Early pandemic messaging on health workers’ masks quite confused, Whitty says

The messaging around what masks NHS staff should wear to protect themselves against Covid-19 was “quite confused” early in the pandemic, according to England’s chief medical officer.

Professor Sir Chris Whitty was asked about the use of FFP3 masks and FRSM masks (fluid-resistant surgical masks) at the Covid-19 Inquiry on Thursday.

Public hearings for the inquiry are currently exploring the impact of the crisis on healthcare systems in the UK.

Inquiry counsel Jacqueline Carey said that when the virus was declassified as a high consequence infectious disease (HCID) in March 2020, guidance from UK Infection Prevention and Control (IPC) “effectively said FFP3s for AGPs (aerosol generating procedures), or hotspots where AGPs are going to be done, FRSM in the other areas”.

She asked: “Do you think that was perceived by some in the profession as a downgrading of PPE that was required?”

Prof Whitty said: “I’m very confident you find some people who thought that was a downgrading, but I think most people would see that as a quite normal sequence.

“They may or may not agree with it, but they would see that as, it’s not a sort of downgrading, it’s simply a move from an HCID to an infectious disease, for which you have standard precautions for that level of risk.”

Ms Carey asked if he thought “that message was sufficiently well communicated to healthcare workers”.

Prof Whitty replied that it was not his area of expertise, but added: “I think that this is a recommendation I would invite the inquiry to consider.

“I think that the messaging near the beginning of this was quite confused.

“And I think the reason that it was confused was it was not entirely clear who was ultimately responsible for making decisions in this fast-moving situation.”

He added: “I think that quite a lot of people thought they were partially responsible, and that’s always an extremely difficult and dangerous situation to find yourself in.

“So it wasn’t that people were trying to walk away from responsibility, but the quite complex system by which Public Health England, as it then was, the infection control cell, NHS delivery of various things, were interacting – and that’s before we get into issues of procurement and distribution, which had a separate set of challenges – I think works fine if you’re changing every six months or so in a reasonably measured way, up against the speed of changes that were needed, I think it led to uncertainty.

“It wasn’t deliberate in any sense, and it wasn’t anybody, as I say, trying to walk away from responsibility, but uncertainty as to who finally was actually trying to both call this and communicate it.”

Sir Chris said one of the things which “we got wrong” during the early stages of the pandemic was communication between people giving infection control guidance and those working on the frontline.

He added: “It is sensible to say to people: ‘Our advice is professionally, we don’t think this makes a difference, but if you feel this is important for your particular situation, this is available for you’. And that might have been tricky right at the beginning because of what was available in the country at that point.”

He said that he did not use FFP3 masks when he was on the wards with people with Covid-19, adding: “My view about this is the guidance is usually there for a perfectly logical set of reasons.

“I did what I what was recommended, not out of the point of principle, but just because I think: ‘Fine, that’s what the experts have recommended. I’m comfortable with that.’

“But people clearly weren’t comfortable, and that that was our failure, was the fact people did not feel, for understandable reasons, comfortable.”

We did not make it clear enough NHS was open for non-Covid emergencies

Officials “didn’t get it across well enough” that people should continue to go to hospital for serious illnesses other than Covid, England’s chief medical officer has said, as he defended the fact not all patients could access NHS care.

Professor Sir Chris Whitty told the Covid inquiry in central London there was never going to be “perfect balance” when it came to stay at home messaging during the pandemic.

However, he said the UK faced an “absolutely catastrophic situation” as it headed towards the first Covid lockdown and, without such a measure, there were very serious concerns about how the NHS would cope.

Critics of lockdowns have pointed to the numbers of people who died from non-Covid conditions which may have been treatable, but where the person stayed at home or could not access normal NHS care.

Jacqueline Carey KC, counsel to the inquiry, asked Sir Chris: “Do you think that we got the balance right between telling people the NHS was open, but equally, protect the NHS, save lives, stay at home? What do you think about that balance?”

He replied: “I don’t think there was ever going to be a perfect balance on this one.

“I am confident what we didn’t do, was to identify over and over again – you couldn’t say it too often – that the NHS is open, in particular if it’s an urgent and emergency life threatening situation, you must go to hospital, as you usually would.

“And there is reasonable evidence, in my view, for example, that the number of people who came into hospital with heart attacks was lower than you’d predict, I don’t anticipate there’s any reason that had been fewer.

“So some of those people were staying at home, who otherwise would not have done, and they would have had remediable conditions.

