seen a sudden sharp increase in Covid-19 infection numbers, leading to fears that a second wave of cases is beginning. Epidemics of infectious diseases behave in different ways but the 1918 influenza pandemic that killed more than 50 million people is regarded as a key example of a pandemic that occurred in multiple waves, with the latter more severe than the first. It has been replicated – albeit more mildly – in subsequent flu pandemics. Until now that had been what was expected from Covid-19.

How and why multiple-wave outbreaks occur, and how subsequent waves of infection can be prevented, has become a staple of epidemiological modelling studies and pandemic preparation, which have looked at everything from social behaviour and health policy to vaccination and the buildup of community immunity, also known as herd immunity. Is there evidence of coronavirus coming back in a second wave? This is being watched very carefully. Without a vaccine, and with no widespread immunity to the new disease, one alarm is being sounded by the experience of Singapore, which has seen a sudden resurgence in infections despite being lauded for its early handling of the outbreak. Although Singapore instituted a strong contact tracing system for its general population, the disease re-emerged in cramped dormitory accommodation used by thousands of foreign workers with inadequate hygiene facilities and shared canteens. Singapore’s experience, although very specific, has demonstrated the ability of the disease to come back strongly in places where people are in close proximity and its ability to exploit any weakness in public health regimes set up to counter it. In June 2020, Beijing suffered from a new cluster of coronavirus cases which caused authorities to re-implement restrictions that China had previously been able to lift. In the UK, the city of Leicester was unable to come out of lockdown because of the development of a new spike of coronavirus cases. Clusters also emerged in Melbourne, requiring a re-imposition of lockdown conditions. What are experts worried about? Conventional wisdom among scientists suggests second waves of resistant infections occur after the capacity for treatment and isolation becomes exhausted. In this case the concern is that the social and political consensus supporting lockdowns is being overtaken by public frustration and the urgent need to reopen economies. However Linda Bauld, professor of public health at the University of Edinburgh, says “‘Second wave’ isn’t a term that we would use at the current time, as the virus hasn’t gone away, it’s in our population, it has spread to 188 countries so far, and what we are seeing now is essentially localised spikes or a localised return of a large number of cases.” The overall threat declines when susceptibility of the population to the disease falls below a certain threshold or when widespread vaccination becomes available. In general terms the ratio of susceptible and immune individuals in a population at the end of one wave determines the potential magnitude of a subsequent wave. The worry is that with a vaccine still many months away, and the real rate of infection only being guessed at, populations worldwide remain highly vulnerable to both resurgence and subsequent waves. Peter Beaumont, Emma Graham-Harrison and Martin Belam

“We’re living through the darkest times the NHS has ever faced and this survey shows the reality of the situation facing hospital doctors at the moment”, said Prof Andrew Goddard, the college’s president.

“The lack of PPE remains their biggest concern and it is truly terrible that supply has worsened over the past three weeks rather than improved.”

In remarks that lay bare leading doctors’ frustration with ministers’ repeated emphasis on the hugely increased amounts of PPE that have reached the frontline in recent weeks, Goddard added: “Healthcare workers couldn’t care less how many billion pieces of PPE have been ordered or supplied. If it isn’t there when they need it, they are in harm’s way.”

Dr Matthew Roycroft, the joint chair of the RCP’s trainees committee, hinted that some doctors may decide to withhold treatment amid the PPE shortage. “Without the right PPE my colleagues and I may find ourselves with the most awful of conundrums on our hands – having to choose between protecting our own lives or protecting those of the patients we treat.”

Hospital bosses said the college’s findings underlined the need for any future inquiry into the UK’s handling of the pandemic to include the action taken on PPE.

Q&A Coronavirus: should everyone be wearing face masks? Show Hide Some countries and states have been recommending that everybody wears face masks in indoor settings where social distancing is difficult or impossible. They have been made mandatory on public transport or in shops in many countries. According to guidance from the World Health Organization, people over 60 or with health issues should wear a medical-grade mask when they are out and cannot socially distance, while all others should wear a three-layer fabric mask. The WHO guidance, announced on 5 June, is a result of research commissioned by the organisation. It is still unknown whether the wearers of masks are protected, say its experts, but the new design it advocates does give protection to other people if properly used. The WHO says masks should be made of three layers – with cotton closest to the face, followed by a polypropylene layer and then a synthetic layer that is fluid-resistant. These are no substitute for physical distancing and hand hygiene, it says, but should be worn in situations where distancing is difficult, such as on public transport and at mass demonstrations. The WHO has been reluctant to commit to recommending face coverings, firstly because the evidence on whether they offer any protection to the public is limited and – more importantly – because it was afraid it would lead to shortages of medical-grade masks for health workers. Sarah Boseley Health editor

Chris Hopson, the chief executive of NHS Providers, which represents health service trusts in England, said: “Trust leaders have told us that, in general, after a difficult start, with the exception of visors and gowns, they now have the PPE they need.

“It will be important – when the time comes for a public inquiry – to examine why the pandemic stockpile was not configured for an epidemic like the one we face today and didn’t have enough gowns and visors.”

Niall Dickson, his counterpart at the NHS Confederation, said that while the self-selecting nature of the survey meant its findings should be treated with caution, shortages were continuing in some areas, though overall the picture is improving. Priority should now be given to getting PPE to GP surgeries, care homes and community-based health services, Dickson added.

Meanwhile, 61% of family doctors are no longer seeing a patient unless they have adequate PPE, according to a separate survey, of 675 self-selecting Gps by the medical website Pulse, while 74% said they fear for their health and their life, it emerged.

Although many GP appointments are now being conducted by telephone or video link, some patients are still coming into surgeries for a face-to-face consultation.

Many GPs have trouble getting hold of face masks, visors or goggles and gowns. Only a third said they had enough masks, for example.

Pulse also found that among GPs who responded:

52% feel unsafe because of PPE shortages.

26% have seen Covid-positive patients without proper PPE.

One in five GPs have had Covid-19 or assume they have.

The Department of Health and Social Care said: “We are working night and day to ensure our frontline health and social care staff have the equipment they need to tackle this virus, and have delivered over a billion items of PPE since the outbreak began.

“Lord [Paul] Deighton is leading the national effort to increase domestic production scaling up existing manufacturing whilst tapping into new resources. In addition, there is a significant international strategy to ensure that we have the PPE we need.”