A problem faced by many BAME professionals in the healthcare industry, this technique will also enable hospital staff the ability to wear mandatory respirator masks over a beard when caring for Covid-19 patients – something which Kamala Harris previously raised concerns about.

The findings of this world-leading study have been published in the Journal of Hospital Infection today (11^th November 2020) and follow numerous calls by Public Health England to protect BAME communities and workforce members.

Gurch Randhawa, Professor of Diversity in Public Health at the University of Bedfordshire commented: “Because shaving was a mandatory pre-requisite for wearing respirator masks, many members of the faith-observant bearded community, such as Sikh, Jewish and Muslim, have been affected and have had to face the dilemma of redeployment from frontline healthcare jobs involving exposure to Covid-19. Redeployment to other areas incurs a loss of skillset and need for re-training, and junior doctors have had their training impacted.

“In 2005, a similar situation had arisen, when a faith-observant bearded Sikh gentleman was denied the position of a corrections officer in California as the job required staff to occasionally wear a respirator mask. NBC News reported that the current Vice-President Elect, Kamala Harris, was the Attorney-General during that time, and was unable to support the appointment as the beard would pose a problem for the policy mandated gas-mask fitting.

“In both of these scenarios, the common theme was that the beard was considered to be an impediment to the wearing of a respirator mask. The other common principle was the concern for the health and safety of the employee. There was no alternative choice – or maybe, it was unexplored.”

Stimulated by this predicament,  in the midst of the first Covid-19 peak in the UK, a transplant surgeon from Manchester, Dr Rajinder Pal Singh, came up with a novel idea of using an under-mask beard cover called ‘Thattha’ to allow him to wear an FFP3 respirator mask which ended up passing the NHS qualitative Fit Test. This pioneering technique was aptly named the ‘Singh Thattha’ Technique.

Dr Singh said: “Respirator masks are the ideal respiratory protective equipment (RPE) for protection from small virus particles such as Covid-19, as well as from industrial toxic gases and smoke.  In the current pandemic, for safety reasons, these masks are mandatory for healthcare workers exposed to aerosol generating procedures (AGPs) involving Covid-19. Wearing these masks requires a person to be clean-shaven to allow for a robust face-mask seal. There is no evidence to suggest why, instead of shaving, the facial hair factor cannot be overcome with an under-mask beard cover.’’

Transplant surgeon Dr Rajinderpal Singh has improvised with a cover over his beard which allows him to wear an N95 mask that's passed a fit test. There's no need to shave to continue saving patients@SikhPA @BBCNews @DailySikhUpdate @ReutersUK @Khalsa_Aid @TOIIndiaNews @SkyNews pic.twitter.com/n2ZAsRl9by

— KhalsaJatha (@khalsajatha) May 7, 2020

This initial trial meant that there now appeared to be a choice – that shaving may not be essential to don a respirator mask. However, the technique needed reproducibility in order for the process to be established and declared safe.

Professor Randhawa – who is also Director of the University of Bedfordshire’s Institute for Health Research – was invited to partner with Dr Singh to address this culturally competent solution and proceed in an in-depth study of this promising alternative. The duo also teamed up with a group of co-authors for the study – Dr Sukhpal Singh Gill, Dr Sukhdev Singh, Dr B S Ubhi, Dr Gaggandeep Singh Alg, Dr H S Safri and Dr Gurpreet Singh.

Over the past few months, the team have collaborated to evaluate the efficacy of the Singh Thattha technique. The study findings showed that, 25/27 bearded Sikh dentists had been able to pass the qualitative Fit Test using the under-mask beard cover. The Sikh Doctors and Dentists Association (SDDA), led by Dr Sukhpal Singh Gill, generously funded a robust quantitative pilot study in Shrewsbury, where 5/5 bearded Sikhs passed the Quantitative Fit test conducted by one of the most experienced and certified Fit Testers.

Dr Sukpal Singh Gill, a General Practitioner in Birmingham said: “The SDDA were delighted to work with Professor Randhawa on this preliminary study in utilising the innovative work of Dr Rajinder Pal Singh, using the ‘Singh Thattha’ technique to achieve a tight fit seal to pass the qualitative and more rigorous quantitative Fit Tests. The concept of making the mask fit the face, rather than making the face fit the mask should be reasonably taken forth in this regard. We look forward to building on these study findings and informing future policy and practice.”

Mr H S Safri, a dentist in Hampshire, commented: “The alternative facemasks recommended for those unable to shave for religious or other reasons, such as PAPR (Powered Air Purifying Respirators) are expensive, limited in supply and are cumbersome to use. For example, they do not allow for fitting of surgical loupes and incur a loss of clinicians’ skill-sets and need for PPE retraining, which causes concern and disruption amongst junior doctors in particular. Also, dentists are unable to perform all the procedures in their repertoire.’’

Dr Rajinder Pal Singh and Professor Gurch Randhawa have successfully worked together on past projects related to organ donation and public engagement, and have joined forces several times during the pandemic to raise awareness of Covid-19 among the Sikh community in the UK, making a number of television appearances.

Dr Singh said: "I was keen to work with Professor Randhawa again to assess the feasibility of the ‘Singh Thattha’ technique and I’m delighted that our work has been published in the eminent Journal of Hospital Infection. The concerns for safety as highlighted by Kamala Harris in 2005 for bearded men to fit a gas-mask for industrial reasons, as well as in 2020 for Covid-19 healthcare reasons now seem to be addressed timely by the ‘Singh Thattha’ technique. We hope that Vice-President Elect Kamala Harris will meet with us to discuss our culturally competent solution and encourage employers in the United States to adopt it too.”

Professor Gurch Randhawa added:

I was honoured to be part of this research team – I feel it’s my duty to help to the health and care workforce from all faith communities in their efforts to look after Covid-19 patients. I believe the pioneering work of Dr Singh will prove to be an exemplar of culturally competent practice, enabling staff from all faiths to look after their patients without having to remove their beards and change their identity.

Read the full report and discover how to re-create the ‘Singh Thattha’ technique yourself