“So the bit of it, which is, did we get it across that people should still go to hospital? I think we didn’t get it across well enough.

“We tried, I know we tweeted, we talked over the podium and so on. Whether we pushed too strongly on the messages the risks of Covid, I think that’s a much harder one, actually.”

Earlier, the leading medic was asked about one of the reasons for the first lockdown in March 2020, which was to prevent the NHS from being overwhelmed.

Ms Carey said: “Can I ask you this, was overwhelmed ever defined by those that were making that decision?”

Sir Chris replied: “Not really, and I think that it’s become, unfortunately, quite a loaded term where people, depending on what point they’re trying to make, either say things were or were not overwhelmed.

“I think the aim of it, though, was to minimise the number of people who died, both directly and indirectly from Covid.”

Describing the health harms from the pandemic, Sir Chris said there were direct harms from Covid – the number of people who died from the virus – and the indirect harms “that come from the system being overwhelmed or at least unable to cope… all diseases, not just Covid, having higher mortality rates than they would have had.”

He said people often forget that, at the time, Covid cases were exponentially rising, with a doubling rate of three to four days.

“At the point we are talking, about four doubling times more would have led us to an absolutely catastrophic situation,” he said.

“I’m not saying that where we were was anywhere short of incredibly difficult and, in many places, individual elements of hospitals, individual hospitals, individual bits (of) the system, were coping nowhere near where they would have been if Covid wasn’t there.

“That’s self evidently true, but if we had not had the lockdown, the expectation is that would have got a lot worse.

“I don’t mean just trivial worse, but really quite substantially worse.”

Asked if the NHS was able to function, he said the “NHS continued to treat sick patients throughout, it continued to treat people who did not have Covid throughout.

“In fact, most, I think, at all times, actually, there were more people in hospital who did not have Covid than had Covid.

“I think certainly for the great majority, I’m sure there were cases where that was not true, it wasn’t true in many ICUs.

“But, more generally, there was still a functioning health service. It was clearly functioning at well below the capacity than it would have normally.”

Sir Chris said the pandemic was “the largest medical emergency” since the Second World War in a high income country and this made the “system really not work anywhere near as effectively as it would if Covid had not been there”.

“But that’s self evidently true. If that were not the case, it would be extraordinary,” he said.

The inquiry heard about research commissioned by the inquiry among 1,683 NHS health workers, where more than half said some patients could not be escalated to the next level of care due to lack of resources during the first two waves of the pandemic.

Asked about those people who could not get NHS care they would otherwise have got, Sir Chris said: “I didn’t see any surprise in (the data in the research).

“I would caveat this by saying, if (people) in the middle of a winter in the NHS pre-Covid had been asked these questions, you would not have got a 100% everyone can be escalated to the next level.

“And I think it is unrealistic, even in those circumstances, to think this would have been the case.

“Pretty unsurprisingly for the biggest pandemic in 100 years for this country – the system was unable to escalate things in the way it normally would.

“That doesn’t seem to me a surprising statement.”

Turning to the “certainty” that a pandemic will occur again in the future, Sir Chris said you could increase NHS capacity “and, taking ICU in particular, the UK has a very low ICU capacity compared to most of our peer nations in high income countries. Now that’s a choice, that’s a political choice”.

Sir Chris, who worked on wards during the pandemic, said he agreed with the evidence presented to the inquiry by Professor Kevin Fong, former national clinical adviser in emergency preparedness, resilience and response at NHS England.

Prof Wong told the inquiry on Thursday morning harrowing details, including nurses wearing nappies because they could not take toilet breaks, staff buying visors at Screw Fix for protection, and hospitals piling up patients and running out of body bags.

“I think much of the trauma that was very powerfully laid out by Professor Fong in the last evidence – with which I fully concur, to be clear – was very apparent in many of the colleagues I had,” Sir Chris said.

During a discussion on long Covid, Sir Chris said he still worries about whether the Government got “the level of concern” right about the dangers of Covid in the beginning.

“I was worried at the beginning. I still worry, actually in retrospect, about whether we got the level of concern right,” he said.

“Were we either over pitching it so that people were incredibly afraid of something where in fact, their actuarial risk was low, or we were not pitching it enough and therefore people didn’t realise the risk they were walking into.

“I think that balance is really hard, and arguably, some people would say we, if anything we overdid it, rather than under, in the beginning.”

He said he was not certain “loading an additional risk on would, in itself, be useful”.

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