Today
Wed 22 September 2021

A former senior advisor to the SARS Commission believes that there should be an investigation into how responses to the Coronavirus pandemic were based on an outmoded theory, leading to the deaths of healthcare workers

A former senior advisor on SARS has accused the World Health Organisation (WHO) of covering up its own evidence proving the airborne transmission of COVID-19, since the earliest days of the global pandemic. 

Speaking exclusively to Byline Times, Mario Possamai – who from 2003 to 2007 served as as a senior advisor to The SARS Commission, established to investigate the 2003 outbreak in Ontario, Canada – described his shock and frustration at the WHO’s failure to address the airborne nature of COVID-19 and how this, in turn, set up governments around the world to fail in their pandemic response strategies.

This failure has been responsible for the lack of proper protections for healthcare workers around the world, leading to at least 17,000 worker deaths over the past year overall – though almost none in Asia. 

Possamai said that the WHO has, for years, been dominated by an outmoded scientific orthodoxy in which infectious disease was believed to be primarily transmitted through large droplets, requiring a focus on washing hands and sanitising the environment.

When powerful evidence emerged early in 2020 that this orthodox view was incorrect in understanding the real risks from the novel Coronavirus rapidly spreading around the world, the WHO inexplicably suppressed it, Possamai claims.


Airborne Protections

During the first three weeks of January 2020, China followed the traditional droplet-based regime for personal protective equipment (PPE). But, after seeing a sharp spike in healthcare worker infections, China ditched the WHO guidance and shifted to rigorous airborne protections.

As a result of the change, “healthcare worker infections quickly dropped to zero,” Possamai told Byline Times.

The decision was explained by Chinese scientists in the QJM Journal of International Medicine. They said: “We have adopted a higher standard of protection in China, compared with the World Health Organisation guidelines against COVID-19.”

The main difference, they said, was that China was using “fluid-resistant protective clothing” – coveralls – with long sleeves and conjoined caps, rather than uncapped isolation garments; as well as respirators rather than medical surgical masks.

“A respirator, double rubber gloves, eye protection (i.e. goggles or a face shield), coverall and shoe covers were the standard equipment in contacting with COVID-19 patients in China,” they said.

But the WHO’s expert mission to China – aimed at distilling the most important lessons from the Chinese experience so that other countries could take the right protective measures – obscured how China had eventually protected its healthcare workers so effectively. 

“The most important lesson from China, in my view, is that China had eschewed the WHO’s recommendations and demonstrated that airborne precautions were shown to be far more effective in safeguarding health care workers,” Possamai told Byline Times. “Yet, this is not the picture that the WHO presented to the world. Instead, with a selective use of the facts, it presented findings that were consistent with the large droplet theory but materially misrepresented the Chinese experience.” 


The WHO’s China Mission

While admitting that transmission among Chinese healthcare workers had been effectively contained “early in the outbreak”, the WHO China Mission’s final report, according to Possamai, “failed to disclose how China had done this – by going to airborne precautions”. “This vital fact was buried in a technical annex at the back of the WHO report… isolated there, without context, explanation or reference to the body of the report,” he added.

The final report simply stated: “Staff in China wear a cap, eye protection, N95 masks, gown and gloves (single use only)… Staff wear PPE continuously, changing it only when they leave the ward.”

But it offered no recognition that this higher level of PPE had played a key role in China’s success in bringing infections among healthcare workers down to zero.

“Tragically, the decision by the WHO to conceal this fact contributed to dooming the world to a preventable level of death and disease,” Possamai said. “Some experts suggested to me that the complete and transparent disclosure of this information at the start of the pandemic might have changed the course of health worker safety in Canada, providing important support for those advocating a precautionary approach.” 

Similar concerns apply, of course, to health worker and public safety around the world. “It is inconceivable that the WHO mission would not have known about the Chinese airborne decision on January 20 2020,” Possamai said. “It came smack in the middle of the WHO mission.”


