A couple of days ago – 30th December 2024 – the Welsh ambulance service declared a critical incident. According to the Wales Online report, the head of the ambulance service, Stephen Sheldon said
“It is very rare that we declare a critical incident, but with significant demand on our service and more than 90 ambulances waiting to hand over patients outside of hospital, our ability to help patients has been impacted.”
Welsh (and English) hospitals are under great pressure from a “quad-demic” of flu, RSV, COVID and norovirus. Three of these diseases are transmitted across the air: flu, RSV and COVID. The fourth: norovirus, is food and waterborne. This pressure has prompted the introduction of both visiting restrictions and masking requirements in Welsh hospitals.
The visiting restrictions for Swansea’s hospitals near where my mother lives are here. If you follow the link you will see a large picture of surgical masks, so looks like visitors to hospitals will be handed surgical masks, to try and reduce the spread of flu (and RSV, COVID etc).
The UK’s regulator for respiratory protection is the Health and Safety Executive (HSE). The HSE considered what respiratory protection is best to reduce the transmission of flu. This is precisely the problem driving the crisis in Wales.
In 2008 the HSE published its report Evaluating the protection afforded by surgical masks against influenza bioaerosols. They concluded
Live viruses could be detected in the air behind all surgical masks tested. By contrast, properly fitted respirators could provide at least a 100-fold reduction.
There are basically two types of respirators in Europe*: FFP2 and FFP3. FFP3s offer more protection than FFP2s but the full benefit requires carefully fitting them, so for visitors FFP2s are I think in the sweet spot of offering a lot more protection the surgical masks currently being dished out to visitors in Welsh hospitals, while being pretty much as easy to wear as surgical masks.
The transmission across the air of flu and similar diseases is unfortunately very complex, so estimating the advantage of visitors wearing FFP2s over surgical masks is very difficult. Using the population data from the NHS’s COVID app, for COVID I estimated that wearing a surgical mask reduces the risk of infection by very roughly 40% while an FFP2 reduces it by approximately 70%. But these are rough estimates for COVID only, and for a general population, not that of hospital visitors, so should be taken with a pinch of salt.
But although quantifying the benefit of FFP2s over surgical masks is tough – it would require research into this to be funded – the HSE’s 2008 conclusion that FFP2s are more effective than surgical masks, is almost certainly correct. It is a shame that NHS Wales has not got the message here. That the NHS in Wales is not, to use the phrase used during the pandemic “following the science”.
Most of the crisis in the NHS in Wales is due to 14 years of austerity and will only be fixed by more (well spent!) money, but it is not helped by easily avoidable substandard measures to control infections such as flu and COVID. As it happens, the Welsh Cabinet Secretary for Health and Social Care, is my mother’s assembly member, Jeremy Miles. I have written to him to point out that flu transmission could be reduced in Welsh hospitals. I hope to get a better response than I got from England’s NHS to my email to Guildford’s then MP.
* Despite Brexit, in this case both England and Wales still count as in Europe.
Chance & Necessity 