UK Inquiry Module 3: Impact on UK Healthcare Systems

[elbows]

The public hearings for module 3 have begun.

I do not have the same mount of time and energy with which to cover this module as I started with when covering the evidence sessions for modules 1 & 2 (and indeed I ran low on time etc before module 2 ended). I shall probably be forced to rely much more on press reporting, and will probably only get the opportunity to dig deeper into the evidence on the occasions that a handful of topics which are of extra special interst to me come up (eg hospital infection control to just name the most obvious one).

It would be great if anyone else has time to contribute to this thread but no worries if not.

Today is mostly about the harrowing intro video, featuring stories of various people affected, and opening statements from legal representatives of core participants. I will have time to highlight the timetable for who is giving evidence each week when each of those is published.

 

[elbows]

The impact film for this module is here, I have not watched it yet:

 

[Silas Loom]

elbows is long covid going to be discussed in this module?

 

[elbows]

elbows is long covid going to be discussed in this module?

Yes, to the extent that the final item in the list of topics in the provisional scope document for this module is:

12. Characterisation and identification of Post-Covid Condition (including the condition referred to as long Covid) and its diagnosis and treatment.

From https://covid19.public-inquiry.uk/w...3-Provisional-Outline-of-Scope-in-English.pdf

I havent had time to check what other future modules may also cover long covid in some way.

 

[elbows]

That list in full:

1. The impact of Covid-19 on people’s experience of healthcare.

2. Core decision-making and leadership within healthcare systems during the pandemic.

3. Staffing levels and critical care capacity, the establishment and use of Nightingale hospitals and the use of private hospitals.

4. 111, 999 and ambulance services, GP surgeries and hospitals and cross-sectional co-operation between services.

5. Healthcare provision and treatment for patients with Covid-19, healthcare systems’ response to clinical trials and research during the pandemic. The allocation of staff and resources. The impact on those requiring care for reasons other than Covid-19. Quality of treatment for Covid-19 and non-Covid-19 patients, delays in treatment, waiting lists and people not seeking or receiving treatment. Palliative care. The discharge of patients from hospital.

6. Decision-making about the nature of healthcare to be provided for patients with Covid-19, its escalation and the provision of cardiopulmonary resuscitation, including the use of do not attempt cardiopulmonary resuscitation instructions (DNACPRs).

7. The impact of the pandemic on doctors, nurses and other healthcare staff, including on those in training and specific groups of healthcare workers (for example by reference to ethnic background). Availability of healthcare staff. The NHS surcharge for non-UK healthcare staff and the decision to remove the surcharge.

8. Preventing the spread of Covid-19 within healthcare settings, including infection control, the adequacy of PPE and rules about visiting those in hospital.

9. Communication with patients with Covid-19 and their loved ones about patients’ condition and treatment, including discussions about DNACPRs.

10. Deaths caused by the Covid-19 pandemic, in terms of the numbers, classification and recording of deaths, including the impact on specific groups of healthcare workers, for example by reference to ethnic background and geographical location.

11. Shielding and the impact on the clinically vulnerable (including those referred to as “clinically extremely vulnerable”).

12. Characterisation and identification of Post-Covid Condition (including the condition referred to as long Covid) and its diagnosis and treatment.

From https://covid19.public-inquiry.uk/w...3-Provisional-Outline-of-Scope-in-English.pdf

 

[elbows]

Witness timetable for this week (not sitting on Friday):

Tuesday:
Morning
Opening Statements Core Participants
Afternoon
John Sullivan (Covid-19 Bereaved Families for Justice – Impact evidence)
Paul Jones (Covid-19 Bereaved Families for Justice Cymru – Impact evidence)
Carole Steele attending remotely (Scottish Covid Bereaved – Impact evidence)

Wednesday:
Morning
Catherine Todd attending remotely (Northern Ireland Covid Bereaved Families for Justice – Impact evidence)
Professor Clive Beggs (Expert in Infection Prevention and Control)
Afternoon
Professor Clive Beggs (Expert in Infection Prevention and Control) (continued)

Thursday:
Morning
Dr Barry Jones (Chair of the Covid-19 Airborne Transmission Alliance)
Richard Brunt (Director of Engagement and Policy Division, Health and Safety Executive)
Afternoon
Richard Brunt (Director of Engagement and Policy Division, Health and Safety Executive) (continued)
Sara Gorton (Head of Health at UNISON and co-chair of the NHS Staff Council, Trades Union Congress)

I shall try to cover Clive Beggs evidence in much depth since thats a subject I never stopped banging on about.

