The masking tapes

Speaker 1: Hello?

Speaker 2: How have you been? You all right?

Speaker 1: Yep, no problem.

Speaker 3: Oh, hello. Oh my goodness!

Speaker 4: Yeah, of course, that's fine.

Speaker 5: No, that's fine. Hello, yes.

Mark Thomas: Hello, and welcome to episode two of ‘Mark Thomas's lockdown check-up’. I’m Mark Thomas and this is the podcast that talks to health and care workers about their lives through the coronavirus pandemic. Once again, I am recording this from the monastic cell that is the spare room in my 85-year-old mother’s two-bedroom flat in south London. The recording equipment is sitting on the bed, the laptop propped against the pillow, and the dog has been expelled to the living room. So let’s get going.

I had been mid-tour when the lockdown started. My last show was in Liverpool and I opened with the line, “Great to see you here for the last time you’ll be allowed out for the next four months.” Little did I realise I was ever the optimist. That was on the 14th of March. On the 16th of March I started cancelling shows. On the 22nd of March I moved in with my mum, just in time to forget Mother’s Day. And on the 24th, lockdown began. Everyone’s world shrank in lockdown, but I felt for my mum. No more visits to the hairdresser, no more visits from grandchildren, no more hanging out with her mates, who she calls the Biddies.

The Biddies would normally meet at least three times a week, at church, for worship and bingo. Two things that need similar levels of concentration and devotion, but with very different prizes on offer. Throughout this period, my mum has desperately missed the Biddies, and I recently relented to allow an old friend of hers, Sylv, to come round for a socially distanced garden visit. They caught up over tea and cake, discussing family gossip, lockdown and how they were coping. This is my mum talking about her friend Sylv.

Mum: Sylv came over the other day. She’s batty but she’s great. She hasn’t got a bad bone in her body. She was a bit neurotic in the beginning. She hadn’t got any sanitiser, so she used gin. She wipes everything down with gin. She goes to pick up a paper, she wears her mask, she wears her gloves. She does them with gin when she gets back, she does the paper down with gin when she gets back. And I used to roll up with laughter.

Mark Thomas: You have to be quite scared to clean a newspaper with gin. Scared and lacking any knowledge of chemistry, but definitely scared. In the first two weeks of lockdown, I was scared. I would wake in the middle of the night in full-on panic mode. “I’ve got a temperature, I’ve got a temperature.” Just completely oblivious to the fact that I was under two duvets with a combined tog of Krakatoa. Or I’d wake up thinking, “I've coughed three times, is that persistent?” And it was only once I’d got through those two weeks with my mum, that first two weeks, that contagion two weeks, that I realised that I had not kissed her in all this time.

Each night I would phone my network of health and care workers and chat to them about their experiences throughout the pandemic. And one of the constant themes to emerge in conversation was the urge to protect others and themselves. And this is what this episode is about: protection.

The government’s failure to manage the personal protective equipment stockpile is well documented. And soon stories began to emerge of people making visors for the NHS, of nurses having to improvise with bin liners or cagoules instead of aprons. The story that seemed to sum it up for me was that of a medical fetish shop who handed over their supply of equipment to their local hospital because the hospital didn’t have enough. This is not a judgement on the kink community or fetish. I just think it’s a government’s job to prepare for emergencies and not to rely on people who become aroused at the sight of a stethoscope.

The first conversation I want to play you is Naomi. Naomi works in a private care home.

Naomi: On the news I can remember seeing the care home in Italy, and seeing these images of all of the care staff in PPE. I'm thinking, “Ooh, that’s awful.” And you kind of do this, “Okay. That’s a care home over there. I work in a care home.” And just my human idiot brain just thought, “That won’t happen. That won’t happen here.” And then literally within two weeks, we were exactly the same. Lockdown, full PPE, people dying. But did we have enough PPE? No, not in the beginning. We couldn’t get masks. We only had a few. We were running out of gloves and we were running out of everything. Our operations manager bought some ... the only place she could find them were like tattooists’ gloves that were like these very scary black things.

Mark Thomas: For music lovers of nu-metal, medical scrubs and black gloves will sound slightly Slipknot. Nearly everyone I spoke to had stories about how their PPE was inappropriate, how it did not meet World Health Organisation standards or it just didn’t turn up. I had a conversation with Jackie, a GP in east London, in the midst of the pandemic, about her practice’s shipment from NHS Supplies.

Jackie: We were all told we were going to get proper PPE this week. We got a couple of boxes of masks. We didn’t get the ones with respirators. We’ve got the normal gloves, because we just got normal clinical gloves, which is fine. We didn’t get any aprons and we didn’t get any eye protection. That, I think, came from NHS Supplies. I’ve just bought myself a few masks with respirators; I bought them online about two weeks ago and it was 75 quid for five. They came yesterday and I’ve never seen anything so like it should cost a quid.

