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TWO WEEKS AGO the HSE launched a major recruitment drive to help deal with the coronavirus pandemic. Minister for Health Simon Harris said that the HSE “needs all hands on deck”, and in an Uncle Sam-like plea Harris told healthcare professionals not working in the sector that “your country needs you”.
Before starting a career in media I worked as a nurse, and on hearing Minister Harris’s call to battle I signed-up the following day to “be on call for Ireland.”
The Covid-19 pandemic has caused many of us to feel powerless and afraid at times. Taking action and going on call gave me a sense of empowerment and pride. But sadly those positive emotions quickly gave way to fear and anxiety.
It’s a vocation
I registered out of a sense of duty. I have skills, albeit rusty ones, that I can offer to my fellow citizens during this time of crisis. My initial fervour dwindled when I realised that a quarter of all confirmed Covid-19 cases in Ireland are healthcare workers. That sobered any sense of nobility I had. This statistic is high even when compared to Spain and Italy where figures of 10-15% of infected healthcare workers have been quoted. Sadly a healthcare worker died here last week. I signed up to be “on call for Ireland” because I want to help take care of sick patients. I did not sign up to become a sick patient.
I don’t underestimate the magnitude of the achievements of the HSE during this national emergency and I was encouraged this week when the government said healthcare workers would be prioritised for testing for Covid-19. The Irish government has accomplished so much in such a short time but now that they have secured a steady stream of personal protective equipment (PPE) via Aer Lingus flights from China, it’s time to look at who gets to wear it and when.
PPE for all healthcare workers
At the moment PPE is recommended for healthcare workers who are dealing with confirmed and suspected Covid-19 patients. Is that enough? Should all healthcare staff be wearing some manner of PPE, namely a surgical mask? This would be to protect not only themselves but also their families, their patients and their colleagues.
Compliance to social distancing measures within the community is high, but in hospitals social distancing is difficult. It’s impossible for a nurse to socially distance from patients. The very nature of the job often requires physical contact when carrying out clinical procedures, or helping the patient with basic needs such as feeding and personal hygiene. So while we ask people in the community to stay indoors and to physically distance from others, in our hospitals and care homes staff cannot distance from their patients.
The word “sneaky” has been used when referring to how Covid-19 has managed
to spread itself throughout communities and to every country in the world. We know that people have asymptomatic or presymptomatic infections, so why isn’t there a policy for all healthcare workers to wear a face mask?
Responding to a recent call by a number of hospitals to move to the more widespread use of masks, the HSE said on Monday that there is no evidence to support the wearing of surgical masks for healthcare workers during close patient encounters and while in staff meetings.
At the HSE’s press briefing on Tuesday of this week, Dr Cillian De Gascun, chair of the HSE’s Coronavirus Expert Advisory Group, acknowledged the anxiety among healthcare workers and said that it’s something they will keep under review. He cited a lack of evidence as to the reason that they don’t recommend the use of masks with asymptomatic patients. Dr Colm Henry, the HSE’s Chief Clinical Officer added, “the use of masks in asymptomatic settings adds little benefit and may increase risk because of the increased movement of hands towards the face”.
Look abroad and learn
Medicine is an evidence-based discipline and the HSE is unlikely to make decisions based solely on staff fears or desires. But logic and judgement should also have roles to play at a time of an emergency. If we look to other regions we might learn how to do things better here.
Media reports suggest that in the early days of the outbreak in Wuhan 1,300 poorly protected healthcare workers became infected and quickly the city began to run out of hospital staff. Thousands more were brought from other parts of China, all of whom used fully protective equipment and few, if any, became infected.
Unfortunately, we don’t have the resources that China did to gown all healthcare workers in full-body protective gear with goggles and N95 masks. Those measures are reserved quite rightly for staff working in high-risk areas. But we can learn from Hong Kong and Singapore, where incidents of infected healthcare workers remain low.
Hong Kong and Singapore took a less stringent approach but still insisted that their healthcare workers wear regular surgical masks for all patient interactions, as well as the use of gloves, hand hygiene, and disinfecting all surfaces in between patient consults. All these measures, except for the use of surgical masks, are in use here.
