Expert denialism: federal Covid advisory committee slow to accept airborne evidence

Feb 19, 2021

Why the official reluctance in Australia to recognise aerosol transmission? 

The UK variant of Covid-19 has changed the game. Oz complacency and the ’relaxed and comfortable’ inaction by the Prime Minister can’t continue. The 40-70% more transmissible UK variant demands strong action.

Yet despite clear evidence about the dangers of aerosol transmission, the government’s expert body, the Infection Control Expert Group, is extremely reluctant to “abandon its outdated views about the transmission of Covid”.

The case for aerosol transmission has been made for months by the now familiar epidemiologists in the media, including Professors Raina MacIntyre and Marylouise McLaws. In July the World Health Organisation recognised airborne transmission aside from cough and sneeze droplets. So did the US Centers for Disease Control.

Back in August Raina MacIntyre spoke strongly against the expert denialists.

“In the midst of the worst pandemic of our lifetimes, we cannot afford to indulge the reasons for this ideology. Continuing to defend or excuse this ideology imperils the lives of healthcare workers, and distracts from the urgent task of keeping them safe at work.”

So why the official reluctance in Australia to recognise aerosol transmission? Despite research published in The Lancet and Nature, former federal deputy health officer Dr Nick Coatsworth asserted on ABC Q and A that aerosol transmission was a ‘live debate’.

This claims was immediately dismissed as ‘wrong’ by Associate Professor Michelle Ananda-Rajah and epidemiologist Professor Tony Blakely.  The Burnet Institute’s Professor Mike Toole (ABC Melbourne) also rejected what he saw as the ‘dogma’ of 1912 when aerosol transmission was not accepted.

After the outbreak at the Melbourne Holiday Inn, the president of the Australian Medical Association, Dr Omar Khorshid, said:

‘We need action now. Smart changes need to be made to airflow in facilities, and better personal protective equipment (PPE) including N95 masks and eye protection for workers in hotel quarantine.’

It’s most likely that these cases are the result of airborne spread, yet the experts advising Government, the Infection Control Expert Group,  have continually played down airborne transmission in the spread of the virus in hotel and healthcare settings.”

Dr Khorshid noted that the AMA and much of the wider medical profession had been calling for better responses to the risk of airborne spread of Covid-19 for months.

Meanwhile the Australian Society of Anaesthetists has lost confidence in the government’s guiding body, the Infection Control Expert Group. ASA president Dr Suzi Nou declared that ‘it‘s time for expert group to abandon outdated views about the transmission of COVID when the number of experts agreeing about aerosol transmission is increasing as rapidly as the virus’.

Masks matter, along with cleaning surfaces, hand-washing and social distancing. The US chief health expert Dr Anthony Fauci believes that universal mask wearing will save tens of thousands of lives and, facing new variants, the CDC has just recommended double masking.

We should condemn the virus denialists posting on Facebook but the problem goes deeper than that.

Public trust in expert advice is a problem when the ‘experts’ disagree. The ICEG, an almost invisible committee, and the AHPCC, don’t like masks. Their ‘Don’t mention the ‘M’’’ word policy marginalises mask wearing and goes against all the evidence.

Why do they do this? The hospital infection/infectious disease experts who comprise the mysterious Infection Control Group are not epidemiologists. Are they less confident about understanding transmission in the community, in different cultures and in the success of the mask-wearing countries of North East Asia? Are hospital clinicians uncomfortable with non-laboratory observation and demographic research?  Or can committees just become too comfortable, even smug?

The Federal Health minister Greg Hunt’s suggested in September an ICEG report on airborne spread but that has come to naught. No report has appeared.

The battalions of professional epidemiologists in the universities and the AMA and fluid transmission researchers have long recognised aerosol transmission and therefore the importance of wearing masks; they are frustrated at governments slow to recommend and mandate masks, particularly the NSW government.

In a December letter to the journal Antimicrobial Resistance and Infection Control Raina MacIntyre and Michelle Ananda-Rajah argued that “scientific evidence supports aerosol transmission of SARS-COV-2”.

Australia would be in for ‘more groundhog days’ if advice did not change, says the Burnet Institute’s Mike Toole.

“Why does this keep happening? The answer is that there is no national standard and a stubborn resistance to taking aerosol transmission seriously. This is going to keep happening again and again until the aerosol transmission is taken seriously.”

The week-long media cycle is fascinated by dramas: by lockdowns, by who is to blame for quarantine infections and the arrival of the magic bullet, the vax. Talkback callers rightly and wrongly blame the Andrews government: there have been serious PPE failings in quarantine hotels.

Public debate needs to look beyond tabloid tales and dramas. The failure of the Infection Control Expert Group to recognise airborne transmission is the problem, not the epidemiologists. The epidemiologists and the AMA tear their hair out in frustration as they seek, to no avail, to follow the primary goal of medicine – to do less harm.

The uncertain ‘vaccine wall’ won’t be fully functional until April. The quarantine frontline urgently needs improved PPE and “mitigating airborne transmission ventilation and other building engineering measures”.

If not, we will have a third – and fourth – wave and more deaths, more “long Covid” illness and everyday restrictions.

The federal committees have left Australia with one hand tied behind its back, although under pressure the ICEG has made noises about reviewing its airborne transmission advice. The federal government needs to act after listening to the epidemiologists.

In the words of the AMA, and the Society of Anaesthetists, ‘we need action’. It is a matter of life and death.

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