UK COVID-19 Daily: Inadequate PPE? Updated BMA Guidance

Tim Locke

April 21, 2020

These are the UK coronavirus stories you need to know about today.

Inadequate PPE? Updated BMA Guidance

Today the BMA updated guidance for doctors considering refusing to treat patients when PPE is inadequate.

It states: "There are limits to the risks you can be expected to expose yourself to. You are under no obligation to provide high-risk services without appropriate safety and protection. You can refuse to treat patients if your PPE is inadequate, you are at high risk of infection and there is no other way of delivering the care.

"The law also requires you and your employer to protect your safety and the safety of others. Employers must provide a safe system of work, which includes provision of appropriate PPE. If you have the employment status of 'employee' you are also specifically protected under employment law to take steps to avoid serious and imminent danger in your workplace without fear of detriment or dismissal."

The BMA tweeted: "Whatever your decision, we will robustly defend our members’ employment rights not to face a disciplinary process or detriment when facing serious and imminent danger in the workplace."

The Royal College of Anaesthetists (RCA) is the latest medical group to speak out about inadequate PPE. "Anaesthetists should not be expected to compromise their health & that of their patients due to PPE shortages. After taking everything into account if you decide that you cannot provide treatment we will support you," the RCA said quoting its President Professor Ravi Mahajan in a tweet.

Asked about PPE supplies again at today's Downing Street briefing, Matt Hancock, England's Health Secretary said: "There are clearly challenges."

He said: "There's more demand across the world than there is supply. and that means that we need to be as nimble as we possibly can and crucially, as much as possible, get right to the source of the PPE, which is often in factories in Asia, including in China, rather than going through middlemen."

He also said the Government is working with 159 potential UK PPE suppliers.

Mr Hancock also denied a claim by a senior Foreign Office official that a decision not to accept the EU's help with providing ventilators was a "political decision".

Vaccine Trial

Oxford's vaccine trial is due to begin in people from this Thursday, Mr Hancock announced. "In normal times reaching this stage would take years," adding that he was backing UK vaccine researchers "to the hilt".

He said: "The upside of being the first country in the world to develop a successful vaccine is so huge that I am throwing everything at it."

Deaths

The daily reported UK COVID-19 hospital deaths rose again today by 823. The number was higher than yesterday possibly due to the weekend effect. The total is now 17,337.

Of the 778 deaths in English hospitals patients were aged between 22 and 103. Of these, 24 aged between 49 and 91 had no known underlying health condition.

Latest figures showed the number of deaths in care homes in England and Wales almost doubled in the 4 weeks up to 10th April (Week 15) since the first COVID-19 deaths were registered.

The data from the Office for National Statistics (ONS) showed a steep increase in the number of deaths overall in Week 15.

There were 18,516 deaths in Week 15, up from 16,387 in Week 14. That was 7996 more deaths than the 5 year average the ONS reported.

Statisticians said it was the highest weekly total since the first week of 2000.

Consultant Remembered

Last night the death of emergency medicine consultant Manjeet Singh Riyat, 52, was announced by Royal Derby Hospital, University Hospitals of Derby and Burton.

Chief Executive Gavin Boyle paid tribute, saying Mr Riyat "was a widely respected consultant in emergency medicine nationally. Manjeet was the first A&E consultant from the Sikh community in the country and was instrumental in building the Emergency Medicine Service in Derbyshire over the past 2 decades. He was an incredibly charming person and well loved."

Miss Susie Hewitt, consultant in emergency medicine, added: "Mr Manjeet Singh Riyat qualified from the University of Leicester in 1992 and went on to train in Emergency Medicine at Leicester Royal Infirmary and Lincoln County Hospital. During this time, and prior to the introduction of paramedics, he acted as team leader for the Accident Flying Squads at both hospitals. Manjeet was also one of the first Clinical Research Fellows in the UK and contributed to the birth of academic Emergency Medicine." 

She continued: "He had that rare gift of maintaining constant joy in the intellectual challenge of clinical medicine combined with gentle kindness and compassion for his patients. He was a powerful advocate for the sickest patients and was well known for his fair, no-nonsense approach. By contrast, Manjeet could be relied upon to lift the mood with his dry humour and sense of fun."

Royal College of Emergency Medicine President Katherine Henderson tweeted: "Manjeet was the Lead examiner for our Fellowship exam. He put so much into his role and there are so many trainees and now Consultants who benefited from his support. The specialty, his team and RCEM will miss him very much."

Also remembered:

  • Patrick McManus, 60, a nurse at Staffordshire Royal Infirmary and the County Hospital in Stafford. Hospital Trust Chief Executive Tracy Bullock said: "He was a lovable character and brought kindness and compassion to all his patients which was acknowledged by the number of compliments and thank you messages he received."

  • Gerallt Davies, 51, a paramedic in Swansea. His death was "a devastating blow for us all," Jason Killens, chief executive at the Welsh Ambulances Services NHS Trust, said.

In Memoriam: Healthcare Workers Who Have Died of COVID-19.

CPR Concerns

"We are deeply concerned by Public Health England’s continued insistence on designating chest compressions as non aerosol generating procedures," the Resuscitation Council UK said in a statement.

It continued: "The absence of high-quality evidence for this should not be interpreted as the absence of risk. The clinical reality is that chest compressions produce excretions from a patient’s nose and mouth. As such, irrespective of whether this is via aerosol or droplet or both, this poses a demonstrable risk to health care professionals."

That stance was backed by Doctors' Association UK. Chair Dr Rinesh Parmar said: "We unreservedly support the Resuscitation Council UK and share their concerns that CPR should be deemed as an aerosol generating procedure. 

"International experts including the WHO and the International Liaison Committee on Resuscitation are agreed in their guidance which is being followed around the world. Public Health England's insistence to recommend lower grade protection to doctors and nurses performing CPR leaves a void and causes confusion and alarm on the NHS front line. Doctors have written to us with concerns that they are now being denied Level 3 PPE, risking their lives as a result of Public Health England guidance."

More News in Brief

  • A new trend is emerging for health departments to issue detailed rebuttals to critical newspaper articles. The Department of Health and Social Care took issue with the Sunday Times at the weekend. Now Public Health England is describing claims in the Sun that it downplayed COVID-19 and was slow to react as "nonsense" and "completely wrong".

  • The House of Commons got back to work today with just 50 MPs allowed in the chamber. Future sessions will include the ability to join remotely by video and online voting.

  • Captain Tom Moore officially opened, by video link, NHS Nightingale Yorkshire and the Humber today. The 99-year-old has now raised more than £27.5m for NHS charities with his sponsored garden walk.

https://twitter.com/NightingaleYH/status/1252597677218545664

See more global coronavirus updates in Medscape’s Coronavirus Resource Centre.

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