The masks debate
The issue of whether all healthcare workers should now be supplied with surgical masks has come to the fore this week. Professor John Crown has been admirable in his calls for the supply for all and I agree with him, as do many of my colleagues.
I was pleased to hear Dr Henry yesterday evening say that the HSE advice on masks is not fixed and that they are meeting with healthcare unions and discussing the mask issue daily. He insisted there isn’t evidence to prove that the wearing of masks by all would work. I understand the HSE is doing its best, but as a healthcare worker prepared to work in this crisis, I am not heartened by this. Neither, I should mention, are my family.
Our healthcare workers are the most valuable resource during this national health emergency. We need them to be healthy so they can take care of the sick. We need to protect them so that they don’t unwittingly pass the virus to their vulnerable patients, their coworkers and their families. If we don’t protect them, how can we entice doctors and nurses to come out of retirement and return from other countries to help us out?
Healthcare workers accounting for nearly a quarter of all confirmed Covid-19 infections here is an unnerving statistic. Nursing is in my blood and I want to care for the sick in the midst of this national crisis, but I also want to feel safe and protected in the workplace.
The Taoiseach said in his address to the nation on St.Patrick’s Day, “not all superheroes wear capes”. How about giving those superheroes face masks?
Deirdre Mullins is a journalist, TV producer and a Registered General Nurse. Twitter: @DeirdreMullins.
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Thank you Deirdre! And agree with everything you’ve said
Just want to say , THANK YOU for your return to help us ALL in the long run .
Totally agree, combined with the increase in hand washing it would definitely help. I’d go as far as to suggest that it becomes mandatory in all places of work and public places. I work as a garda and our police force should be setting an example with mandatory wearing of ppe while on duty. Every bit helps. Stay safe
@Alan Campbell: Isn’t it a little unsettling how so many people end a sentence with the words “stay safe” these days. I agree with you, I think we as a society should adapt to wearing masks right now and especially those who deal with the public, emergency services, healthcare workers, shop assistants etc. As the author said, there’s ample evidence from societies who do wear masks that indicates significantly less of their healthcare workers become infected. This is something worth paying attention to.
I can’t help but get the impression that the decision not to have healthcare workers wear masks here was a political rather than medical one. There simply wasn’t enough masks available for the tens of thousands of healthcare staff, bearing in mind they’d have to be changed at least every half hour. I’m sure someone said they didn’t want to scare people by seeing health staff wearing masks, although this is nonsense, it’s a common sight in any hospital to see medical staff in scrubs, gowns and masks.
It’s been reported from other countries in Europe who bought PPE and test kits from China they had to reject them as they were substandard. On tonights RTÉ news we were told the PPE we bought recently from China may be different from what we’re used to, it’ll work, but be “different”. Draw your own conclusions.
I am also a nurse on the frontline. I have accepted that I am inevitably going to get covid19 at some point. We are being told that we are not allowed to wear a mask, let alone PPE for suspected contact cases unless they have symptoms. It IS virtually impossible to maintain social distancing from patients when you have to personally assist and examine them. Many patients ARE contacting Covid 19 within the hospital setting. I firmly believe that healthcare workers are a link in the spread of this virus, to no fault of our own. Our hands are red raw and broken from washing. PPE and masks are being locked away and there is almost an inquisition into why we request it. Why ask our community to sacrifice so much in their lives when we as healthcare workers cannot protect them!
@Gwen Murphy:
No wonder 25% of cases to date are actually healthcare workers, as reported yesterday. You’re not even given protective equipment.
Dr Holohan also said that only 20% of healthcare workers with the virus picked it up in work, the remainder (80%) are as a result of travel or in the community. That brings the overall tally to less than 5% in real terms. It is expected that the proportion of healthcare workers infected will fall overall as the travel ban and social distancing measures kick in.
Fair play for coming back and don’t worry, very few of those returning are being placed on isolation wards, there are still plenty of other sick people that need your care.
@Pharmy: Ah well, as long as you are happy with those statistics that’s what counts.
