The continuation of the Covid-19 pandemic requires a holistic response from the global to the personal. However in many instances this is not happening.

The following letter had been sent by Doctors in Unite to a number of the medical Royal Colleges in England calling for a more focused response to the airborne nature of this infection.

 

Dear President / Chair

After almost two years of constant high level alert due to the Covid pandemic, as a medical trade union, Doctors in Unite share the profession’s concerns about the continuing implications of this ongoing situation for patients, society, the wide clinical team and the profession itself.

In the last two years much attention has been given to keeping safe our patients and those who care for them, including your members, with particular attention being given to PPE, social distancing and vaccination. However, as medical trade union, Doctors in Unite is very concerned at the poor response to addressing what is a substantially an airborne disease. The importance of a clean air environment for patients, clinicians and the wider public has been at the very best an afterthought.

It is quite clear that current protections against the virus for both health care workers (HCW) and patients, are inadequate and failing to keep them safe. One only has to look at the alarming increase in staff absence due to Omicron (at a time of rising hospital admissions) and the high numbers of hospital acquired infections to see this. This comes on top of over 1,500 HCW deaths 1 and 11,600 patient deaths 2 from nosocomial infections. It has been heart breaking to see so many of our colleagues in the front line die from this preventable disease. HCWs from black and Asian communities have paid a particularly heavy price, accounting for over 60% of HCW deaths while making up only 20% of the NHS workforce.3 Unless we recognise the centrality of airborne transmission going forwards, and respond rapidly by implementing airborne protections in our hospitals and clinics, we fear that further unnecessary illness and death will be the consequence for our colleagues in hospital and for patients.

When we apply the standard health and safety “hierarchy of controls” to Covid-19, it is clear that airborne protections are literally central to that response. Vaccines, while essential, are not on their own going to get us out of this crisis. Assessing ventilation with CO2 monitors, improving ventilation where it is inadequate, installing air filters where this is not possible in the short term, and the wearing of respiratory protective equipment (RPE) will help ensure that HCWs and patients breathe clean air and will not get infected.

Providing proper ventilation and clean air cannot be done at an individual level. It demands a collective and corporate strategic response from a wide range of agencies to make public spaces, including work and clinical spaces, safe. Employers, i.e. NHS Trusts have a critical role here. The WHO has now formally recognised airborne transmission of Covid-19 and recently stated, “Respirators, which includes masks known as N95, FFP2 and others, should especially be worn in care settings where ventilation is known to be poor.” 4

As a Royal College, you have a very important role in setting standards, educating and promoting professional well-being. We hope you will be able to use your good offices to support growing demands on NHS employers to recognise airborne transmission and provide safe, clean air working environments for patients and staff throughout their estates. The distribution of RPE to all HCWs could be done within a matter of days, while other measures are being assessed, and would have a significant impact on transmission as this recent study at Addenbrooks Hospital showed. 5

We look forward to hearing from you and would be happy to discuss things further if that would be helpful.

With kind regards,

Jackie Applebee.

DiU Chair


References

1. https://committees.parliament.uk/oralevidence/2318/html/
2. https://www.telegraph.co.uk/news/2021/11/08/exclusive-11600-people-caught-covid-hospital-died/
3. https://twitter.com/WHO/status/1473668676549283844
4. https://www.bbc.co.uk/iplayer/episode/m000sv1d/why-is-covid-killing-people-of-colour
5. https://www.cam.ac.uk/research/news/upgrading-ppe-for-staff-working-on-covid-19-wards-cut-hospital-acquired-infections-dramatically

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