COVID19: Physios and PPE

I want to voice my very real and very genuine concerns for the safety of all healthcare workers, including many of my physiotherapy colleagues who are being placed at unnecessary risk when working with COVID19 patients due to some ridiculous guidelines on personal protective equipment, often abbreviated to PPE.

Whilst on the topic of abbreviations I also want to say that if I hear ‘AGP’ which stands for ‘Aerosol Generating Procedure’ being misused or abused by some government official, NHS manager, or other misinformed numpty to justify why one healthcare worker gets full ‘SAS style’ PPE and another gets a food apron and a pair of poorly fitting rubber gloves when working with COVID patients I’m going to blow a gasket.

This ridiculous and quite frankly non-evidenced based guideline on PPE needs to change immediately, otherwise I fear more doctors, nurses, physios, careers, cleaners, porters, etc are going to suffer unnecessarily.

I don’t say this to be dramatic or spread fear or anxiety among my fellow healthcare workers, I say this as I have real concerns that many of my selfless, dedicated and brave colleagues are being, at best misinformed, or at worst deliberately misled.

I have mentioned a number of times on social media how I am both confused and concerned at the hugely different levels of PPE being worn in pictures of physios attending to COVD19 patients.

The response I get back is that government, NHS, and CSP, guidelines state that full PPE (that is a viral filtering FFP3 face mask or respirator, face visor, full length surgical gown, hat, double gloves, and foot protection) is only needed when there is a risk of AGPs producing airborne viral particles such as during ITU intubations, extubations, or rolling a ventilated patient. All other interactions with COVID patients need only a basic non-viral filtering mask, apron, and gloves as they don’t produce airborne viral particles.

This is simply complete and utter bollocks, not true, correct, or accurate in anyway based on plenty of evidence that clearly shows viral aerosols are generated with not just with intubations, but also with coughing, sneezing, and even breathing (ref, ref, ref, ref, ref, ref, ref).

Any COVID19 patient who is breathing should be considered an aerosol generating subject (AGS), and any time a healthcare worker is working in close proximity, ie less than 2m, it should be considered an an aerosol generating exposure (AGE). This includes all nursing, caring, and of course physiotherapy that helps COVID19 patients clean, mobilise, or rehab for ITU acquired weakness (blog on that coming out very soon).

I think many physios and healthcare workers who work on medical and recovery wards, as well as those in care homes and the community are being exposed to the COVID19 virus without adequate protection. Personally, I think one of the safest places to work as a healthcare professional currently in the UK is in an ITU department due to the higher levels of PPE they get compared to other areas.

Although thankfully COVID19 has a low complication and mortality rate, and appears to affect the elderly and those with other health issues more severely, it’s just NOT this simple. The reasons why some young, fit, and healthy individuals develop more severe symptoms is complex and still not fully understood in these early days, but it does appear that higher initial viral loads maybe an important factor to consider (ref, ref).

It does appear that individuals who come into contact with either a lot of virus at once or via repeated exposures over time can develop more severe symptoms and complications without any other risk factors. This potentially means healthcare workers who are in regular close proximity to COVID19 patients are potentially at higher risk of being exposed to higher initial viral loads and more severe symptoms and complications (ref, ref).

Again I have no wish to scare or worry any of the amazing, dedicated, hardworking, and heroic frontline healthcare workers including my fellow physiotherapists, I just want them to be as safe and as protected as possible during these unprecedented and difficult times.

I would therefore ask ALL physios and ALL healthcare workers working with ALL COVID19 patients in ALL areas including medical and rehab wards, care homes, and in the community to re-evaluate their PPE guidelines. I would ask all healthcare workers NOT to blindly accept their current PPE guidelines or accept that full PPE is only needed in ITUs or when AGPs are likely.

I would ask ALL healthcare workers to consider ALL COVID19 patients as aerosol generating subjects just by breathing and therefore working in close proximity to them potentially increases you risk of being exposed to higher levels of COVID19 virus. And just because a COVID19 patient is NOT on ITU and is improving doesn’t mean they are any less infectious or risky for to work with.

Please remember that those infected with COVID19 are highly infectious long after they have recovered from the worst of their symptoms, with some studies showing some COVID19 patients being positive and infectious for up to 4-5 weeks after the onset of their symptoms. (ref, ref)

This is such disturbing photo!!!

I therefore plead with ALL healthcare managers and ALL senior members of hospital, care, and community staff not to take flippant, unnecessary risks with your staffs health and safety due to some flimsy, nonsensical, non-evidence based government or local NHS trust guidelines. I would plead with you ALL to see that these guidelines have been drawn up more to protect PPS supplies and resources rather than to protect humans.

I would plead with you ALL to look at the evidence and re-evaluate the risks yourselves and make your own fully informed decision to decide if standing next to a breathing COVID19 positive patient is safe without full PPE for yourself or others.

Finally, I would ask all managers and team leaders to NOT think of those who raise concerns about lack of PPE as being difficult, obstructive, or lacking courage, but rather as genuinely concerned and justified. And if you are a healthcare worker and you feel unsafe or insufficiently equipped to do your job, please raise your concerns and if they are not acknowledged and met consider refusing to put yourself in harms way.

One thing I learnt very early on in my military training before becoming a physio is there is a HUGE difference between being brave and being reckless. Thinking you are being brave by helping others by taking unnecessary risks only tends to create two problems rather than solving one.

As always thanks for reading, and please take care of yourselves, and others, and please stay safe if you are working with or close to COVID19.


Whilst you made it this far could you please consider signing this petition for public enquiry into the governments lack of planning and preparation to adequately supply and protect all healthcare workers with PPE during this COVID crisis. Thanks




  1. Thank you for the post. The references really make me think. Appreciate the links to them, especially since I work acute care.

  2. Brilliant. Deserves praise for a great piece of writing and research. Hope it can make a difference! Well said

  3. Hi Adam,

    Great post mate! I messaged you on FB and I’m not sure if you got the message. If there is a more appropriate way to get in touch with you please let me know.



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