Doctors criticising other doctors in the COVID-19 pandemic

The British Medical Association (BMA) – the body that represents medical doctors – is producing reports on the COVID-19 pandemic, in consultation with their members. The first report is How well protected was the medical profession from COVID-19?. Summary here. As you would expect, it makes pretty grim reading and repeats the (well founded, I think) criticisms of the UK government’s response, such as inadequate PPE.

It also talks about inadequate Infection Protection and Control (IPC) guidance given to doctors and other healthcare workers:

The refusal of the IPC cell to recognise that aerosol transmission occurs outside AGPs [Aerosol Generating Procedures, eg intubating a patient – see earlier post] and therefore requires higher levels of PPE [Personal Protective Equipment], specifically RPE [Respiratory Protective Equipment], and the reliance by employers on the IPC guidance rather than long-standing legal requirements under health and safety law meant that medical professionals started to feel they were not being adequately protected under the IPC guidance at the time.

page 14 of How well protected was the medical profession from COVID-19?, BMA, 19th May 2022

IPC cell is a mysterious group of mainly, I think, senior medical doctors that draw up guidance on what measures hospitals, GP practices, etc need to take to protect both healthcare workers and patients from infection by COVID-19. It is mysterious because the members (unlike SAGE for example) are unknown. In a response to a Freedom of Information request, we have some idea of what their qualifications are. They look to be mainly medics, i.e., MDs not PhDs, and the request is explicit that there are no virologists or epidemiologists.

It does not mention engineers or physicists, but I think it is very unlikely that either are on IPC cell. This is a shame as one of the many sensible recommendations made by the BMA report is for better ventilation. Ventilation is something civil engineers are qualified in, but not MDs.

The BMA report continues with a description of this mysterious body the IPC cell, performing a swift, unexplained, U turn;

… in January 202228, when the IPC guidance briefly recognised that aerosols can be spread by coughing and talking and in effect meant that healthcare workers ought to routinely wear RPE when dealing with COVID-19 positive patients. This was following more than a year of constant campaigning by the BMA and others. The IPC cell has since ‘re-clarified’ this guidance to say that they believe FRSMs are sufficient for dealing with COVID-19 positive patients and have removed previous references to aerosols being generated by daily actions30. This means that, as of writing this report, healthcare workers in this country are still being denied the appropriate level of protection when treating COVID-19 positive patients.

page 14 of How well protected was the medical profession from COVID-19?, BMA, 19th May 2022

I find it surprising that in the taxpayer-funded democratically accountable NHS, important decisions are being made by an organisation – IPC cell – whose membership is secret, and where there are no meetings minutes, or detailed justifications of their decisions. But this is the situation. I also don’t know who appoints the IPC cell members, or why it lacks expertise in airborne disease transmission, ventilation, and epidemiology. The BMA seems unhappy with this situation but I don’t know if it will change.

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