Mark Thomas: At the start of the lockdown, roughly at the time my mum’s friend Sylv was drowning her newspaper’s sorrows with gin, I told my mum of how a local pharmacist was charging seven pound for a tiny bottle of hand sanitiser. “Seven quid?” she had said. “They’re taking the piss. I hope you didn’t get it.” “Of course I didn’t,” I lied.

One of my mum’s biddies lives in a care home a short walk away, and I am in charge of taking cake to the care home. I became quite adept at pressing the buzzer of the care home with my elbow and leveraging the door with my hip in a bizarre homage to the Alan Partridge sketch of how to use a toilet on a train without touching anything. For the people I was talking to each night, it was slightly more than paying over the odds or opening doors with their elbows. Sophie is a nurse from Liverpool who is working in a variety of roles on wards with COVID-19 patients.

Sophie: The guy taking temperatures at Hong Kong Airport’s got more fucking PPE on than me. He’s only pointing a thermometer. So why do they think that’s acceptable? On what basis have they made that decision? You get PPE envy when you see things on the telly. You’re not watching them clapping, but you’re saying, “What they wearing? What they wearing? Is that a…?” Because I want to know what they’re wearing, honestly. You turn into these twitchy neighbours to see what PPE other nurses have. It’s awful.

Mark Thomas: Max, who worked on a ward with cancer patients and COVID-19, may or may not have had similar types of PPE envy, but he was certainly unimpressed with the standard of equipment when I spoke to him.

Max: I’ve got photographs of PPE equipment and it had a sticker on. I think one of the sisters came up to me on the ward and said, “Have a look at this.” And clearly there were three or four stickers placed on top of each other with different dates so that it seems like it was within dates. And maybe about a week or two afterwards, I think Public Health England issued a statement saying, “This is an issue. We’ve done testing on PPE and the PPE has to be intact so it’s okay to use.” And then a friend of mine mentioned, “How many have they tested?” It’s not very clear. How do they test it? It’s not very clear. They’ve tested very few pieces of PPE.

Mark Thomas: One of the places I felt quite vulnerable was the local supermarket, where the aisles were narrow and people had varying attitudes to social distancing. And one way I found of dealing with this was to sing loudly while shopping. A quick burst of, “Why do birds suddenly appear,” just very near the chiller unit will make people keep their distance. Likewise, answering the doorbell to my mum’s flat in underwear and holding a bottle of bleach – well, it proved quite the deterrent.

Mark Thomas: As I shuffled around the flat in t-shirt, boxers and towelling robe, I realised I was channelling my inner Tony Soprano. But I was not the only one with an idiosyncratic dress code. Naomi worked in a care home and they had up to 50 per cent of their staff off sick or shielding or were just scared. For the staff that did turn up though, they took “make do and mend” to a new level.

Naomi: People who are like dedicated nursing staff, they just wanted to carry on and they just wanted to not be putting anyone at risk. And they did home-made hair protection, they wore double aprons. At some point I think some of them wore like double masks, visor, goggles.

Mark Thomas: That “make do and mend” ethos might mean that individuals can get by. But this is Siobhan, who is head of nursing at a major London hospital. And their version of make do and mend is on a slightly different scale. I started the conversation with Siobhan by asking her how they were getting on with PPE.

Siobhan: Fine. We’ve been fine. We’ve got really good procurement in our organisation. We’ve got a really great guy. We chartered one of the first planes from China to bring back PPE. I mean, there have been a few times that we’re coming down to the ... We’ve had like two days’ or three days’ supplies. One weekend we thought we were going to have to move into the coveralls rather than gowns, but actually then we’ve got another delivery. So another 30,000 gowns. We were using about 6,500 gowns a day, but we managed to keep our supply chain, or open new supply chains, and keep stock coming in. So for us there wasn’t really those concerns.

We also opened a 3D printing farm. We’ve got a big storage unit in Dartford and we set up 200 3D printers to make visors. So we were producing about, I think, 2,000 visors every 24 hours that we were bringing into the hospital.

Mark Thomas: The depleted PPE stockpile and the lack of planning left the UK government panic buying in the midst of a frenzied global market. The Financial Times recently estimated that the UK government has been vastly overcharged, and we have spent more money than any other European nation on PPE. Between March and July 20th, the government spent £3.2 billion on PPE. So I think I got off quite lightly with hand sanitiser at seven quid.

As the pandemic goes on, we acclimatise to new rituals. So when going to the shops, I now reach for wallet, keys, phone and mask. Likewise, health workers, well, they have new procedures and new rituals. This is Michaela, who worked in an intensive care unit in an area with relatively few COVID cases and no major issue with PPE.

