Emma Mi is a Deputy Chair of Ealing and Acton Conservative Association and Diversity Officer of Conservative Young Women. She and Ella Mi are doctors working in acute medicine in a central London hospital and also involved in COVID-19 research.
The UK is in the midst of an unprecedented health crisis, with struggles over coronavirus testing and personal protective equipment (PPE) centre-stage in the national consciousness.
As doctors in an acute medical unit of a major London hospital and researchers in COVID-19, we’re experiencing these issues on the frontline. The lessons are clear: instead of relying on state directives and the Government to do it all, we need to harness the potential of health and care staff, NHS organisations, local communities, and individuals for self-action.
The science shows that the routes of Coronavirus transmission are respiratory droplets, contaminated surfaces (the virus can survive 72 hours in the environment), and aerosol. So healthcare workers need PPE, such as masks, gowns, and visors, to protect against these.
There’s been a continuous onslaught on the Government over inadequate supply. Of course it’s the responsibility of our employers to provide us with safety equipment – but these are exceptional times, of worldwide shortages, and we must allow flexibility. As health and care workers, we need to think practically about how we can help ourselves.
Take eye protection. We could use goggles (DIY or even swimming) that we already have, or borrow it from family, friends or neighbours. We’ve been doing that for the past month and they work, are easy to clean and store, so can be reused. More and more colleagues were doing the same.
We can find solutions for clothing protection, too. There are justifiable concerns over aprons, since they offer no coverage of the arms or back, but stocks of fluid-resistant gowns are critically low. So why not have us bring in a lab coat (a frequent leftover from medical school) or a waterproof raincoat?
As doctors and nurses, we’re trained in ‘aseptic non-touch technique’ to avoid contaminating sterile clothing and equipment. By applying these techniques in reverse when putting on and taking off PPE, we can reuse PPE without contaminating ourselves, provided we take strict care.
Yes, these aren’t the gold standard, and they shouldn’t be a substitute in high-risk situations, like intensive care, but in the vast majority of hospital wards, GP surgeries, and care homes, they do the job of cutting the routes of transmission.
Employers need to encourage these resourceful individual behaviours, and do more to facilitate efficient PPE use and reduce risk of staff infection. Our hospital, like many, has reconfigured clinical areas (into ‘COVID’ and ‘non-COVID’ zones), but employers can go further.
There needs to be designated areas for putting on and taking off PPE, for cleaning, and facilities for storage: simple hooks and hangers would allow staff to safely remove and put back on gowns and masks when they take breaks, rather than throwing these away.
Instead, where masks and visors can be reused, they are, at times, left on desks and computer stations, in COVID zones, but which are handled by others not wearing gloves. NHS trusts should emphasise to staff guidelines on the correct order of putting on and removing PPE, as well as issue precise advice on good hygiene practice at work and home – i.e: segregating and cleaning clothes, shoes and possessions. Some colleagues who caught coronavirus say they didn’t take enough precautions on this front.
Hospitals also need to harness technology to reduce non-essential contact with Coronavirus patients: we’ve seen people going into rooms just to ask patients their meal preferences. This could be as simple as speaking to patients on their mobile phones. These may seem like small details but, in combating COVID-19, details are what counts.
Health and care organisations should actively develop partnerships in the community to help get the resources that they need. For example, hospitals could source lab coats and goggles from local research institutes, avoiding logistical challenges of national-level distribution. These partnerships could also help ramp up testing. This would allow the Government to focus resources on areas which are in greatest need.
As well as staying at home, the public can take simple actions to keep themselves safer. Current advice to self-isolate for seven days if you have coronavirus symptoms is right, but better advice would be to also monitor yourself. Basic monitoring we do for patients in hospital includse measuring parameters like heart and breathing rate.
If you’re unwell, it’s worthwhile regularly checking these at home. You can measure your heart rate (usually 60-100 beats per minute) with any number of gadgets, or simply by feeling your pulse and counting beats, and your breathing rate (usually 12-20 breaths per minute) by getting someone else to observe you and count when you’re not aware.
High heart or breathing rates indicate you’re likely to need medical attention. Everyone should be encouraged to get a thermometer to spot coronavirus early (37.7 degrees or above is a fever) and to track the illness: high and prolonged fevers are a bad sign.
In hospital, we decide who needs oxygen by measuring patients’ blood oxygen saturation using a pulse oximeter – a clip-like device placed on the fingertip. It’s one of the most important metrics we rely on.
Normally, in healthy people, this is over 94 per cent, and we give oxygen to patients with readings below 90 per cent. It would be useful for people to get their own pulse oximeter, which can be bought relatively cheaply online. COVID-19 is a disease marked by fast deterioration, and some people don’t feel very unwell until it’s too late, leading to the tragic sudden deaths at home that we’ve seen. Self-monitoring can help prevent this.
Up and down the country, communities have mobilised with incredible speed. It’s heart-warming to see initiatives supporting key workers by the public and local businesses, resident groups coordinating aid for vulnerable people, and local authorities partnering with hotels to help the homeless. As we move to relaxing lockdowns, we will need a system of testing, contact tracing and targeted quarantine to prevent a second wave; communities will have an even more vital role.
Many people, especially in big cities, live in small properties and/or large households, in which it may be impossible to self-isolate effectively. We have cases of delayed discharge from hospital because families are understandably concerned about having a coronavirus patient back at home, especially when there are vulnerable family members.
There needs to be a focus on the provision of quarantine facilities for people who need it, which is already happening for NHS staff (who are offered hotel or hospital accommodation). Local authorities could lead that effort. We also need to create a network of temporary care facilities for Coronavirus patients who need social care, given difficulties in getting PPE to care staff and risk to other residents. It’s far easier logistically to supply PPE to such facilities than to reach individual carers, agencies and care homes.
Although these last months have seen Britain challenged, they have also brought out the generosity, solidarity, and creativity that has always so defined the British people. This includes many positive changes within the NHS to drive more efficient working – from better streamlining of patient care, to greater cooperation between different teams, and more judicious use of resources.
It is only through this – the initiative of individuals, of staff, employers, communities and the public – that the NHS and the country will get through this crisis and come out stronger for it.