Thread by @vonnie700

The @BelfastTrust is failing to protect vulnerable patients from exposure to SARS-CoV-2. This is unacceptable and unsustainable.
A thread about my experience on Friday 🧵

https://twitter.com/vonnie700/status/1664759154370662401

I had an outpatient appointment at Belfast City Hospital. Upon my arrival I was dismayed and alarmed to witness the absence of masks among hospital. staff & visitors. I saw just one or two patients in masks, including a woman who was a cancer patient. It was heartbreaking to see.

After my appointment, I had to walk past the entrance to the Cancer Centre and watched many staff, patients and visitors entering and leaving without wearing masks.

I saw one patient and her husband enter - both masked and looking frightened - and my heart went out to them.

I asked a passing member of staff whether masks were still mandatory inside the Cancer Centre, and she told me that they were, but only in treatment areas.

While @BelfastTrust acknowledges the risks to clinically vulnerable patients by implementing a mask mandate in treatment rooms, it fails to recognise the risks they face when moving through the hospital’s public areas to access treatment. The risks start at the front door.

.@BelfastTrust Covid mitigations are needed everywhere in your buildings.

https://twitter.com/jamie_weisman/status/1660650567151042563

And this is why #CleanAir is needed too.

https://twitter.com/jamie_weisman/status/1660650865991065602

Can I ask @BelfastTrust @publichealthni to publish your risk assessments to support the removal of masks within healthcare?

The NHS has a list of people who are particularly vulnerable to C*vid and cancer patients are on that list. It is unacceptable for @BelfastTrust not to have mandatory mask policies in place to protect people undergoing cancer treatment, and others who are clinically vulnerable.

Can I ask @BelfastTrust how the removal of masks has been assessed in regard to health and safety, CoSHH and other relevant legislation?

IPC guidance is not the law, and the PHA has been careful to remind providers of their own legal obligations.

Hospitals are superspreader environments. One individual caused 80 people to be infected with MERS (another coronavirus) during a visit to an emergency department in 2015, which subsequently spread to several other healthcare facilities.

There are reports of a recent Covid outbreak on a neurosurgery ward in the RVH. This is not only tragic for the families involved, but also puts additional pressure on beds and staff. 
belfastlive.co.uk/news/health/ro…
@BelfastLive

Many hospitals have reinstated mask mandates following similar outbreaks.
sfchronicle.com/health/article…

Despite the ending of the emergency phase of the pandemic, the WHO stated recently that “millions of people each week continue to be reported as infected/reinfected (a recognised underestimate of the true circulation of SARS-CoV-2 at the present time)…

… hundreds of thousands of people are in hospital with COVID-19 and thousands are dying each week. While we are currently dealing with the acute effects of COVID-19, current estimates suggest that around 6% of symptomatic infections result in Post COVID-19 condition…

…suggesting that hundreds of millions of people are in need of longer-term care now and for the foreseeable future.”
apps.who.int/iris/rest/bits…

The same WHO document notes that “our work is not done and the pandemic continues” and cites “reduced use or abandonment of public health and social measures” as a driver of transmission.

The WHO Director General said "The worst thing any country could do now is to use this news as a reason to let down its guard, to dismantle the systems it has built, or to send the message to its people that Covid-19 is nothing to worry about".
who.int/director-gener…

SARS-CoV-2 is a Group 3 Biological Hazard under COSHH legislation - on a par with tuberculosis and highly pathogenic avian influenza.
hseni.gov.uk/articles/coshh
hse.gov.uk/pubns/misc208.…

Covid is, among other things, a vascular disease, and has been recognised as such by this NHS-led study and many others. 
rbht.nhs.uk/news/long-covi…

The latest statistics report 11 Covid deaths in NI in a week.
coronavirus.data.gov.uk/details/deaths…
Over a year, that’s 572 deaths.
Imagine if 572 people a year were being killed on our roads. We would not say that we just have to ‘live with it’. Indeed, we go to great lengths to prevent it.

Annual road deaths are one-tenth of this figure, and we try so hard to reduce those with multiple mitigations - driver training/testing, speed limits, drink drive laws, seatbelts, signs, road design etc.
If we can aim for zero road deaths, why not zero Covid deaths? @roadtozero

FFP respirators reduce transmission very effectively.
cam.ac.uk/research/news/…

We need layers of protection.
The ‘Swiss cheese’ model helps to prevent infection. The diagram below illustrates shared responsibilities that are beyond the power of individual patients.

Here is the @publichealthni advice on reducing the risk of catching Covid.

nidirect.gov.uk/articles/coron…

This sounds exactly like a hospital…

Seems like everyone should be wearing masks in healthcare settings.

“Keep your distance” - this is impossible in hospital corridors, waiting rooms and shared spaces. Not to mention being in close proximity to healthcare staff for physical examinations, blood tests and so on. The only way to reduce the risk is to wear masks and clean the air.

