Behind the Masks: The Controversial Decisions That Left Healthcare Workers Exposed

The path to the Covid pandemic – and its handling by the Johnson government – was a long one, paved with decisions that may have seemed trivial at the time. But they would go on to determine the response to the biggest pandemic in a century. 

Some of those decisions were set in motion, in the eyes of health and safety expert David Osborn (a participant in the Covid inquiry), more than a decade before Coronavirus first hit these shores. 

David Osborn, a Chartered Safety and Health Practitioner with Trident HS&E Ltd, has been digging deep into those years before the pandemic. And in a new article for the Patient Safety Learning outlet, seen by Byline Times, he sets out his take on how Covid was mishandled – and what it means for us now. 

In 2013, two public health experts – Dr Lisa Ritchie and Nottingham University professor Jonathan Van Tam (JVT) – co-authored a paper about respiratory viruses. It discussed the threat of airborne viruses, and called for respirators (FFP3 masks) to be used in the event of an airborne virus outbreak instead of surgical ones. For viruses like SARS,  the authors declared that pathogens which are “truly transmissible via the airborne route…a respirator will be required.” 

Fast forward to 2016, and a sub-committee meeting of the little-known New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) was chaired by JVT and Nottingham clinical scientist Ben Killingley. They reviewed the UK’s stockpile of PPE, which had started in 2009 during the H1N1 influenza pandemic. They recommended that health bodies rotate the stockpile – like a supermarket would – so that PPE could be used before expiry. 

All very sensible, if it had been put into effect, David Osborn argues. But masks purchased in 2009 were still being issued in 2020 – six years after expiry. Osborn rejects claims that “stringent tests” were carried out on those masks to make sure they were safe.

At that 2016 NERVTAG sub-committee meeting though, they made another key decision – to allocate high-end respirator FFP3 masks only to certain high-risk health settings, while other health workers would receive only surgical masks (FRSMs). The latter – the flimsy masks we’ve all come to recognise – are only good for so-called ballistic (large, projectile) droplets. Jonathan Van Tam, by this time deputy chief medical officer, was one of those signing off the decision. 

Those decisions had major ramifications in 2020 amid a worldwide shortage of proper PPE. 

Fateful Gatherings

On Friday 13 March 2020 – just a few days before the first lockdown – two crucial meetings took place. Osborn describes it as a dark day that set the stage for the two years to come. 

One was the ninth Covid meeting of NERVTAG, the expert committee of the Department of Health and Social Care (DHSC). 

At the NERVTAG meeting that day on Covid, participants noted that the Department for Health and Social Care was “moving towards FRSM [surgical masks] over FFP3 [respirators]”. Members discussed the problem that COVID-19 was classified as a High Consequence Infectious Disease for which health and safety rules required respirators such as FFP3s to be worn. This didn’t sit comfortably with the switch to surgical FRSM masks. 

Coincidentally, at exactly the same time, the Advisory Committee on Dangerous Pathogens (ACDP) was also meeting virtually. The minutes reveal that the Chair “informed the Committee that he had been contacted by DHSC regarding the classification of COVID-19 as a High Consequence Infectious Disease (HCID). The Committee unanimously agreed that this infection should not be classified as a HCID.”

The rules at the time for handling High Consequence Infectious Diseases (HCID) required the wearing of FFP3 masks. Indeed, as Byline Times has previously reported, NHS staff were initially expecting these respirators to protect themselves from Covid. (The High Consequence Infectious Disease classification also necessitated deep cleans of ambulances after coming into contact with an infectious case – which took three hours and was impossible given the surge in cases.) 

NERVTAG members however, seemingly realised there weren’t enough of these high-quality masks available. Guidance was revised to recommend weaker surgical masks for most staff. Osborn believes JVT would have known that the shortage stemmed from his review of PPE supplies in 2016. 

The decision was controversial. Was it based on cost rather than clinical necessity? 

