Evidence given to a Tynwald Committee by Dr Ranson the Medical Director of the DHSC, has raised serious questions about the gov’s reactions and decision making throughout the pandemic.
The Medical Director then told the committee that the clinical group she had formed had started to have more conversations about moving away from PHE advice, when word reached Ms Magson, she emailed Dr Ranson to say: “I understand that there was a discussion yesterday about deviating from Public Health England guidance? At the moment we have been clear in our messaging around following Public Health England guidance and if we should wish to change this, we would need to agree this at the strategic meeting which is set for Friday, and probably Gold Control with CEOs, depending on what the item is. Can I suggest the clinical group this PM focuses on the clinical guidance around patients in hospital and provide a recommendation on the proposed pathway on the Friday for sign off?”
Dr Ranson said that having had it made clear to her that ‘I should focus on clinical guidance around patients in hospital’, she decided that there was a need for a consideration of all of the issues to find the best way forward. She told PAC: ‘I was quickly understanding that there was absolutely no effective public health on the Isle of Man, we could equally access Public Health England documents on the website. I therefore knew it was down to me and my team, a small group of senior doctors, who rallied around. The other aspect of that email from Kathryn Magson is that she was highlighting that there was an opportunity, as I saw it, for Friday 13th March for us to influence the change in direction.’
She in turn wrote back to Mrs Magson, again repeating her concerns about signage at the ports and said the island needed to ‘ramp up self-isolation information’.
Given that the island had not seen a pandemic of this type in living memory, Dr Ranson says there was a degree of naivety amongst the public about what it could mean for our island and that she came to the conclusion that the island’s best defence was that we are just that, a small island with control over its own borders.
She told PAC: ‘Our only hope, it seemed to me, was to stop the blind following of Public Health England. It was imperative that we explain to the Government why this approach was flawed and the consequences if they continued in this direction. We needed data, we needed evidence and we needed to do what doctors are used to doing in their everyday practice, which is look at the whole picture, understand all of the evidence and critically appraise it. We needed analysis and we needed vision.’
However, on the evening of March 12 2020, Chief Secretary Will Greenhow sent an email to all ministers to advise them to follow PHE’s advice and move to delay the virus. He wrote: ‘I would recommend that the IOMG now move to the delay phase of the planning and maintain our current position of following the advice issued by Public Health England.’
Later that night, ahead of a presentation she was due to give on March 13, Dr Ranson finished the presentation with a slide which said: ‘Avoid the surge and avoid becoming overrun, push forward with isolation, stop social gatherings and entry points.’ She said: ‘By this I meant borders. In effect, let us stop this coming to the island.’
First Briefing and False Figures
On Friday March 13, the gov held a briefing where Minister David Ashford announced that those with symptoms of Covid-19 should self-isolate for seven days, there was no advice to contact 111 for testing. This was also the briefing where it was confirmed that the TT was cancelled.
Dr Ranson said: ‘He also said that 90% of cases were mild. That is inaccurate. I do not know where he got that information from. It may have come from Public Health England, but it was not the picture that I had seen and it was not the data that we had.
‘The press conference highlighted a number of significant concerns for me. The Chief Secretary had given the advice to move to Public Health England delay. The decision to follow Public Health England to delay had been taken without any advice from me as DHSC Medical Director, or the clinical group, because we know that the Director of Public Health is on holiday.
‘The decision to take this very significant step of following Public Health England to delay had been made prior to the Coronavirus Working Group meeting scheduled to take place within a few hours at 12:30 on 13th. The presentation we had prepared for the meeting was intended to give a full understanding of the impact COVID-19 would have on this island. I personally had been up until the early hours of the morning of 13th March adding the finishing touches to the presentation. The Ministers have proceeded with no regard to the information we were working on. Kathryn Magson knew we were working on a presentation, she knew we were working on modelling and I had already informed her that I was bringing a presentation, and in fact I had sent her a draft of the presentation that night.’
‘The Minister, I felt, had been put in a position where he had made this public announcement that was wholly inappropriate for the island’s situation. We had no cases of COVID-19 on the island and therefore it would be foolhardy, indeed I would say reckless, to not at least attempt to contain the infection because of our limited resources for health and care on the island.’
Flights Are Booked
On the afternoon of March 13, Dr Ranson attended a meeting chaired by Ms Magson which included the CEO of Home Affairs and of GTS. Dr Ranson told PAC: ‘It was very obvious that Ms Magson just wanted to get the meeting over. I could only assume because the delay position had already been announced, and she was booked on the afternoon flight to London.’
Amongst the slides in that presentation was one that said that the island’s ICU capacity would be exceeded ‘within six weeks’ if there was unmitigated spread of the virus.
At this time Dr Ranson also produced her new final slide which said: ‘‘Nature has given us a natural barrier. We should take advantage of this, containment or delay.’ She told PAC: ‘The last point was border controls. This was the first mention of putting in border restrictions to my knowledge.’ However despite this, Ms Magson told her that the gov was sticking to following PHE advice.
After coming out of that meeting, Dr Ranson ‘bumped’ into Minister David Ashford and expressed her disappointment to him and later sent him the presentation. Her email said: “We have a window of opportunity at the moment and the message needs to be that we should grasp that opportunity and learn from the errors of other countries. I am happy to talk it through because we are keen that you understand the critical message it conveys. Given our limited ITU beds and the duration required to ventilate each patient, it is likely that we will quickly reach a situation where we are choosing who should be ventilated.”
She told PAC: ‘I was telephoned by Ms Magson from the UK that evening, who expressed her unhappiness with what had gone on during that meeting [with the CEOs]. Dr Ranson said that faced with opposition from Ms Magson she took it upon herself to work towards reversing the decision of following PHE advice. She said ‘That team, I had just created, because the only people I could be in charge of was the doctors. So I needed a team and I needed a body of people who had gravitas, because what I wanted to do was change the direction of travel.’
On March 15, Dr Ranson held a meeting with the senior medical leadership team at Noble’s, in effect this was the island’s 10 most senior doctors, surgeons and physicians and others. After the meeting, she wrote the following to Minister Ashford: ‘‘The views were unanimous that urgent action is required at our borders in our community and across the Island. We have made a list of those recommendations. Hours do matter when we are talking about virus transmission, and we were all extremely worried that we are not taking a firm enough stance. I realise that you have an incredibly difficult job, and I respect that you and your ministerial colleagues will do what is best for the Isle of Man. I am always happy to discuss and explain our position.”