Dr Evonne T Curran NursD 💙🇺🇦
@EvonneTCurran
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If we don't investigate and own up to our mistakes as a profession, we are lost. Our job (IPC) is to keep people safe. When we make mistakes we correct them.
Joined May 2012
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So, it's not often you're having tea when you spot a Nobel laureate. A delightful. gentlemen. Peter Ware Higgs, theoretical physicist.
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So is this correct?
The planes are not airborne because covid is airborne...
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At the dentist an alarm rings.
Dentist: is that your alarm?
Me: Oh yes, that's my CO2 alarm. It's over 1500
Dentist: we have bad air?
Me: yes
Dentist: is that why I am always tired? Puts the ventilation on (it was put in for covid)
Wanted to say could be the CO2 could be long C
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BREAKING: NHS England is to release an IPC Manual at the end of March which says COVID-19 is spread via DROPLETS
SARS-CoV-2 is transmitted by aerosols (and droplets) and thus HCWs need RPE and cleaned air.
Evidence of droplet-only-resp transmission DOES NOT EXIST.
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Ok you job today is to identify whether the authors have a bias against N95s
"We found no evidence that the more expensive, irritating and uncomfortable N95 respirators were superior to simple surgical masks."
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Could someone tell me which scientific papers people are reading which show it will be safe (no harm done) to anyone by the removal of masks in care settings.
I cannot find any.
Doing it cos others are, is neither sound nor evidenced.
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There is no respiratory infection for which the most important transmission preventing action is hand washing.
None.
We all know that measles is spread by aerosol: it's an airborne virus. So why does the public-facing NHS advice (below) falsely say that measles is spread by 'coughs and sneezes'? A short 🧵
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Still reading the book. Amongst many brilliant lines and forensic analyses, this...
"The idea that the best way to protect yourself from a virus is to get the virus is like using pregnancy as a form of contraception."
👏👏👏👏
@19joho
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The decision-making was wrong because the situation assessments were wrong.
The situation assessments were wrong because the precautions wrong.
The precautions were wrong because the guidance wrong.
The guidance was wrong because the modes of transmission were just made up.
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I don't understand how these measures will keep children safe in schools when they do not address the primary mode of transmission - airborne.
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Absolutely shocked by the mode of transmission error here in Scotland.
Covid is airborne.
You cannot control an outbreak with the wrong measures
@P_H_S_Official
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Explosion just went off at the
#CovidInquiryUK
Words to the effect:
We just never considered the vulnerable...
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I met important people today. I made several strong arguments in support of covid being airborne. I hope I did sufficient to change minds.
Here are the arguments:🧵
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Bet those CO2 monitors and HEPAs look cheap now...
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I am at a loss. There is removal of mitigations in hospitals with a nosocomial acquisition of 30%.
The C of Practice says - all nosocomial infections should be prevented...
Q: what is the goal with regard to the prevention of nosocomial of SARS2?
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To all those who have not stopped trying to reduce airborne transmission using physics, engineering, statistics, contradictions in guidance, connections in data, showing a lack of legal H&S decision-making, ethics, education, truth and
proposing safer decision making.
Thank you
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This is a tragedy we are allowing to unfold in our children
Thorough review of long covid in kids. Just published. Expect the minimisers to keep doubling down as the evidence of significant harm continues to mount. Admitting their role in the harm would lead to personal and professional annihilation.
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For clarity, no one has published any scientific evidence during this pandemic to evidence droplets as a dominant transmission mode.
No one.
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It seems we have prevention programmes for many diseases, e.g. cancer / heart disease. But NONE for an infectious virus which is causing cancer and heart disease....
Could someone wake up public health
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The best summary of 'COVID is airborne' comes from
@trishgreenhalgh
A mental model of the 10 reasons its airborne
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Airborne viruses predominantly cause infection by inhalation. Not by contact.
Clue is in the name, 'airborne'...
#BeatWinterViruses
with good handwashing 🧼.
Airborne viruses like flu and COVID-19 linger on surfaces we touch daily.
