BAPEN News

 

Update on Covid-19 inquiry

The week beginning 9th September was a momentous one for BAPEN and the Covid-19 Airborne Transmission Alliance - CATA. Module 3 of the UK Covid Inquiry began hearing evidence of the impact on healthcare workers and the NHS. As members will recall, BAPEN was a founding member of the predecessors of CATA - AGPA and CAPA chaired by BAPEN’s Barry Jones. CATA is a core participant in this module, one of only 36.

It all started with our last President, Trevor Smith, asking for clarification of nasogastric tube (NGT) insertion’s status as a high risk procedure during the pandemic. We all know that Covid-19 (C-19) patients cough and that coughs release aerosols carrying the virus towards our faces only 1 meter away. To our surprise, NGT insertion was not categorised as an aerosol generating procedure (APG) by WHO and UK government bodies. We protested that the science underpinning this decision was totally flawed and even the Health Protection Scotland which reviewed the evidence said that the AGP list was unfit for clinical use - but it entered UK IPC guidance anyway! This was compounded by the UK IPC Cell which set the guidance insisting that transmission was by ballistic droplets >5 µm in diameter but aerosols <5 µm for AGPs. This meant that many of you had to perform your duties, including NGT insertion or swallowing assessment, using nothing more than a flimsy surgical mask (which are not designated as PPE). Our efforts to overturn this and to change IPC guidance in favour of better respiratory protection for you all has taken the last 4.5 years and still the IPC guidance is inconsistent on the topic of mode of transmission with marked differences as you cross into Scotland and Wales.

It was immediately obvious to us that C-19 was transmitted by the aerosol route, irrespective of procedure, as well as possible droplet and fomite (touch) routes. This view was vigorously resisted by government bodies, but especially by the UK IPC Cell which seems to have had remarkable powers to ignore superior bodies such as SAGE, The Cabinet Office, PHE (now UKHSA) and all stakeholders, such as BAPEN, NNNG and CATA. The Chair of the IPC Cell until June 2021 still adheres to the >5 µm droplet paradigm despite scientific evidence from the engineering and physics communities that the definition of an aerosol or droplet was completely wrong. As explained by Professor Beggs the day before I appeared for CATA at the Inquiry, the true threshold is 100 µm, which means that every time the IPC Cell said transmission was by droplets, they were describing aerosols. Thus, all their guidance was, and is, null and void. Despite evidence from top aerosol scientists such as Professor Beggs, the Chair of the IPC Cell and still Deputy Lead of UK IPC, Lisa Ritchie, stated at the inquiry that she believes the droplet and fomite routes are the dominant ones and that she still adheres to the 5 µm definition! Dr Hopkins of UKHSA agreed and said that evidence for use of FFP3 respirators is still too weak. It most certainly is not!

Further evidence from Professor Beggs shows that it is the smallest respiratory particle fraction (aerosols) in which most Sars-CoV-2 is present, not in large droplets as previously assumed. These small aerosol particles (<20 µm) are also the dominant type of particle and even larger ones evaporate to smaller ones within a fraction of a second to become smaller aerosols. They are also able to penetrate to alveolar level unlike large droplets which only reach the nasal and oral mucosa or eyes. We never produce true droplets without aerosols. Since we all have to breath and share others’ exhaled air, this is a far more plausible route for transmission, especially where ventilation is poor. Since FRSM masks are neither PPE nor able to filter aerosols, their use as PPE placed all who were given no alternative at risk of C-19 infection. The only use for FRSMs is as source control where there is some evidence of efficacy as they do stop larger particles escaping and becoming aerosols.

All BAPEN members should have been able to access proper respiratory protection either as FFP3 respirator masks or PAPRs (power assisted personal respirators) - such as those pioneered by Trevor Smith’s colleagues in Southampton. Nobody wants to wear such equipment without good reason but the alternatives of C-19 infections, death - as affected at least 2300 Health and Social Workers (HCWs) - or Long Covid affecting up to 200,000 HCWs, are good reason to take the best protection available. The persistent denial of close-range risk from aerosols on the grounds that risk declines beyond 2 m and droplets fall before 2 m (so it must be droplet transmission) ignores the fact that aerosols are also most dense within 2 m of source. Such a simple fallacy exposes the poor nature of IPC logic.

