As the PPE shortage continues to threaten the lives of UK healthcare workers in the Covid-19 epidemic, the question remains of how the crisis was allowed to reach breaking point and beyond.
Insufficient supplies led to the government last month advocating the reuse of PPE protective clothing, relaxing and going against previous WHO and PHE guidelines. The depletion of stock continues to leave healthcare staff faced with the prospect of making very difficult decisions on the job, about whether or not to treat patients diagnosed with coronavirus when they themselves are without life-saving protection.
The PPE equipment required for medical workers in general contact with Covid-19 patients (confirmed or possible) includes:
- Eye protection
- Fluid resistant surgical mask
- Disposable apron
But many frontline staff are now having to improvise with their PPE kit. Doctors and nurses have been photographed wearing makeshift items such as bin bags in place of proper coveralls. Slow recognition of the PPE shortage’s sheer scale has had grave consequences in the UK, with high-profile botched attempts to source supplies from other countries.
In January, the WHO classified Covid-19 as a high consequence infectious disease, with enhanced Ebola-style PPE being widely used by medical workers.
On 11th February, Steve Oldfield, chief commercial officer at the Department of Health and Social Care, reportedly assured staff that the NHS was ‘well prepared for these types of outbreaks’. At this point, there were just eight confirmed Covid-19 cases in the UK.
On the same day, the government advised that doctors treating Covid-19 patients should now wear a fluid-repellent gown, an FFP3 respirator mask and goggles or full-face visors.
On 18th February, an NHS briefing to primary care workers stated that PPE shouldn’t be needed for dealing with Covid-19 patients, who would be isolated to contain the disease’s spread.
On 27th February, the WHO released updated advice on the use of PPE protective clothing, stating that medical workers treating Covid-19 patients would need a mask, gown, gloves, and eye protection.
On 3rd March, the WHO warned that global output of PPE equipment would need to be increased by 40%, with the onus on governments to create incentives for expanding production. The growing disruption to supplies was attributed to ‘rising demand, panic buying, hoarding and misuse’. Surging prices and erratic or slow delivery timelines, up to several months long, were further complicating the situation. The WHO estimated that per month, the coronavirus would require 89 million medical masks, 76 million examination gloves, and 1.6 million goggles to meet worldwide demand.
On 11th March, the WHO finally declared the Covid-19 virus a global pandemic. The late move to make the situation’s severity official was largely blamed for the overseas sale of crucial PPE supplies from the UK. This was due to orders not being placed quickly enough in the UK, without the growing threat made unequivocally clear. Andrew Pear, chief executive of PPE supplier Reliance Medical, told the Telegraph that he and many other companies were wary of paying inflated prices from foreign suppliers, after over-ordering during the Sars epidemic in the early 2000s. He cited the financial issues which surplus stock brings, potentially having to sell at a loss if a vaccine is brought in; as he asserted was also the case during the bird flu and swine flu pandemics.
On 10th April, the Doctor’s Union reported they had found out that London and Yorkshire’s PPE supply levels were not sufficient to cope with the coronavirus outbreak.
On 11th April, Matt Hancock announced the government’s plan to ensure that critical equipment would be delivered to workers responding to the crisis. He stated at the Downing Street briefing that there was enough PPE to meet the required levels, but “only if it’s used in line with our guidance”, sparking anger from medical staff at the implication of misuse. The plan included a new national supply system, to ensure that those who needed supplies would receive them as quickly as possible, as well as the increase of domestic PPE production.
On 17th April, Public Health England advised that healthcare workers should help to optimise PPE supplies. This extended to the reuse or sessional reuse of masks, gowns, coveralls and eye protection. Aprons and gloves were excluded from this advice. Despite some items of the NHS COVID-19 Ensemble being adequate for single-use only, PHE declared that compromise was necessary. The recommendations were still stated to give ‘appropriate protection for health and care workers’.
On 18th April, it was announced that 84 tonnes of PPE would be arriving in the UK from Turkey imminently.
On 20th April, the government blamed ‘unexpected delays’ on the fact that the PPE supplies had still not arrived from Turkey. This came after only one RAF plane was sent over, instead of the promised three.
On 21st April, The Telegraph exclusively reported that millions of items of PPE equipment, desperately needed by key workers in the NHS, were being shipped abroad. They revealed how supplies were sent to Germany, Spain and Italy by lorry, after suppliers’ pleas to government to help provide for UK staff were ignored. Company bosses were left with no choice but to secure trade elsewhere.
On the same day, the Trades Union Congress urged an independent inquiry into the government’s failures in providing safe levels of PPE. This came after the confirmed deaths of more than 80 healthcare staff.
On 22nd April, the plane sent to Turkey finally brought back PPE equipment to the UK – however, there were only enough supplies to satisfy the levels needed by the NHS for a few hours. Further flights were then sent over to secure 400,000 gowns.
On 27th April, the government were warned by the head of six Royal Colleges that they had a duty of candour to healthcare professionals. This came after pressure to admit mistakes had been made over the repeated failures to adequately deal with PPE shortages.
On 6th May, it was made public that the 400,000 gowns brought back from Turkey had all been impounded, due to the gear not meeting UK standards. A similar failure was confirmed to have occurred with millions of masks purchased from factories in China. Despite a vast number of the faulty masks also being impounded, it is feared that some were already used by NHS staff during their shifts.