Washing your hands with soap and water for at least 30 seconds will eliminate germs before passing them on.
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Cleaning the air and masking are the best ways to prevent transmission of SARS-CoV-2 in hospitals. But we can't be bothered with evidence, so we are going to blame it on you and your hand hygiene. Stop it
@NHSuk
Washing your hands with soap and water is one of the easiest ways to protect yourself and others from viruses like norovirus, flu and COVID-19 - and it helps reduce pressures on healthcare services.
➡️
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Perhaps if the head of immunisation thinks the UK can stop an airborne virus with hand washing, its time to get another spokesperson.
Is this mis-prevention recommendation activity deliberate
@UKHSA
?
1:10,000 according to the CDC
Dr Mary Ramsay, Head of Immunisation at the UK Health Security Agency (UKHSA) said on this week's report 🔽
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So I have a question
@P_H_S_Official
If influenza is transmitted 1 day before symptoms, how is it spread via coughs and sneezes that have yet to develop?
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Update: to include transmission in an empty room 4+hrs post the infectious occupant leaving
When you have eliminated the impossible transmission routes, those that remain, however much they don't fit in to your biased paradigm, must be/include the truth.
Its airborne
Apols to SH
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It does not make sense to aim to prevent MRSA bacteraemia, + MDROs, + CDI, & device related infections if the patients get COVID.
The more you get COVID the more your chance of long term harm.
The mortality is significant.
Prevention of SARS-CoV-2 must be primary.
Over 83,000 people with hospital-acquired Covid-19 in a year (and likely an underestimate!). Many of these will have died.
For reference, c.diff reports are about 5,000 a year. MRSA bacteraemia about 1,000. These are infections that we (rightly) are working hard to prevent.
2/
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My comments on the Cochrane mask review are up. Apparently when evaluating studies to find out if masks work you don't need to define transmission modes, or whether the mask was capable (by design and as worn) to prevent transmission...
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The Coroner, looked at the crowded assembly, directed all the windows to be opened. This caused commotion. The Coroner said that with the influenza about again an unventilated room was a death-trap.
Whose Body. Dorothy L. Sayers. Ch VI 1923
@CathNoakes
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Correct.
If only you said it was airborne from the start....
@WorldHealthSmt
@DrTedros
@Karl_Lauterbach
@AlsisiOfficial
"One of the great tragedies of
#COVID19
is that none of this had to be that way.
We cannot let the painful lessons of the pandemic go to waste.
That is why WHO has developed a plan for a more equitable, inclusive and coherent global architecture for health emergency
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Today I wrote to the UK's CNOs. I made 9 points in support of the argument that airborne diseases necessitate airborne precautions. The points made were as follows:
1) Droplet precautions applied globally have failed to contain this pandemic and prevent nosocomial infections
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So I have a question....
Why if you cannot diagnose COVID without a test
And COVID is a notifiable disease
Is it possible to have a standing instruction not to test for COVID?
h/t
@DRTomlinsonEP
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"Prevention of SARS-CoV-2 transmission to patients with cancer should be prioritized to minimize impact on cancer treatments and maximize quality of life for individuals with cancer during the ongoing pandemic..."
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I wrote a paper that pointed out over the past 30 years through 5 versions of guidance authors had removed all recognition that MRSA was disseminated by the air.
It's been - 'air-brushed'
Paper rejected yesterday.
So to answer your question, I'm lost.
Because MRSA is airborne.
And looking at the other HAIs? An awful lot of other airborne pathogens lie at their root.
But anywho....
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There never was evidence for droplets
The
@WHO
said it was droplets
& those charged with guidance said it was droplets
& still do so.
Its airborne
'The NHS sold out its staff': Doctors whose lives were devastated by long COVID to sue health service
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Why would you continue to put the workforce in a surgical mask which is not designed to prevent transmission by inhalation as a defence against a disease which is transmitted via the air and enters to infect via inhalation?
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For those who only read the abstract read this...
"All masks & respirators [tested] significantly reduced exhaled viral load without fit tests or training"
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So if its very dangerous for some, why are you not protecting them with masks in healthcare ?
