Doctors avoiding work with coronavirus patients due to compensation fears if they die

By | March 30, 2020

Hundreds of doctors are avoiding working extra hours in the NHS’s coronavirus battle because they’ve lost death-in-service benefits amid pensions row and freelance contracts

  • A survey by the Doctors’ Association UK (DAUK) highlighted doctors’ fears
  • 350 medics said they were less willing to work in high-risk areas amid crisis
  • They have concerns their families will not receive death-in-service benefits
  • Benefit amounts to two years of pay if the doctor is on the pension scheme 
  • The concerns follow the deaths of at least two NHS workers last week 
  • Coronavirus symptoms: what are they and should you see a doctor?

Hundreds of doctors say they are avoiding work with coronavirus patients because they fear their family won’t be compensated if they catch the disease and die.

Some 350 respondents to a survey by the Doctors’ Association UK said they were less willing to work in high risk areas or increase their hours amid the coronavirus crisis.

They have concerns they are not entitled to receive the full death-in-service benefit, which would be equal to around two years’ worth of pay for their families.

The lump sum is only available to those who are members of the NHS pension scheme, which has been shunned by many doctors amid an ongoing tax row.

It may also be unavailable in full to locum doctors, who work freelance, or to the more than 2,660 medics who have come out of retirement to work in the crisis.

The concerns follow the deaths of two NHS staff, Adil El Tayar, 63, and Amged El-Hawrani, 55, and a suspected third. 

The tragic news add more pressure on the Government to provide protective clothing (PPE) for frontline workers, including face masks and eye protectors. 

For weeks, staff say they have been forced to care for COVID-19 patients without wearing adequate protection, leaving them at risk of catching the infection or passing it to other patients in hospital.

Hundreds of doctors are avoiding work with coronavirus patients because they fear their family won’t be compensated if they catch the killer disease and die, a survey by the Doctors’ Association UK (DAUK) shows. Pictured, NHS medical staff at King's College Hospital, London

Hundreds of doctors are avoiding work with coronavirus patients because they fear their family won’t be compensated if they catch the killer disease and die, a survey by the Doctors’ Association UK (DAUK) shows. Pictured, NHS medical staff at King’s College Hospital, London

NHS staff have consistently expressed their fears about working around COVID-19 patients as the outbreak rapidly grows. Rachel Clarke, a doctor in palliative care in Oxford, said the lack of personal protective clothing (PPE) is an emergency

NHS staff have consistently expressed their fears about working around COVID-19 patients as the outbreak rapidly grows. Rachel Clarke, a doctor in palliative care in Oxford, said the lack of personal protective clothing (PPE) is an emergency 

There is concern for retired NHS workers who have been asked to return to work because they are in the vulnerable groups, due to their age. A family doctor working in Canada, Dr Pavan Kaliray, hashtagged #NoPPEnoWork

 There is concern for retired NHS workers who have been asked to return to work because they are in the vulnerable groups, due to their age. A family doctor working in Canada, Dr Pavan Kaliray, hashtagged #NoPPEnoWork

The number of positive coronavirus tests in the UK is expected to rise above 20,000 today and 1,228 people are confirmed to have died already.

NHS staff, who are not being tested for the coronavirus and who say they don’t have enough protective equipment, have been putting themselves in danger for weeks. 

Now, The Guardian reports that hundreds are put off taking on extra work to fight the pandemic because they fear their families won’t be compensated if they catch the disease and die.

The survey was done by the Doctors’ Association UK (DAUK), an NHS lobbying group. It is not clear how many health workers were questioned in total.

More than 350 respondents said they were less likely to work in high-risk areas or increase their hours or return to service because they were not entitled to death-in-service benefits.

Forty people indicated they had declined to change their hours and working patterns because of this.

Speaking on condition of anonymity, a locum GP with three young children told the DAUK survey: ‘It is a very real worry and threat that healthcare workers could die as a direct result of working with positive Covid patients.

‘We are all here to help our patients but, weighing up everything, it would be devastating for me to die and on top of that my family be in financial difficulty. 