How can we implement this advice as individuals? The burden of infection control should not be solely on the shoulders of the most vulnerable. But that is where we currently are.

It is the responsibility of the Trust to provide a safe environment for patients (and staff).

Public health is just that. We have a collective responsibility. Wearing masks in a hospital should be a universal expectation, not just a personal choice.

You may not like wearing a mask in shops or restaurants. But I hope you would agree that they should be worn in a HOSPITAL.

Mitigations are lifesaving for immunosuppressed patients. This study shows a reduction in viral respiratory and gastrointestinal infections in children undergoing cancer treatment while Covid prevention measures were in place 🌟
thieme-connect.com/products/ejour…

Can we have a mask mandate to protect children undergoing cancer treatment?

Can we have posters everywhere in hospitals underlining that the simple act of wearing a mask could save the life of a child cancer patient?

@BelfastTrust @publichealthni

Surveys have consistently shown high levels of support for masking within healthcare. The psychology of mask wearing means that mandates work best, and strong encouragement with positive reinforcement is also effective. People tend to do what is socially acceptable.

.@publichealthni even has guidance on how to encourage mask-wearing. It suggests offering virtual appointments to people who DON’T wear masks, in order to protect public health.

publichealth.hscni.net/sites/default/…

publichealth.hscni.net/sites/default/…

Staff should be wearing masks at the very least. This study states that “in studies conducted during the pandemic, half to two thirds of health care personnel acknowledged working with symptoms of respiratory illness…”
acpjournals.org/doi/10.7326/M2…

The study concludes that “exposing patients unnecessarily to infections that are preventable by masking seems directly contrary to the principles of patient safety”.

Masks are a crucial tool to prevent the transmission of infectious diseases, particularly for vulnerable patients. They reduce the spread of many infections, not just C*vid. The current burden of disease is overwhelming the NHS.

med.emory.edu/departments/me…

Healthcare is not a luxury. Nobody can avoid essential medical care. Patients deserve to be safe, and so do staff. We need leadership, mask mandates and clean air please.
@BelfastTrust @publichealthni @drcathyjack @explainedsnow @clooneydiamond @CraigBlaney @deepamann_kler

Please sign and share this petition to #KeepMasksInHealthcare.

https://twitter.com/cv_cev/status/1646200145506189349

91% of clinically vulnerable people have or would delay/cancel medical appointments due to high Covid risk.
91%.
Please make healthcare safe.
@BelfastTrust @publichealthni @cv_cev

.@BelfastTrust who will fill all the extra vacancies as more and more staff develop Long Covid and are too ill to work?

https://twitter.com/meetjess/status/1665825310808461312

91% of clinically vulnerable people have or would delay/cancel medical appointments due to high Covid risk.
91%.
Please make healthcare safe.
@BelfastTrust @publichealthni @cv_cev

Thank you for your reply.

1. Please reintroduce masks to *prevent* outbreaks, rather than waiting until vulnerable patients have been infected.
2. There’s already a report of an outbreak in the neurosurgery ward, is this correct? Have there been others?

https://twitter.com/belfasttrust/status/1666365588673900546?s=21&t=Wkd2ngWiI3AsOU8zg5OwOg

3. How has the removal of masks has been assessed in regard to health and safety, CoSHH and other relevant legislation? IPC guidance is not the law, and the PHA has been careful to remind providers of their own legal obligations.

https://twitter.com/belfasttrust/status/1666365588673900546

4. Will you publish your risk assessment for the removal of masks? The impact of an outbreak would be high, and for vulnerable patients it would be very high or catastrophic.

https://twitter.com/belfasttrust/status/1666365588673900546

5. Here is a simple risk assessment matrix. The probability of an outbreak is higher the fewer mitigations are in place, and the impact is highest for the most vulnerable patients.
It is clear that the removal of masks increases the likelihood of an outbreak.

https://twitter.com/belfasttrust/status/1666365588673900546

6. Masks prevent transmission of many pathogens besides Covid. Many of these are causing our hospitals to become overwhelmed. Has this been reflected in your risk assessments?

https://twitter.com/belfasttrust/status/1666365588673900546

7. Here is the hierarchy of controls. Can I ask to see your Covid risk assessment now that you’ve removed the bottom rung (PPE)? Are the other mitigations in place? Elimination, substitution, engineering and administrative controls? PPE is the *last* line of defence.

https://twitter.com/BelfastTrust/status/1666365588673900546

8. Evidence already exists that masks prevent infection. Please don’t ask patients to be part of an monitoring study that will harm us. It’s unethical.
cam.ac.uk/research/news/…

https://twitter.com/belfasttrust/status/1666365588673900546

9. Here’s a story about the removal of masks causing a cancer patient to be infected with Covid. This is happening elsewhere. Are you waiting for proof within your own hospitals? Have patients been asked for consent to to be part of this high-risk experiment @BelfastTrust?

https://twitter.com/sakerrie/status/1666696703062208514