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  • Writer's pictureRichard Cree

In PPE we Trust

Updated: Apr 25, 2020

Easter Monday - 13th April 2020

COVID Figures for 12th April

UK Hospital Deaths 737 / Total 10,612

James Cook Hospital – Total deaths – 83

The second of two days at home with the family. Like many people we were supposed to be away on holiday over Easter and had been looking forward to a long break. Nearly everyone at work has cancelled their time off over the next few months in order to maintain staffing levels in the department, so it’s been nice to have a couple of days off this weekend.

Ironically a month ago we had been complaining about how busy life was; the two of us work full-time and have the three children to look after. It just goes to show that no matter how busy you think you are, life can always get busier.

I find myself still in good health this morning which is something of a relief. 11 days ago on one of the COVID units, a ventilator circuit disconnected in front of me and the ventilator discharged virus-filled air around me. This was entirely accidental and I was, of course, wearing my Personal Protective Equipment (PPE). I should have remained confident this would protect me.

However, there is always doubt. Many of the healthcare workers who have died around the world were probably exposed to a high initial dose of the virus. This increased ‘infectious dose’ may increase the severity of the illness and explain the excess mortality in this group. This is true for viruses such as influenza. Exposure to higher viral doses during the SARS and MERS coronavirus outbreaks was associated with a worse outcome.

Of course there are other reasons why healthcare workers may be more at risk. They can contract coronavirus from multiple patients. It has been postulated that multiple repeated viral exposures may worsen severity and may explain the death rate seen in bus drivers.

Sleep deprivation and fatigue have been proven to increase the likelihood of becoming infected following exposure to rhinoviruses (responsible for the common cold). This is hardly surprising. Everyone knows that being tired and sleep-deprived is not good for your immune system. NHS staff are not able to rest as much at the moment. The alcohol consumption of the average doctor may also play a part in immunosuppression!

Knowing all this I will admit to having been a little worried. I am usually a ‘glass is half-full’ kind of chap but each morning I have been feeling relief that I haven’t developed symptoms. As far as I can tell, I am now clear of the coronavirus incubation period relating to that exposure. Looking at the research, one study showed that nearly 98% of people exposed to the virus developed symptoms within 11.5 days.

So I can relax and not worry too much now. I know for certain that my PPE works. A lot of healthcare workers see infection with the virus at work as being inevitable. We are not able to isolate ourselves like the rest of the public. As long as we are fastidious with how we use the protective gear, we are perhaps more likely to contract the virus from mixing with colleagues at work.

So, at best we are left with the same anxiety that a lot of the population feel. As a man who has not long become a quinquagenarian (that’s apparently someone in his or her fifties), Nicky remains worried about me becoming unwell and I worry about her. In some ways she wishes that we would both just contract it and ‘get it over and done with’. If neither of us becomes too unwell and we recover, then we could both return to work and not have to worry further.

Personalised Protection

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Richard Cree
Richard Cree
Apr 13, 2020

Hi Heather. Good to hear from you. Our Trust are following the standard PHE guidance so Basic PPE is used for normal patient contact not involving Aerosol Generating Procedures (AGPs). In our trust, Basic PPE is a fluid-repellent (standard surgical) face mask, plastic apron (no sleeves) and ‘optional eye protection’. My personal opinion is full suits are overkill in this setting. I believe that Basic PPE does offer appropriate protection but it is essential that you wear eye protection in the form of a visor. Rigorous attention to detail when removing the PPE safely is vital. Hope this helps. All the best and stay safe. Cheers, Richard


Apr 13, 2020

Hi Richard. Good news to hear you are through the 11day-threat. Love the blog , just enough to keep us posted and updated - much appreciated. Lots of HCPs around the country (I'm talking outside ITU) are getting quite twitchy about the standard of their PPE. We;'re assured over and over again that the PHE guidelines re an apron, gloved and Fluid resistant mask +/- visor are quite appropriate for every day clinical contacts which are non aerosol generating. In some areas GPs working in Covid clinics are being supplied with full space suits, whilst others a getting little more than a plastic pinny! Naturally this inconsistency is causing some angst. Do you have any thoughts on this that mig…

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