COVID-19 Update 02/04/2020
The past 10 days has seen a decisive shift, as we in the UK have moved from the epidemiological to the operational phase of the global pandemic. Increasing numbers of Covid-19 infected people are being treated in secondary care and encountered in clinical and other settings in the community. Occupational physicians and OH teams across the country are playing their part in supporting the NHS and key services, as they work above and beyond to try to deliver the best possible outcomes.
Three issues stand out as particular challenges in Keeping our Workforce Safe – vulnerable staff, provision and usage of personal protective equipment and laboratory testing for Covid-19. We are facing a new pathogen for which there is as yet a very limited specific evidence base upon which to base recommendations, which adds to the challenge. Official guidance continues to evolve based upon knowledge and experience gained during previous outbreaks and epidemics, particularly of respiratory viral infections, established principles of infection control, the situation on the ground in the UK and new evidence about Covid-19 as this emerges and is evaluated.
FOM in collaboration with the RCP provided an information sheet on Healthcare staff with underlying health conditions: implications and adjustments on 27.03.2020 (https://www.fom.ac.uk/general-news/covid-19-fom-information-sheet-27-03-2020) which will be reviewed and updated, particularly as further information is provided by other specialist colleagues. OH services face pressures in the continuing requests for assessments of fitness for work in those with underlying health issues. Many specialists in occupational medicine are working on algorithms and other tools to assist their decision making so that they can, as far as practicable, offer evidence based advice to individuals and, with consent, to their employer.
Provision and use of personal protective equipment, as the final part of the hierarchy of control which should be applied to any hazard, has been the subject of wide debate and publicity. Today sees the publication of PHE’s guidance on PPE. This is a consensus document which has taken account of wide consultation with professional bodies during the past week, to which the FOM has contributed, including participation in a teleconference for professional bodies facilitated by the Academy of Medical Royal Colleges.
The document has been agreed by the four nations IPC cell, led by NHS England, by the four country CNOs and CMOs and HSE. It highlights a risk based equitable approach across all sectors.
The Faculty of Occupational Medicine supports this document. Its release should improve confidence, particularly for those working in health and social care. The guidance will be subject to revision if new evidence suggests that this is required. https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control
The Chair of our Ethics committee comments as follows:
“During this period of intense pressure and scrutiny, it is important for occupational health advisers to maintain high standards of care and ethical practice. The hierarchy of control guides us on risk control and PPE selection, and use should be carefully considered. National guidance has been carefully and extensively debated, with International experience included, and represents best advice, balancing many complex considerations. It aligns to the ethical principles we have adopted in our guidance for occupational health practitioners and deserves careful consideration and application wherever possible. All occupational health practice requires consideration of local conditions and needs, and our specialist skills are needed to ensure employers and workers understand how best to apply such standards.”
Dr Steve Boorman CBE
Further guidance on the third major challenge, testing for Covid-19, is expected to follow shortly and remains an issue under careful scrutiny.
Dr Anne de Bono
President
Dr Steve Boorman
Chair, Ethics Committee