Michaela: We get changed. We get fully gowned up outside, walk into a little area where, when we come out, we will wash. So we don outside, go in through this little antechamber area, but it’s where we then doff when we’re coming out. So we take it all off. I accidentally walked in once without a mask on, and I don’t know how I did it, but I did. I didn’t get very far in, but I was like, “Oh my gosh. Oh.” I don’t know how I did it.

Mark Thomas: On arriving home to her teenage twins, Michaela was greeted with their rituals.

Michaela: I don’t think they worry about me, particularly. They worry about what I’m bringing home. “Have you had a shower? Go and have a shower now.” But I don’t know. I’ve been under a lot of safety equipment today. I don’t feel like I'm bringing anything home. I’ve washed my hands. Sorry. I just have to ... Charlotte, do you worry about me?

Oh, she says she does worry about me, but I don’t personally think she needs to. I don’t worry about me. I’m more worried about going to the shops.

Mark Thomas: She’s obviously heard me singing by the chiller cabinets. Mike works in a care home. He’s a nurse and he works with dementia sufferers. And at the start of the pandemic, his care home had no masks and very little guidance.

Mike: The first patient that we had that had it, he had severe advanced dementia and was very agitated for most of the time. So trying to treat him at the first stages of it, just trying to get some paracetamol into him to help bring his temperature down, it was just a fight. I ended up getting COVID, I think, from him. Because while we were dealing with him, we didn’t have the full PPE that was recommended. We were just gloves and aprons. And so while we were trying to get some paracetamol down, he spat in my face. And then it was a few days after that, I started coming down symptomatic.

Mark Thomas: Max, who you heard earlier talking about out-of-date PPE, worked through the pandemic on a ward with cancer patients and specifically blood cancer and COVID-19 sufferers. Here he details the moments when a patient with COVID arrested.

Max: We did actually have one patient who ended up needing intubating on the ward. And that was obviously very traumatic too, because they had COVID. That was an arrest situation. So we had to get the intensive care team in, and there was a scramble to find all the PPE. Enough PPE for all of the people who were coming on to the ward. And that was a young man who had a blood cancer. So that was a very traumatic situation.

Mark Thomas: One of the things that struck me over the course of these conversations was how little we were prepared, how little we knew about the virus and how to deal with it. And this lack of knowledge, coupled with mixed messages and sometimes in absence of guidelines, meant protecting people became, at times, nearly impossible.

We have had over 550 care and health workers die from COVID-19 so far. And people I talked to were genuinely frightened. This is Sophie, who you heard from earlier talking about PPE envy, and this time she's talking about the Clap for Carers and what it meant to her.

Sophie: You look on ICU, there’re 40- and 50-year-olds dying, and they’re sending us out there with a pinny. And people clapping isn’t helping, because they’re deifying us like we’re this ... I’m not. I’m just a scared 50-year-old woman who’s been asked to do her job without stuff. So clapping at us is just getting them off the hook. Because we’re angels when we ... all of this deification of us, I think, is dangerous. I know why they’re doing it, but this actual deification – “Oh, you’re angels, warriors” – we’re not. We’re actually just a scared workforce who haven’t been given what we need because the government didn’t prepare.

Mark Thomas: In the middle of that first surge of COVID-19 in April, Public Health England, who issued guidance for PPE requirements, downgraded the virus. Although it was contagious, it was not as lethal as Ebola. And with the downgrading of the virus came the downgrading of the PPE needed to fight it. A lot of people I talked to were critical of the government’s response. PPE shortages and the incredible fear of the virus meant that when Public Health England downgraded the level of PPE for health workers, it was met with disbelief and, I genuinely think, hurt. Anna is a hospice nurse, and this is what she says.

Anna: I wonder how good the guidance is, for instance, on the PPE. Because on my first day, as I said, we were originally wearing two long-sleeve gowns, one backwards, one forwards. And we were in shoe covers. Now they’ve decided we don’t need long-sleeve gowns. We’re okay with a little plastic apron. I suspect it was based not on best practice; I suspect it was based on what they had or what they could get. The idea that ... The wearing two long-sleeve gowns, one backwards, one forwards, was actually based on hospice policy. And it was based on our team making their best guess of what was the best way of protecting staff. I didn’t become a nurse to swathe myself in plastic. I mean, equally, I didn’t become a nurse to say, “I’m a human sacrifice, you infect me with whatever you've got.”

Mark Thomas: The shock of downgrading the PPE requirements in the middle of a PPE shortage struck a raw nerve with many. This is Siobhan, the London-based head of nursing.

Siobhan: Where we struggled is when the national guidance changed from using long-sleeve gowns to just the aprons. We struggled not because we didn’t have that, because people were used to wearing like full armour and then were told to go out in a bikini.

