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Cognitive Dissonance
...or a timeline of how we were led up the garden path (and over the cliff face) by the ICEG and AHPCC... a thread!
...or a timeline of how we were led up the garden path (and over the cliff face) by the ICEG and AHPCC... a thread!
From the outset of this pandemic, Australian infection prevention experts have hitched their wagon onto the presumption that SARS-CoV-2 is purely a droplet/contact spread disease.
This is still the current position in the ICEG guidelines
https://www.health.gov.au/resources/publications/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilities
This is still the current position in the ICEG guidelines
https://www.health.gov.au/resources/publications/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilities
There has been growing evidence of aerosol transmission for a LONG time now.
On 8 April the National Academy of Science convened rapid advice on masks in the US, citing concerns of presymptomatic transmission from bioaerosols from talking/breathing. https://www.nap.edu/read/25776/chapter/1#2
On 8 April the National Academy of Science convened rapid advice on masks in the US, citing concerns of presymptomatic transmission from bioaerosols from talking/breathing. https://www.nap.edu/read/25776/chapter/1#2
Also back in April Prof Raina Macintyre with a group from UNSW and MIT conducted a systematic review of the literature, which also found evidence of distant spread and aerosolisation - supporting increased precautions for healthcare workers https://academic.oup.com/jid/advance-article/doi/10.1093/infdis/jiaa189/5820886
Fast forward to 6 July, when 239 scientists from 32 countries wrote an open letter to the WHO, summarising the evidence and pleading for strategies to mitigate aerosol spread.
In response, the WHO softened their language to 'cannot be ruled out'
https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa939/5867798
In response, the WHO softened their language to 'cannot be ruled out'
https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa939/5867798
A pre-print earlier this month went as far as isolating, culturing and infecting cells with live SARS-CoV-2 virus collected from air samples up to 4 metres away from an infected patient https://www.nytimes.com/2020/08/11/health/coronavirus-aerosols-indoors.html
As recently as a few weeks ago yet more literature reviews summarising the growing evidence of aerosol spread, with a long list of transmission events that occurred beyond the 1-2 metre range of droplets. https://www.sciencedirect.com/science/article/pii/S0160412020319942
To date there is evidence of:
1. Detection of distant viral RNA
2. Detection of distant whole virus
3. Detection, culture, and cell infection of viable virus from distant air samples
4. Epidemiological evidence of transmission events occurring beyond 1-2 metres of droplet range
1. Detection of distant viral RNA
2. Detection of distant whole virus
3. Detection, culture, and cell infection of viable virus from distant air samples
4. Epidemiological evidence of transmission events occurring beyond 1-2 metres of droplet range
The response in AUS?
Much of the same language used to explain 'magical' transmission events in Measles actually:
https://twitter.com/jmcrookston/status/1297251138086023169?s=20
Dismissal, refusal to acknowledge the evidence, and some very weak excuses as to why healthcare workers should not be wearing respirators:
Much of the same language used to explain 'magical' transmission events in Measles actually:
https://twitter.com/jmcrookston/status/1297251138086023169?s=20
Dismissal, refusal to acknowledge the evidence, and some very weak excuses as to why healthcare workers should not be wearing respirators:
Prof Peter Collignon infectious disease specialist and microbiologist:
"N95 masks are difficult to wear for hours" https://twitter.com/CollignonPeter/status/1278170070988910592?s=20
"N95 masks are difficult to wear for hours" https://twitter.com/CollignonPeter/status/1278170070988910592?s=20
Prof Lyn Gilbert, Chair of the ICEG:
"Our advice has been, that for ordinary routine care of
patients with COVID, surgical masks are appropriate. And the reason for that is that N95 masks are not that easy to wear. They need to be properly fitted." https://www.abc.net.au/7.30/the-debate-over-masks/12497510
"Our advice has been, that for ordinary routine care of
patients with COVID, surgical masks are appropriate. And the reason for that is that N95 masks are not that easy to wear. They need to be properly fitted." https://www.abc.net.au/7.30/the-debate-over-masks/12497510
Prof Lyn Gilbert again:
"N95 or P2 masks – are only effective when fitted to produce a firm seal around the face, which requires training and ‘is not straightforward’" https://www1.racgp.org.au/newsgp/clinical/ppe-debate-continues-as-expert-accuses-authorities
"N95 or P2 masks – are only effective when fitted to produce a firm seal around the face, which requires training and ‘is not straightforward’" https://www1.racgp.org.au/newsgp/clinical/ppe-debate-continues-as-expert-accuses-authorities
Professor Allen Cheng, ID Physician and President of ASIDANZ:
"You do not want to use an N95 mask unless you really need to. They are very uncomfortable."
https://parliament.vic.gov.au/images/stories/committees/paec/COVID-19_Inquiry/Transcripts_Round_2/DHHS_11_August_verified_transcript.pdf
"You do not want to use an N95 mask unless you really need to. They are very uncomfortable."
https://parliament.vic.gov.au/images/stories/committees/paec/COVID-19_Inquiry/Transcripts_Round_2/DHHS_11_August_verified_transcript.pdf
There have been flawed arguments about the need to 'ration' our PPE - save it for a rainy day. Except once it started pouring healthcare workers have been left out in the rain with inadequate protection. https://twitter.com/peripatetical/status/1244521011199893504?s=20
That prompted many Australian health professionals to write this letter of no confidence in the ICEG and its members, asking for greater diversity of expertise and application of the precautionary principle. https://drive.google.com/file/d/1bpIHXIwtHq49XC7JMHw5RSVk_Smat5A2/view
Meanwhile in Victoria, something was happening in healthcare.
