Tag Archives: protective equipment

Over 90,000 health workers infected with COVID-19 worldwide: nurses group

By Cecile Mantovani

(Reuters) – At least 90,000 health-care workers worldwide are believed to have been infected with COVID-19, and possibly twice that, amid reports of continuing shortages of protective equipment, the International Council of Nurses (ICN) said on Wednesday.

The disease has killed more than 260 nurses, it said in a statement, urging authorities to keep more accurate records to help prevent the virus from spreading among staff and patients.

The Geneva-based association said a month ago that 100 nurses had died in the pandemic sparked by a novel coronavirus that emerged in the central Chinese city of Wuhan late last year.

“The figure for health care workers infections has risen from 23,000 to we think more than 90,000, but that is still an under-estimation because it is not (covering) every country in the world,” Howard Catton, ICN’s chief executive officer, told Reuters Television in its lakeside offices.

The 90,000 estimate is based on information collected on 30 countries from national nursing associations, government figures and media reports. The ICN represents 130 national associations and more than 20 million registered nurses.

Catton, noting that 3.5 million cases of COVID-19 have been reported worldwide, said: “If the average health worker infection rate, about 6 percent we think, is applied to that, the figure globally could be more than 200,000 health worker infections today.

“The scandal is that governments are not systematically collecting and reporting on this information. It looks to us as though they are turning a blind eye which we think is completely unacceptable and will cost more lives,” Catton, a Briton, added.

The World Health Organization (WHO), which is coordinating the global response to the pandemic, says that its 194 member states are not providing comprehensive figures on health worker infections as they grapple with the unprecedented crisis.

The WHO last said on April 11 that some 22,000 health workers were thought to have been infected.

The ICN said it now believes those “shocking” figures to significantly underestimate the reality.

“This failure to record both infection rates and deaths among healthcare workers is putting more nurses and their patients in danger,” the statement said.

(Writing by Stephanie Nebehay; Editing by Mark Heinrich)

UK calls in army and warns people to stay home or face lockdown

By Kate Holton and Sarah Young

LONDON (Reuters) – Britain sent in the army to deliver protective equipment to hospitals on Monday and told people to stay at home and heed warnings over social distancing or the government would bring in more extreme measures to stop the coronavirus spread.

With some doctors saying they felt like “cannon fodder”, the government said the military would help ship millions of items of personal protective equipment (PPE) including masks to healthcare workers who have complained of shortages.

So far, 281 Britons have died from coronavirus and, in the last few days, British authorities have rapidly stepped up action to try to limit the spread of the disease and prevent a repeat of the death toll seen in other countries where thousands have died.

However, there have been complaints from frontline medical staff about shortages of kit, saying they did not feel safe at work. In a letter pleading with Prime Minister Boris Johnson to increase PPE supplies, more than 6,000 frontline doctors said they were being asked to put their lives at risk with out-of-date masks, and low stocks of equipment.

Health Secretary Matt Hancock admitted there had been issues but promised action was being taken. He said the army would drive trucks throughout the day and night to get supplies to medical staff.

“It’s like a war effort, it is a war against this virus and so the army have been incredibly helpful in getting those logistics so we can get the supplies to protect people on the front line,” he told the BBC, saying the health service now had 12,000 ventilators, 7,000 more than at the start of the crisis.

Britain has brought in a series of measures to try to curb the spread of the virus.

On Monday, a much-reduced rail service was introduced and jury trials were suspended, coming days after Johnson advised Britons to work from home if possible and ordered the closure of pubs, gyms and leisure centers.

ADVICE IGNORED

But advice to stay at home and avoid social gatherings went unheeded by millions at the weekend who took advantage of sunny weather to flocked to parks and beauty spots over the weekend, ignoring instructions to stay 2 meters (6 feet) apart.

Emyr Williams, chief executive of the Snowdonia National Park Authority in Wales, said the past 24 hours had been unprecedented.

“We have experienced the busiest visitor day in living memory. The area has been overwhelmed with visitors,” he said.

