CDC’s HICPAC Passes Draft Gutting Patient Protections Against Airborne Respiratory Viruses, Faces Challenge at HHS Office of the Inspector General (and You Can Help)

By Lambert Strether of Corrente.

Readers who have been following our HICPAC journey (CDC’s Healthcare Infection Control Practices Advisory Committee) will be aware that HICPAC has now dropped — apt word! — a draft version of the PowerPoint (“Isolation Precautions Guideline Workgroup“) presented on June 8; its title: “Healthcare Personnel Use of N95 Respirators or Medical/Surgical Masks for Protection Against Respiratory Infections: A Systematic Review and MetaAnalysis.” I need a short title, so I’m going to use “Review,” even though “Baggy Blues 4EVA” would be a more accurate choice. This should surprise no one. As I wrote back in July, in my analysis (“personnel is policy”) of the composition of the Committee:

1. None of the hospitals with which the HICPAC members are affiliated have a policy of universal masking.

2. Though some of the HICPAC members look not unfavorably on masking, and on airborne transmission generally, none could be characterized as advocates.

3. Favorability toward universal masking, ideally with N95s, is inversely correlated with institutional clout; Mass General/Brighams vehemently opposed; the University of North Carolina and Barnes-Jewish persuadable.

4. The HICPAC committee members are in the pleasant position of being able to ratify as guidance policies that their institutions have already adopted (i.e., no universal masking, let along universal masking with N95s, going forward). One might, indeed, go so far as to characterize the HICPAC meeting as theatre, were there drama involved in a clearly pre-determined outcome[2].

In other words, the fix was in. That doesn’t mean that HICPAC’s exercise in stochastic eugenicism is a done deal, or that it should not be opposed.

In this post, I will not put on my yellow waders and do a close reading of “Review,” a Gish Gallop which weighs in at a robust 80 pages. The key point here is that the process through which “Review” was “dropped” is fatally flawed. I will show those flaws at a high level by presenting a sample message that you deliver to the HHS Office of the Inspector General (OIG) by phone. Then I will present the complaint brought against HICPAC to the OIG by the World Health Network, which will show those flaws in greater detail. (The full Complaint is embedded in the Appendix at the end of this post as a PDF file, along with its supporting material.)

How to Call the HHS Inspector General

Alert reader SGD throws the following over the transom. This puts the OIG complaint in short form, and should give you inspiration for your own call:

In her public testimony at the HICPAC meeting this past Friday (11/3), Kathleen Turturice [National Nurses United public supporter, here] gave the number for calling the Office of the Inspector General: 202/619-3148. Her testimony gives a brief capsule of the Complaint, and if someone has not yet read it, they can get the gist of it from what she said.

If people would like to call the IG in support, they should make a statement in their own words and be sure to be courteous to whomever answers the phone. I don’t want to tell people what to say – it’s important that they speak for themselves in their own words, so please don’t quote me about what to say.

If I were calling, I’d say something like this:

• “Please investigate the complaint filed by World Health Network this past October 29. I’m very upset with what’s going on at HICPAC. It looks like their membership violates the law. HICPAC does not have the required number of members and doesn’t have one aerosol expert as a voting member. That makes them unable to adequately address the problem of the aerosol transmission of Covid and diseases like it. Please investigate the complaint filed by World Health Network this past October 29.”

(The first and last sentence duplicate to make sure the gist gets written down.) I’m sure that there are many NC readers who can translate these suggestions into their own words — some of them with credentials the OIG is sure to respect! And if any of you take notes and want to share, feel free to send them to me for a follow-up.

Note that the HHS OIG has serious clout. From the About page:

Since its 1976 establishment, the Office of Inspector General (OIG) has been at the forefront of the Nation’s efforts to fight waste, fraud and abuse and to improving the efficiency of Medicare, Medicaid and more than 100 other Department of Health & Human Services (HHS) programs. OIG is the largest inspector general’s office in the Federal Government with approximately 1,650 personnel.


The Office of Inspector General (OIG) for the United States Department of Health and Human Services (HHS) is responsible for oversight of the United States Department of Health and Human Service’s approximately $2.4 trillion portfolio of programs.

The Case Against HICPAC in the Complaint to the Inspector General

I’m going to present big chunks of the Complaint here, helpfully highlighted for your perusal. I’m also going to intersperse them with some posts of my own, because [lambert preens] a smol avian creature told me that my posts triggered some thought processes in the minds of the actual lawyers who put the complaint together for World Health Network (WHN).

The bold-face names:

Number of Committee Members:

I must admit that I missed this!

