Covid, masks and the clinically vulnerable: What's going on?

The incident took place on October 20 when a practice nurse from her GP surgery came to her home in Edinburgh to carry out a routine blood test.

Dr Witcher, who has been disabled from the age of two and has multiple co-morbidities including immune system malfunction, respiratory and circulatory problems, lung damage, and high blood pressure which combined put her at high risk from Covid - an infection she has so far avoided - said she was stunned when the nurse arrived with no face covering.

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She said: "I politely asked if she could put one on and if she had an FFP3 mask, which I was happy to provide if not (surgical masks aren’t designed to protect against airborne infection) at which she declared 'That’s it - I’m away' and stormed off.

"Merely asking the question was literally all it took. Her behaviour was extraordinarily unprofessional by any standards, and it left me very shaken. I was just trying to keep myself safe in my own home."

The blood test has yet to be rescheduled.

EXPLAINED: How have face mask rules changed over time?

Dr Witcher said she had been 'bowled over' by the response to her tweet on October 20 (Image: X/Twitter)

Dr Witcher said her experience is shared by a growing number of clinically vulnerable people who are encountering hostility among healthcare professionals when it comes to mask wearing.

A recent survey found that some are avoiding healthcare appointments altogether because they are worried about their risk of exposure.

There has been a six-fold rise in Covid rates in Scotland since the beginning of July, based on the numbers of people with the virus in hospital (*changes to how hospital patients are counted from May 8 2023 mean current rates cannot be compared to pre-May 8 period) (Image: PHS)

When Dr Witcher posted about the incident on X (formerly known an Twitter) her feed was inundated with hundreds of responses and reposts, as well as nearly 3000 'likes'.

She said she had been "gobsmacked by the scale of response", adding: "Maybe I shouldn’t have been surprised, given the countless reports I’ve seen from clinically vulnerable people who have encountered similar and worse behaviour at the hands of the medical profession.

"They’ve been placed at extreme risk, harassed to remove their own masks, their well-founded concerns dismissed.

"But I’ve also heard from healthcare workers, including one or two following my tweet about my experience, who are deeply unhappy with current guidance, understand its significant potential for harm but feel under pressure to go along with it and keep quiet."

Guidelines updated in May removed the requirement for health and social care staff in Scotland to wear masks, while Covid testing for symptomatic staff was suspended at the end of August.

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A NHS memo sent to medics in early September advised that "staff who attend work with respiratory symptoms should wear a mask throughout their shift" but "avoid immuno-compromised patients for five days after the onset of symptoms".

The strategy is part of ongoing efforts to "live with" Covid, but campaigners - including some healthcare workers - have warned that it is putting staff and patients at unnecessary risk, including from long Covid.

Dr Sally Witcher said that she had been contacted by healthcare workers who feel under pressure not to wear masks now (Image: Gordon Terris/Herald&Times)

Just days after Dr Witcher's experience, another X user - Carolynne Hunter - went viral after posting that a senior nurse at NHS Forth Valley had threatened to cancel the care package it provides to her severely disabled daughter, Freya, if she demanded that the nurses coming to her home wear facemasks.

Within days of the post being shared, NHS Forth Valley updated its guidance for winter saying that staff should use fluid-resistant masks "if requested" when providing "direct personal care".

Ms Hunter, from Tillicoultry in Clackmannanshire, remains alarmed by her experience and the response from hundreds of people sharing similar stories.

"It's affecting a lot of people - it's a big thing," she said.

Ms Hunter, a part-time charity worker, is the main carer for her daughter, Freya, who is immobile as a result of severe cerebral palsy.

The 13-year-old, who is also blind and has epilepsy, receives oxygen round-the-clock to help clear her airways, is fed through a tube, and requires regular nebulisers, suctioning and chest physio to help her breathing.

READ MORE: Hundreds of wards closed due to Covid 

She requires two-to-one care at all times. Her NHS care package includes one full-time and one part-time nurse to support Ms Hunter - a single mother-of-three - to provide intensive care at home.

To date, Freya has avoided Covid, but she was hospitalised last winter after a flu infection left her critically ill and she has not yet received her latest Covid and flu boosters.

Already concerned by rising Covid rates in the community, Ms Hunter became aware that three members of Freya's regular nursing team had recently been off sick with the virus.

I asked @NHSForthValley if all NHS staff could wear a mask whilst nursing Freya at home given #covid is affecting so many people.

I was told NO! It isn't @scotgovhealth@ScotGovFM@P_H_S_Official Gov Guidelines!

Stuff your guidelines! My Freya is health vulnerable!

Freya is… pic.twitter.com/U28F2ZEiVH

— Carolynne Hunter (@CazMac38) October 24, 2023

Freya Hunter, 13, requires two-to-one care at all times (Image: Carolynne Hunter)

As a precaution, she contacted Freya's complex care team at Forth Valley Royal hospital on October 24 to request that the nurses coming to her home wear masks, but was shocked by the response.

Ms Hunter said: "The Sister wasn't happy that I knew [that three nurses had been off with Covid] and said 'well, it's not government guidelines' and she'd 'have to speak to infection control'.

"I said 'no, I'm not waiting weeks upon weeks for you to speak to infection control and tell me what I can do in my own home'.

"So she said 'well, if you ask the staff to wear masks when it's not in the guidelines I might have to pull your care package'.

"It was awful. I'm just trying to do what's best for my daughter."

READ MORE: Backlash as NHS staff told 'not to test for Covid' even if they have symptoms

Ms Hunter added that Freya's nursing team have since worn masks at her request and that, while she welcomes NHS Forth Valley's recent update, it only applies to close contact nursing such as aerosol-generating procedures rather than wearing masks at all times around very vulnerable patients. 

She added that the timing of her phonecall had coincided with the "heartbreaking" opening day of proceedings in the Scottish Covid inquiry. 

She said: "I just thought, we're not out of Covid: we've still got a pandemic for our vulnerable people that we love and care for, and this is supposed to be about learning.

"But we're not - we're still making the same mistakes."

A spokeswoman for NHS Forth Valley said: "We cannot discuss individual cases; however, our staff follow relevant national policy and guidance on the use of face masks.

"While there is no longer a requirement to wear face masks when visiting patients at home, we always try to respond to any requests or preferences expressed by local patients and families, wherever possible."

A spokesman for the Scottish Government said it "would expect that respectful discussions on the use of PPE would take place between patients and healthcare providers".