 

[elbows]

Already it has been mentioned in the counsel to the inquiries opening statement that one witness will say that over 100,000 people were likely infected with Covid in hospital (nosocomial spread).

 

[elbows]

If I get a chance I will also focus on the idea that the picture we were given of a healthcare system that avoided getting completely overloaded by covid demand, that we avoided 'NHS collapse or the sight of patients stuck waiting outside hospital in despair as seen in a few countries" was something of a lie, because actually there were moments in some places where they artificially reduced demand by denying admission to some people who needed hospital treatment for covid. There are a number of different ways this might have been done, and one has already come up.

In opening remarks the inquiry counsel just mentioned temporary changes that were introduced to the ambulance patient triage system, "for patients who contacted the service with confirmed or suspected covid - this was known as protocol 36, and in short if protocol 36 applied the patient was triaged into a lower category and had to wait longer for an ambulance response".

 

[elbows]

Apparently there is an ambulance worker in the video that spoke of the difficult decisions they had to make. I still havent had a chance to watch it yet.

On the same broad theme this came up on the screen:

 

[elbows]

There was also a graph that showed how levels of transfers between critical care units rose (transfers that are normally a last resort and are far from ideal).

 

[Silas Loom]

Yes, to the extent that the final item in the list of topics in the provisional scope document for this module is:



From https://covid19.public-inquiry.uk/w...3-Provisional-Outline-of-Scope-in-English.pdf

I havent had time to check what other future modules may also cover long covid in some way.

Will be very interested in who the enquiry considers to be an expert in that respect. My expectation is that whoever is fielded and whatever is recorded, the patient community will be unimpressed.

 

[Maltin]

That list in full:

1. The impact of Covid-19 on people’s experience of healthcare.

2. Core decision-making and leadership within healthcare systems during the pandemic.

3. Staffing levels and critical care capacity, the establishment and use of Nightingale hospitals and the use of private hospitals.

4. 111, 999 and ambulance services, GP surgeries and hospitals and cross-sectional co-operation between services.

5. Healthcare provision and treatment for patients with Covid-19, healthcare systems’ response to clinical trials and research during the pandemic. The allocation of staff and resources. The impact on those requiring care for reasons other than Covid-19. Quality of treatment for Covid-19 and non-Covid-19 patients, delays in treatment, waiting lists and people not seeking or receiving treatment. Palliative care. The discharge of patients from hospital.

6. Decision-making about the nature of healthcare to be provided for patients with Covid-19, its escalation and the provision of cardiopulmonary resuscitation, including the use of do not attempt cardiopulmonary resuscitation instructions (DNACPRs).

7. The impact of the pandemic on doctors, nurses and other healthcare staff, including on those in training and specific groups of healthcare workers (for example by reference to ethnic background). Availability of healthcare staff. The NHS surcharge for non-UK healthcare staff and the decision to remove the surcharge.

8. Preventing the spread of Covid-19 within healthcare settings, including infection control, the adequacy of PPE and rules about visiting those in hospital.

9. Communication with patients with Covid-19 and their loved ones about patients’ condition and treatment, including discussions about DNACPRs.

10. Deaths caused by the Covid-19 pandemic, in terms of the numbers, classification and recording of deaths, including the impact on specific groups of healthcare workers, for example by reference to ethnic background and geographical location.

11. Shielding and the impact on the clinically vulnerable (including those referred to as “clinically extremely vulnerable”).

12. Characterisation and identification of Post-Covid Condition (including the condition referred to as long Covid) and its diagnosis and treatment.

From https://covid19.public-inquiry.uk/w...3-Provisional-Outline-of-Scope-in-English.pdf

This seems quite a lot to scope in. Do you know how long this module is likely to last?

 

[elbows]

This seems quite a lot to scope in. Do you know how long this module is likely to last?

4 days a week from now till 28th November. With 2 weeks off in October. The same sort of rushed pace as the previous 2 modules.

 

[elbows]

Apparently there is an ambulance worker in the video that spoke of the difficult decisions they had to make. I still havent had a chance to watch it yet.

