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Dublin: 24 °C Tuesday 2 June, 2020
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A nurse returning to work at the frontline: 'Not all heroes wear capes, but they all need a face mask'

I left nursing years ago and now I feel I have a duty to return, but the odds are against us, writes Deirdre Mullins.

Deirdre Mullins

TWO WEEKS AGO the HSE launched a major recruitment drive to help deal with the coronavirus pandemic. Minister for Health Simon Harris said that the HSE “needs all hands on deck”, and in an Uncle Sam-like plea Harris told healthcare professionals not working in the sector that “your country needs you”.

Before starting a career in media I worked as a nurse, and on hearing Minister Harris’s call to battle I signed-up the following day to “be on call for Ireland.”

The Covid-19 pandemic has caused many of us to feel powerless and afraid at times. Taking action and going on call gave me a sense of empowerment and pride. But sadly those positive emotions quickly gave way to fear and anxiety.

It’s a vocation

I registered out of a sense of duty. I have skills, albeit rusty ones, that I can offer to my fellow citizens during this time of crisis. My initial fervour dwindled when I realised that a quarter of all confirmed Covid-19 cases in Ireland are healthcare workers. That sobered any sense of nobility I had. This statistic is high even when compared to Spain and Italy where figures of 10-15% of infected healthcare workers have been quoted. Sadly a healthcare worker died here last week. I signed up to be “on call for Ireland” because I want to help take care of sick patients. I did not sign up to become a sick patient.

I don’t underestimate the magnitude of the achievements of the HSE during this national emergency and I was encouraged this week when the government said healthcare workers would be prioritised for testing for Covid-19. The Irish government has accomplished so much in such a short time but now that they have secured a steady stream of personal protective equipment (PPE) via Aer Lingus flights from China, it’s time to look at who gets to wear it and when.

PPE for all healthcare workers

At the moment PPE is recommended for healthcare workers who are dealing with confirmed and suspected Covid-19 patients. Is that enough? Should all healthcare staff be wearing some manner of PPE, namely a surgical mask? This would be to protect not only themselves but also their families, their patients and their colleagues.

Compliance to social distancing measures within the community is high, but in hospitals social distancing is difficult. It’s impossible for a nurse to socially distance from patients. The very nature of the job often requires physical contact when carrying out clinical procedures, or helping the patient with basic needs such as feeding and personal hygiene. So while we ask people in the community to stay indoors and to physically distance from others, in our hospitals and care homes staff cannot distance from their patients.

The word “sneaky” has been used when referring to how Covid-19 has managed
to spread itself throughout communities and to every country in the world. We know that people have asymptomatic or presymptomatic infections, so why isn’t there a policy for all healthcare workers to wear a face mask?

Responding to a recent call by a number of hospitals to move to the more widespread use of masks, the HSE said on Monday that there is no evidence to support the wearing of surgical masks for healthcare workers during close patient encounters and while in staff meetings.

At the HSE’s press briefing on Tuesday of this week, Dr Cillian De Gascun, chair of the HSE’s Coronavirus Expert Advisory Group, acknowledged the anxiety among healthcare workers and said that it’s something they will keep under review. He cited a lack of evidence as to the reason that they don’t recommend the use of masks with asymptomatic patients. Dr Colm Henry, the HSE’s Chief Clinical Officer added, “the use of masks in asymptomatic settings adds little benefit and may increase risk because of the increased movement of hands towards the face”.

Look abroad and learn

Medicine is an evidence-based discipline and the HSE is unlikely to make decisions based solely on staff fears or desires. But logic and judgement should also have roles to play at a time of an emergency. If we look to other regions we might learn how to do things better here.

Media reports suggest that in the early days of the outbreak in Wuhan 1,300 poorly protected healthcare workers became infected and quickly the city began to run out of hospital staff. Thousands more were brought from other parts of China, all of whom used fully protective equipment and few, if any, became infected.

Unfortunately, we don’t have the resources that China did to gown all healthcare workers in full-body protective gear with goggles and N95 masks. Those measures are reserved quite rightly for staff working in high-risk areas. But we can learn from Hong Kong and Singapore, where incidents of infected healthcare workers remain low.

Hong Kong and Singapore took a less stringent approach but still insisted that their healthcare workers wear regular surgical masks for all patient interactions, as well as the use of gloves, hand hygiene, and disinfecting all surfaces in between patient consults. All these measures, except for the use of surgical masks, are in use here.

The masks debate

The issue of whether all healthcare workers should now be supplied with surgical masks has come to the fore this week. Professor John Crown has been admirable in his calls for the supply for all and I agree with him, as do many of my colleagues.

I was pleased to hear Dr Henry yesterday evening say that the HSE advice on masks is not fixed and that they are meeting with healthcare unions and discussing the mask issue daily. He insisted there isn’t evidence to prove that the wearing of masks by all would work. I understand the HSE is doing its best, but as a healthcare worker prepared to work in this crisis, I am not heartened by this. Neither, I should mention, are my family.

Our healthcare workers are the most valuable resource during this national health emergency. We need them to be healthy so they can take care of the sick. We need to protect them so that they don’t unwittingly pass the virus to their vulnerable patients, their coworkers and their families. If we don’t protect them, how can we entice doctors and nurses to come out of retirement and return from other countries to help us out?

Healthcare workers accounting for nearly a quarter of all confirmed Covid-19 infections here is an unnerving statistic. Nursing is in my blood and I want to care for the sick in the midst of this national crisis, but I also want to feel safe and protected in the workplace.

The Taoiseach said in his address to the nation on St.Patrick’s Day, “not all superheroes wear capes”. How about giving those superheroes face masks?

Deirdre Mullins is a journalist, TV producer and a Registered General Nurse. Twitter: @DeirdreMullins.

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