"I work with babies that are about 400-600g. They’re really vulnerable," says Maria, 29, who herself uses a steroid inhaler for asthma. She adds, in a small voice: "And even if I don’t get the symptoms myself, the last thing I’d want to do is give this disease to my little patients."
Maria is a junior doctor working in a neonatal ICU ward. Her job is to resuscitate newborns who can barely breathe. With news yesterday that children may be, contrary to earlier wisdom, at some risk of severe illness caused by coronavirus, she’s even less comfortable having to wear cumbersome gloves or a mask "that’s so big I can’t see".
There are many problems with personal protective equipment — or PPE, as it’s known. Its regular purpose is to keep medical staff safe from patients’ bacteria and viruses and because coronavirus is so infectious, an increased set of protective layers is necessary.
The main, pressing issue with PPE is that NHS workers are claiming they’ve not got enough of it. They’ve had to adorn themselves in bin liners and buy their own goggles online. In response to this issue, Public Health England has rejigged the rules to allow for PPE to be reused and the government has promised a Herculean effort to get as many visors and gowns and masks and so on for its healthcare workers. We’ve seen passenger planes chock-full of PPE hurtling towards the UK, companies switching production from cars, flooring and textiles to PPE creation, and the government distributing 1 billion items of PPE to our beleaguered NHS.
Against this backdrop, though, there is another, equally pressing issue, chafing against the noses and chins of the women who make up 77% of the NHS workforce: the size of PPE.
There are many biological differences between cis-male and cis-female bodies. One is that cis-female faces and bodies tend to be smaller than cis-male faces and bodies. However, this doesn’t seem to be a consideration, as women are required to wear PPE "designed to fit the default European male face and body shape," according to Dr. Sarah Hallett, chair of the BMA Junior Doctors Committee.
Rebecca*, 35, a paediatric surgeon, has a physical understanding of this issue. "I was fit-tested on two types of mask. One was big, the other fit me. However, the hospital has now bought in slightly different masks and even the one that’s supposed to fit me is now bigger."
Her response is to pull it ever tighter. "It pushes onto my eyes, impeding my sight, and clings to my chin. I’m 5’4, a small to average-size woman, but not only am I concerned the mask has left me in pain and discomfort on my chin, but that it doesn’t give the right seal."
The reason her PPE doesn’t fit properly is, she says, very obvious. "Although I’m sure the PPE is the right grade for protecting against COVID transmission, it’s made for men. The box for the mask even has a photo of a man on it."
As for Maria, she’s "an XXS type of person and yet the gloves I have to use are XXL. This is nothing new — they’ve never been a great seal — but now it’s more worrying."
During a pandemic of such seismic proportions, where over 100 NHS staff have died, ill-fitting PPE has an impact on workers’ already elevated stress levels.
Maria has already been warned by other staff several times that "the stock of my mask is low and advised I don’t use them too much. It’s scary as I’m high risk."
She adds: "When you’re fearing being exposed to getting the disease, it’s tricky to brush that stress away. But you have to not think about it, crack on and give the care you can to that baby. It’s so difficult."
Rebecca also feels an added pressure. "This PPE is not protecting me against potential COVID-19. Though I’m lucky to have not operated on anyone with it, it’s scary, NHS workers are dying."
Clare*, 34, is an imaging doctor and regularly deals with dozens of patients with confirmed or suspected COVID-19. While she hasn’t yet had a problem with the fit of her PPE, she is anticipating that the masks which do fit her are dwindling in supply. "I feel so confident when I’ve got the 3M mask on. But supplies seem low and I don’t know what’s happening down the line."
The alternative masks, she says, "will fall down my nose while I look down or around or press buttons and there’s nothing I can do about it because my hands are dirty by then. When it’s coming off, it’s not doing the best job. It’s anxiety-inducing."
Of course, no NHS worker, regardless of sex, is delighting in this era, made up of persistent struggles to keep alive hundreds of people later reduced to digits on daily death toll tickers. But when the gear intended to protect these workers does so only adequately for a proportion of them, those for whom it doesn’t work will inevitably feel a deeper kind of anxiety.
