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The waiting game

‘Reassuring’ evidence on surgical masks for GPs but only in use with other PPE

A standard surgical mask provides similar levels of protection against respiratory viruses to a respirator mask, a rapid review set up to provide answers for staff working in primary care has concluded.

But the evidence to date is based on other infections including influenza, SARS, and MERS and not on Covid-19, the researchers from the Oxford Centre for Evidence-Based Medicine said.

Professor Trish Greenhalgh, professor of primary care health sciences, who co-authored the review, told Pulse that masks are only one component of protective equipment which must also include eye protection, gowns and general infection control measures as well as training on how to properly use it.

Work is underway on the evidence for other aspects of PPE, she said.

It comes after GPs and other healthcare staff in primary care had raised concerns about the limited PPE that had been provided for them.

Community and primary care teams wanted to know whether and in what circumstances standard masks were putting healthcare workers at risk compared to respirator masks, the researchers said.

The rapid review on face masks found that for non-aerosol-generating procedures (AGPs) ‘there is no evidence that respirator masks add value over standard masks when both are used with recommended wider PPE measures’.

The evidence provides ‘cautious support for the use of standard surgical masks in non AGPs’, it concluded although there is little evidence on their use outside of hospital.

‘The review is reassuring – but only up to a point,’ Professor Greenhalgh said.

‘It seems to show that for non-aerosol-generating procedures, and with the caveat that the mask must be properly fitted and worn (no undoing the top straps and letting it dangle between patients, for example), a standard surgical mask provides similar levels of protection against respiratory viruses to a respirator mask.’

But she added that there were also issues around what other protective gear was being worn in addition to the mask, such as goggles, gowns and aprons and gloves, for which recommendations had been issued.

‘It is very important to get the message across that the mask is only one component of the prevention package.’

There are also questions remaining around what should count as an AGP, she said.

‘It seems to have been assumed by people writing guidance that AGPs are things that mainly occur in hospital such as intubation but there are some common procedures like measuring peak flow rate and administering nebulisers which some clinicians are claiming could generate aerosols.

‘We are currently reviewing that literature and will have the reviews on the Oxford CEBM website as soon as they’re ready.’

NHS England has said every GP practice in the country has now received a delivery of PPE and they have launched a hotline which GPs can call if they require more.

But the BMA and RCGP have warned this is not the case for all members, with the BMA stating that GPs and hospital doctors 'will die' without proper protection.



Readers' comments (20)


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  • Grateful thanks to the academics who have conducted this study of whom this comment is not a critisism. Just wondering why, as this is a meta-analysis and therefore the data already existed, the UK Government did not do it and sooner.

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  • @KevlarCardie. Great article. UK Goverment - complaicent & penny pinching. Massively false economy which will cost thousands of lives and billions of pounds.

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  • Where's Optimus?

    Oh great....
    So long as no one sneezes and generates an aerosol...
    the surgical mask will be ok....
    This sounds like someone trying to justify that only outdated masks have been sent out...
    Let's talk how many boxes..instead of masks...

    We've sent out a million nuts and bolts....
    Oh so a few crates basically..

    Stop the press...
    Italy you can let up and change to surgical masks...

    Just put the face mask on the patient AND yourself
    Let the patient keep theirs...

    Not enough to go round?

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  • Where's Optimus?

    Boris and Matt Hancock and medical advisors ...positive for Covid..
    They may just see first hand the state of the services they are responsible for...uh oh
    Karma can be a bitch?

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  • Professor Trish Greenhalgh currently only OBE. Please start a petition to have elevated to CBE.

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  • GPs need FFP3 masks, visors and long sleeved gowns. My colleagues and I resuscitated a patient in our Surgery who required open suction in order to manage her airway. This is considered an APG by the WHO and the NHS. This happened a week last Friday; the GP who performed the suction is now self isolating with symptoms.
    Of course, GPs deal with similar situations all the time and will be more exposed as COVID plays out.
    A roll of plastic aprons, standard gloves and paper masks is far from adequate PPE during this pandemic. Also, GP is not being resupplied by NHSE; have to source what we can ourselves. A local tattoo parlor has given us gloves and the secondary school has given us all of their science goggles. This is not a joke.
    Feeling totally let down but will keep doing whatever I can for patients.

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  • *AGP

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  • Why us our death rate higher than Germany. Please explain. Would actually like to know.

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  • Germany test a lot more and look at the quality of the PPEs their staff are wearing, just screening people compared to our colleagues. The population also follows social distancing. Those differences will lead to different outcomes.

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