Loose-fitting surgical masks are inadequate protection against Covid-19 (Photo by Universal Images … [+]
While seemingly esoteric and of little impact to health workers and the public, a little known group is creating a firestorm in the public health community.
The Healthcare Infection Control Advisory Committee advises the CDC on guidelines for infection control in healthcare settings. HICPAC met in June and published slides summarizing its draft guidelines. This is where the controversy began.
It is scheduled to meet again on Tuesday, Aug 22, and, per its published draft agenda, to vote on finalizing its plan for the CDC. However, I was told by a CDC representative that there will not be a vote until at least November.
The planned HICPAC revisions would water down infection control protections, particularly for aerosol transmission and multidrug-resistant organisms.
Most immediately worrisome is its conclusion that plain surgical masks (aka “baggy blues”) are equivalent to N95s and provide adequate protection to healthcare workers and patients. There is abundant evidence to the contrary. This from the CDC:
N95 user showed a lower odds of acquiring Covid than those using a surgical mask.
It is clear that N95s offer far better protection against aerosols, such as from Covid-19 and other inhaled pathogens.
More than 900 experts in infectious disease, public health, industrial hygiene, aerosol science and ventilation engineering signed a letter to Mandy Cohen, M.D., the new CDC director, explaining how the new draft guidelines weaken protections for healthcare workers. They state, “Surgical masks cannot be recommended to protect health care personnel against inhalation of infectious aerosols.”
The experts’ letter was coauthored by Lisa Brosseau, Jane Thomason and Peg Seminario, among others. Seminario was the director of occupational safety and health for the AFL-CIO from 1990 to 2019.
The CDC responded to Seminario and the experts’ letter only now, a month later, and just before the scheduled Aug 22 meeting. The agency offered no substantive or specific rebuttal, but spoke of its dedication to “improving healthcare quality” and commitment to “to transparency, communication, and stakeholder engagement.” It also claimed that the CDC is meeting the guidelines for transparency required by the Federal Advisory Committees Act. The letter is not yet publicly available.
HICPAC’s proposals also fail to include ventilation, UV disinfection and HEPA filtration, all essential tools against an airborne pathogen.
There are many concerns regarding HICPAC’s process, as well.
Meetings did not include experts in aerosol transmission, ventilation, occupational health and worker protections, Occupational Safety and Health Administration (part of the Department of Labor), National Institute of Occupational Safety and Health (part of CDC which researches worker health and safety) or representatives of healthcare workers.
Lisa Brosseau, an expert on respiratory protection from infections at the Center for Infectious Disease Research and Policy and a retired professor, expressed outrage at HICPAC’s process: “Why are they not consulting with all the people and all the stakeholders? They are not, and that’s a sort of basic expectation of a federal advisory committee.”
Brosseau was equally critical of the committee’s literature review, saying that it was “cherrypicked” and “the most ridiculous literature review I’ve ever seen.” She concluded, “I think they were hoping nobody would notice” how the review was manipulated.
While HICPAC suddenly (Aug 15–a week before its scheduled meeting) invited public participation, it has not provided meeting notes, minutes, transcripts or a draft policy beyond its bullet point slides.
A doctor during an appointment with her senior patient. Both are wearing loose-fitting medical … [+]
Jane Thomason, lead industrial hygienist at National Nurses United, said that they had submitted a FOIA request for the committee’s evidence review in its entirety and the minutes from the last nine months of working group meetings. These were denied, violating rules under the Federal Advisory Committees Act.
Thomason said HICPAC is “weakening existing guidance for infection control and not following the science that has been built over the last several decades about aerosol transmission.” She added that, in their goal of providing more flexibility, “They said to employers, ‘Here are the minimal standards, and you guys figure out what you need and want to do.’” They are proposing minimal crisis standards of care.
Brosseau added, “Being in health and safety, I know where that goes. It means you get nothing, workers get nothing, no protections. You don’t leave it to the employer to make decisions about workplace hazards.”
Richard Corsi, co-inventor with Jim Rosenthal of the Corsi-Rosenthal box, a DIY air filter, and now dean of engineering at the University of California Davis, was also critical of the lack of emphasis on ventilation as well as inadequate education from the CDC.
Corsi noted, “The CDC does not say, ‘We have a surge right now and people should be wearing good masks of this kind, and people should be taking precautions and ventilating using MERV-13 filters in their HVAC systems and using portable air cleaners.’” If the CDC is not stressing the need to be increasingly vigilant, with rising detection of Covid-19 in wastewater levels and two new variants circulating, he added, “This has a domino effect,” going from the CDC to the state, to the county and local level, “and then nothing gets done.”
Responding to my inquiry about these concerns, a CDC representative said that the June presentation was only from a HICPAC working group and that any decisions would have to come from the entire HICPAC committee, which has broader representation. I was also told that there would not be a vote on these draft guidelines this week, despite that being listed in the public agenda and HICPAC’s slide stating, “Goal is to have Precautions Guideline for HICPAC review and vote by August 2023.” This discrepancy remains unexplained. The CDC spokesperson stressed that it is very early in the process and people shouldn’t jump to conclusions based on the June hearing and slides—they are still developing materials that people can react to. Again, the discrepancy with the written material was not explained.
One can only hope that the CDC will take this barrage of criticism from an array of experts, nurses and patient advocates seriously and revise its approach.
The process must be transparent with public meetings. The CDC must provide transcripts and thorough references, seek input from an array of experts in related disciplines and actually listen to public comment.
HICPAC must not rush through these drastic changes to infection control, as they will put patients, nurses and all frontline healthcare workers at increased risk of acquiring Covid-19, MDROs or new emerging pathogens.
Written comments from the public must be received by Aug 25 and will be included in the minutes. An email from HICPAC today says that not all people who signed up to speak can be accommodated. Instructions are here.
I reached out to HICPAC for comment and will update the story if it responds.