Nafeez Ahmed reveals how the UK has been failing to fully protect frontline staff from the pandemic and is now trying to deny its culpability

The Government’s Health and Safety Executive (HSE) is refusing to investigate a formal complaint from one of its own advisors alleging that healthcare workers have died due to flawed personal protective equipment (PPE) guidance on the airborne transmission of COVID-19, documents seen exclusively by Byline Times reveal.

A letter from HSE chief executive Sarah Albon to HSE advisor David Osborn has rejected the need for an investigation, on the grounds that infection protection and control (IPC) guidance was “consistent with the [World Health Organisation] guidance on the use of masks in healthcare”. But the suggestion in Albon’s letter that current PPE guidance is in line with the World Health Organisation (WHO) advice is misleading.

“A criminal investigation of those involved in producing guidance that was in accordance with the world authority in a global pandemic is therefore inappropriate,” Albon wrote in response to a formal complaint by Osborn, a 27-year chartered health and safety consultant who is a ‘consultee member’ of the HSE’s Control of Substances Hazardous to Health (COSHH) Essentials Working Group, where he has helped HSE to prepare guidance for employers and employees.

In his complaint in February, Osborn accused the agency of failing to use its statutory authority to correct “seriously flawed” IPC guidance imperilling “the health and safety of healthcare workers by failing to provide for suitable respiratory protection”.

He described it as “the largest single health and safety disaster to befall the United Kingdom workforce since the introduction of asbestos products”.

The continued failure to protect healthcare workers from the airborne transmission of COVID-19 through appropriate PPE, the letter, said, has led to more than 100,000 avoidable illnesses and deaths.

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Well Established Facts

In several letters responding to Albon, Osborn points out that WHO guidance published on 22 December 2021 “confirms that a respirator (such as FFP3) should be worn by health workers before entering a room where there is a patient with suspected or confirmed COVID-19. I note that this concurs exactly with HSE’s own guidance for healthcare workers entering a room in which there is a patient known or suspected to have a SARS disease.”

The documents confirm that the HSE and the IPC Cell – the NHS authority responsible for formulating PPE guidance – are both in contravention of WHO guidelines on the need for healthcare workers to protect themselves from COVID-19 airborne transmission.

On 15 March 2022, the IPC Cell issued updated guidance advising that respirators designed for airborne protections must only be worn by staff when “caring for patients with a suspected or confirmed infection spread predominantly by the airborne route (during the infectious period)” – i.e. not in the full set of circumstances proscribed by the WHO.

If complying with WHO guidelines is a litmus test, the question is why the HSE is not currently advocating compliance with the WHO’s guidelines. Either Albon’s claim concerning the need to comply with WHO guidelines is correct, in which case HSE is now contradicting its own position on compliance with the WHO – or it is false, in which case citing WHO guidelines as a justification for the failure to ensure adequate airborne protections is spurious.

However, Osborn points out that, in any case, the WHO’s guidance is designed to be compatible with varying standards of healthcare provision around the world in both rich and poor countries, and that airborne transmission was recognised by the UK Government early during the pandemic – long before the WHO caught up with the science.

He notes in one letter responding to Albon that HSE “did know, in the early months of 2020 that the virus presented an airborne risk (viz the paper published by your Chief Scientific Advisor/EMG in April 2020 confirming it).”

This contradicts Albon’s suggestion that HSE did not know of airborne transmission until recently. “Care needs to be taken, therefore, not to see decisions made in the early months of 2020 through the lens of what we know today about the airborne transmission of COVID-19,” she says.

Osborn’s letters repeatedly point out that HSE, the Government’s Scientific Advisory Group for Emergencies (SAGE) and numerous other officials and relevant health agencies were fully aware of the risk of COVID-19 airborne transmission as early as April 2020.

Yet none of Albon’s responses to Osborn admit or acknowledge this early recognition of airborne transmission; nor do they therefore provide any explanation for the gap between this recognition and the failure to ensure healthcare workers are protected from airborne transmission.

The implication of the IPC Cell guidance is that airborne protections are unnecessary for COVID-19 because airborne transmission is not predominant.

But in fact it is now widely recognised that COVID-19 is predominantly airborne. “Airborne transmission arises through the inhalation of aerosol droplets exhaled by an infected person and is now thought to be the primary transmission route of COVID-19”, concluded one peer-reviewed research paper in the Proceedings of the National Academy of Sciences in April 2021 authored by two top Massachusetts Institute of Technology (MIT) scientists.

As Osborn argues in his letter to Albon regarding the updated IPC guidance, no hard scientific evidence is available which supports a definition of “predominantly”. Not only is there no evidence that ‘droplet’ transmission is predominant, Osborn writes, “If a disease is airborne IN ANY PROPORTION then it is still a risk that must be controlled where a lethal virus is concerned. The ability of a disease to transmit by fomite or droplet does not negate the airborne route in any shape or form.”


Institutional Misconduct?

Osborn goes on to accuse the IPC Cell of scientific misconduct, and concludes that HSE’s refusal to intervene is evidence of its support for a policy contravening statutory health and safety regulations – the breach of which is a crime.

In one damning passage, Osborn writes:

“If the physicians and scientists comprising the UK IPC Cell seriously believe (and try to get others to believe) that the ‘droplet’ and ‘fomite’ routes of disease transmission in some way negate the ‘airborne’ route, then this is such a ridiculous notion that (a) you really need to desist from referring to them as ‘eminent’ and (b) there is a prima facie case that they should be investigated for scientific misconduct and be dealt with accordingly by their professional institutions.

Meanwhile, as regards HSE’s position, you have made it very clear in your letter that you do not believe that the IPC guidance has been, and continues to be ‘flawed’. The only interpretation which can be drawn from this opinion, together with your refusal to intervene, is that you clearly do support a policy which contravenes the COSHH Regulations which you are supposed to enforce.”

This batch of correspondence also suggests that the HSE has stalled for six months Osborn’s Freedom of Information requests to obtain copies of the “technical input” provided by HSE to those responsible for the IPC guidance.

The latest ONS data published on 10 March reveals that a total of 2,129 health and social care works have died of COVID-19 since the start of the pandemic. Figures from early 2021 showed that around 122,000 UK healthcare workers are suffering from ‘Long COVID’.

Even despite changes in WHO guidance in December 2021, the UK has failed to translate this into adequate airborne protections for healthcare workers today.

Byline Times asked HSE to confirm exactly when it became known to the agency that airborne transmission is a risk for COVID-19, and why this has not translated into adequate respiratory protections for workers even now. At first, a spokesperson for HSE promised to “provide our answers to the outlined questions”. However, they later declined to comment, referring instead to Sarah Albon’s correspondence with Osborn – in which she respectfully declined “to engage in further correspondence on this subject”.

Altogether, the letters seen by Byline Times between Osborn and the HSE raise urgent questions about the ongoing failure of UK authorities to provide adequate PPE to healthcare workers.

They also underscore that the UK’s systems of accountability are broken. If airborne transmission plays a significant role in COVID-19 infection – and all the data has shown, since April 2020, that it does – it means that the very Government authority tasked with enforcing the law on health and safety in the UK, is inexplicably refusing to do so.

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