On the same broad theme this came up on the screen:

View attachment 441907

The full document detailing the findings of this staff survey based study has been published here:

https://covid19.public-inquiry.uk/wp-content/uploads/2024/09/09173747/INQ000499523.pdf

 

[elbows]

Having had time to listen to many of todays opening statements, I was reminded of just how many topics of vital importance will come up that I wont be able to cover, either because of a lack of time or because I dont feel I am well informed enough to convey the full details properly or undo any spin. This includes a large amount of stuff relating to how people were left isolated by stuff such as severe restrictions on visiting people in hospital. Harrowing account of women who lost their baby during pregnancy but were unable to have their partner with them at key moments are just one example of this.

 

[elbows]

An extract from opening remarks by a representative of 13 Pregnancy, Baby and Parent Organisations and Clinically Vulnerable Families, from pages 160-161 of todays transcript. https://covid19.public-inquiry.uk/w...9-Inquiry-9-September-2024-Module-3-Day-1.pdf

I am restricting myself to just quoting a part pf what they said that relates to airborne transmission:

A crucial question, we say, is: what are the implications of what we know now? Ms Carey this morning referred to the Inquiry's important forward-looking perspective. That is music to the ears of CVF. The fact that Covid is airborne is an inconvenient truth, because it undermines many of the major messages given out during the pandemic to the public. Hands, Face, Space. What about air? It undermines much of the guidance which was the foundation of how patients and healthcare workers were protected or, as it turned out, unprotected.

For many of the pandemic the clinically vulnerable and clinically extremely vulnerable were told: if you follow some simple rules you'll be protected, you will be shielded. But as the evidence in this module will show, there was a paradox. The people who were given the strictest precautionary advice at home were the same people who were most likely to have to spend time at GP practices and in hospitals, and there they were exposed to a serious risk of contracting Covid-19. The clinically vulnerable were told to take personal responsibility, wash their hands and keep their distance.

But by focusing on personal responsibility, public authorities may at the same time have been washing their hands of their own responsibility. Patients cannot be responsible for the environments in healthcare settings. Institutions are responsible for those environments. The realisation that Covid-19 is airborne requires a paradigm shift in our understanding of how to protect everyone from the virus, and any airborne pathogen, including the flu. We need better ventilation, air filters, high quality masks.

Good ventilation is key, as Ms Carey said this morning. In one sense the pandemic has been the greatest ever missed opportunity to educate the public on those simple mitigations. Improving air quality would be the simplest improvement in infection prevention and control since hand washing. Improving conditions for the clinically vulnerable means improving conditions for all.

We trust, Chair, that now you have such high quality and conclusive evidence, not just me holding up an air monitor, for example from Professor Beggs, that your Inquiry will not squander the same opportunity, or we will be back to square one now and when the next pandemic hits.

 

[elbows]

Will be very interested in who the enquiry considers to be an expert in that respect. My expectation is that whoever is fielded and whatever is recorded, the patient community will be unimpressed.

There has already been disquiet from some other groups in regards who was not accepted from their list of submissions in regards who should be called as a witness.

Regardless of those failings, I am still there will still be moments where some of the bullshitters claims are contradicted by other witnesses.

If you would like to read the opening remarks by the representative, they are to be found on the pages numbered 134-141 of todays transcript. I would love to quote it all but copying & pasting isnt smooth for these documents, I have to do loads of manual work to fix the format and its too exhausting to attempt this for lengthy passages. Instead I will just quote a very small portion of it:

Second, the understanding of Long Covid has been and continues to be impeded by delayed and then inadequate and now abandoned data gathering and research on both the prevalence and degree of impact of Long Covid.
There has been no publicly recorded data on the prevalence of Long Covid since the ONS winter infection study was closed in March 2024. NHS England cannot feasibly model current and future demand for Long Covid services in the absence of any current data on the need for such services. Research into Long Covid has been insufficient and delayed with consequential adverse effects on clinical care.

Long Covid in children and young people has been and continues to be an inconvenient truth. The reluctance to accept that Covid-19 could have a more profound effect on some children led to even greater delays in recognising, diagnosing and responding to Long Covid in children and young people. When finally established in England, dedicated children and young person Long Covid hubs were sparse. Such dedicated clinics in Wales, Scotland and Northern Ireland were either absent or too slow to be established.