In January 2020, Covid had been defined as an airborne disease – in other words, one which required respirators, not FRSM paper masks. The decision to declassify the virus as no longer a HCID did not, of course, change the facts: it was an airborne disease.

Yet at that 13 March meeting of NERVTAG, people who knew surgical masks were not suitable for protecting staff and the public from the pandemic agreed to change the mask guidance, downgrading provision in most cases from respirators to ineffective surgical masks. Again, Lisa Ritchie and JVT, who had authored the 2013 paper on the matter, were active participants of the meeting. 

This was not malicious: the UK’s high-end FFP3 supply was indeed dangerously low and past expiry. There are questions hanging over the “stringent tests” supposedly conducted on the out-of-date supplies handed to health workers – given that some masks had to be withdrawn as they were falling apart.

Photos of healthcare workers with falling apart labels and new labels over old expiry dates only added to the concerns.

The lack of supply for respirators, in the view of Osborn, was also a key factor in a decision at that March 13 meeting to no longer classify Covid as a High Consequence Infectious Disease. 

The ACDP justified their de-classification from a HCID because Covid had a lower case fatality rate than some other coronaviruses. Although the SARS-CoV-2 virus is a close relative of the deadly SARS, which occurred in 2002 to 2003, it was considered a “pussycat” in comparison, with a mortality rate of “only” 3%.  

But other factors, such as the fact that Covid could be spread through symptomless transmission, and the fact it had “global pandemic” status, should not have been ignored: they should have led Covid to be considered “high consequence” from the get-go, Osborn argues.

“Secretive” Cell

A separate Four Nations Infection Prevention and Control Cell (IPC) group also bears scrutiny. 

The group – comprising the most senior clinical figures of the UK – met almost daily throughout 2020 until autumn and the frequency reduced to 5 days weekly in 2021. We don’t know exactly who was in the cell as it was kept closely guarded secret, but we do know that it had more than one chair, one from each nation who all shared its meetings from time to time. 

Lisa Ritchie was one of them. The various editions of IPC guidance were signed off by the chief medical officers of the four nations, so that would include Chris Whitty for England, as well as the four chief nursing officers. 

The IPC executed a “command role” during the national management of Covid, steering the NHS and coordinating decisions UK-wide. Minutes were taken, but never released into the public domain again. Indicative of the secretive and shadowy nature of the group. One might ask why all of the groups like SAGE, NERVTAG and others published their minutes, but not the IPC cell. Dr Ritchie chaired some of the IPC meetings. 

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Researchers have only managed to obtain a few sets of minutes of meetings through Freedom of Information requests from the height of the second wave. They show that while the then-Public Health England recommended a much wider use of respirator FFP3 masks, the IPC cell rejected this. This was curious, Osborn believes, because PHE was in theory the lead government authority for the pandemic. 

Minutes from a meeting in late 2020 show that at least one IPC member expressed concern that if advice changed to use FFP3s now, healthcare workers might question why they had been under-provided in terms of PPE during the first wave. 

The second and subsequent waves of Covid kept the advice – with health care workers still lacking the protection they deserved. 

Current Wave of Covid

This matters not only for learning lessons from the Covid pandemic, amid the ongoing public inquiry, but because surgical masks are still being issued in the current wave of Covid. 

The evidence base is growing behind the understanding that repeat infections for healthcare workers causes worse Long Covid. So why are health workers still not being properly equipped?

You won’t see it widely reported, but there is currently a fresh outbreak of Covid, and there are signs of another wave with rising admissions. 

The authorities have still not recognised their failure to treat Covid as the airborne virus it is – versus the droplet-spread virus that they perhaps wished it should have been, Osborn says.

Osborn and others concerned for the welfare of our healthcare staff are “mortified” to learn that NHS Trusts are reportedly telling their staff that they should come back to work even if they are testing Covid positive provided they feel okay.

