Tom Downs - Masks for all (Part 2)

Masks for all: and finally when those masks are gone, we must breathe clean air

30th April 2020

I wrote the following entry about masks at the beginning of April. It is now the last day of April 2020 and I am in isolation with Coronavirus. I have been lucky to have had very mild symptoms, no persistent cough, no fever. Testing facilities have been improved meaning I could quickly get tested. We are now all wearing masks in hospital.

Having mild symptoms shows how important the rules of social distancing, hand washing, and the extra measure of wearing a mask is because we don’t always know when we are infective.

The following piece captures my reflections from the frustrations relating to Personal Protective Equipment (PPE) at the beginning of this month:

8th April 2020

Today at the hospital, we received masks made in the community. These will be masks that we can wear out and about and in non-clinical areas. We are very grateful for the support from the community.

Masks have been a hot topic in the hospital that has led to tensions. I was challenged by a senior colleague a couple of weeks ago for wearing a mask seeing new patients on the surgical assessment unit, and this has not been an isolated incident. Pressure not to wear personal protective equipment (or social protective equipment!) has been common and we have seen stories like this and other similar frustrations in the news.

The guidance had weeks, even months, to learn from other countries. Proffessor Kim Woo-Ju, Dept of Infectious Diseases, Korea University College of Medicine said “Masks are definitely effective, one of the reasons Korea has a relatively low rate of infection is because everyone is wearing a mask and washing their hands regularly, that’s how every individual will be contributing to ending this outbreak.”. That our policies were slow to take into account the precautionary principle (a strategy for approaching issues of potential harm when extensive scientific knowledge on the matter is lacking), listen to the concerns of their staff, and find the support they need from the community and other industries for  shortages that they may have.

I was also excluded from the ward’s “We stay here for you, stay home for us” photo because I was wearing a mask. Masks rather than COVID-19 causing anxiety has been a common narrative heard on many hospital wards. We now have updated guidance on Personal Protective Equipment issued last week. Slowly, universal mask wearing is becoming the norm. Concerns that we don’t have enough of the fitted masks and once we have the guidance recommending further use of masks we won’t have the supplies for that either seem to be ongoing. Often staff have had to take getting the equipment they need into their own hands ordering off eBay and getting donations from friends, family and people locally.

The evidence is that masks of any type are effective at protecting others if you are sick with Coronavirus, the thing is often we don’t always know when we are infectious, so wearing masks at all times is a good way to protect others. This is very important in hospital that we don’t spread the virus to our vulnerable patients and all wear masks.

Masks are most effective when everyone wears them and in hospital we cannot follow the rules of physical distancing so extra precaution is required. I have been calling masks Social Protective Equipment rather than Personal Protective Equipment and wrote to the shadow health secretary about this last week. Obviously, mask wearing must also be considered within the wider preventative measures we all take and doesn’t replace the need for hand washing and physical distancing.

A local Iranian refugee in isolation made 50 homemade masks and donated them and we are very grateful! Now many of the secretaries on general surgery, ward clerk on surgical assessment unit and some of the other junior doctors have these fashionable African print masks!

30th April 2020: Final thoughts

Would infections like mine have been prevented if action were taken more quickly? (there are probably many people thinking similar questions) But what is reassuring about my case compared to what you see on the news is that I have not been too unwell, I am getting better and for me anyway it is much easier to see the other side  -this is not going to last forever.

I am glad I was able to recognise my atypical/mild symptoms and protect others in the hospital. I now have the opportunity for some down time from usually being very busy so I want to make the most of this time for some reflection and learning. How valuable and vulnerable our health is and how interconnected we are with everyone across the planet.

I have been thinking more and more what life will be like after coronavirus now I am getting better. There was one really powerful thought provoking message from Dr Maria Neira, the Director of Environment Climate Change and Health at the World Health Organisation about masks- “We will go out of this crisis no doubt, but we will probably go out all of us wearing masks, but believe me the day when we take off those masks we want to breathe clean air. No way will we accept again the levels of air pollution we had been facing up until now. So let’s invest in that capitalise in that, so when the masks are gone we will breathe clean air.”

What we have all sacrificed until now cannot be for nothing, we have to find ways to build back better. That’s why this evening I will be joining MedAct to work on a UK Green New Deal for Health. When the masks are gone, we must breathe clean air and I will play my part in ensuring this through my Bevan Exemplar project within this hospital initially and then - wider afield(more on this later)

I hope everyone is continuing to stay well and my heart goes out to anyone who has lost someone or has been affected personally during this time. Let us learn from this so we can do better in the future. Let us put behind us everything about PPE and now focus on building back better coming out of this and putting health and science at the heart of all of our future decisions, as-well as recognising planetary health.


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