For some, flu or COVID-19 can be very dangerous and even life-threatening. Flu and COVID-19 vaccines reduce the risk of serious illness in colder months.
Find out if you’re eligible and book now at or on the NHS App.
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Please elaborate on your plans to stop a driving force for community transmission of SARS-CoV-2 - school classrooms.
If the classrooms could be better ventilated, children would not be infected so many times and they would not spread it to fellow pupils.
Time in the classroom is important and even small moments in a school day make a real difference to children's lives. Increases in persistent absence have been reported as a post-pandemic challenge in schools around the world.
1/5 🧵 Here’s how we're improving school attendance
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I have now written to the Nursing and Midwifery Council to ask for an opinion as to whether the
@UKHSA
Is forcing HCWs to break the Code of Practice, specifically section 4 and 19.
@CNOEngland
@profalexmcmahon
@CNOWales
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I am so bitterly disappointed in the
@WHO
.
Enough.
Can someone ask
@mvankerkhove
to explain why
@WHO
Geneva Campus in spring 2020 modified their ventilation system with increased air supply, better air filtering and no recycling of air?
Was it so she could safely spread this message?
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"COVID has not gone away..."
Then why have you stopped the precautions?
Dept of Health
#CovidInquiry
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Reminder: Scotland has just admitted that everything they said about the droplet / aerosol dichotomy was wrong.
4-years after a lit review & 10 mths into the pandemic, they said this.
Where is the apology?
Scotland ARHAI... "the clear inadequacy of the droplet/airborne dichotomy"
I think they just admitted all they wrote about pandemic transmission was wrong
Of course, it is without regret, reason or remedy
No words - well not that I am putting down here
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So are we all to get infected to prevent getting infection...?
She just told
#r4today
most the population will get a boost to their immunity when they come into contact with the new variant...
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Just in case people still think it's masks or lock downs
It was and is the virus...
Did you know that the CDC says that Covid infection has an effect on the immune system?
And that it's likely to increase the risk of fungal infections?
Can I say a polite *fork you* to everyone who told me that Covid doesn't affect the immune system?
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Oh hang on
CV people should ask visitors to
- keep their distance
- test pre visit
- wear a mask
But go to health care, share spaces with positive patients, and no masking and just put up with it
Fails the DIMS test - it does not make sense
Fails ethics
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Thread is 140 posts long.
Most important thread you'll read - possibly. It's full of science and critical thinking and it's why droplets are NOT the driver of this pandemic but aerosols.
Mandatory for all in IPC. HNY.
1/ What were the historical reasons for the resistance to recognizing airborne transmission during the COVID-19 pandemic?
Our peer-reviewed open-access paper is now published:
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Yes, Yes, Yes, Yes, Yes, Yes
Standard precautions should include 'safe ventilation' to minimise far-afield airborne transmission in health and social care settings.
Of course that would involve changing the guidance from droplets - lets go for it.
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Great. Can we start with the pandemic.
The mental models for transmission have been done by world experts in aerosols (not IPC).
Here is of
@trishgreenhalgh
's evidence on the virus being airborne.
How about discussing infection prevention and control (
#ipc
) knowledge integration as a human factors and ergonomics (
#hfe
) challenge? What are the
#mentalmodels
needed?
@WHO
@allegranzib
@jonotter
@eliowa
@ermiratartari
@AysePGurses
@CelineGardiol
@julesstorr
@a_stewardson
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7 slides showing that neither CDC nor WHO presented evidence for the existence of droplet transmission
You may have seen this from the WHO most pandemic refs refer to it - note lack of evidence (its not in 5), and in the def or aerosols it says 'its not yet clear'
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I can understand governments.
I cannot understand
@UKHSA
, those in public health, those who write national IPC guidelines, or those who write IPC society guidelines.
Speak, write, act - this is an airborne virus and airborne mitigations are needed to prevent transmission
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In awe of
@SalWitcher
in the
@HMcArdleHT
piece Herald. People know nosocomial transmission happens. Yet, in the face of high HAI the action - stop the data. Stopping data wont stop transmission.
