{"id":47229,"date":"2020-04-17T18:24:18","date_gmt":"2020-04-17T17:24:18","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47229"},"modified":"2020-04-24T12:54:17","modified_gmt":"2020-04-24T11:54:17","slug":"covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/","title":{"rendered":"Covid-19: If we can\u2019t protect our workers, we can\u2019t protect our patients"},"content":{"rendered":"<p><span style=\"font-weight: 400\">At the beginning of March, Roberto Stella,<\/span><span style=\"font-weight: 400\"> a GP, from Busto Arsizio near Milan, became the first doctor to die from covid-19 in Italy. Only days earlier he had attended a Regional Health Board meetin<\/span><span style=\"font-weight: 400\">g where he had warned that the personal protective equipment (PPE) available to GPs was inadequate. He had asked for adequate protection to be provided to all GPs coming into contact with patients, arguing that many people are asymptomatic for 48 hours while shedding the virus so it is impossible to tell whether patients may be covid-19 positive when they present.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">His death was quickly followed by those of three other GPs in the hardest hit Lombardy region, and I learned of these deaths in an email from an Italian doctor friend of mine, Giuseppe Rivolta, on 10 March. Rivolta had been at the Regional Health Board meeting with his colleague and friend Roberto Stella. Rivolta pointed out to me in the email that the European Centre for Disease Prevention and Control (ECDC) indicates that FFP2 or higher PPE should be the standard for doctors. However, rather than following the ECDC recommendations the Italian government appears instead to have turned to an older directive issued by the World Health Organization (WHO). This WHO directive was not written with Europe in mind, it was developed to offer a sustainable solution for countries where proposing an expensive FFP2 mask would have been impractical and where a surgical mask was an acceptable alternative.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Italian doctors pointed out that if the government had said that they could not get adequate PPE so healthcare staff would have to make do with what was available, medical staff would have accepted the position and just got on with it. It was the insistence that this was the correct protection that they found particularly upsetting.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">In the UK, the BMA has been vocal and persistent about bringing the issue of PPE to the government\u2019s and the media\u2019s notice. The BMJ has launched a <a href=\"https:\/\/bmj.com\/wellbeing\">campaign for #properPPE<\/a>.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Despite this, distribution of PPE is still erratic. When I worked in my practice on Good Friday, there were gloves and paper masks, but little else. We have a hot hub where we can send patients we suspect may be covid-19 positive and where they will get observations (blood pressure, temperature and oxygen saturation) but no testing.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">It seems that a strategy similar to Italy\u2019s may be developing in the UK. The government appear to be adjusting their recommendations to what PPE is available rather than what PPE is adequate to protect those healthcare staff working with possibly infected patients.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Part of the problem is that every patient may be infected. Rivolta wrote \u201cThe experience of these last weeks teaches us that the danger is not with the easily identifiably-ill patient with covid-19 symptoms, but with those patients who are asymptomatic and are not seen as problematic. If GPs want to be operationally safe then the masks they use must be FFP2 standard or above\u201d.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">There is a hospital in <\/span><span style=\"font-weight: 400\">Naples w<\/span><span style=\"font-weight: 400\">here no doctor has been infected with covid-19. It is an infectious diseases centre when protection is good and hygiene safety rules are strictly adhered to. PPE here seems to work in the way it should.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Rivolta was tested as a contact of Stella\u2019s. He had no cough, no fever and no shortness of breath. He was found to be covid-19 positive and a CT scan showed moderate interstitial pneumonia. He did not know he was ill. He and his family are now in quarantine.<\/span><\/p>\n<p><span style=\"font-weight: 400\">We have a duty during the coronavirus pandemic to protect the medical and nursing staff at the same time as we care for our patients. In the UK the airline safety procedures are often quoted with regard to the health service. One of these rules is, of course, \u201cAdjust your own oxygen supply before you attend to others.\u201d This applies to health care staff too. If we can\u2019t protect our workers, we can\u2019t protect our patients.<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Mary McCarthy<\/strong> is vice president (and BMA representative) of the Union of European General Practitioners (UEMO), and a GP at the Belvidere Medical Practice, Shrewsbury<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Giuseppe Rivolta<\/strong> is a member of the Italian delegation of UEMO, Secretary of the National Autonomous Union\u200b of Italian Doctors (SNAMI0 in Lombardy, and a GP at &#8220;Duturnet&#8221; General Medicine Network, Erba (Como) Italy<\/span><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>At the beginning of March, Roberto Stella, a GP, from Busto Arsizio near Milan, became the first doctor to die from covid-19 in Italy. Only days earlier he had attended [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":47067,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-47229","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Covid-19: If we can\u2019t protect our workers, we can\u2019t protect our patients - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Covid-19: If we can\u2019t protect our workers, we can\u2019t protect our patients - The BMJ\" \/>\n<meta property=\"og:description\" content=\"At the beginning of March, Roberto Stella, a GP, from Busto Arsizio near Milan, became the first doctor to die from covid-19 in Italy. 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Only days earlier he had attended [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2020-04-17T17:24:18+00:00","article_modified_time":"2020-04-24T11:54:17+00:00","og_image":[{"width":540,"height":350,"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/04\/coronavirus_hospital_staff.jpg","type":"image\/jpeg"}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Covid-19: If we can\u2019t protect our workers, we can\u2019t protect our patients","datePublished":"2020-04-17T17:24:18+00:00","dateModified":"2020-04-24T11:54:17+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/"},"wordCount":747,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/04\/coronavirus_hospital_staff.jpg","articleSection":["Guest writers"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/","url":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/","name":"Covid-19: If we can\u2019t protect our workers, we can\u2019t protect our patients - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/04\/coronavirus_hospital_staff.jpg","datePublished":"2020-04-17T17:24:18+00:00","dateModified":"2020-04-24T11:54:17+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/17\/covid-19-if-we-cant-protect-our-workers-we-cant-protect-our-patients\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/04\/coronavirus_hospital_staff.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/04\/coronavirus_hospital_staff.jpg","width":540,"height":350,"caption":"Hand out photo - Medical staff of intensive care unit of the Robert Pique military training hospital (HIA) is seen at work in the fight against the Covid 19 in Bordeaux, France, March 31, 2020. 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