Where these women NHS workers can turn for help is limited. Rebecca, who is in her final year of study, doesn’t feel comfortable coming forward with her concerns about PPE because she fears being "told I can’t operate if I can’t use that mask. My training would fall off a cliff and I can’t afford to do that after taking time off to have children."
Her choice is stark: either complain about what she knows is unsuitable and potentially throw away years of training ("I’m worried if I have 3-6 months off, I’ll never catch up") or keep quiet and suck it up. Maria, one of the NHS' many immigrant workers (who comprise 13% of its workforce), says she feels this sentiment acutely. "I’ve been told before I should feel privileged to be working at all. But if I lose my job, I lose everything. That’s a huge pressure.
"Medicine still has a gender gap, especially when it comes to being listened to. I’m 29 but look 14 and it’s hard for my voice to be heard. If a senior tells you to do something, even without PPE, you can’t say much back."
The solution is very clear: make sure women have the right PPE. The British Medical Association (BMA), Trades Union Congress (TUC), the Women’s Equality Party, a group of over 60 women’s charities and the Labor party are all in agreement about this.
Marsha de Cordova, shadow minister for women and equalities, tells Refinery29: "Women working in our NHS are putting their lives at risk to protect us from this virus.
"It is scandalous that they are not given the right PPE to keep themselves and their loved ones safe."
She calls on the government to do more, as does Dr Hallett, who tells Refinery29: "We’ve seen lots of women healthcare workers — doctors, nurses, physiotherapists — reporting that they’re struggling to find masks to fit their face shape.
"We need an adequate supply of PPE but equally one that takes differing needs into account. It’s not good enough to have PPE; NHS workers need PPE that will protect them in the workplace."
Dr Hallett says more data collection is needed to note the true, less anecdotal scale of the issue — something Caroline Criado-Perez, author of Invisible Women: Exposing Data Bias in a World Designed for Men, has been calling for. The writer and activist has long voiced the need for PPE to fit women properly, often receiving abusive and critical messages in response. As she put it: "I still have men in my mentions insisting I’m making this all up or if there is a problem it’s just that professional medical staff don’t know how to wear their PPE properly. It’s so depressing that anti-feminists don’t let up even in a pandemic."
Those who insist women’s and equalities issues have no part to play are wrong to assume this crisis is indiscriminate. We already know that BAME people — who make up 14% of the general population but comprise 44.3% of the NHS' medical workforce – are more likely to die from COVID-19 and its related issues than white people. And we know men are dying of COVID-19 at far higher rates than women. As inquiries take place to find out why these tragedies are happening, it seems like a good time to factor in the major differences between our population’s bodies.
A spokesperson for the Department of Health and Social Care told Refinery29 in a statement: "The safety of our staff is paramount and we are working around the clock to ensure PPE is delivered as quickly as possible to those on the frontline.
"PPE is designed to be unisex, although some products are available in different sizes to enable fit to both small and larger frames."
Women’s importance in the NHS cannot be understated and they should receive all the protections they need to be able to treat patients safely. Even against the backdrop of wider issues — the lack of PPE in general, the pandemic as a whole — their concerns should not be sidelined.
Without easily available PPE, too many women NHS workers are feeling obliged to extend gratitude for the small luck they have had. Every woman who speaks to Refinery29 for this piece insists things could be worse. Certainly that’s true — but do they have to start off this bad?
Just as other workers have re-routed themselves to a new normal — intolerable Zoom meetings where a phone call would have sufficed, endless smug Instagram posts, endless snide tweets — these women have got used to discomfort and fear at work. Why should they have to make space in their already enormous workloads for the box files of emotional labor required to put on a brave face behind badly fitting masks? As Maria puts it: "If I were to see someone sick, even if I didn’t have PPE I would jump in to save them. I wouldn’t conceive of it any other way but I think maybe the people higher up rely on that: the fact we will do it anyway."
*Names have been changed.