NHS mask 'not fit' to protect from coronavirus, warns Scots study

It has raised worries that the standard level of protection adopted throughout the NHS after their latest guidelines is "woefully inadequate" and "not fit for purpose".

A "vital equipment" flight from China to Scotland which included around 10 million IIR face masks was distributed on April 18.

Expert say the virus is most commonly transmitted in droplet form, when someone sneezes and coughs, possibly infecting someone nearby, or when droplets fall on hard surfaces and can survive for hours.

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A study conducted by Fort William GP James Douglas, who is an expert in occupational health and aerosol generating procedures in industry, and Lochaber-based PPE expert Niall McLean is a PPE expert based in Lochaber, Scotland says that the standard IIR surgical facemask recommended by the government is "unsuitable in the prevention of contamination from the Novel Coronavirus".

Testing in a Highland quarry included wearing several surgical masks in layers and sealing the sides to the face with tape.

The tests involved exposing masks to five minutes exposure of intense smoke to model an eight-hour shift in a healthcare setting.

"We concluded that [the mask] will allow the patient's exhaled air to enter the respiratory system of the healthcare worker when in close proximity," said Mr Douglas.

"We tried simple modifications to the surgical mask including three layers, and use of tape, but the smoke although reduced was still clearly visible."

He added that there was "no added benefit" from wearing a visor.

He said that in a healthcare setting, if people are taking throat and nasal swabs to make a Covid-19 diagnosis there was a "sporting chance" the patient will cough over the tester.

The study found that the re-usable FFP3 industrial mask gave "complete protection".

An FFP2 industrial mask was "better" than a surgical mask but still demonstrated smoke contamination on the breathing tube.

Tingy Simoes, a spokeswoman for the Confederation, the first and only trade union to be recognised under UK law to protect the welfare of surgeons, said they were satisfied with the findings of the Scots study that the PPE is "not fit for purpose".

"We want to bring this study to the attention of the public and the health care community," she said.

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"The thing is that the traditional surgical mask was never meant for any use other than to protect the surgical cavity [from sneezing] in the operating theatre.

"They are sending us into Covid-positive patients with an IIR mask. This is, by and large, what everyone is using and buying.

"It is like sending firemen to deal with a burning building in swimming trunks.

"That is why we have these doctors and nurses are dying, yet the guidelines are saying to use this mask."

Government PPE guidance states that the fluid resistant IIR surgical facemasks "should be worn whenever a health and social care worker enters or is present inpatient area (for example, ward) containing possible or confirmed Covid-19 cases, whether or not involved in direct patient care."

It said evidence reviews were performed by Health Protection Scotland and the Centre for Evidence Based Medicine, University of Oxford.

The FFP3 industrial mask, which allows wearers to breathe filtered air from the sides but contains a seal are among items of PPE that must be worn in "higher risk areas" containing possible or confirmed cases.

The confederation pointed out that a technical review by HSE in 2008 showed a six-fold reduction in inhaled aerosol with the surgical mask versus a 100-fold reduction with the industrial FFP3 mask.

Consultant plastic surgeon and founding member of the confederation, Mark Henley added: “The surgical world has been vocal in our grave reservations about the level of protection offered by current recommended personal protective equipment (PPE)[5] and we are extremely concerned about the safety of our workforce - in particular those undertaking procedures within close proximity to the mouth and nose."

The new study says the IIR mask was designed with open sides for breathing and did not sufficiently seal to protect wearers from the spread of the virus.

Dr Douglas said: “Whether it’s a fish processing plant or the paint shop in a car factory, the objective is always to reduce toxicity in the breathing zone of the worker by extraction ventilation and use PPE as a last resort. The NHS, in all its history, has never had to deal with any disease that is infecting and killing its workforce.

"But industry does have the experience. Asbestos is a tragic example, and the establishment underplayed the seriousness for decades – but we now know, that 1 in 10 people exposed to asbestos develop an incurable cancer 20 or 30 years after exposure to asbestos. And thus, asbestos clearance workers are sent into construction sites dressed as if they were going to land on the moon.

“The current guidelines on the standard surgical mask (IIR) are patently nonsense, and not even consistent with the guidance being given to the public on social distancing in a park. These masks were designed to protect the patient during surgery, they were never designed to protect the surgeon. This is why reaching out to industry makes sense – it’s ridiculous to be fretting about shipments from Turkey or China when there are store cupboards full of this equipment in locked down factories. Reusable masks could be cleaned and last the whole epidemic.

"Industry experts could advise hospitals on fitting and type of respirators. It feels almost like a pantomime: ‘(the solution) is right behind you!’”

Gillian Higgins, a surgical trainee who leads Med Supply Drive Scotland, the charity which through simply cold calling local industry was able to supply nearly 10,000 pieces of kit in just a few days and are endorsing the FFP3 respirators.

The charity is aiming to coordinate a nationwide effort to redirect unused PPE from non-healthcare related settings to the frontline where it is urgently needed the most.

In a recent presentation to Med Supply Drive Scotland over their study Dr Douglas, who was appointed director of the Remote And Rural Areas Resource Initiative (RARARI) on behalf of the Scottish Executive in 2000 said: "We now have got a situation where their matching PPE policy to supply, and not employing a basic risk analysis grid.

"An important bit about understanding about PPE is what it is designed to do. Well it certainly wasn't designed to protect you from droplets, it is designed to protect the patient from the doctor and it is designed to detect liquid splashes from the patient.

Mr McLean said the PPE tests came after a community group was set up in the village of Ballachulish to look for any weaknesses in delivery of coronavirus protection.

He said: "I was absolutely horrified to find out that one of the weaknesses was the PPE to frontline staff."

He said a local hospital had ten masks and three face-shields, yet a local quarry had in stores 380 FFP3 masks, and was very quickly able to re-supply.

Mr McLean, who is a director of Geo-Rope, a Scots engineering contractor for rail, highways, forestries and quarries added: "FFP3 masks are the bare minimum that we would use on a work site, the absolute bare minimum. Surgical masks, you would get laughed off the site if you turned up with those.

"There has been hard lessons learned in industry, with thousands people dying to get to the stage where we are now, with the knowledge we have now, and that should not be wasted by the NHS, and they should look very closely at it."

He added: "Asbestos, used to be a hazard that is now controlled. The hazard hasn't gone away, but the control measures have lifted up to meet the hazard and it is going to be the same with Covid one day because it is not going to be sustainable to lose hundreds of medical staff to it.

"I think need to be in a position where they call things out when they see them and talk truth to power, and really correct people when they are wrong.

"We need to be in a position where the medical community feel empowered enough to stand out to the managers and politicians and say, 'no, this is not correct'."

The Department of Health and Social Care were approached for comment through the week.  There was no response.