‘This will almost certainly mean I will do less face to face work/less hours altogether.’

Another GP, who is restricting their shifts, said: ‘No personal protective equipment plus no death in service plus lack of clear leadership/guidance here feels like freefall to me.’

Dr Habib Zaidi, 76, (pictured) fell ill on Tuesday and died in intensive care at Southend Hospital in Essex on Wednesday

Amged El-Hawrani, 55, was an ear nose and throat (ENT) specialist at Queen's Hospital Burton. He has become the first NHS frontline worker to die of coronavirus

Concerns about death-in-service follow the deaths of two NHS staff, Adil El Tayar, 63 (left), and Amged El-Hawrani, 55 (right)

THREE NHS WORKERS DIE OF COVID-19

The family GP who died in hospital on March 25 is believed to be the first British doctor to fall victim to coronavirus.

Dr Habib Zaidi, 76, became ill on March 24 and died in intensive care at Southend Hospital in Essex the next day. He had been self-isolating at home and had not seen patients in a week.

His COVID-19 test results have not come back yet, but his daughter Dr Sarah Zaidi, who is also a GP, says he suffered all the ‘textbook symptoms’ of the virus and said his death was the ultimate ‘sacrifice’ for helping fight the deadly infection.

The beloved grandfather was described by a colleague as the ‘father of the medical community’ who served three generations of families in the Southend area for 49 years. 

Dr Adil El Tayar, a working surgeon, also died on March 25 at West Middlesex University Hospital in Isleworth, west London, his family told the BBC.

His cousin, journalist Zeinab Badawi, paid tribute to the 63-year-old in a report for Radio 4’s From Our Own Correspondent programme.

Dr Zaidi was a family doctor in Leigh-on-Sea for almost five decades and a managing partner of Eastwood Group Practice with his wife, Dr Talat Zaidi, who has been forced into quarantine away from the rest of her family.

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His local NHS trust gave him a ‘lifetime achievement’ award last year, with his family claiming he always tried to be innovative and improve the quality of his care as much as he could.

Amged El-Hawrani, 55, died on Saturday at Leicester Royal Infirmary.

He was an ear nose and throat (ENT) specialist at Queen’s Hospital Burton. But before he became unwell he had also been volunteering in A&E.

Dr El-Hawrani – who was described as being ‘extremely hard-working’ and deeply committed to his patients – died on Saturday evening (March 28).

His family paid tribute to him in an emotional statement, which described him as the ‘rock of our family’ who ‘always put everyone before himself’. 

Doctors’ death-in-service benefits ensure a tax-free sum of money goes to their partner, spouse, or chosen family member or organisation if they die as a result of their work.

It is payable if the worker is an active pension scheme member, or if a retired worker has been in receipt of their pension for less than five years. 

It can be worth around two years’ wages, which would be a considerable sum for a grieving family – on average, GP doctors in the UK make around £92,000 per year. 

However, many working doctors have opted out of the pension scheme because their mandatory contributions left them paying more tax than the money they were saving.

This has been the source of an ongoing row between the Government and medics around the country, who have called for the tax-free cap on pension contributions to be lifted.  

Health Secretary Matt Hancock called on tens of thousands of retired NHS nurses and doctors to consider returning to aid ‘a huge national effort to protect lives and protect our NHS’.

Of 65,000 former staff, some 12,000 agreed to return, including 2,660 doctors and 6,147 nurses, it was revealed last week.

It is not clear if NHS staff who have retired, and now signed up to return to work, will be eligible for death-in-service.  

Those who have declined say if death-in-service arrangements were changed they would be more inclined to come back.

Last week the Department of Health and Social Care said it was ‘considering proposals to offer further support for those returning to the frontline’. 

There is also concern that retired NHS workers coming back to fight coronavirus are vulnerable to it because of their age.

Dr Samantha Batt-Rawden, an intensive care doctor who leads DAUK, said: ‘It is simply morally unforgivable that at this time where we ask them to put their lives on the line, those recently retired and returning to service, locum doctors and those forced out of the NHS pension scheme by a punitive tax are not eligible for death in service benefit.

