Health

How COVID-19 transmission confusion still haunts us


BILLIONmany years after the pandemic began, we finally have a clear understanding of how COVID-19 is transmitted: some infected people exhale the virus in small, invisible particles (aerosol). These do not fall quickly to the ground, but travel through the air like cigarette smoke. Others can become infected by breathing in those aerosols, nearby, in the general air of a room or, less often, at a distance. But the journey of acceptance overwhelming scientific evidence on how COVID-19 spreads too slow and controversial. Even today, up-to-date policies and guidelines on how to protect yourself are randomly applied, in part because of one word: “in the air.”

This basic misunderstanding about the virus The response took shape miserably during the first few months of the pandemic and continues to this day. We still see it now in surface cleaning procedures that many people have adopted even when walking around without a mask on. There is one main explanation for this initial error. In hospitals, the word “in the air” is associated with a series of rigorous methods of protection, including the use of N95 respirators for workers and negative pressure rooms for patients. These are heavily used and legally required resources. There was a shortage of N95 at the start of the pandemic, so it would be difficult, if not impossible, to fully implement airborne precautions in hospitals.

Due to its specific meaning in hospitals and the long-standing misunderstanding of How airborne transmission actually occurs? and underestimate its importance, public health officials have been wary of saying the word, even though it’s the most obvious way to inform the public about transmission and how to control it. As one article put it, “They say the coronavirus is not airborne – but it is certainly airborne.“Because the word “airborne” is unlimited, it felt like we went to a basketball game and thought it was a boxing match.

During a press conference in February 2020, the Director-General of the World Health Organization said, “This is in the air, the halo is in the air, ”Although a few minutes later, he corrected himself,“Sorry, I used the word military, aerial. It is meant to be spread through droplets or the respiratory tract. Please go that way; not military language”. In March, WHO completely denied that Covid-19 was airborne, posting on society media, “FACT: #COVID19 is NOT in the air” and called it “misinformation”. We and our colleagues, scientists and engineers, who have studied airborne particles our entire careers, meet WHO in April 2020 expressed our concern that airborne transmission plays an important role in the spread of COVID-19. WHO vehemently rejected our offer and considered us an intruder who doesn’t understand what’s going on in the hospital.

Likewise, the US Centers for Disease Control has deliberately avoided using the word and instead tied itself in knots when trying to describe transmission. Final we started to be heard, but the initial period of the pandemic, when virus containment was more feasible, and when everyone was attentive and ready to adapt new protective behaviors, has been lost. Protective measures are almost useless against this virus, such as disinfecting surfaces and washing ingrained hands. Billions of dollars have been spent on plexiglas . barriers that can increase transmission. Gradually over the past two years, these two agencies have recognized airborne transmission of the virus, and in December 2021, WHO finally used the word “aerial” on a website to explain how COVID-19 spreads among people, although the organization’s social media posts continue to avoid the word altogether. The word remains intact for CDC

We’re used to talking freely about water-borne, food-borne, blood-borne or vector-borne diseases. If even President Trump knew in February 2020,”You just breathe the air, and that’s how it goes, ”Why was the public not clearly informed that the virus was airborne? According to conventional wisdom in the medical community, colds and hot flashes are spread primarily by large droplets, and there is a very high threshold for demonstrating an airborne disease. Historically, transmissions by air have been associated with long distances, beyond the 6 feet range. Such occurrences are difficult to demonstrate for a rapidly spreading virus, as our observations at the time were limited by rules restricting contact tracing to people within 6 feet due to age-old practice.

Read more: How to properly clean indoor air against COVID-19

Ideas about how transmission routes work have been dominated by observations in hospitals, which tend to have excellent ventilation and therefore a lower risk of airborne transmission. Good ventilation removes viruses from the air and prevents viruses from accumulating over time, reducing the chances of someone inhaling a sufficient amount of infected virus. As the pandemic progressed and we and our colleagues worked to demonstrate that all the evidence points towards Airborne transmission, public health leaders are beginning to acknowledge that it can happen in exceptional situations, that is, in patients with poor ventilation. What they may not realize is that, compared to hospitals, nearly all other buildings — homes, schools, restaurants, and many workplaces and gyms — would qualify as such special situations. In these buildings, indoor air can be replaced by outdoor air once or twice per hour, while in hospitals, ventilation rate of at least 6 air changes per hour in the ward and 15 in the operating room.

We’ve studied airborne viruses long enough to understand that “in the air” is a healthcare trigger word, but we find it frustrating that the word has crossed the line during a pandemic. Translate. It’s okay to talk about aerosols, but not “in the air” or to explain “like smoke,” although it is much more effective to communicate with the public. To the general public, the word simply means something in the air, like a kite or pollen. The situation is like trying to explain a diagnosis of carcinoma to a patient without using the word “cancer”. Using the word earlier in the pandemic will facilitate the implementation of more effective mitigation strategies, such as Japan’s 3C—Avoid close contact, avoid crowds, and avoid closed, poorly ventilated places — instead of focusing too much on 6 feet and surface cleaning. It can also reduce resistance to the mask.

The medical field should not have a monopoly on the word airborne. One way to reduce the risk of future miscommunication is to change the designation of different categories of precautions for infection prevention and control in hospitals. Instead of attaching specific words to existing categories — contact, droplet, and airborne — hospitals can assign numerical levels (e.g. 1, 2, 3, 4…) to groups of measures. various precautions, such as those used for biosafety procedures in the laboratory. This will avoid the association of certain words with regulatory requirements, freeing up words for general use.

From the outside, it is easy to see that the traditional, health-centered approach has contributed to the sclerotic response to the airborne spread of Covid-19. We realize this sounds self-serving, but we need to recognize that expertise broader than medicine is needed for public health, and certainly to combat airborne viruses. We, the two authors, know almost nothing about what happens to a virus once it’s inside your body or how to deal with it, but we do know how viruses behave in the environment. – whether indoor or outdoor – and how to get rid of it. It is the field of environmental engineering, mechanical engineering, atmospheric science and aerosol science, fields devoted to understanding the motion and control of gases and particles in the environment. This kind of expertise has been cast aside in our pandemic response.

We are happy to see White House recognizes airborne transmission and importance of indoor air quality through the Clean Air in Buildings Challenge as part of National COVID-19 preparedness plan. While this is a good start, more regulation and funding will be needed to achieve clean air in all of our buildings and realize its full benefits in the long run. And because building operations are responsible for approx 30% of greenhouse gas emissionsWe have to figure out how to do this efficiently.

We can’t let “airborne” be a dirty word. Instead, increased public attention to the air we breathe is an opportunity to provide science, technology, and policy tools to ensure that the air in our buildings stays clean. clean and healthy.

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