It is playing Russian roulette with NHS workers’ health from a Long Covid point of view, Osborn argues: “What about patients who are often medically vulnerable? They go into hospital to get better not to catch the latest variant of Covid from the people they are trusting.”

His new analysis leads us towards the decision-making figures – in government and public health – who played a role in downgrading both PPE for health workers and allegedly ignoring the science on Covid being a “High Consequence” and airborne disease. 

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Timeline and Key Questions

2003: After the SARS outbreak in 2003, the government, guided by an “enlightened” Chief Scientific Advisor Sir David King, begins preparing for a major pandemic. Research is conducted to assess the effectiveness of standard surgical masks, and the results are clear: health care workers need proper respiratory protection equipment (RPE) for protection from airborne diseases.

2008: Health and Safety Executive lab research on masks finds that no surgical FRSM masks should be used during an influenza-like pandemic – only respirators. 

2009: The ‘Swine flu’ pandemic prompts a massive stockpile of respiratory RPE masks. But as the equipment reached its expiry date in 2014, questionable decisions are made to extend their life, potentially affecting their efficiency. 

2016: Despite clear recommendations for using RPE like the gold-standard, FFP3 respirators, decisions at NERVTAG were made and signed off by JVT – to equip ward staff, paramedics and other HCWs with standard FRSMs should another killer virus come along. 

This failure to protect workers adequately would come back to haunt the government when a new SARS-Cov2 virus emerged to cause a global pandemic.

2020: With the new disease spreading in 2020, the government finds itself with a low stockpile of respirators. 

A series of decisions were made by the four-nation Infection Prevention Control group, each raising ethical questions:

1. Declassification of the Disease: The disease is declassified from a “high consequence infectious disease” (HCID), just two days after a global pandemic had been declared.
2. Changing Transmission Understanding: Despite “clear” evidence, government health figures including Jonathan Van Tam declare the virus is no longer airborne but transmitted via droplets, leading to a response strategy that may have compromised safety.
3. Misleading Terminology and Protection: Both surgical masks – largely useless against airborne diseases – and respirators are both “misleadingly” lumped together as ‘PPE’ potentially leading health care workers to believe they were adequately protected.
4. Occupational Exposure Ignored: Reporting of occupational exposure to the disease is discouraged or rejected, potentially affecting health care workers’ ability to prove work-related disablement, as Byline Times has reported.

The carnage and chaos that ensued in hospitals was clear to see, Osborn argues. Health care workers felt as though they were being thrown to the wolves, without proper protection. 

Many died as a result, and many more became seriously ill with long-lasting effects. It was a total governance failure, Osborn says.

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The safety consultant’s new analysis serves as a reminder of the importance of “ethical governance”, transparency, and adherence to safety standards. But it also raises critical questions about the handling of a crisis that cost over 200,000 British lives – including those of thousands of health care workers. Osborn and colleagues at the Covid Airborne Transmission Alliance (CATA) are seeking protection for staff both now and ahead of future pandemics. 

Many questions remain. Where was the main health and safety regulator, the Health and Safety Executive, during all this? It is supposed to be responsible for ensuring workers’ health and safety.

Expect to see CATA and health worker bodies bring up these issues in front of Covid inquiry chair Baroness Hallett when it returns for module two (political decision-making and governance) after the summer. Because they will be using every opportunity possible to sound the alarm. 

A Department of Health and Social Care spokesperson did not respond to specific questions but said: “Throughout the pandemic the government acted to save lives and livelihoods, prevent the NHS being overwhelmed and deliver a world-leading vaccine rollout which protected millions of lives across the nation.

“We have always said there are lessons to be learnt from the pandemic and we are committed to learning from the COVID-19 Inquiry’s findings which will play a key role in informing the government’s planning and preparations for the future. We will consider all recommendations made to the department in full.”

Prof Jonathan Van Tam did not wish to speak for this article before the Covid Inquiry concludes in several years. Lisa Ritchie was also contacted for comment.