Evidence given to a Tynwald Committee by the Medical Director of the DHSC, has raised serious questions about the gov’s reactions and decision making throughout the pandemic.

The previously private evidence given by Dr Ranson to the Public Accounts Committee was released on Wednesday night and reveals that in the early days of the pandemic opportunities to delay Covid reaching our island were missed, that Public Health overruled a clinician over testing a potentially positive person in Noble’s Hospital and that the gov were intent on following flawed advice.

The Signs Weren’t There

Dr Ranson told the committee, chaired by then Speaker Juan Watterson, that on February 8 2020, after she became aware that there was no obvious signage, announcements and no effective public information on what someone should do if they became unwell and had recently travelled from a high-risk area of the world, she emailed Director of Public Health Dr Henrietta Ewart to raise these issues but received no response. 

Dr Ranson

Dr Ranson added: ‘In my email, I wrote: “As the coronavirus situation seems to be developing, I think it would be really useful to have a daily update on coronavirus, even if it is just to confirm there is no change in the position”.’

She went on to say that the daily updates she asked for ‘never happened’ and that by March 11, when a senior consultant radiologist raised the issue of the lack of information announcements for travel questions at the border, as she was very alarmed that people were arriving from Italy, which at the time was seen as one of the European hotspots for Covid. 

Dr Ranson said: ‘So I raised the issue in February and to my horror it is still an issue in March. And, when I say that there was no quality assurance, there was no mechanism and Public Health did not seem to take any responsibility, or even make sure that somebody was ensuring what Public Health guidance was – we had all decided this was appropriate and we are going to follow this, but nobody checks that it is implemented or adequately adhered to.’

Presumed Positive

Before the island had its own Covid testing capabilities, samples were taken and sent via a courier to the UK. Dr Ranson said this was not only costly but also a slow process which caused other issues around isolating presumed positive people. She told the PAC that such was the concern at one point that the idea of paying for the air ambulance to fly samples to the UK was suggested.

She said: ‘There was an impact on service delivery where patients had to be assumed to be positive until the results were returned. This meant such patients had to be isolated in side rooms. It also affected staff who were having to use PPE for precautions while caring for patients who may ultimately be negative.

‘At this stage, we had very limited PPE supplies. Later on we had limited swabs available to take the tests with and therefore had to limit the number of daily swabs taken. Public Health England had put a limit at one stage on the number of swabs they were willing to process for testing. This necessitated me to call the professor in charge of the lab in Manchester that he make an exception for the Isle of Man, as we did not have community spread – this was some time later – and to explain to him what we were trying to do here, what I was trying to do, which is make sure that we did not get to a situation of community-acquired COVID-19. I had been told that they were going to limit it to 30 tests a day.’

Dr Ranson said that this was ‘going to be completely inadequate’ and praised the ‘amazing’ work by Dr Rachel Glover and the rest of the team which set up the island’s Covid lab.

Hospital Admissions

The Medical Director later told the committee that while the island was testing people who were symptomatic having been to countries with Covid, they were not testing people going into Noble’s Hospital. She explained that ‘there were patients admitted to Noble’s who had symptoms that clinicians were concerned may have COVID-19 but who were not being tested because Public Health England had set down strict criteria on who could be tested’.

She said that the island’s following of PHE guidance was ‘causing some unease’ for Manx clinicians and said it was hard to question advice given as there was ‘no engagement in the debate between the Director of Public Health and the clinicians’.

Dr Ranson also produced an email from Dr Ewart, sent on February 9 2020, which said: “There seem to be other inappropriate behaviours developing. It is not appropriate for staff to be requesting or putting pressure on colleagues to test for coronavirus when the patient does not meet the current criteria.”

She told the committee: ‘This was the tone of the type of interaction for the clinical teams who were genuinely concerned about the presenting illnesses of patients arriving in Noble’s, who they were treating directly. In my view, it is entirely appropriate for a clinician to ask for a test for an ill patient that they suspect has an illness… 

‘Now, for any other condition, you would just send off a test, I fully understood that – and also knowing that we were sending them off Island, and clearly the UK did not have the facilities, so they were limiting them. So I fully understand that, again, you have got this balancing of risks, but in no way could you describe it as an inappropriate behaviour of a clinician. It is entirely appropriate for the clinician to do everything they can for their patient, to advocate for them and their skill is: what could be wrong with them? And in their mind there are reasons why this potentially could be coronavirus. So I would expect them to highlight that. I would expect them to have a discussion and debate, because that is what you do.’

Overruled

Julie Edge, who at the time of the PAC hearing was MHK for Onchan, asked Dr Ranson whether Public Health had overruled a clinician wishing to have a patient tested. Dr Ranson confirmed that they did.

She added: ‘Ultimately they cannot overrule what we do for patient care, because the duty of the clinician and the consultant is to the patient. So it was not the fact that they were saying, no, it is not possible; it was the fact that it was being highlighted and articulated as an inappropriate behaviour to even ask the question.’

Manxifying?

While the island was following PHE’s advice and guidance, Dr Ranson said there was a process of ‘Manxifying’ documents to make them applicable to the island. However she added: ‘This in itself may have been an appropriate starting point, but it seemed that this was not taken as an opportunity to review and consider carefully the contents for the island’s situation, but more an administrative approach by adding logos of Isle of Man Public Health. I had also noticed that there seemed to be a lack of rigour and oversight of the implementation of the Isle of Man Public Health measures at an operational level. So, in retrospect, there seemed to be no quality assurance mechanism to make sure that any guidance issued by Public Health Isle of Man was implemented adequately.’ 

Early March 

By March, despite there being community spread in the UK, the Manx gov’s position was that the risk to the island’s population was ‘moderate’ and that the risk to individuals was ‘low’. This position remained in place until March 16 when the gov’s website said that there are no Covid cases and the risk remained low. But Dr Ranson said that by this stage transmission onto the island was ‘inevitable’. 

Dr Ranson said that after a conversation in her office with a consultant radiologist, she began trying to push the DHSC CEO Kathryn Magson and the Director of Nursing to look at the situation in Italy where hospitals were at over capacity and to work out what could be done at Noble’s to prevent a similar situation here. However, not getting the response she wanted, she organised a meeting with senior doctors at Noble’s to ‘prepare a response for the whole system’. 

Even while the gov began to put the 111 team together and more systems were put in place, Dr Ranson told PAC: ‘It became increasingly apparent, even though I had only been in the post for a few weeks, that the Island was unprepared for what was the equivalent of this tsunami heading for our shores.

‘I could not understand why the UK government, under the guidance of Public Health England, were taking the decisions they were and more importantly, I could not understand why we on the Isle of Man were intent on following what was becoming increasingly obvious was flawed advice. At this stage what did we know? COVID-19 was now officially a pandemic. Without some control of public movement the COVID-19 virus would spread rapidly through a community with many people requiring oxygen, hospital admission and with significant mortality’

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