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A leaked internal NHS memo has revealed the true strain Covid-19 has put on the health service, with workers stranded abroad for more than five days forced to take annual leave or go unpaid, and those exposed to confirmed coronavirus cases without protective kit still permitted to work.

Vulnerable staff members, including pregnant workers and those over 70, are being asked to remain at work, although away from “high risk” areas. 

The memo, shared with HuffPost UK, and circulated to all staff members working at one NHS trust in England, reveals that staff stranded abroad for  will go unpaid or be forced to take their absence as annual leave. 

Travel bans and the grounding of some airlines have caused travel chaos worldwide.

Foreign secretary Dominic Raab confirmed last week that up to a million Britons could be stranded abroad, admitting: “If they can stay safely in the countries where they are for a period, I think that’s a choice they will have to think very seriously about.” 

The NHS trust document obtained by HuffPost UK states: “We have agreed that managers should give up to 5 days paid special leave. If an employee requires a longer period of leave, this will need to be taken as annual leave or unpaid leave.”

Employees could also be asked to cancel their leave in “exceptional circumstances on a “case by case basis”.

Workers who have been exposed to patients with the virus have also been asked to continue working, even if they weren’t wearing personal protection equipment (PPE). 

The Doctor’s Association said on Sunday that medics felt as though they were “lambs to the slaughter” amid the lack of access to proper protective clothing. 

The memo specifies that frontline staff who may have been exposed to the virus during an aerosol generating procedure (a procedure that stimulates coughing to promote the release of airborne particles that may contain infectious agents) can stay at work, but are required to report to occupational health for 14 days afterward to confirm they are well.

The document also gives more detail on accommodation being sourced for NHS staff who are asymptomatic, but live with someone with symptoms of the virus – despite the official advice for members of the public being to stay at home for 14 days from the day the first person in the home started having symptoms.

A letter to all chief executives of all NHS trusts and foundation trusts, published online on March 17, first revealed that free hotel rooms would be sought for health workers to live in if a member of their household showed symptoms, so staff can remain on the frontlines without having to quarantine – despite government guidance that anyone with a sick household member should stay indoors for a fortnight.

The latest leaked document states: “We recognise that NHS staff may choose to continue working who are not themselves unwell and we are therefore sourcing free accommodation for 14 days for asymptomatic staff who want to continue working, but are unable to do so if sharing a household with someone who is symptomatic.

“We recognise this guidance is different for health care workers because it is recognised that if all NHS staff self-isolate for 14 days due to the symptoms of a household member rather than their own personal sickness there will be a potentially unmanageable strain on staffing during this very difficult time.

“In order to ensure that those health workers who choose to continue to work do not inadvertently spread the virus a decision by the health worker to return to work and stay in a local hotel should be taken as quickly as is reasonably practicable (ordinarily within one to two days of the virus being identified within their household).”

Any staff member who does return to work but develops symptoms has been asked to self-isolate in accordance with official guidelines.

With fears that employees falling ill could have a serious impact on the number of staff filling frontline jobs, workers have also been warned that they may need to waive their EU-granted right to a maximum 48-hour work week and potentially lose their breaks. 

The guidance states: “Ideally we would like staff to keep to a maximum of 48-hour working week, but we can see that flexibility may be required with respect to the Working Time Regulations particularly in relation to night work limits, right to rest periods and breaks.” 

Staff have been told, however, that their right to say no to working beyond 48 hours a week will “of course” be respected. 

Employees who are not clinical or patient facing could also be asked to volunteer for extra roles. Though the memo does not specify what type of duties could be required, the guidance states: “We are asking all employees if they would be prepared to volunteer to undertake on-site related activities, subject to the appropriate training. We will pay people at their substantive grade wherever they volunteer.”

NHS England declined to comment on the advice given in the document seen by HuffPost UK.