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. 

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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.

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“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.