Thread by @DRTomlinsonEP

@mancunianmedic @bmj_latest I think with 1,500 HCWs dead, over 120,000 with long covid & NHS Trusts still anchored on droplet transmission beyond AGPs, you've got a right to be angry.

You mention the pandemic stockpile lacking necessary supplies. I agree.

I hope you don't mind my 2c...

@mancunianmedic @bmj_latest In advance of PPE re-procurement, Spring 2016, the NERVTAG ‘Sub-committee on the pandemic influenza Facemasks & Respirators stockpile’ recommended that ‘fluid repellent surgical masks (FRSM) could be used for the majority of clinical care on normal wards during a pandemic...

@mancunianmedic @bmj_latest ...escalating to respirators for AGPs.’

In contrast, for MERS Coronavirus, FFP3 respirators were required for all HCWs, but as MERS was not deemed to have pandemic potential, stockpiling for this purpose was not deemed necessary.

SARS was not considered.

@mancunianmedic @bmj_latest Notably, Dr Ben Killingley & JVT, Chair & vice-chair of the sub-committee respectively, in a 2013 publication, acknowledged that not only coughing & sneezing but also tidal breathing represented a potentially important source of infectious respiratory viral aerosols...

@mancunianmedic @bmj_latest Meeting minutes don’t include a bibliography to help illuminate these decisions, but one possible reason for anchoring on AGPs as the sole aerosol transmission risk is...
ncbi.nlm.nih.gov/pmc/articles/P…

@mancunianmedic @bmj_latest the 2014 ‘WHO Guidelines: Infection prevention & control of epidemic- & pandemic-prone acute respiratory infections in health care’.

Regarding SARS, authors state: ‘Human-to-human transmission of SARS occurs mainly through droplets or direct contact...

@mancunianmedic @bmj_latest ...although transmission through infectious respiratory aerosols of various sizes may occur at short range (ref 31)

These guidelines state an apparent greater transmission risk during intubation & recommend airborne precautions only for AGPs.

@mancunianmedic @bmj_latest However, ref 31 actually confirmed airborne SARS in a patient’s room & the sampling methods required patients to ‘stay 15 feet away from the air sampler & not to cough in the direction of the air sampler.’

@mancunianmedic @bmj_latest The conclusions to this paper state: ‘Confirmation that the SARS virus can be shed into the air of a patient room will guide the response to any future SARS outbreaks.’

@mancunianmedic @bmj_latest The first author listed on this [WHO IPC] document is Dr John Conly, Professor, infectious diseases specialist & current Chair of the WHO IPC Research & Development Expert Group for Covid-19.

@mancunianmedic @bmj_latest Most recently, Dr Conly co-authored the WHO-sponsored ‘SARS-CoV-2 & the role of airborne transmission: a systematic review’, which concludes: ‘The lack of recoverable viral culture samples of SARS-CoV-2 prevents firm conclusions from being drawn about airborne transmission.’

@mancunianmedic @bmj_latest This preprint has been rejected during open peer review, on the basis of serious methodological concerns over selection bias, thereby excluding methodologically rigorous data which proves airborne SARS2 transmission.
f1000research.com/articles/10-232

@mancunianmedic @bmj_latest The authors also state [v.2, Sept 2021] that the previous epidemiological evidence towards SARS1 being airborne was weak, yet the reference provided to support this assertion links to an unqualified/un-referenced statement - an opinion, basically.

I hope this was helpful.