There was a clear departure of the healthcare worker infection rate from the growth of the general population around late July.
Shown here as the number of cases/cases on 16 July.
There was a clear departure of the healthcare worker infection rate from the growth of the general population around late July.
Shown here as the number of cases/cases on 16 July.
Somebody from DHHS obviously noticed, as there was a quiet change in PPE guidelines on the 1st of August
This increased N95 use in hospitals.. in settings of prolonged contact, unplanned AGPs or to prevent frequent changing/wastage of masks (but NOT for all care of COVID pts)
This increased N95 use in hospitals.. in settings of prolonged contact, unplanned AGPs or to prevent frequent changing/wastage of masks (but NOT for all care of COVID pts)
Except sadly they forgot about care of COVID-19 residents in aged care...
Those guidelines were not updated until August 12 https://twitter.com/healthcare_19/status/1298036942647353344?s=20
Those guidelines were not updated until August 12 https://twitter.com/healthcare_19/status/1298036942647353344?s=20
This is surprising, from DHHS's own release on 6 August, it was clear there was something very VERY wrong in the aged care sector.
The odds of an AC worker being infected with COVID were >8 times that of a non-healthcare worker based on those figures https://twitter.com/healthcare_19/status/1298232895555817473?s=20
The odds of an AC worker being infected with COVID were >8 times that of a non-healthcare worker based on those figures https://twitter.com/healthcare_19/status/1298232895555817473?s=20
That brings me to the 10th of August, when we heard from the Health Minister and Andrew Wilson of SaferCare VIC that only 10-15% of healthcare workers were getting infected at work.
This was as offensive as it was implausible.
https://twitter.com/healthcare_19/status/1293199237010743298?s=20
This was as offensive as it was implausible.
https://twitter.com/healthcare_19/status/1293199237010743298?s=20
Turns out Prof Wilson had made a grave error in interpreting the data - making this assertion having only investigated 13% of HCW cases (20% of which acquired at work), most from 1st wave, and assuming that the un-investigated or uncertain were not workplace acquired.
Woops.
Woops.
While SaferCare was focusing on the sources of individual cases, it wasn't really until the 21 August that the CHO announced a full report and release of data into healthcare worker infections, and not until the 25 August when that was publicly released.
https://twitter.com/sophiescott2/status/1296647089951141888?s=20
https://twitter.com/sophiescott2/status/1296647089951141888?s=20
While the changes announced yesterday are welcome, they were painfully and forcefully excised against the efforts of a regulatory committee determined not to listen to all sides, or to apply precautionary principle
In the words of Prof Macintyre: https://twitter.com/venessb/status/1295454489013436417?s=20
In the words of Prof Macintyre: https://twitter.com/venessb/status/1295454489013436417?s=20
I have no interest in entertaining the spin that there were not warning signs; that we did all we could; that the large no. of HCW infections were not preventable; or that guidelines were adequate because they went above national standards (a v low bar). https://twitter.com/an_leavy/status/1298090805609914368?s=20
So, the To Do List:
1. No HCW should care for a suspected/confirmed COVID patient w/out a respirator
2. AGPs should not be performed w/out airborne protection if COVID status unknown
3. HCWs must be fit tested
4. ICEG - disband and reform w OHS input:
https://docs.google.com/forms/d/e/1FAIpQLSeLyO3FRivR3J2HYgqGKl6ELOZWwh72yGkb-NURo-XQ41L06g/viewform
1. No HCW should care for a suspected/confirmed COVID patient w/out a respirator
2. AGPs should not be performed w/out airborne protection if COVID status unknown
3. HCWs must be fit tested
4. ICEG - disband and reform w OHS input:
https://docs.google.com/forms/d/e/1FAIpQLSeLyO3FRivR3J2HYgqGKl6ELOZWwh72yGkb-NURo-XQ41L06g/viewform
Turning point for recognition of airborne potential:
Was Not:
-> systematic reviews
-> primary scientific/epi research
-> expert scientific opinion
It Was:
-> An anecdote from a colleague at the Doherty
The perfect end to this thread on Cognitive Bias! https://twitter.com/healthcare_19/status/1298496586343882752?s=20
Was Not:
-> systematic reviews
-> primary scientific/epi research
-> expert scientific opinion
It Was:
-> An anecdote from a colleague at the Doherty
The perfect end to this thread on Cognitive Bias! https://twitter.com/healthcare_19/status/1298496586343882752?s=20