As we near 5 years since the pandemic struck, several 100 patients are still dying every week from the infection and pose an ongoing threat to those caring for them both at close quarters and further away if ventilation is inadequate - something all too prevalent in UK hospitals. We still hear of our colleagues being denied RPE by their managers or IPC leads. The AGP list is still the main predicator of RPE use with FRSM for routine care, although some flexibility exists in the current National IPC manuals. To be clear, this list is obsolete and unfit for purpose and so should be abandoned in favour of situational risk, not procedural risk.

This story represents the biggest failure of public and occupational health in history bearing in mind that almost a quarter of a million of our fellow citizens have died from C-19 and 2 million suffer from Long Covid.

As we approach the end of Module 3 in November, CATA’s job is done ,and we will be standing down. The final report next year will surely contain conclusions in accord with CATA’s evidence.

Again, I must pay tribute to all those who have supported us throughout this long and tedious journey, but in particular, my fellow Executive members Kamini Gadhok MBE (ex-CEO RCSLT), Prof Kevin Bampton (CEO BOHS) and David Osborn (H&S expert) without whom I could never have functioned as Chair or put together such comprehensive evidence. BAPEN and NNNG have supported us throughout and deserve great credit.

- Dr Barry Jones

CATA Statements:

• INQ000273913 - Witness Statement provided by Dr Barry Jones on behalf of the Covid-19 Airborne Transmission Alliance, dated 31/10/2023. - UK Covid-19 Inquiry (covid19.public-inquiry.uk)
• INQ000474276 - Expert Report by Professor Clive Beggs titled An expert report on the physical sciences underpinning Covid-19 transmission and its implications for infection prevention and control in healthcare settings, dated 07/08/2024. - UK Covid-19 Inquiry (covid19.public-inquiry.uk)
• INQ000502157.pdf (covid19.public-inquiry.uk) CATA’s written opening statement Module 3
• Impact of Covid-19 Pandemic on Healthcare Systems in the 4 Nations of the UK (Module 3) - Public Hearings - UK Covid-19 Inquiry (covid19.public-inquiry.uk) CATA appears at inquiry 12/9/24.

Please also find a link to a podcast between myself and the UK Bereaved Families for Justice: https://youtu.be/c2FjK_L16g8?feature=shared.

 

 

 

National Survey of Malnutrition and Nutritional Care

1st – 30th November 2024

Calling all health care workers across all health & social care settings

This November, we will be running our national malnutrition screening survey to gather information on the prevalence of malnutrition in adults and gain insights into the nutritional care they receive.

We need as many people as possible across all health and social care settings (hospitals, care homes, mental health units, GP practices, patients’ own homes, etc.) to get involved with the survey to enable us to build an accurate picture of the state of malnutrition across the UK.

From 1st November, a simple form will be accessible from this page on the website, from where you can easily input your data. We really need your help to make this a success so mark it in your diary, it’s a ‘MUST’!

Remember to add you email address to the form so we can share your local data with you and enter you for a potential prize for being a top regional screener.

 

 

New Radiographer-Led Pathway to Improve NG Tube Safety Launched

The Society of Radiographers (SoR) is working alongside BAPEN, the Royal College of Radiologists (RCR), and the British Society of Gastrointestinal and Abdominal Radiology (BSGAR) to launch a new radiographer-led nasogastric (NG) tube position check pathway aimed at reducing misplacement incidents and improving patient safety.

Radiographers will be trained to evaluate and record NG tube placement via X-ray, increasing efficiency and providing a safe consistent structured process.

Find out more here: www.bapen.org.uk/bapen-news/new-radiographer-led-pathway-to-improve-ng-tube-safety-launched/.

 

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