Composition of the Committee:

From [lambert preens] “CDC’s HICPAC Prepares to Violate the Letter and Spirit of the Federal Advisory Committee Act at Its August 22 Anti-Mask Teleconference“, after discussing GSA guidance on the Membership Balance Plan:

It’s plain as day that HICPAC’s membership is not “divergent” as FACA understands the term; every one of its members is affiliated either with a hospital or a medical care facility. Conflicts aside, the controlling assumption can only be that hospital staff have nothing to learn about infection control from anyone outside their milieu. Surely such mental and ideological inbreeding is exactly what an open and transparent process seeks to prevent? (“Sunlight is the best disinfectant,” as they say.) CDC has an entire institute, NIOSH, with expertise in “respirators and masks.” Are we seriously to believe that NIOSH has nothing to contribute to HICPAC on masking? Or ventilation? Or training? Even if NIOSH doesn’t sit on the committee, why are they not invited experts? Why on earth does HICPAC’s draft “Isolation Precautions Guideline Workgroup” deliverable (PDF), which is driving masking policy and the infection model for HICPAC, not even mention NIOSH?

Records violations:

Also from [lambert, still preening] “CDC’s HICPAC Prepares to Violate the Letter and Spirit of the Federal Advisory Committee Act at Its August 22 Anti-Mask Teleconference“:

Where are the 2023 minutes? (To be fair, the CRO writes that the GSA’s FACA “guidance does not indicate that meeting minutes must be published in advance of the committee’s next meeting date.” CDC says although HICPAC meetings may occur “up to” 8 times a year, this year (at least according to the Federal Register) the only previous 2023 meeting — oddly; was there nothing to discuss (in public?) — was on June 8. Surely 67 days is enough time for a large Federal agency to prepare meeting minutes?)


IANAL, so of course I forgot to include the remedies![2]

I bring these to your attention not merely to preen, but to reinforce that Naked Capitalism does have impact, however unexpected the trajectory, in the real world (and big ups to the WHN for filing the complaint, and to the legal beagles who drafted it). This is what blogs do, and what your support enables.


HICPAC’s “Review” is a murderous abomination, an affliction for patients and hospital workers alike. From CNN, and it’s a pleasure to see coverage of HICPAC move to the mainstream; I’m sure it’s the last thing those goons want. CNN on workers:

In July, NNU drafted a letter to CDC Director Dr. Mandy Cohen voicing its concern that the new guidelines, if implemented as drafted at the time, would significantly weaken protections for health care workers. Thousands of health care workers died during the Covid-19 pandemic and others have been disabled by long Covid.

NNU’s [Jane] Thomason fears that if [since] the new guidelines walk back protections for health care workers, the US could see a similar catastrophe during the next pandemic.

“What they are working on … it’s going to impact patients and health care workers in so many different places. It’s going to determine whether some of them live or die, quite honestly,” Thomason said.

And patients:

During public comment periods on Thursday and Friday, HICPAC heard from several patients with long Covid or conditions that lower their immune function that they did not feel safe accessing health care because they couldn’t be sure their providers would wear protective masks when treating them.

Christine Braile said she was commenting on behalf of her 16-year-old son, who has a condition that weakens his immunity called primary immune deficiency. She said he is now living with long Covid after catching the infection from a home infusion nurse who did not mask properly.

“Loosening the patient protections for respiratory diseases, especially Covid will only hurt patients and further decimate staffing levels,” Braile told the committee.

“I am deeply afraid of being in a situation where avoiding health care is not an option,” said Seifer Almasy, who spoke as a member of the public. He said he was recently in that situation when he decided he couldn’t put off getting his updated Covid-19 and influenza vaccines. He said he made 34 phone calls and was on hold for more than four hours to find a provider that would wear an N95 while giving him his vaccines.

And on HICPAC’s institutional capture:

Dr. David Michaels, an epidemiologist and professor at the George Washington University School of Public Health, said the new guidelines should have benefited from all the knowledge about the transmission of respiratory infections gleaned during the pandemic. Instead, he said, “this is going backwards.””I think what’s happened here is the members of this committee came to us with prejudgment on how infection control should be applied,” said Michaels, who was part of a group of experts that addressed HICPAC with its concerns about the draft during an October listening session.

“This committee has no members who have expertise in worker protection, or in aerosol science,” said Michaels, who is also the former head of the Occupational Safety and Health Administration. “And so their view of infection control is a hospital-based view and hasn’t changed in decades.”

Yep. Make that call. Let’s save some lives.


[1] See, e.g.