Fourth, the healthcare system has not committed even now to preventing Long Covid, there is no treatment for Long Covid. The only way to avoid contracting it is to prevent Covid-19 infections and yet practitioners, patients and the public were not and are not adequately warned about the risk of Long Covid. Further, there was no communication of the risk of Long Covid as part of the drive to encourage vaccine take-up.

https://covid19.public-inquiry.uk/wp-content/uploads/2024/09/09191436/C-19-Inquiry-9-September-2024-Module-3-Day-1.pdf

 

[Silas Loom]

There has already been disquiet from some other groups in regards who was not accepted from their list of submissions in regards who should be called as a witness.

Regardless of those failings, I am still there will still be moments where some of the bullshitters claims are contradicted by other witnesses.

If you would like to read the opening remarks by the representative, they are to be found on the pages numbered 134-141 of todays transcript. I would love to quote it all but copying & pasting isnt smooth for these documents, I have to do loads of manual work to fix the format and its too exhausting to attempt this for lengthy passages. Instead I will just quote a very small portion of it:

https://covid19.public-inquiry.uk/wp-content/uploads/2024/09/09191436/C-19-Inquiry-9-September-2024-Module-3-Day-1.pdf

Thanks. The LC groups have ten arguments, apparently, of which six were presented, but it looks as if the issue of inappropriate and harmful treatments hasn’t been included, which is a shame.

 

[elbows]

DNACPR stuff came up frequently today but I am unable to quote all references to it. Hopefully I will get a chance to quote some of the witnesses who discuss aspects of the misuse of such do not resuscitate notices in future.

Services being overwhelmed and access to care being restricted, demand destroyed artifically via triage etc, was another near-constatnt theme today. I have now run out of time till Wednesday so I will just quote a little bit from UK bereaved families for justice opening remarks in this regard:

These quotes are from pages 126 and 131 of todays transcript.

She will also tell you that the ITU consultant responsible for her father candidly explained that he could not be admitted to critical care or HDU because there were no available beds, and indeed that was the picture for much younger patients too.This was a capacity and not a clinical decision, a point that chimes with comments made by Ms Carey earlier.

A very different picture painted by Boris Johnson, Matt Hancock and others, who have brazenly asserted that one of the key successes of the Covid response was that the NHS was never overwhelmed.
True enough, we did not see scenes from a dystopian disaster film, with empty ransacked hospitals, but the fact that hospitals and healthcare facilities continued to operate at some level must not be allowed to point to a dangerously misleading conclusion that things went reasonably well. Where acute demand for emergency and critical care services outstripped supply, those services were indeed overwhelmed and unable to function as they should. This is not a metric measured in missed targets, it's not a matter of semantics. Overwhelmed services cost lives.

Whether this evidence of overwhelmed services was simply because of the extreme seriousness of Covid or whether overwhelmed services were a result of no proper planning, no adequate resilience, chronic underfunding, austerity, is a matter for you, but either way the narrative that the health services coped without becoming overwhelmed is a false one and needs to be called out at such. Pretending nothing is wrong means nothing changes. From ambulances to hospitals, like critical care bed capacity referred to earlier. But we already heard evidence in earlier modules that the UK had the lowest number of doctors and nurses per capita than any other comparable OECD country. Bed capacity regularly a problem even with seasonal flu spikes.

 

[elbows]

Just time left to say that inequalities, struxctural and otherwise, look like they will come up plenty on this module.

Again I lack the time and expertise to delve deeply into this, but here are just a few examples from todays transcript:

Page 29:

You will hear about some specific examples of potential racial inequalities. May I just give two examples. During the pandemic, there were concerns about the use of pulse oximetry for Covid-19 patients being managed at home. Pulse oximeters can identify a drop in someone's blood oxygen level, which can be an indication, amongst others, that the person's condition is deteriorating. From November 2020 pulse oximeters were used in England to monitor patients who were well enough to stay at home but who were most at risk of becoming seriously unwell, and concerns emerged that suggested that inaccurate and variable readings when the device was used on a darker skin were not appropriate. So, put another way, the reading was inaccurate because it would suggest that oxygen levels were okay when in fact they weren't, and it resulted in delays in those people potentially being taken to hospital and being treated.

Page 129:

In that vein, we've examples of where it appears that algorithmic questioning failed to take account of racial characteristics -- you already heard about oximeters. But Lobby Akinnola's father sought assistance from the 111 service.He was asked whether his lips had turned blue, a question which might well have been appropriate for a white person.