‘These doctors feel a strong moral duty to do all they can to serve patients at this time of national crisis and deserve the same parity of esteem as their colleagues.

‘We therefore ask Matt Hancock to ensure that all doctors receive death-in-service benefit. This will allow doctors to continue fighting this pandemic without the added stress of worrying about leaving their families in financial difficulty should they die in the line of duty.’

The DAUK’s concerns echo that of the British Medical Association (BMA), the doctors union, who said those who have opted out of the NHS pension scheme may lose out.

It remains to be seen how many medics have contracted the virus so far, but the BMA said it is aware of a small number of UK doctors requiring intensive care.

The dangers of COVID-19 to NHS medics became abundantly clear last week, after the death of Adil El Tayar and Amged el-Hawrani.

Dr El Tayar, a 63-year-old surgeon, had been volunteering in A&E departments in the Midlands. He died last Wednesday at West Middlesex University Hospital in London, his family told the BBC.

Dr El-Hawrani, a 55-year-old ear, nose and throat consultant at University Hospitals of Derby and Burton, died on Saturday at Leicester Royal Infirmary.

Another doctor, GP Habib Zaidi, was suspected to have had COVID-19 before his death at Southend Hospital, Essex, on Wednesday.

The BMA warned that Dr El-Hawrani’s death would reverberate amongst NHS staff, who are becoming increasingly concerned over the lack of protective equipment.

Only last week the trade union claimed lives would be lost because the clothing and masks were being rationed by hospitals, with doctors forced to source their own.   

Robert Jenrick told a Downing Street briefing on Sunday that 170million masks and almost 10 million items of cleaning equipment are among the items being delivered to NHS trusts and healthcare settings soon.

It follows weeks of concerns raised by medical professionals about a lack of PPE amid global shortages and difficulties with distribution. 

It is believed that up to 50 doctors have died in Italy, which has the most deaths from – COVID-19 in the world – nearly 11,000 – according to National Federation of Orders of Surgeons and Dentists (FNOMCeO). 

More than 6,000 medical workers have been infected, the Italian Federation of Medical Professionals said on March 26. 

The Department of Health and Social Care said today: ‘NHS staff are doing an incredible job in the fight against coronavirus, including the thousands who have already signed up to return to the NHS.

‘For the remainder of this tax year, no clinician in England who is part of the NHS Pension Scheme will be worse-off as a result of taking extra shifts and from April.

‘Changes to the threshold will take up to 98 per cent of consultants and 96 per cent of GPs out of the taper altogether based on their NHS earnings.

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‘Staff who recently retired from the 1995 Section of the pension scheme will have already received a tax-free lump sum and we are considering proposals to offer further support for those returning to the frontline.’

WHAT DO WE KNOW ABOUT THE CORONAVIRUS?

What is the coronavirus? 

A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.

The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.

Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.

The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.

Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals. 

‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses). 

‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’ 

The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.

By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.

The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000. 

Where does the virus come from?

According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.

The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.

Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat. 

A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.

However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.

Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.

‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’  

So far the fatalities are quite low. Why are health experts so worried about it? 

Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.

It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.

Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.

Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.

‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’

If the death rate is truly two per cent, that means two out of every 100 patients who get it will die. 

‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.

‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’

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How does the virus spread?

The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.

It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.

Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person. 

What does the virus do to you? What are the symptoms?

Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.

If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.

In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.

Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why. 

What have genetic tests revealed about the virus? 

Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world. 

This allows others to study them, develop tests and potentially look into treating the illness they cause.   

Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.

However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.

This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.   

More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.

How dangerous is the virus?  

The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.

Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.

However, an investigation into government surveillance in China said it had found no reason to believe this was true.

Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.

Can the virus be cured? 

The COVID-19 virus cannot be cured and it is proving difficult to contain.

Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.

No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.

The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.

Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.

People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.

And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).

However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.

Is this outbreak an epidemic or a pandemic?   

The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’. 

Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.

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