Admit airborne, povide IAQ, resps & keep people safe. Show the data. Prep 4 winter
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They have withdrawn masks in Scotland's Healthcare system and referred 'concerned staff' to complete a risk assessment.
Lets fill out their risk assessment...
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And here it is Appx 5.
They could not agree that short-range airborne = airborne precautions because it would cost money.
NOT because they don't need RPE, but because Legal, Logistic, Operational, Financial and global implications re equity & access.
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I don't remember voting for living with any virus that is
a) killing people (of all ages)
b) transmitting in hospitals & care settings with lethal consequences
c) resulting in so much long term sick
d) harming children and their long term health prospects
@UKHSA
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There is no point trying to prevent some but not all HAIs. None.
There is no point, honesty, or reality in doing QI unless you do COVD prevention.
Why aren't infection prevention societies screaming?
I resigned. I can't be part of an organisation allowing this.
Upcoming life support training. What is so striking is the effort and care we put into this, while ignoring everything we have learned about the dangers of infectious disease transmission from healthcare workers to critically ill patients. Odd, isn't it?
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Here is my suggestion.
Put it down.
Pick up the phone to some aerosols scientists.
Get them in the room, and start again.
Deference to experts and expertise - IPC are not experts on aerosol physics or transmission.
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Is my child's school too ill for my child?
Perhaps parents are (or should be) instead asking "Is the school too ill for my child"?
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Everyone who said it was droplets because CDC/WHO said it was (including me) and who now believes droplet only resp transmission does not exist, what have you done about it?
Who have you told?
Only by all sharing that we are working with a nonexistent paradigm can we change it.
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Hands - wash them
Face - cover it
Distance - keep it (2m)
Windows - open them
Crowds - avoid them
Surfaces - clean them
How hard is that.....
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It's neither a cold nor the flu.
It's not being prevented in hospitals, or schools on national instructions. There are no treatments yet.
For you today
@jasonleitch
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One priority risk for the world is this:
The people who made this level of error are still in position to do it again.
🧵February 7, 2020.
@DrMikeRyan
on the cruise ship outbreak :
“Let’s be careful not to overreact..Remember, in SARS..this disease isn’t airborne..[😳]there was a great scare that this was airborne..It didn't turn out to be so..
a cruise ship is a very particular environment.”
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I promised a review
@19joho
“This book is fundamentally about the obligations doctors [and nurses] have when communicating with the public [and colleagues] about a deadly virus.”
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Am laughing now...
"The term 'through the air' is similar to waterborne, and bloodborne ..."
It would be more similar if they called it 'airborne' ....
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Well lets start by reducing staff and patient exposure to an airborne pathogen by applying airborne precautions.
BBC News - NHS struggling to open extra winter beds and fill staffing gaps
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The CMO/CNO letter on removal of masks in Scotland was examined.
The case from the CMO/CNO is shown in blue.
The CMO/CNO's situational awareness assessment omitted the harms from the decision (and the benefits of the status quo) summarised here.
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I think Dr Berger's question is critical for all in IPC.
Because if you don't prevent the most significant preventable infection what is the point of IPC.
Are infection control professionals still worth having?
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To be Clear. Evidence based guidelines are for following. Opinion pieces from renowned scientists are for considering. Individual single papers are for noting. Tweets themselves are not evidence of anything.
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Well, that is inevitable when you apply droplet precautions to try to stop an airborne virus.
Covid is continuing to cause more disruption to the health service than all other infectious diseases combined (norovirus, flu, RSV etc) when in comes to sheer numbers of ward closures. That's a major headache for NHS capacity and recovery
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Let's take a look at where we are:
We have normalised a pathogen that's breaking the NHS with cases.
We are advocating
- droplet precautions for an airborne virus.
- airborne for AGPs which fails the DIMS test
HAI covid is through the roof.
Anyone for the engineers taking over?
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I think it is wrong to label
@UKHSA
'experts' when they fail so appallingly on infection prevention and control.
