Update on CATA - Covid-19 Airborne Transmission Alliance

Dr Barry Jones
Chair of CATA/CAPA and Lead for BAPEN

Since I last gave an update to Conference in Edinburgh, CATA (of which BAPEN and the NNNG are core members) has been deeply engaged in preparations for the public hearings in Module 3 of the UK Covid Public Inquiry.

To date, we have also participated in the 3 preliminary hearings with our KC, Stephen Simblet presenting our written and oral evidence¹ to good effect. We have been strongly endorsed by other core participants (CPs) in these hearings and we have been liaising with likeminded CPs, including the TUC, BMA, RCN and R Pharm Soc. It seems that the public inquiry legal team are now fully appraised of the importance of the airborne route and its mitigations.

We were delighted when WHO published its latest paper² on the airborne route, which leaves no doubt as to its importance during the pandemic and beyond. Also, the much-publicised droplet and fomite routes have now been relegated to minor players. This means that our campaign to change IPC guidance from early 2020 was fully justified. It also means that those involved with frontline care during the pandemic were seriously mislead and betrayed by those in power and, in particular, the IPC guidance setting bodies. There can no longer be any pretence that surgical masks were protection from Sars-CoV-2 and that proper respiratory protective equipment, such as FFP3 or powered respirator hoods, should have been made available to all staff working in healthcare settings at the height of the pandemic. Even now, the current IPC guidance as embodied in the National IPC manuals is not clear on how you should respond when faced with an infectious respiratory pathogen such as Sars-CoV-2, Influenza or RSV. Furthermore, the Covid virus still seems to change its mode of transmission and mitigations as one crosses the Scottish or Welsh borders!

Such inconsistencies have been targeted by CAPA (Covid Airborne Protection Alliance, the predecessor of CATA) which has continued to advocate for changes to current IPC guidance, including that for procedures such as nasogastric tube insertion or dysphagia assessments. Neither was ever included in the so-called AGP list, which should now be regarded as obsolete in the face of the demonstration that aerosols are emitted even when just breathing, talking, shouting, laughing, sneezing and, most importantly, when coughing. This was always so but our efforts to influence those responsible for setting the IPC guidance was rebuffed, ignored or obstructed by those in charge and AGPs remain a principle predication for RPE. We shall be pursuing these matters vigorously at the public hearings in Module 3 which start in September. Our aim is to persuade the Inquiry chair, Baroness Hallett, to conclude that any future pandemic should be better prepared for an airborne pathogen and that those who provide care should be properly protected in all healthcare settings.

CAPA continues to work closely with the RCN on a revised version of their Risk Assessment Tool to advise on what precautions you should take if faced with a confirmed or suspected respiratory pathogen.

As Chair of the Alliance and lead for BAPEN, I am indebted to the support of my fellow Executive members, Kamini Gadhok MBE (late CEO RCSLT), Prof Kevin Bampton (CEO BOHS) and David Osborn (Health & Safety Expert), and to all of those individual members and organisations who continue to provide support.