Where does the ‘guilt’ really belong?

This week’s blog is written by David Osborn (@SafeDavid3), a health and safety consultant,  reflecting on the blog written by Anna Carey regarding her guilt about not being able to return to work because of her Long Covid.

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Anna’s is such an incredibly moving story. I’m confident that I can speak for the millions of people up and down the country who ‘clapped for carers’ at their doorsteps in saying that our hearts go out to her and all the health and social care workers who have acquired COVID-19 as a result of their work caring for patients and service-users. Let’s hope that time and rest (coupled with more focused research and treatment/interventions) will help her get better.

Then, whilst drafting this blog, I came across Brenda Eadie’s vlog. It is absolutely outrageous and an affront to common decency that, after 28 years of faithful service, she should be cast aside with just a phone call and a letter containing weasel words from her Health Board. As Brenda says, this is being repeated thousands of times across the UK. Not only is this so morally and ethically wrong, but it also seems as though a Scottish Court would deem Brenda’s dismissal illegal too (Equality Act 2010, Section 6).

Sadly, so many Health Trusts/Boards stubbornly deny that you healthcare workers were infected through your work, even though this is patently obvious given that you weren’t issued with the Respiratory Protective Equipment (RPE) such as FFP3 masks which would have prevented much of this illness. To have misled you into believing that those flimsy surgical masks would keep you safe when caring for infectious patients was absolutely outrageous and engendered a false sense of security.

As the Health and Safety Executive (HSE) have confirmed throughout the pandemic, surgical masks do not protect the wearer’s respiratory system from small airborne droplets and aerosols.  In fact, HSE also warn that, under health and safety legislation, surgical masks aren’t even Personal Protective Equipment (PPE) at all, despite the widespread and mischievous use of the term by Public Health England,  DHSC, NHS etc. Their role as “medical devices” is primarily to protect others (e.g. patients) from any infectious droplets of saliva and mucus that may emit from the wearer’s mouth or nose.

No. You nurses should definitely not feel guilty. Absolutely not. The  people who ought to feel guilty about your situation are those who promulgated the myth that these masks would keep you safe and issued guidance that they must be worn when providing close-quarter caring to infectious patients. However, any sense of guilt they may feel is probably assuaged by the medals and other honours that have been lavished upon them for their ‘services’.

For the past 28 years I have been a health and safety practitioner. I am well-versed in health and safety legislation and specialise in the area of COSHH (hazardous substances i.e. chemical and microbiological risks) and PPE, particularly Respiratory Protective Equipment (RPE).

I must admit that I have never been so utterly ashamed of those in authority in this field, namely the Health and Safety Executive, who have stood silently by and allowed this catastrophe to unfold in front of their very eyes. By virtue of their training, qualifications, statutory duties and even by reference to their own published guidance (HSG53) they knew, or should have known, the extreme risk to healthcare workers’ health (and lives) of allowing this flawed IPC guidance to be promulgated unchallenged throughout the UK. 

I am not persuaded by HSE’s claim that, because the pandemic is a ‘public health emergency’, they are obliged to follow Public Health England (now UK-Health Security Agency) as the ‘lead department’. Whether they like it or not, the HSE are the lead authority in worker safety (including healthcare workers) and they are the nation’s experts when it comes to respiratory hazards and protective equipment.

They, and other Government Departments and Agencies have been warned time and time again by an Alliance of Healthcare professional Institutions and Trade Unions about the risks being posed to workers by “the wrong masks”, but the authorities have stubbornly refused to engage or take any notice whatsoever. We just get the usual ‘GovSpeak’ platitudes like “the health and safety of staff is our greatest concern” and “our experts are constantly reviewing the evidence”.

I apologise if any of the foregoing causes upset or increases frustration. Whilst no Inquiry or campaign will restore your health per se, at least you know that there are people out here who are rooting for you and wishing you well.

David Osborn BSc CMIOSH SpDipEM

Background and Personal Statement:

Since January 2021 I have provided pro-bono support to an alliance of healthcare professional institutions known as CAPA (Covid Airborne Protection Alliance) which includes the Queens Nursing Institute, Doctors Association UK, College of Paramedics and several other medical organisations as can be seen in one of the many letters we have written to UK Government Departments and Agencies seeking better protection for healthcare workers from this awful disease.

The dismal failure of those in authority (not just in the UK, but also in the World Health Organisation) at the outset of the pandemic to accept contemporaneous scientific knowledge about the airborne transmission of Covid-19, their rejection of competent, expert advice that was pouring into them from all over the world and their refusal to accept that RPE was needed to prevent widespread healthcare worker illness and death are frankly matters of national and global shame.

In the UK, it was the Scottish Government’s Health Protection Department who, on 10th March 2020, set the scene for the rest of the UK by formally abandoning what is known as the “Precautionary Principle”. This has, for decades, been the fundamental principle underpinning UK Health and Safety Policy. In simple terms it means “In the absence of scientific certainty about something, we err on the side of safety, proceed cautiously and manage risk accordingly”.

At that time there was definitely no “scientific certainty” that COVID-19 could not be transmitted from person to person through the air. Neither was there any “scientific certainty” that fluid resistant surgical masks would provide healthcare workers with effective protection against catching the disease from their patients. Even HSE’s own laboratory had produced a report dispelling any notion that surgical masks could be relied upon to protect healthcare workers against aerosols.

The “Precautionary Principle”, as stated in the previous version of the guidance issued just 5 days earlier, had mandated the use of FFP3 respirators for all close-quarter care of potentially infectious patients (not just for aerosol generating procedures {AGPs}).

Some commentators might say that the fateful decision to remove the “Precautionary Principle” from the IPC guidance on 10th March represented “throwing caution to the winds”. Just two days later, on 12th March, the Deputy Chief Medical Officer for England sent similar guidance out to the NHS. It should be noted that, at that time, FFP3 respirators were the required level of protection for any airborne disease which was designated as a “High Consequence Infectious Disease” such as COVID-19. So, to all intents and purposes, the UK effectively broke its own rules.

We in the above-mentioned Alliance are working hard to become closely involved with the UK Public Inquiry so that these issues can be laid before the Chair, Lady Hallett, and exposed to public scrutiny.  Hopefully this will:

(a) engender a step-change in the approach to protecting healthcare workers during any future pandemic or the anticipated resurgence of the current one,  and

(b) also set arrangements in place for the ongoing support of those chronically affected by occupational exposure to COVID-19.

Author: Alison Twycross PhD RN

Chair - Supporting Healthcare Heroes UK; Editor-in-Chief - Evidence Based Nursing; Former Deputy Dean and Professor of Children’s Nursing

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