Fatal Consequences

Prior to his stint at The SARS Commission, Mario Possamai had spent the previous three decades leading investigations into corruption, fraud and complex money laundering in north America, Europe, Africa, Asia and Australia; once serving as an expert witness for the Attorney General of Canada, and another time providing investigative support to the Government of Malawi.

His last role before retiring in 2018 was as director of enterprise intelligence at the Royal Bank of Canada, where he led its strategic and tactical intelligence programme on emerging fraud, money laundering, and cyber threats.

Possamai’s verdict is that the WHO’s failure to inform the world that droplet precautions were insufficient had fatal consequences.

“The WHO China Mission report gave comfort to countries adhering to droplet precautions, who believed that COVID behaved much like the flu,” he told Byline Times. “A more accurate report would have given weight to the arguments of those who advised on the need to follow the precautionary principle, err on the side of caution, and follow the lead of China and move to airborne precautions until evidence showed it was safe to do otherwise.”

The large droplet approach led to a swathe of precautions such as protective screens, handwashing, sanitising surfaces and one to two metre social distancing rules which would ultimately fail to prevent the spread of the virus.

“As a consequence of the WHO’s bad advice – and its refusal to address airborne transmission risks with purpose, focus and determination – we collectively spent tens of millions of dollars on the wrong solutions,” Possamai said. “These solutions gave people a false sense of security and… may actually have made things worse by impeding good ventilation.”


Ignoring the Evidence

The WHO’s reluctance to recognise airborne transmission also contradicted mounting evidence going back well over a decade.

“SARS and MERS – genetic cousins of COVID – were both shown to be airborne viruses,” Possamai told Byline Times. “At the very least, we should have been cautious that such a similar pathogen like COVID might have an airborne risk.

“The science of airborne transmission had progressed in leaps and bounds in the years following SARS. The work of researchers like Donald Milton in the US, Yuguo Li in Hong Kong, Lidia Morawska in Australia, and Lydia Bourouiba in the US, showed that aerosols were a much more significant factor than previously thought. Their research demonstrated the weakness of the large droplet theory of disease transmission that was the widely accepted medical orthodoxy.”

A year before the Coronavirus pandemic, four of the most respected researchers in this field published a summary of where the science stood, concluding that the large droplet model was simply inadequate to understand the dynamics of new pathogens.

They described how clinical and epidemiological data highlighted “the potential for aerosol transmission” for MERS and the Ebola virus, and warned that the supposed clear distinction of “large droplet (short-range) versus airborne (short and possibly long-range) transmission” was misleading.

The orthodoxy was ignoring “the potential for pathogens under both classifications to be potentially transmitted by aerosols between people at close range”.

Post-SARS research into airborne transmission, according to Possamai, “was the most intensive and intense since the seminal work of William Wells at Harvard first identified large droplets”.

“Wells’ instruments were too primitive to capture and analyse small aerosols,” he said. “Nevertheless, his findings were treated as dogma: unless a virus acted like Measles or Tuberculosis – which are the classic airborne viruses – transmission was through large droplets that fell to the ground within one to two metres of a cough or sneeze.

“So, as COVID-19 took hold, the large droplet orthodoxy of how disease was transmitted – an orthodoxy that was embraced by the WHO and most national public health agencies – was being challenged by new scientific research and by the fact that COVID-19’s cousins, SARS and MERS, appeared to have airborne characteristics.”


Jettisoning the Precautionary Principle

Possamai argues that, in the absence of clear evidence either way, public health professionals should at least have been making clear that the exact modes of transmission of COVID-19 were unknown, and that short-range aerosol transmission should be recognised as a strong possibility. 

The WHO’s suppression of this issue was all the more bizarre, according to Possamai, given that in 2008 the body warned about the risk of a ‘Disease X’ emerging with characteristics closely matching those of COVID-19.

“Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease,” it said. “The R&D Blueprint explicitly seeks to enable early cross-cutting R&D preparedness that is also relevant for an unknown ‘Disease X’.”  

The reality of this risk was widely known. In the Ontario SARS Commission’s final report – for which Possamai led the investigations into healthcare worker safety issues and pandemic planning – Justice Archie Campbell warned of the need to be prepared for a novel pathogen.