[2] Also because IANAL, I picked the wrong target; my thought was to seek redress from HICPAC’s Designated Federal officer; but clearly WHN’s approach of asking the Inspector General to investigate the head of HHS, the head of CDC, and the Designated Federal Officer is more appropriately scaled to the scope of the debacle, plus more righteous.


Here is the World Health Network Complaint:

FINAL PDF - Complaint of Gross Misconduct

Here is the Evidence and Analysis in support of the complaint. Many hilarious moments!

FINAL PDF - Analysis & Evidence Re IG Complaint
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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. playon

    Thanks for this – I was looking over comments from concerned citizens to HICPAC in the pdf linked here the other day — all commenta that I read were universally opposed to loosening guidance on airborne pathogens. These people at the CDC and HICPAC are truly disgusting.

    Hopefully this complaint will go forward promptly and get some media attention as well.

  2. Tom Stone

    Masks are once again required for all Health Care Workers in Sonoma County Ca due to the recent surge in Covid 19 cases, but not for patients.
    There was a nice big sign advising me to that effect in front of my Pharmacy and a box of baggy purples for the customers inside the door.
    Of 5 pharmacy workers one KN95 and 4 baggy purples.
    Of the 9 customers one P100 and one baggy purple chin diaper.

  3. JBird4049

    “This committee has no members who have expertise in worker protection, or in aerosol science,” said Michaels, who is also the former head of the Occupational Safety and Health Administration. “And so their view of infection control is a hospital-based view and hasn’t changed in decades.”

    Is this the cause or just the excuse? Aerial transmission of diseases has been proven for about 150 years and suspected for thousands of years before that. Fomites or aerosols, it really does not matter. If they know as well that Covid is very transmissible, that makes it more obvious that greater efforts using all the techniques available. If they were not absolutely sure that Fomites were the only cause, that would also indicate greater efforts.

    Anyways, I am not majoring in biology, but really all this dancing around even mandatory masking is baloney. Cheap, effective, and easy to do, which means it’s affordable, useful, and convenient. Heck, it would save the hospitals and the medical insurance leeches money. If this was about money, people would be wearing masks, which means that it is not about money.

    1. Acacia

      If this was about money…

      Well, yes, but money for who.. ? Somebody is profiting from these policies, methinks.

  4. Iseeyoudock

    Excellent coverage of the issue here Lambert. Thanks to you and Yves for your coverage of the whole fiasco.

    Aware health care providers have had frustration with this issue for years.

    During the very start of the pandemic I had read enough to make the correct presumption that it was airborne. There was a very early study of a group on a four hour trip bus trip from Wuhan with a seating chart showing where the index patient was seated and how far it had spread. (Wish I had saved that reference)

    Over 15 feet. By criteria, airborne. This was very early in 2020.

    That and accounts from the Diamond Princess of infection in passengers that did not leave their stateroom.

    Early inferential evidence, but enough for me to draw the conclusion that it was most probably an airborne mechanism, and until further evidence, gear should reflect that presumption.

    To be fair, the early R(nought) was low enough to argue against that thesis, ~2 ish, at least until Delta, when it jumped to (disclaimer, this is from recall) around 6 – 8, with omicron around 10. Much more supportive of mechanism.

    Viral evolution and vaccine escape at work. Easily predictable.

    I donned a PAPR, n-95 and a spacesuit that I borrowed from one of the total joint surgeons, in preparation of being drafted into the ICU. Promptly was summoned into the office of a very officious administrator, and told I couldn’t wear that, that I was scaring the staff, to wear a paper mask and a plastic apron.

    Reminded me of the scene from Brave Heart when Longshanks says “send in the Irish”.

    I sat in this office, had a long discussion about what was known at the time, and expressed concern that standard PPE would be ineffective, donned a paper mask and stuck my finger in it along the lateral recesses at the side, inhaled deeply and blew out, and said “Do you really think that this will stop an airborne virus?”

    Blank stare, condescending smirk.

    Send in the Irish, indeed.

    1. lambert strether

      I remember the Chinese bus story vividly because there was a seating diagram and IIRC airflow shown (though I’m not sure the bus was from Wuhan). That story immediately sold me on airborne transmission and I linked to it. It was in the South China Morning Post, but larer, oddly, disappeared….

  5. Lambert Strether Post author

    This HICPAC post got some traction:

    Yaneer Bar-Yam is not only a co-founder of WHN, but President of NECSI, the New England Complex Systems Institute, which, in a paper co-authored by Nicholas Nassim Taleb, got Covid very very right, and very very early: “SYSTEMIC RISK OF PANDEMIC VIA NOVEL PATHOGENS – CORONAVIRUS.” On January 26, 2020 (!!).

    Exalted company here, people [lambert blushes modestly].

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