Thread by @DRTomlinsonEP

🚨 NEW 🇬🇧

Guidance on IP&C for seasonal respiratory infections including SARS-CoV-2

Welcome to the world of SEASONAL SARS2 [does this sound more 'cuddly' to you?] & alternative reality according to the IPC Cell.

🧵

gov.uk/government/pub…

Hot on the heels of the new campaign where dCMO @Thomas_Waite states:

'People with COVID-19 release virus particles into the air whenever they speak, breathe or cough & these can linger in unventilated settings.'

Will the IPC Cell sustain the AGP myth?

gov.uk/government/new…

Reviewing this on the fly...

'This guidance is intended to prevent transmission of seasonal respiratory viral infections focussing on influenza, SARS-CoV-2, & respiratory syncytial virus (RSV) in health & care settings'

Nice tactic: Try to remove focus on SARS2 alone

Thinking this may worth referring back to:

'This guidance is INTENDED TO PREVENT TRANSMISSION...'

Got that?

The team that has wilfully ignored evidence referenced by them on physiological aerosol creation [2011] & SARS transmission [2013] NOW wants to PREVENT transmission.

Irony alert:
'Out of scope for this guidance:
high consequence infectious diseases (HCID) transmitted by the airborne route such as emerging pandemic influenza or other novel respiratory viruses'

SUCH AS SARS2 UNTIL YOU REALISED YOU LACKED FFP3s

Sorry, I am trying not to shout.

Straight after, repetition:

'This guidance outlines the infection prevention & control (IPC) principles required to PREVENT TRANSMISSION of COVID-19 & other respiratory viruses & minimise disruption to health & care services.'

Blimey. Maybe they have ditched the AGP after all?

Oh.

'Please note:
this guidance is of a general nature. Employers should consider the specific conditions of each individual place of work & comply with all applicable legislation & regulations, including the Health & Safety at Work etc Act 1974.'

I think we know what's coming.

For a minute there, all that talk of preventing transmission had me thinking the IPC Cell was going to listen to @Thomas_Waite, accept the reality of breath-exhaled respiratory viruses & go all 'CDC Sept 10th' on us & mandate airborne RPE for all HCWs.

Sadly, not. 👇

'3.1 Scope
The COVID-19 pandemic remains a threat.'

This is what it says.
Honest.

Then, a gratuitous bit of advertising:

'The COVID-19 vaccination programme across the UK continues at pace & this has been successful in reducing the most severe consequences of the disease.'

Boring but very important:

'4. Governance & responsibilities
Organisations are responsible for ensuring safe systems of work, including managing the risk associated with infectious agents through the completion of risk assessments approved through local governance procedures'

See what they've done there?

YOU are responsible, Mrs NHS Trust CEO, to do YOUR OWN risk assessment, [with methodology] APPROVED BY YOUR LOCAL PROCEDURES.

Boring but v important: what, if any, risk assessment method PERFECTLY predicts transmission risk?

Ans: It does not exist.

'5.3 Triaging
Patients with excessive cough & sputum production & those at higher risk of severe outcomes should be prioritised for placement in single rooms whilst awaiting testing.'

Sigh

Only useful if coughing is aerosol-generating, cos everyone's in a surgical mask, innit?

'6. Transmission based precautions'

Need to flick to the glossary for a definition of #airborne:

'The spread of infection from one person to another by airborne particles (aerosols) containing infectious agents.'

Paging @gabbystern @doctorsoumya @mvankerkhove

'Airborne particles are very small particles that may contain infectious agents. They can remain in the air for long periods of time & can be carried over long distances by air currents. Airborne particles can be released when a person coughs or sneezes, & during AGPs'

Hang on..

But what about this, from 5th Nov?!

'People with COVID-19 release virus particles into the air whenever they speak, breathe or cough...'

@Thomas_Waite the IPC Cell is spreading misinformation regarding SARS2 transmission: will you tell them please? 💙
gov.uk/government/new…

'6.2.1 Isolation for patients with respiratory symptoms

A specialised isolation suite/room is not necessary but where available should be used for patients undergoing aerosol generating procedures (AGPs).'

But but but coughing?

I thought this demon was exorcised in Oct 2020.

'6.3.2 Primary care & outpatient settings

Towards minimising transmission:

'staggering clinic times for patients with & without respiratory symptoms, ensuring disinfection of communal areas between clinics'

Disinfection of the AIR? @andymoz78 @mjb302

'6.4 Safe management of care equipment and the care environment'

Deep breath.

Remember this from earlier?

'This guidance is INTENDED TO PREVENT TRANSMISSION...'

What do we get? Loads of details on SURFACES, ZERO DETAILS on cleaning the air.

Truly, it's a zombie apocalypse.

'6.5 Personal protective equipment'

🥁🥁🥁

Don't forget: "People with COVID-19 release virus particles into the air whenever they speak, breathe or cough & these can linger in unventilated settings." @Thomas_Waite

👇Not what I was expecting.

'Droplet route' = surgical mask

So wtf is a 'droplet'?

[glossary again; fun isn't it?]

Closest I can get is this - 'droplet' is not defined.

'Respiratory droplets
A small droplet, such as a particle of moisture released from the mouth during coughing, sneezing, or speaking.'

I have nothing. Anyone?

I was seriously NOT expecting this.

It's IPC gatekeeping on a whole new level.

A committee w/o published minutes or membership decides whether a condition is WHOLLY airborne.

Glossary says cough generates aerosols; so does DHSC.

But in healthcare only AGP merits RPE.

Wow.

Here'a a nice table to amplify & anchor this BS.

But remember:

'This guidance is INTENDED TO PREVENT TRANSMISSION...'

It's written by very nice people.

They mean well, honest. 💙

'6.6 Aerosol generating procedures'

It's IPC scripture: the 'holiest of holies'.

No blasphemy of breath-exhaled infectious aerosols is permitted.

This is 2021 folks

[but glossary appears to have been written by someone w/o such bias, like @Thomas_Waite - don't tell 😬]

There's too much BS & it's getting late.

Last 'highlight':

'10.5 Personal protective equipment
PPE is considered to be the least effective measure of the hierarchy of controls.'

Considered least effective by whom?

Try nursing a breathing SARS2 patient; RPE is a life saver.

'This guidance is INTENDED TO PREVENT TRANSMISSION'

In reality, it's 'next level' IPC gatekeeping.

A secret committee decide whether a pathogen is WHOLLY airborne.

Physiology of aerosol creation is ignored.

DHSC campaigns on SARS2 transmission DO NOT APPLY to healthcare. 💙

@trishgreenhalgh @Ozbilgin @sameo416 @hughes_eilir @huwwaters @microlabdoc @mjb302 @ThePalpitations @Linzofm87 @BarryMcAree @LawtonTri @isfrackingsafe @CNagpaul @dgurdasani1 @Chakladar_A @docjon55 @gallagher_rose @KGadhok @doctorasadkhan @NHSLeader @doctor_oxford @LABailey

@ProfEmer @SafeDavid3 lol