As new variants of COVID-19 are identified, the RCN insists that nursing staff, including those in community settings, are adequately protected. Here’s what is known about the UK variants and why we’ve taken our demands for improved safety measures directly to the prime minister
In the past few months, a number of new COVID-19 variants of concern (VoC) have emerged across the globe. Early indications are that these are more transmissible than previous strains of the virus.
The first known case of the UK variant was recorded on 20 September; by mid-December nearly two-thirds of new UK cases were attributed to it.
This VoC has now spread across the UK and even overseas and further human variants have been identified in South Africa and Brazil. Most recently, further mutations of the UK VoC have been reported and this remains an area of concern.
What do we know about the UK variant?
A December report from the UK’s New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) said that the transmission rate of the UK variant was 71% higher than previous variants. This figure comes from research headed by Dr Erik Volz at Imperial College London’s Department of Infectious Diseases and Epidemiology.
The UK has been collecting thousands of virus samples per day. Analysing these, researchers were able to see how quickly the UK variant of the virus was spreading. Dr Volz told the BBC in January: “We’ve been tracking lineages for many months now and that value of 70% was much bigger than anything we’d seen before... It basically means someone with the old variant might infect one person, then someone with the new variant would infect 1.7 people on average.”
NERVTAG also warned that this variant may result in a higher viral load in respiratory samples of those with the infection. This could be important as there is some evidence to suggest a correlation between viral load, disease severity and potential transmission between people.
In late January, NERVTAG highlighted preliminary evidence that the new UK variant of COVID-19 may cause more severe cases of the virus. Unpublished papers from the London School of Hygiene and Tropical Medicine and Imperial College London suggested there may be an increased fatality rate in people with the new variant. This was most significant for people in their 80s and 90s.
What the RCN is doing
Our members work in all health care settings, including people’s own homes. While we're in the early days of understanding the implications of the new VoC, our members are still at work. On 14 January, NHS England published figures showing staff absence due to COVID-19 had risen by a huge 22%.
We’ve written to Government Chief Scientific Advisor Sir Patrick Vallance, Health Minister Jo Churchill, and the Health and Safety Executive. Now, after inadequate action, we’ve joined with other royal colleges and trade unions, scientists and academics to escalate our demands to Prime Minister Boris Johnson.
Given the new variants and the emerging evidence on airborne transmission, we’re demanding an urgent and in-depth review of existing infection prevention and control (IPC) guidance and ventilation in health care settings. Preventing the spread of COVID-19 requires good infection prevention and control measures including hand hygiene, changing gloves between people/tasks, social distancing and high standards of environmental cleaning.
In addition to these, because of increased viral load, we’re calling for staff in all health care settings to be given a precautionary higher level of respiratory protective equipment (RPE) to protect against airborne spread. The use of higher level PPE more generally is supported by the World Health Organisation (WHO), which states that “FFP2 /3 masks may be worn by health care workers when providing care to COVID-19 patients if they are widely available and cost is not an issue”.
“As soon as we became aware of the new variant and the fact that it is more transmissible and potentially more infectious, we demanded clarity on whether the guidance on PPE, particularly respiratory protection, was adequate and whether it needed to be updated in light of the new variant,” says Kim Sunley, RCN National Officer.
“In the absence of evidence about the increased risk of new variants, we called for the precautionary principle to be put in place. When you don’t know the risk, you put in a higher level of protection as a precaution.”
A precautionary higher grade of RPE would address concerns around airborne spread of the UK variant of COVID-19 and align the UK IPC guidance with WHO advice.
A recent government public health advert (below) about the dangers of airborne transmission from breathing, speaking and coughing claimed that ventilating indoor spaces could reduce the risk of infection by up to 70%. Yet staff have not received such advice for health care settings.
“It’s within our psyche as nursing staff to look at the evidence and ask questions about its application,” says Rose Gallagher, RCN Professional Lead for Infection Prevention and Control.
“When members watched the government video on the risk of airborne spread of the virus in homes, they rightly questioned what that means in a health care setting where you can’t open windows and there is a high concentration of people with COVID-19. We have been told throughout the pandemic that standard surgical masks do not protect against aerosols so it’s not surprising our members are confused.”
A recent study found that coughing generates aerosol particles 10 times more infectious than those from speaking or breathing, putting staff working with COVID-19 patients at even greater risk. There is also empirical evidence that the virus is transmitted in health care settings beyond formally classified aerosol generating procedures (AGPs), with the risk of health care workers developing and dying from COVID-19 three-four times greater than that of the general public.
We are urging the government to review ventilation and provide tailored ventilation advice for all health and social care employers.
“In health and safety legislation, if you can’t remove a hazard in the first place, then you take measures to reduce exposure. We haven’t yet eliminated COVID-19, so the next step is to put in place measures, such as vaccination programmes and good ventilation,” Kim explains.
“This is known as the hierarchy of controls; at the bottom of that hierarchy is PPE, it's not the first thing you jump to because it’s so uncomfortable to wear for long shifts and must be fit tested accurately to give proper protection. However, for the foreseeable future, we are going to need both effective ventilation and suitable PPE.”
In the absence of clarity from the government, some hospitals have made the decision to provide staff with the higher grade of RPE as a precaution. The current IPC guidance acknowledges that trusts/boards can choose to provide nursing staff with higher grade RPE based on local risk assessment. The RCN is concerned this is creating a “postcode lottery” for nursing staff where some have access to the higher grade face masks and others do not, despite high rates of infection across the country.
“COVID-19 is a new infection caused by a new virus and there is international agreement that we need to do more research, but we need to be cautious until we have definitive evidence,” says Rose.
“Protecting health and care workers is our top priority and we are disappointed by the government’s lack of response on this issue. It is entirely reasonable to ask questions and seek assurance. We should not dismiss concerns when it comes to the health and safety of staff.”