Mark Thomas: I think this was certainly the case for Sophie, the Liverpudlian nurse. Her PPE guidelines had originally been devised by a colleague at a hospital who was an expert in infection control. So when Public Health England changed the rules, she felt betrayed.

Sophie: So when this all came out, I started off with a full respirator mask, a full face visor, gown, hat, double gloves. Because he said that’s what we need because he’s an expert in infectious diseases. Of course the government changed it. The hospital then can’t provide us what the government say we don’t need. So we’re now in what I’ve told you, a pinny and gloves. So they classify it as the same as flu. And no one’s really appreciating how vulnerable everyone feels because they’ve took shit off us. We didn’t start off with pinnies; we started off with a full kit and when they couldn’t get it, it was downgraded and downgraded. So we do feel vulnerable.

Mark Thomas: This vulnerability was something that Eimear picked up. Eimear is lead on infection control at a London hospital. And I asked her about Public Health England issuing new guidance on PPE and if she thought it was correct.

Eimear: I think at the start we were dealing with it as a high-consequence infectious disease along the lines of Ebola. And I think that was, we now know, probably over the top in most cases. But the perception of staff who had been wearing those kinds of protections, when the changes happened and that people kept saying things like, “All I’m getting is this simple mask and this flimsy apron.” That type of comment. “How do I know I'm safe?” I mean, that was a frequent question in the early phase. “I’m testing people who have coronavirus. Do I have the right protection?” was a common question. That was very difficult. It comes down to, “Does it feel like it’s the right thing to do?” And it felt like it was the right thing to do to support that and get our colleagues feeling safe doing that.

Mark Thomas: Talking to the network, I think, gave me a sense of how much trust has been eroded in the government’s response by the failure with PPE. At the peak of the crisis in April, I spoke to Barbara, who is a consultant in major trauma.

Barbara: I think that we should have been in fuller PPE about two weeks before it all started to kick off, actually. So I think we were seeing people with it a couple of weeks before the lockdown and a lot of people got infected as a result of inadequate PPE. The government advice for us is a bit of an outlier compared to other countries. You see people in China, in South East Asia – healthcare workers, porters, radiographers – and they are in full PPE the entirety of their shift. Whereas we’re not. I think it’s pretty shit, to be honest with you. I think if you want to protect your staff then you should put them in full PPE. That's what I think, really. It is distressing seeing our staff get sick and die.

Mark Thomas: Throughout this episode you have heard from a nurse from Liverpool called Sophie, talking about her fears and anger about inadequate PPE. In my last conversation with her just a week ago, she told me some interesting personal news.

Sophie: I’m actually antibody negative. Did I tell you?

Mark Thomas: No, you didn’t.

Sophie: So how the fuck’s that happened? So I haven’t had it. All those people on the ward, I haven’t had it.

Mark Thomas: Well, is that a good ... is that a, “Hurray, my PPE works?“

Sophie: No, because I ... well, I’m still not convinced, because people who were wearing the same PPE as me got it. So I’m not convinced. I think the PPE reduced the risk, but I think it should have been better and I still stick by that. I was very religious with it and I shouted at everyone else, and I always wore a visor and not the goggles, so my whole face was protected. And I also have a slut wash at the end of me shift. I literally washed every bit of skin I could reach without breaching decency acts. And I’m wondering whether that was it.

Mark Thomas: Well, if washing your hands was the official guidance, you can’t go far wrong washing the rest of you. The last word tonight should go to my mum, who, despite the protestation from my sister Ruth and I, initially refused to wear a mask. This is my mum, the ex-nurse, a midwife, who took quite an anti-mask stance on the basis that everyone else was putting theirs on incorrectly.

Mum: I had to wear it when I went for blood tests the other day. Both the nurse and I laughed together because she didn’t have hers on properly. And Ruth told her that there’s a notice up, you need to wear a mask in there. Which is fair enough. And then, Ruth being Ruth had to take photographs and distribute it around Facebook. Nothing’s sacred in this family. Nothing.

Mark Thomas: Indeed, nothing is, Mum. And I wonder what I will tell our listeners about you next week. The next episode, by the way, is on communication. And I hope you’ll join us. Thank you for listening. Thanks to all the people who gave up their free time to come and talk to me. Thanks to the Imperial Group of NHS hospitals for their continual support. And thanks to my mum.

‘Mark Thomas’s lockdown check-up’ was recorded, written and presented by Mark Thomas. The sound editor was Helen Atkinson. The producers were Nicolas Kent and Susan McNicholas. And the podcast was commissioned by Wellcome Collection.

Speaker 1: All the best Mark, take care.

Speaker 2: Thanks for the free therapy.

Speaker 4: Give your mum a hug from me as well.

Speaker 3: Okey doke, take care, bye.

Speaker 5: And you mate, see you soon.

Speaker 6: Really nice to talk to you, and look after your mum.