This is an airborne virus. Wash your hands all you like but don't expect the outcome to be sufficient to prevent cvd.
Masks, ventilation yes.
"UKHSA experts recommend regular handwashing and staying away from others where possible if you have symptoms of a respiratory illness."
Yes, by all means, wash hands, the second part is spot-on... but there's something missing 🙄😷😷😷😷😷😷😷😷😷😷😷😷
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"Meanwhile, those inactive because of long-term sickness increased to a record high." ONS
Everyone repeatedly getting COVID & increasingly becoming long term sick is
not a viable economic strategy
not a viable economic strategy
not a viable economic strategy
or an ethical one.
Headline indicators for the UK labour market for February to April show:
▪️ employment was 76.0%
▪️ unemployment was 3.8%
▪️ economic inactivity was 21.0%
➡️
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What makes COVID the disease we should not count and the disease we should not prevent?
If we don't count this disease, why do we need to count, any other disease?
Also, if we don't prevent this disease, why prevent any infectious disease?
What would you call an epidemiologist who doesn’t want to monitor cases of infectious disease? An ex-epidemiologist? An anti-epidemiologist?
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Reality check
Just another winter virus ❌
Herd immunity ❌
Only over 65s need vaccine ❌
Droplet spread ❌
No requirement for airborne precautions in schools /hospitals❌
It will be fine next year❌
Need to regularly get infected ❌
Stop listening to the people getting it wrong
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So not immunity debt or mask wearing then
It was exposure to covid
....preventing covid and covid associated diseases, including RSV
lets prevent that damage on the immune and respiratory system... for you today
@jasonleitch
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Its not just the
@WHO
have admitted AIRBORNE they have dumped droplets
So 'probably droplets' must be dumped as well....😉
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Ok so an update of the 10 scientific reasons
@trishgreenhalgh
pic,
& it went backwards on a bus 5m,
& it stayed in the air for 4+hours
& now - infections between cinema screenings 3 to 4 & 5
And your evidence for droplets is where...
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Yesterday at Inq - was hard hitting
Its clear now...
We followed the guidance wont do.
We followed the WHO wont do.
Wake up call: its still airborne, its still transmitting, its still causing serious harms and its still killing.
& IPC still have guidance saying - droplets.
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Unsafe for people...
Unacceptable for those who must comply with a Code of Practice
Lancashire Teaching Hospitals. Sent to all staff yesterday, staff not to test unless on Ribbelsdale (inpatient oncology) or ward 25 (renal). No-one else should test, incl outpatient oncology clinic, cancer treatment centre, and dialysis.
I despair...
@ShaunLintern
@PMGallagher1
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To be clear, it spread from the driver to the riders of the bus.
It spread backwards on the bus. Airborne then.
No AGPs were undertaken on the bus.
Ergo, you don't need an AGP for airborne transmission in hospitals.
Buses can be one of the highest risk settings for spread of COVID. Here's why: 👇
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This is an outstanding thread on norovirus transmission. Faecal oral route for norovirus is a misnomer.
Perhaps one for your podcasts
@emrsa15
If its in the air - and it is in the air - we have to rethink prevention
Source-to-infection pathway might look like this...
#NorovirusIsAirborne
.
#Norovirus
is airborne. 🧵
As always fomites and droplets are not ruled out.
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Excellent
@wesstreeting
Can we have honesty in the situation awareness of COVID as well?
Including nosocomial COVID an in the prevention needed
CQC should be asking COVID questions - its not ok to get covid in hospitals.
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1 It is illogical in the UK guidance to write that SARS-CoV-2 is spread via droplets, and droplet precautions are required, because the definitions used for airborne fits within the definition of droplets!
There is no evidence for droplet only respiratory transmission.
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How can the biggest cause of death be - we don't have a clue....
Oh my word, you've probably seen this already, but this is the ONS breakdown of excess deaths in the UK...
