‘Shielded’ anaesthetists and intensivists during the COVID‐19 pandemic

Publication
Anaesthesia

We are clinicians who are part of the ‘shielded’ or ‘extremely vulnerable’ group, as determined either by the government [1] or local policy. Whereas we appreciate the unprecedented and rapidly evolving nature of this situation, our group has been conspicuous by its absence from organisational guidance. The unexpected and frustratingly unique position we are in is strikingly different from our lifestyles of 2 months ago, and currently there is no exit strategy.

Public Health England has offered no guidance with regard to employment in its shielding document [1, 2]. Whereas we have been making efforts to support frontline work from home, we have had mixed results. Barriers include physical distancing leading to reduced communication, lack of IT provision and confidentiality issues surrounding healthcare data.

The guidance for those shieldings is simple: “Stay in your house, do not attend any gatherings, strictly avoid contact with those displaying symptoms ” [1]. The initial shielding period is due to end on 30 June, though it is likely to be extended. With plans to re‐introduce normal working patterns across the NHS, we look to organisations, including the Royal College of Anaesthetists (RCoA), the Faculty of Intensive Care Medicine (FICM) and the Association of Anaesthetists, to help identify barriers and potential solutions to enable our safe, supported return to clinical duties.

National guidance is limited. Pregnant staff have been offered an interpretation of the guidance by the RCoA/FICM/Royal College of Obstetricians and Gynaecologists, reflecting the associated risk involved with our clinical practice [3, 4], whereas those advised to shield have not as yet. The RCoA/FICM have acknowledged the uncertainty around how and when the shielding requirement may be lifted and that it will likely be on a case by case basis [5]. Whereas this acknowledges shielding, it lacks specific strategies/advice for individuals, departments, Trusts and Deaneries going forward. A framework adaptable to individual circumstance that enables future planning should be developed. We strongly believe this is possible in order to support the inevitable upcoming transition period.

Shielding anaesthetists and intensivists have some areas of concern; common themes include guilt, and a sense of being forgotten. Many departments have been incredibly supportive, but with little official guidance. There are feelings of anxiety and uncertainty regarding our futures, as anaesthetists and clinicians. Whether as a consultant, specialty doctor or trainee, working in their usual capacity has ceased for as long as the threat of COVID‐19 remains.

There will be training implications for many and some have concerns about returning to work, meaning discontinuation of clinical care or early retirement. Departments across the UK are now asking ‘how can we welcome shielding staff back to clinical settings safely’? We invite open discussion with key stakeholders on how we can facilitate our safe return to work.

We are unsure how the guidance may evolve. Flexible return to work programmes and appropriate risk stratification are going to be key. Perhaps the option of working at clean sites could be explored [5]?

We would welcome the chance to work with national bodies to address the following:

  1. Provision of guidance for anaesthetic departments with shielded staff.
  2. Advice for individuals, departments and deaneries regarding options for redeployment and training.
  3. Development of a framework to assist in return to work planning.
  4. Improved support for those shielding.
  5. Longer term suggestions for work and training should the shielding period be extended beyond 30 June.

We thank you for enabling us to highlight our concerns and are hopeful that this will act as a catalyst for action.

References:

[1] Public Health England. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID‐19. 18 May 2020. https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 (accessed 20/05/2020).
[2] Public Health England. Staying alert and safe (social distancing). 11 May 2020. https://www.gov.uk/government/publications/staying-alert-and-safe-social-distancing/staying-alert-and-safe-social-distancing (accessed 20/05/2020).
[3] Royal College of Obstetricians and Gynaecologists, Royal Collage of Midwives, Faculty of Occupational Medicine of the Royal College of Physicians. COVID‐19 virus infection and pregnancy. 21 April 2020. https://www.rcog.org.uk/globalassets/documents/guidelines/2020-04-21-occupational-health-advice-for-employers-and-pregnant-women.pdf (accessed 20/05/2020). [4] Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists, Royal College of Anaesthetists. Advice for pregnant members of the anaesthesia and intensive care workforce during the COVID‐19 pandemic. 27 April 2020. https://icmanaesthesiacovid-19.org/advice-for-pregnant-members-of-the-anaesthesia-and-intensive-care-workforce-during-covid-19?utm_source=COVID-19+Weekly+Update&utm_campaign=7ba004532a-COVID+Weekly+Update+290420&utm_medium=email&utm_term=0_bbfed564bc-7ba004532a-173250377 (accessed 20/05/2020).
[5] Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists, Royal College of Anaesthetists. Restarting planned surgery in the context of COVID‐19 pandemic. 1 May 2020. https://icmanaesthesiacovid-19.org/restarting-planned-surgery-in-the-context-of-the-covid-19-pandemic (accessed 20/05/2020).

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