@Pharmy: Healthcare workers on isolation wards will often use the same facilities as others, same canteen, elevators and other facilities within the hospital, labs etc. They can’t teleport in and out of their work area.
@Pharmy: I am also a nurse on the frontline. I have accepted that I am inevitably going to get covid19 at some point. We are being told that we are not allowed to wear a mask, let alone PPE for suspected contact cases unless they have symptoms. It IS virtually impossible to maintain social distancing from patients when you have to personally assist and examine them. Many patients ARE contacting Covid 19 within the hospital setting. I firmly believe that healthcare workers are a link in the spread of this virus, to no fault of our own. Our hands are red raw and broken from washing. PPE and masks are being locked away and there is almost an inquisition into why we request it. Why ask our community to sacrifice so much in their lives when we as healthcare workers cannot protect them!
@Gwen Murphy: Ah but that speech.
On your side by the way, this is what happens when management who won’t be near the front line get to make the decisions for those who are.
But that speech.
@Gwen Murphy: My partner is a hca in a nursing home and tells the same story in relation to ppe.
I work in an acute hospital, I am familiar with the current situation. All those that need PPE, have it. All those who want it, do not. It’s an important distinction.
Most of our PPE is locked away and distributed on an as needed basis because of wide scale theft of this vital equipment from the hospital.
Given the huge number of workers in our hospitals and their increased risk of contracting the virus through increased exposure, keeping our number at less than 5% of the national total would be OK.
My wife has been taken out of theater and placed in a ward, she went to the ward yesterday and discovered no nurses are wearing masks or are they being given out on the ward. When she rang occupational health and she was informed that it is up to hospital management to decide on these precautions. This is wrong, if nurses are putting there health, and that of there families, at risk they should be afforded all protection. HSE must give all hospitals clear guidance on health staff protection. All patients must be assumed to be contaminated and appropriate precautions taken and enforced for health workers safety. If we fail in this we are doing these people a massive disservice.
When all of this is over and we come out the other side, please don’t forget how hard healthcare workers have worked, don’t forget the risk to our own lives, don’t forget that we continued to show up for work as this situation worsened, many of us with longterm illnesses ourselves, many of us with family members and friends who we could not see for months and months, many of us isolated and isolating so as to protect the general public, our own families and friends from the risk of contracting the virus from us, many of us losing family members, friends and colleagues and unable to attend funerals and unable to grieve properly. Please don’t forget about all of this the next time the government suggest pay cuts and job cuts for those who have protected us all.
@Sirius: Well said.
@paulmurphy
Stop making excuses there are solutions. Masks are vital to protect our frontline staff. It is a huge morale issue if healthcare workers are having to treat their colleagues.
Think outside the box. We can make our own surgical masks. For much less than the price of the Dail printer. There is currently an offer on the table. See link!
https://twitter.com/neilosands/status/1244911275060142085?s=20
@Barney Corleone: The World Heath Organisation are now changing their stance with regard to the wearing of masks, I personally have chosen to wear one since this outbreak and will continue to!
I would suggest that the author would read all the information that has been made available to healthcare workers only as late as Monday that continual wearing of surgical masks would require six changes per day to be effective and therefore is wasteful. The issue is that we are going through PPE faster than we can acquire it because of people panicking and not having all the facts about cases before donning the required PPE. The cohorting of patients in hospitals is making it easier to identify where you do and don’t need PPE. If we all start wearing masks just in case to carry out our daily tasks, there will be no PPE for when the surge happens. Spreading misinformation is worse than spreading the virus.
@Paul Murphy: Ok let’s waste lives, not masks!
@Paul Murphy: It’s not okay to “waste” masks but it’s okay to let medical workers get infected and potentially die? Are you serious???
@Paul Murphy:
Stop making excuses and find solutions. Masks will save lives and should be worn. 8 per day if needs be. Protect our frontline staff.
