The UK’s COVID-19 enquiry is back and it does not make cheerful watching. I first watched testimony of Dr Barry Jones, Chair of the Covid Airborne Transmission Alliance (CATA). He is was impressive, and is clearly very very unhappy with the IPC Cell (IPC=Infection Prevention and Control), and I agree he has reason to be. The IPC cell was set up at the start of the pandemic and is somehow part of the then Public Health England (PHE) (now renamed as Health Security Agency) and the NHS. It issued “guidance” on how to prevent the spread of COVID-19, that went to PHE who seemed to rubber stamp it and send it to hospitals who all obeyed it. I then watched testimony (continued here) from the Chair of the IPC, for a year of the pandemic, Dr Lisa Ritchie. Dr Ritchie was less impressive.
Jones, on behalf of CATA, made attempts during the pandemic to question both IPC Cell “guidance” and the basis on which it was made, for example, the recommendation that surgical masks were adequate protection, when for aerosols FFP3s offer much more protection. It seems he was rebuffed with “we’re following the science”, when both he and I would say that IPC Cell was not following the science. Jones is a senior medic representing many HCWs, so this is disappointing.
A lot of this is not new, for example he commented on COVID-19 being downgraded(!) from a High Consequence Infectious Disease (HCID) in March 2020 – see a post from 3 years ago (another here). This downgrading is both absolutely astonishing and very suspicious, although whether that was IPC Cell’s fault is unclear to me. But it is sobering to see that this senior and very capable medic was ignored by his fellow medics and nurses on the IPC Cell. They not only ignored physicists and engineers (I think there were few to none of those on IPC Cell) but IPC Cell also ignored fellow HCWs, including others at the frontline.
What was new to me was testimony from the chair on the IPC Cell. The IPC Cell does seem to be have put together in a hurry, and staffed with only limited expertise: few/no engineers or physicists, and maybe few/none epidemiologists, in practice mostly HCWs with perhaps limited experience of interpreting the complex science for a complex problem like infectious disease transmission. And then somehow IPC Cell made all the decisions*, that were in effect passed down to hospitals as if on tablets of stone. Possibly in part because nobody, PHE, politicians, senior NHS leaders, etc, wanted to take responsibility for guidance that was a matter of life and death, for both HCWs and their patients.
Ultimately, it was the then Prime Minister Boris Johnson’s responsibility that the NHS infection prevention was left to such a dysfunctional combination of an underpowered IPC Cell with others that just left it to the IPC Cell. But it is also true that this is a very responsible position, so if you are out of your depth, as I think many on IPC Cell were, then you have a responsibility to ask for help, or ultimately to step down.
* The Chair of the IPC Cell seemed to downplay the Cell’s role, portraying them as more of a channel for recommendations from other committees such as NERVTAG. But this may be disingenuous.
Chance & Necessity 