The government warned that Britain would face a shutdown with curfews and travel restrictions if people continued to flout the advice.

“Well, we’re perfectly prepared to do that if we need to because the objective here is really clear which is to stop the spread of the virus. Of course we will enforce and bring in further strong measures if we need to,” Hancock told Sky News.

The government was also pondering whether to close all non-essential retail shops, the BBC’s political editor reported.

Some firms have already acted because of slowing demand, with clothing retailer Primark and department store John Lewis saying on Monday they would temporarily close all of their shops.

It comes as Britain opened the first part of a 330 billion pound ($384 billion) loan guarantee scheme for businesses , which will help small and medium-sized firms borrow up to 5 million pounds to deal with coronavirus stoppages.

(Additional reporting by Costas Pitas and David Milliken; Writing by Michael Holden; Editing by Guy Faulconbridge and Alison Williams)

Who gets the ventilator? British doctors contemplate harrowing coronavirus care choices

By Stephen Grey and Andrew MacAskill

LONDON (Reuters) – The coronavirus pandemic is forcing senior doctors in Britain’s National Health Service to contemplate the unthinkable: how to ration access to critical care beds and ventilators should resources fall short.

The country’s public health system, the NHS, is ill-equipped to cope with an outbreak that is unprecedented in modern times. Hospitals are now striving to at least quadruple the number of intensive care beds to meet an expected surge in serious virus cases, senior physicians told Reuters, but expressed dismay that preparations had not begun weeks earlier.

With serious shortages of ventilators, protective equipment and trained workers, the physicians said senior staff at hospitals were beginning to confront an excruciating debate on intensive care rationing, though Britain may be a long way from potentially having to make such decisions.

Rahuldeb Sarkar, a consultant physician in respiratory medicine and critical care in the English county of Kent, said local NHS trusts across the country were reviewing decision-making procedures drawn up, but never needed, during the 2009 H1N1 flu pandemic. They cover how to choose who, in the event of a shortage, would be put on a ventilator and for how long.

Decisions would always be based on an individual basis if it got to that point, taking into account the chance of survival, he said. But nevertheless, there would be difficult choices.

“It will be tough, and that’s why it’s important that you know, that two or more consultants will make the decisions.”

Sarkar said the choices extended not only to who was given access to a ventilator but how long to continue if there was no sign of recovery.

“In normal days, that patient would be given some more days to see which way it goes,” he added. But if the worst predictions about the spread of the virus proved correct, he suspected “it will happen quicker than before”.

Britain is by no means the only country that faces having its health system overwhelmed by COVID-19, but the data on critical care beds – a crucial bulwark against the disease – is concerning for UK authorities.

Italy, where the coronavirus has driven hospitals to the point of collapse in some areas and thousands have died, had about 12.5 critical care beds per 100,000 of its population before the outbreak.

That is above the European average of 11.5, while the figure in Germany is 29.2, according to a widely-quoted academic study https://link.springer.com/article/10.1007/s00134-012-2627-8 dating back to 2012 which doctors said was still valid. Britain has 6.6.

‘MANY TIMES MORE’ VENTILATORS

Estimates of the potential death toll in Britain range from a government estimate of around 20,000 to an upper end of over 250,000 predicted by researchers at Imperial College. As of March 19, 64,621 people had been tested, with 3,269 positive.

The NHS is preparing for the biggest challenge it has faced since it was founded after the ravages of World War Two, promising cradle-to-grave healthcare for all.

It was stretched long before COVID-19, struggling to adapt to the vast increase in healthcare demand in recent years. Some doctors complain that it is underfunded and poorly managed. About a tenth of its more than one million staff roles in the health service are vacant while almost nine out of 10 beds are occupied.

The department of health referred a request for comment to NHS England, which said it was crucial to reduce the coronavirus’s infection rate to ease peak pressure on the health system.

“Unmitigated, there is no health service in the world that would be able to cope if the virus let rip,” said NHS England head Simon Stevens. “In the meantime, what the NHS is doing, of course, is pulling out all the stops to make sure that we have as many staff, beds and other facilities available.”