Neil O. Sands (#AnswerIrelandsCall)
@neilosands
Has made an offer to fund and house a surgical mask manufacturing machine if aerlingus will take care of the logistics. It can produce 600 surgical masks per minute.
https://twitter.com/neilosands/status/1244911275060142085?s=20
@Barney Corleone: I’m working on the frontline…..I know what I need and waste will lead to lost lives as will misinformation. You won’t see educated hospital workers walking around with masks on
@Seriousnojoke: I’m working on the frontline…..I know what I need and waste will lead to lost lives as will misinformation. You won’t see educated hospital workers walking around with masks on. At this point more people are becoming infected in supermarkets than they are in hospitals and thats fact!
@Gwen Murphy: I’m working on the frontline…..I know what I need and waste will lead to lost lives as will misinformation. You won’t see educated hospital workers walking around with masks on.
@Paul Murphy: What a stupid comment. So your argument is that to effectively protect healthcare workers would require a lot of masks and PPE, so let’s not bother. Have you thought this through? And when the rates of those getting infected increases to 50%, who will replace them, where will they come from? You’ve just said the existing staff are disposable.
Who are you keeping the PPE for, what emergency, these people are the frontline emergency staff, there is nobody else.
@Paul Murphy: Can you explain what you mean by “educated hospital workers”?
@Paul Murphy: Then I feel very sorry for you. Truly.
Look at the medical workers infection rate in South Korea and China where wearing masks are mandatory. And look at Europe’s, in particular Italy’s and Spain’s.
Knowledge is continually being gained and updated based on evolving realities. Guidelines that worked 10 or 5 years ago may have become inept today, let alone facing a brand new epidemic.
Use your brain.
@Paul Murphy: Hi Paul. Your colleagues in ST James’s and the HCSA in the UK would disagree with you. And for good reason. Are they uneducated? https://www.google.com/amp/s/amp.theguardian.com/world/2020/apr/01/all-uk-hospital-staff-and-patients-should-wear-masks-says-doctors-group
@G Row: I would suggest you enquire to the amount of education and training that has been made available to all grades across the HSE in relation to the PPE required and the daily updates disseminated through various means to all workers. We are quite educated in the risks and requirements , yes there are shortages of certain items such as ‘Duck Bill’ FFP3 masks purely because people used the wrong masks initially and tye were no longer available , but retrospectively these masks are only required around patients that require aerosol producing interventions such as intubation.
@Arch Angel: i didn’t say healthcare workers , like myself, are disposable, what I have said there is a responsibility to reduce waste in the equipment we will eventually require en masse when the surge appears and to be part of the solution rather than part of the problem . If we follow the education provided we will get through this. It is in the HSE’s best interest to protect its workers in the best possible way to ensure we have a functioning front line and not to have people preaching panic measure because they haven’t heeded the advice on offer.
@Barney Corleone: I really wouldn’t be taking any advice from the UK given their initial reaction to the current crises and I can’t comment on any action in any other hospital other than my own location. However I would offer that ALL of the information I have to hand is distributed on a national basis and not a local basis and St. James is indeed in the same hospital group I work in and I haven’t had any instruction that states I should be wearing PPE in all cases, I reckon if you were asked to provide documentary evidence of same you would be hard pushed to do so.
@Paul Murphy: Here you go Paul. https://twitter.com/ProfJohnCrown/status/1243698377931530242?s=09
@Paul Murphy: Management I presume?
@Barney Corleone: Thanks for that,
@G Row: don’t presume
@Paul Murphy, Bet I am right though?
@G Row: Nope
@Paul Murphy: Don’t believe you.
@Paul Murphy: so misinformed and off point. If there is enough masks for all, we should all wear masks. It’s how south Korea achieved their current status. This health care comment of “I need the mask not you” it pathetic now. Educated professionals in Korea wear masks all the time too, and I’d rate their health service around 400 times higher than Ireland. Stop spreading lies
@Paul Murphy: there are none so blind as those who will not see. Don’t waste your time on the wilfully ignorant, you have better things to do.
I fully understand the concern of the health care workers, along with the welfare of patients most of them are concerned about bringing it home to their own families.
Is the issue a global supply shortage? Genuinely is there much more anyone can do? And this not a point the already been made.
have your say