 

[elbows]

Thanks. The LC groups have ten arguments, apparently, of which six were presented, but it looks as if the issue of inappropriate and harmful treatments hasn’t been included, which is a shame.

Module 4 is titled Vaccines and theraputics. Log covid treatments arent a headline aspect of this module but since it hasnt started yet there is still hope that the issue you mention could be included in that module in some way.

 

[elbows]

Although I havent quoted about it directly, it was quite clear today that the absurdities of the fact the UK government messaging focussed on the somewhat inverted idea of 'saving the NHS' rather than saving patients will receive all sorts of focus in this module.

As expected the BBC coverage so far is going soft when it comes to which forms of framing they draw the most attention towards. Some of the BBC live updates reporting during the day was also incredible sloppy in places, at one point totally confusing the act of carrying out CPR with the Do Not Attempt CPR notices! For fucks sake.

What the BBC said on their live updates page:

Jacqueline Carey KC, counsel to the inquiry, starts by saying this afternoon's proceedings could be distressing and that people can leave the room if they wish.

She explains the use of CPR on Covid patients during the pandemic, an emergency procedure that aims to restart a person's heart. It's an invasive and dramatic medical intervention, she says.

She says there are reports of it being used inappropriately, and one report found a worrying picture of poor record keeping and a lack of scrutiny over the decisions of when to use it.

Just one example of what was actually said (page 82 of todays transcript, I dont have time to quote all the other stuff about misused DNACPRs):

Now, during the course of the pandemic, there were reports of blanket DNACPRs being imposed. For example, the BMA heard reports of GP practices sending blank DNACPR forms to patients over 65 or to those with a disability. There are also reports of DNACPRs being used inappropriately.

The Guardian reporting is hardly perfect but at least doesnt suffer from the particular 'going soft on the powers that be' flaw so far:

Covid inquiry: Johnson and Hancock accused of making ‘false’ NHS claims

Inquiry told how NHS entered pandemic with high nursing vacancies and low number of critical care beds

www.theguardian.com

 

[elbows]

I note that at some point the BBC did fix their DNACPR mistake in their live reporting (todays live updates are at NHS staff tell Covid inquiry of 'lack of support' at start of pandemic )

 

[elbows]

I note that in the opening video, a GP from London mentions that they started to see people with a loss of smell in January 2020.

 

[elbows]

Todays witness, professor Clive Beggs, expert in infection prevention and control is not from the clinical side of the field, but rather the physics, engineering, fluid simulations side of things. And before his academic career, he was in the air conditioning and ventilation industry.

So far they have used him to get an intro to the differences between droplet and aerosols, airborne transmission, the way air moves around rooms, where viruses come from in the body and where the receptors are in the body that can receive them. They have also used him to cut through all the terrible bullshit in areas such as asymptomatic transmission (including asymptomatic transmission in influenza) and the disgraceful orthodoxy that enabled really shit guidance to be used in the pandemic, shit that was achieved by clinging to the idea of aerosol/airborne transmission not being an important thing. So far he has been a clear and useful witness in this respect, especially given that he already believed in the important role of aerosols in spreading viruses, he didnt have to wait until the pandemic itself belatedly brought new understanding to this and related issues. And he certainly didnt need to rely on a load of bogus shit in order to generate guidance that was compatible with shabby practical realities of the hospital estate and things like PPE supplies.

 

[Callie]

I note that in the opening video, a GP from London mentions that they started to see people with a loss of smell in January 2020.

They think this was linked to COVID? Anosmia happens for other reasons too (and other viral infections)

 

[elbows]

They think this was linked to COVID? Anosmia happens for other reasons too (and other viral infections)

It was just a short comment in the intro video, they were not a quizzed witness.

The fact they bothered to mention it suggests what they saw was a noticeable uptick in such cases at the time, although of course some application of hindsight has been used.

In terms of the broader timing story, I think there is enough anecdotal, and in a few cases clinical, evidence that there were some real covid cases in that early time period in places including London. However, we also know that there wasnt enough of it around in enough vulnerable people to cause a noticeable amount of death in January 2020, not enough to rise significantly against background levels of death, unlike what happened later. I suppose for the purposes of being exhaustive, I cannot completely exclude an alternative explanation that the virus changed at some point which impacted on the death picture.

