Face mask advisory resisted by the HSE to ensure adequate supply for health professionals

There were sharp divisions at a meeting of the National Public Health Emergency Team two weeks ago over the need for health workers to wear surgical masks, it can be revealed.

The Government’s Expert Advisory Group (EAG) called for face masks to be worn by health care workers dealing with COvid-19 patients, but this was resisted by the HSE, it has emerged.

At a meeting of the NPHET on April 14, the advisory group made a new recommendation that “Health Care Workers (HCWs) who are providing near-patient care (i.e. within two metres) to patients who are not currently a suspected or confirmed case of Covid-19 should wear a surgical face-mask.”

The EAG also recommended that health care workers in clinical settings should wear a surgical face-mask when they cannot maintain physical distancing from their colleagues.

According to minutes of the NPHET meeting, there was a “detailed discussion” on the EAG’s advice and “the challenges outlined by the HSE in meeting the demand for surgical masks across a wide range of healthcare settings, including long term residential care homes".

Rather than accept the advice there and then, “it was agreed that the HSE, working with the HPSC, would further consider the advice of the EAG and to revert with a recommendation at the next meeting of NPHET".

“The NPHET was generally supportive of the EAG advice, however, in light of the issues identified, it decided to accede to the HSE’s request to revert with a further proposal on this matter by Friday 17th April 2020,” the minutes reveal.

“The HSE emphasised the importance of ensuring that there would be an adequate supply of masks for healthcare workers in high-risk situations. In light of the supply issues and the need to secure the use of masks for healthcare workers."

The minutes also state that every effort should be made to enable an adequate supply of surgical masks to meet the needs of healthcare workers: "It was noted that a clear recommendation on masks may provide clarity on manufacturing and supply requirements. It was noted that Public Health England had adopted a more nuanced approach in their guidance and that there was now Ethical Guidance available on PPE.”

To date, no new protocols about the wearing of masks have been forthcoming.

Clonakilty, West Cork, Ireland. 28th Apr, 2020. A woman queues to go into Clonakilty Pharmacy wearing a face mask to protect herself from Covid-19. Picture: Andy Gibson

The minutes state that the recommendation of the EAG was made in “the context of widespread community transmission in Ireland, a significant number of Covid-19 infections in healthcare workers, growing concern regarding the burden of asymptomatic and pre-symptomatic transmission, and continued growth in the numbers of those infected, and hospitalised, with COVID-19".

“The EAG also made particular comment that masks were only one of a suite of measures that should be used and did not circumvent the need for hand hygiene, appropriate infection prevention and control, physical distancing and appropriate PPE use. It was noted that the evidence for this is not very high quality but appears to be trending towards a benefit in wearing masks. The EAG said it will keep this recommendation under review, and may amend its advice at a future date, depending on the evolution of the pandemic.”