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How can we avoid making the same mistakes when a number of expert reports produced for the inquiry have failed to address one of the greatest mistakes made early on in the pandemic?
While other elements of the first module’s hearings of Baroness Hallett’s public inquiry in the Coronavirus crisis have attracted considerable attention the core remit of the inquiry is to ensure lessons are learned, and a fundamental focus of a future pandemic response will require understanding the mode of transmission that should determine how control measures are utilised.
Covid is airborne, and the main mode of transmission is through aerosols exhaled by infected individuals. However, in the first week of hearings for module one on pandemic preparedness, there has been a severe lack of focus on aerosols.
Respiratory Viruses
On the first day of hearings the British Medical Associations’s submission stated that “one consequence of the predominant focus on an influenza-style pandemic was that the UK’s response for COVID-19 failed to properly consider the potential for aerosol transmission” which impacted public health measures to have a focus on “hand washing and the delay in mandating mask wearing.”
This was further highlighted by the BMA’s legal representative, there was “no attempt by the health and social care board to follow the science on airborne transmission and the need for staff to have FFP masks and HEPA air filters.”
On the second day’s hearing the representative of the Government Office for Science which includes SAGE and the Chief Scientific Officer, stated “COVID-19 has not gone away…health and social care are still fighting it,…Those with clinical vulnerabilities are also leading more restricted lives in some cases.”
Despite this acknowledgement, the requirement to wear masks has been removed from settings with the most vulnerable immunocompromised patients such as those undergoing treatment for cancer. Hospital-acquired infections are causing deaths and there has been no meaningful government investment or regulation in regards to improving ventilation or providing air filtration for indoor spaces which is why many clinically vulnerable people are leading more restricted lives.
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Expert witnesses Professor Jimmy Whitworth and Dr Charlotte Hammer were questioned regarding their report on planning for pathogens with pandemic potential on the second day’s hearing. Looking at a range of bacteria and viruses the conclusion was that respiratory viruses are the most likely to cause a pandemic. But the reason for this being due to airborne transmission wasn’t explicitly explained.
Throughout many hours of hearings over multiple days on the subject of improving pandemic preparedness, there was no mention beyond the BMA’s representation that specifically covered the benefits of HEPA filtration. An omission that has alarmed a number of authors of scientific papers on aerosol transmission of Covid.
If healthcare is still fighting covid and airborne transmission is also a likely cause of a future pandemic then shouldn’t addressing clean air be a key measure in making workplaces and public spaces more resilient?
Health inequalities between different communities was the focus of the fourth day explaining that pre-existing inequalities prior to the pandemic worsened the disproportionate impact of covid. Air pollution is considered to be a health inequality by the RCPCH which in January 2020 called for air quality regulation to protect children’s health.
The World Health Organisation’s Airborne Mistake
The WHO’S failure to acknowledge aerosols throughout 2020, with its Director-General going as far as to tweet in March 2020 that Covid “is not airborne”, is considered by many public health experts and epidemiologists as one of the gravest mistakes of the pandemic. Unfortunately, it appears the WHO isn’t willing to recognise its error.
Sections of The Independent Panel for Pandemic Preparedness and Response report produced for the WHO in May 2021 which was submitted as evidence to the inquiry highlight the failure to confirm human-to-human transmission at the very start of the pandemic but omit the mistakes on aerosols.
Prof David Heymann, Chair of the WHO Strategic & Technical Advisory Committee on Infectious Hazards (STAG-IH) 2017-2022, who appeared for questioning on the third day also provided written evidence in the form of a lengthy report which repeatedly describes the mode of transmission as “droplets and aerosols” and doesn’t use the term airborne except in regards to specific aerosol-generating procedures.
Heymann provides a number of studies which suggested at the time that transmission was by aerosols rather than droplets due to the distance over which people were infected but describes these as evidence of both droplets and aerosols. Confusion of terminology was given as an explanation for why it took the WHO so long to make recommendations for control measures such as masks for healthcare workers, a decision which went against WHO Infection Prevention Control (IPC) which requires adherence to the precautionary principle until modes of transmission are definitively ascertained.
David R Tomlinson, an author of the BMJ’s Covid inquiry series paper on airborne transmission, has expressed on Twitter his concerns about the WHO’s recollection of events in 2020.
“SARS2 was known to be airborne in Jan 2020: When did you know?
Vague & unconvincing statements about the need for clearer terminology don’t stack up against the complete abandonment of WHO’s own precautionary principle
Healthcare workers were shafted, and died caring for others
Millions more were infected, and died, thanks to WHO’s inability to say the word ‘airborne’ & state an empirical truth they knew to be correct, in Jan 2020, loud & clear, Covid is airborne.
Bring on the UK ‘scientist experts’ to wriggle on the hook and claim they did not know.”
Tomlinson’s final sentence references inconsistencies in current UK guidance for healthcare workers compared to the WHO’s recommendations. Although the WHO sidesteps initial mistakes, it now recommends particulate respirators should be worn by healthcare workers before entering a room with an infected person, while the updated UK IPC manual for all NHS providers states covid is only transmitted by aerosols when certain aerosol-generating procedures are conducted. The removal of required testing of in-patients means healthcare workers will regularly be coming into contact with individuals they don’t know are infected.
If the inquiry is to be successful it will need to address these inconsistencies between evidence produced by UK authorities and the guidance currently in use.