Although I will add that we started finding severe cases in people already in hospital, and deaths in hospital, as soon as we actually started testing people in those settings who did not have a relevant travel history. So likely if we had started testing in those settings earlier, we would have recorded our first deaths earlier too. But again, not in the sort of quantities that would case overall mortality to spike upwards in a highly significant way, since you dont need to do tests and get the cause of death right to see such spikes.

 

[elbows]

The session with that witness continued by looking at examples of how long it took authorities including the WHO to gradually shift their stance away from 'covid isnt airborne' to 'covid is airborne'.

Unlike what I said earlier, the inquiry didnt hear any ranting about these sorts of possibilities being dismissed because they were deeply inconvenient possibilities, rather this witness described some of the reasons why the wrong impression had become the previous consensus on these sorts of matters. He did make reference to the fact that some scientists are still clinging to the wrong beliefs about this stuff.

We did hear an example of evidence that pointed to airborne transmission during the pandemic, such as analysis of the Skagit Valley chorus superspreading event, and the fact that the paper on this arrived by September 2020, before the 2nd wave really went massive.

There was discussion about various air ventilation, conditionaning and cleaning systems. And the various official guidance on this stuff that was in use from 2007 to 2021, and an updated version in 2021 that was still based on pre-pandemic opinions. The consequences of this sort of thing were that properly dealing with air quality to reduce infection risks tended to be limited to only a few settings, dealing only with certain procedures and two infectious diseases that were actually classified as airborne - TB and measles. It was also made clear that the sort of recommendations for how many times the air should be replaced in general wards was talked about only in terms of reducing bad smells. Trying to improve the situation in hospitals with poor air ventilation by using stuff like portable air cleaners was discussed, along with the need for practical research into best practices for exactly where these should be deployed and configured, although we didnt really get to the bottom of the extent to whoch they were ultimately used in hospitals later in the pandemic.

On the basis of what was said today, we might expect these themes to be revisited a number of times in this module, and that the inquiry will eventually recoomend completely new guidance that takes account of this stuff properly in future.

The limitations of surgical masks were discussed, along with the advantages of FFP3 masks but also the downsides of such masks (lack of comfort, burden of fit testing etc). The witness is interested in the possibility of a middle way, eg wider use of FFP2 masks which arent as good as FFP3 ones but are at least better than surgical masks, and more practical than FFP3 ones in several respects.

 

[elbows]

Here is just one example of a news story about one of the many witnesses that I regrettably wont have time to listen to and report on in this module.

Pregnant mum did not feel safe, Covid Inquiry told

A woman who lost her baby after contracting Covid, has told the Covid Inquiry that the healthcare system was "unprepared for the pandemic".

www.bbc.co.uk

 

[elbows]

The first witness today was Dr Barry Jones, Chair of the Covid-19 Airborne Transmission Alliance.

This session mostly expanded on a couple of yesterdays themes, involving dodgy decisions and guidance that largely came from the IPC cell (under PHE) and which led to the shit surgical mask advice and an unwillingness to shift that policy later. The witness was especially scathing about all of this stuff, including at the international level via the likes of the WHO, the secrecy eg the lack of IPC cell minutes being publicly available, the lack of common sense. I will probably try to fish out some quotes from this session in the coming days, at times he did not mince his words.

It does appear that there is a whole IPC discipline which uses a dodgy definition for what counts as droplets and what counts as aerosols, and this is how they are able to cling to crap standards of masking in a range of healthcare settings. They seem to define the boundary of particle size for aerosols vs droplets at 5 microns, whereas some other disciplines such as the ones represented by Clive Beggs yesterday, use 100 microns. This matters because droplets are said to follow a ballistic trajectory and so fall to the flaw with a meter or so. But aerosols can be airborne and can continue to circulate based on the complex dynamics of airflows within enclosed spaces etc. By using an absurdly low maximum size for droplets, they can claim that all sorts of things fall to the ground within a short distance that dont actually behave that way at all, and then that bullshit can be used to construct really unsafe claims about how little risk is then present at greater distances in the air, and crap masking standards can be set. Although the pandemic has gradually forced various expert bodies and authorities to sing a slightly different tune about covid and airborne transmission, it does not sound like the full implications of this have worked their way through the entire system, and so certain authorities have still been able to maintain their woefully inadequate guidance.