“SARS taught us that we must be ready for the unseen,” he said. “That is one of the most important lessons of SARS. Although no one did foresee and perhaps no one could foresee the unique convergence of factors that made SARS a perfect storm, we know now that new microbial threats like SARS have happened and can happen again.

“There is no longer any excuse for governments and hospitals to be caught off guard and no longer any excuse for health workers not to have available the maximum level of protection through appropriate equipment and training.”

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Despite mounting awareness, the WHO and national governments prepared exclusively for an influenza pandemic rather than a novel pathogen, said Possamai. And this faulty thinking led all the way to the COVID-19 outbreak. 

The equation of COVID-19 with flu has continued to plague the response to the pandemic, with speculation that recurring waves of the virus will lead it to become a ‘fifth’ seasonal coronavirus like those behind the common cold. While there is little evidence for such theories, more than a thousand scientists warn that allowing the virus to run will create an ideal breeding ground for new variants against which existing vaccines might be increasingly ineffective, thereby decreasing the prospect of ‘herd immunity’.

“Taking their lead from the WHO, most countries treated COVID-19, initially, as if it had the dynamics and characteristics of influenza,” Possamai told Byline Times. “Thus, from the start, the WHO recommended droplet precautions for health care workers treating potential COVID cases. What made the WHO report’s omissions even more troubling is that The Lancet and other journals published letters and papers from Chinese experts from February to March 2020 warning about the risks of airborne transmission.”

Possamai pointed Byline Times to five scientific studies (cited in his report for the Ontario Nurses Association) published in this period which “strongly recommended” airborne precautions for healthcare workers – in particular including fit-tested N95 respirators, goggles, and protective gowns “for all interactions with suspect and confirmed cases”.

But the WHO’s leadership was “too closely aligned with the large droplet scientific orthodoxy”, he believes, and the evidence was simply “disregarded”.

It took the WHO more than a year to finally concede that there was a role for airborne transmission, but it was too little, too late.

“The WHO has grudgingly accepted that COVID-19 can be transmitted through aerosols, and it has publishing some related guidance,” Possamai said. “But it has not done so with any commitment or passion. This kind of sea change requires strong leadership, a strong tone at the top, to explain to people how they can best protect themselves through ventilation, air purification and proper airborne PPE.”


The Great Barrington Declaration Lobby

In a world facing an escalating series of complex emergencies, the ability to rapidly collate scientific data; explore multiple perspectives; and reach shared, accurate understandings of the evidence through generative dialogue is not an ‘ivory tower’ pursuit – but the only way to survive.

While the WHO has been an important forum to do this during the Coronavirus pandemic, Mario Possamai’s analysis suggests that it still has a long way to go. 

But the organisation’s inability to move on from the 70-year-old large droplet orthodoxy may not simply be the result of bureaucratic inertia. It also appears to be linked to the powerful influence of right-wing libertarian lobbying groups. 

As Byline Times has previously reported, several scientists involved in advising the WHO’s work on infectious disease and COVID-19 are part of the lobbying network behind the ‘Great Barrington Declaration – an initiative that promoted a ‘herd immunity by natural infection’ strategy to the virus, backed by the Koch-funded climate science denial network. 

“The motives for the World Health Organisation’s incomplete and misleading presentation of the Chinese experience warrant further investigation,” according to Possamai.

A spokesperson for the World Health Organisation said: “From the very first recommendations WHO issued to health workers in January 2020, WHO highlighted the need to use protection against transmission of aerosols. We follow a rigorous process that weighs evidence and gathers expert and country perspective and advice to formulate recommendations that are suitable at that time and adapted as evidence evolves.

“We take airborne spread into account as a mode of transmission by continuing to strongly emphasise the importance of ventilation as a core protective measure against COVID-19 and by issuing recommendations for ventilation in settings such as health facilities, public buildings and private homes, and for airborne precautions – according to risk assessment – in health facilities.”

The spokesperson concluded that the organisation’s guidance “increased understanding of transmission and protective measures have led to a global decline in health worker cases and deaths”.

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