So how many life-saving ventilators are needed?

Health Secretary Matt Hancock said on Sunday that hospitals had around 5,000 but that they needed “many times more than that”.

The physicians interviewed by Reuters said, if ventilators were secured, the aim was to increase intensive care beds from around 4200 to over 16,000, partly by using beds in other parts of hospitals.

Rob Harwood, a consultant anesthetist in Norfolk who has worked in the health service for almost four decades, said access to critical care could ultimately have to be determined by patient scoring systems for survivability. Systems developed for SARS, another coronavirus that broke out in 2003, could for example be refined, he added.

“Once you have exhausted your capacity and exhausted your ability to expand your capacity you probably have to make other decisions about admission into intensive care.”

But he emphasized that, for now, admission criteria would stay unaltered: “We are a country mile from that at the moment.”

‘BECOME CANNON FODDER’

While shortages of critical care equipment may be most alarming, the coronavirus has exposed how generally ill-equipped the health system is for a pandemic.

The British Medical Association said doctors have been asked to go to hardware stores and building sites to source protective masks.

Some doctors are worried about Public Health England’s (PHE) new advice last week which reduces the level of the protective equipment they need to wear.

Previously, staff on ward visits were told to wear full protective equipment, comprising high quality FFP3 face masks, visors, surgical gowns and two pairs of gloves. But the new advice recommends only a lower-quality standard paper surgical face mask, short gloves and a plastic apron.

PHE referred queries about doctors’ worries to the health department, which did not respond to requests for comment on the matter.

A senior NHS epidemiologist, who was not permitted to be named, told Reuters this advice was based on a sensible assessment of the biohazard risk of the virus. “It’s not Ebola,” the doctor said, pointing out the risk to medical staff without underlying medical conditions was low.

Matt Mayer, head of the local medical committee covering an area in south of England, said GPs had been sent face masks in boxes that said “best before 2016” and that have been relabeled with new stickers reading “2021”.

“If you are going to lead people into a hazardous situation then you need to give them the confidence that they have the kit to do a decent job and they are not just going to become cannon fodder,” said Harwood the anesthetist.

The department of health said that they had tested certain products to see if it is possible to extend their use.

“The products that pass these stringent tests are subject to relabelling with a new shelf-life as appropriate and can continue to be used,” a spokesman said.

RAPID GUIDELINES

Dr Alison Pittard, dean of the Faculty of Intensive Medicine and a consultant in Leeds, northern England, said there had been chronic underinvestment in critical care in Britain. But she said the country was not yet at the stage where it had to make calls about rationing patient resources.

She said, if rationing became necessary, medical ethics should still prevail and guidelines needed to be issued on a national level so that no patient was worse off based on where they lived. The NHS might need also need the advice of military leaders, she said, on how to effectively triage.

“If we got to a difficult position where we had to exhaust every bit of resource in the country then, yes, we may have to change the way we approach the decision-making.”

Stephen Powis, the National Medical Director of NHS England, said there were plans to issue new guidance to give doctors advice on how to make difficult decisions if there was a surge in coronavirus cases, like in Italy.

The National Institute for Health and Care Excellence (NICE) said on Friday it would shortly announce a “series of rapid guidelines” on the management of people with suspected and confirmed COVID-19, including in critical care.

The guidelines are not, however, expected to be prescriptive but to suggest leaving key decisions to individual doctors.

Pittard said patients with pre-existing conditions who already had life-threatening health difficulties should be having conversations with their family about how they wished to spend their last days, in the event of them being infected.

“If I get coronavirus now I’ve got a very high chance of dying of it,” she said, putting herself into the shoes of such a patient. “So do I want to die in hospital and when my relatives can’t come in to visit me because it’s too risky, or would I like to die at home?

“And if I do want to go into hospital, do I then want to go to intensive care where my chances of surviving are minimal?”

(Editing by Guy Faulconbridge and Pravin Char)