The top killer in March was... wait for it... "symptoms, signs and ill-defined conditions", which would be hilarious if it wasn't excess deaths we're talking about. 😮
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We don't have to keep infecting people in our hospitals and care settings with a vasculopathic, cardiopathic and neuropathic virus.
There is a plan 'B'
If you are a decision-maker and going with plan A, please provide evidence of safety - I cant find it.
PPS if you pay staff...
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Reality check for those in PH who were yesterday blasted by the
#CovidInquiryreport
for groupthink and a lack of prevention.....
You are still doing it...
Long COVID puzzle pieces are falling into place – the picture is unsettling!
My piece in The Conversation
@ConversationUS
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I read it
This pandemic is spread via AIRBORNE TRANSMISSION
Preparedness for another via AIRBORNE TRANSMISSION MUST involve
Aerosol scientists
Indoor Air Quality
RPE
This WHO doc omits all of the above
It will not prepare the planet for the next one
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So very disappointed to read this response.
It begins with the statement below...
I'll be honest I cant find any evidence that there is continuous reviews of the evidence but lets take a look.
Where are they published; how are they done?
What is the difference between a 'restriction' and a 'protection'?
Today, the government responded to Clinically Vulnerable Families' petition.
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Serious question:
Who owns (which specialty) owns covid, its complications, its prevention, its treatment, its long-term sequalae?
Who is doing / leading on the guideline, surveillance, prevention, treatment, and complications?
The answers are absent in the NIPCM.
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So 20yrs post SARS1
4yrs into SARS2
We now have great definitions of airborne transmission & a risk assessment for IAQ
How do we get to the bit where we have and monitor indoor air quality and prevent inhalation transmission in hospitals.
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Come on
@guardian
get a grip.
The evidence is not hard to find.
It was not the lockdowns what did it.
It was the virus that damaged the brains, immune systems and other organs, and caused repeated infections virus leading to long covid...
Don't go all daily mail on cvd.
🚨🚨Hands down the worst piece of minimisation of the long term health effects of Covid infections I've yet seen from
@guardian
and
@hannahdev
.
Genuinely awful.
Please tell them how bad this is.
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As the author this is difficult to comprehend. It's all referenced to published peer reviewed scientific literature. The ref to the WHO preparedness doc and the absence of physics therein is there for all to see.
My LinkedIn account will be deleted.
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why are we doing this to people?
A new study has shown that Covid‐19 may have a small, but lasting impact on people’s cognitive and memory abilities, potentially for a year or more after infection ➡️
@NHSEngland
@imperialcollege
@ImperialBRC
[1/4]
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Dear
@ukhsa
measles is airborne and hand hygiene is woefully inadequate.
Measles transmission is airborne, yet the best
@UKHSA
teams can come up with is this
What about letting in some fresh air?
What about face mask (preferably respirator) use?
Why is the UK health security agency so weak on public health messaging towards cleaner air?
@SMHopkins
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So many people are looking at reality, and they just can't see it...
It is airborne
It is not seasonal
Risk can be made visible (CO2)
It is preventable
"not yet developed a clear seasonal pattern"
'yet' doing an extraordinary amount of heavy lifting here. 🙄
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"Covid Risk Patient Placement"
The placement of a patient in a multi-bedded area where patients or staff therein are likely to be infectious or incubating SARS-CoV-2
This is against the CQC fundamental safety standard: you must not put patients at risk of harm...
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I talk about covid because hosp acq covid levels are obscene and the IPC guidance is based on a misinterpretation of evidence.
Covid is airborne and we need IAQ in hosps, HCWs need respirators, to prevent covid being acq in hospitals by both patients and staff.
1/ Hi Meaghan - I talk a lot about Covid because I genuinely believe that letting a novel coronavirus that has the potential to cause significant long-term health problems in some of those infected rip through society using only a vaccine strategy to mitigate is a bad idea.
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I think its beyond time that journals and societies are brave and start reporting the...
- what we got wrong
- how we got it wrong
- how we are going to make sure that never happens again
or are we expected to believe in unevidenced droplets forever?
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Can we agree what the shared mental model of this pandemic looks like?
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