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Why aren’t we talking more about airborne transmission?

theatlantic.com

261–270 of 292 posts

Re: Why aren’t we talking more about airborne transmission?

#261

Earlier quoted context omitted.

> Most viruses do form aerosols, and those aerosols do seem to be infectious. It's my understanding that most don't spread in this fashion. If you're hospitalized with cold/flu, your care team will observe droplet precautions, not aerosol ones. If you have measles, which spreads via aerosol, they'll be using substantially more gear. The aerosol transmission is also why measles is shockingly easy to spread versus most…

> If you're hospitalized with cold/flu, your care team will observe droplet precautions, not aerosol ones. From my understanding, part of this is because most hospitals don't have aerosol specific precautions. Pre-COVID, anything requiring more than droplet precautions was simply handled with full-airborne precautions (negative pressure room, PAPR, etc). Ideally, we'd have the airborne-precaution PPE for all COVID ca…

This is my point but people keep downvoting it. "That's expensive, so that can't be true."

Re: Why aren’t we talking more about airborne transmission?

#262
post #189

Earlier quoted context omitted.

The thing is -- why assume it can't form aerosols and that those aerosols aren't infectious? By demanding evidence for aerosol formation that is what they are stating. It makes no sense. Most viruses do form aerosols, and those aerosols do seem to be infectious. Are you really prepared to make the bet that they aren't infectious?

> Most viruses do form aerosols, and those aerosols do seem to be infectious. It's my understanding that most don't spread in this fashion. If you're hospitalized with cold/flu, your care team will observe droplet precautions, not aerosol ones. If you have measles, which spreads via aerosol, they'll be using substantially more gear. The aerosol transmission is also why measles is shockingly easy to spread versus most…

From WHO:

>The physics of exhaled air and flow physics have generated hypotheses about possible mechanisms of SARS-CoV-2 transmission through aerosols.(13-16) These theories suggest that 1) a number of respiratory droplets generate microscopic aerosols (What the WHO and some doctors are doing is going: "despite the fact that it seems like it can spread via aerosols and that seems fairly likely, we want hard proof and are willing to risk our lives on that basis."

So, lol.

Re: Why aren’t we talking more about airborne transmission?

#263
post #198

Earlier quoted context omitted.

If you are in the USA, I don't believe your claim that most commercial or schools have HEPA in their air filtration system, and know it isn't true for new residential in the PNW. The school I attended as a child didn't have any filtration at all, for example.

there's certainly variation, regional, by quality level, as well as generational. class A commercial will almost certainly have filtered hvac, for example. my 1930's vintage high school most certainly didn't.

Filtered, yes, but not HEPA.

Re: Why aren’t we talking more about airborne transmission?

#264

Earlier quoted context omitted.

Your claims do not reflect what the article and the evidence it cites show. To quote: > Cowling told me that it’s better to call these “short-range aerosols,” as that communicates the nature of the threat more accurately: Most of these particles are concentrated around the infected person, but, under the right circumstances, they can accumulate and get around. This is the precise opposite of your claim that 6 foot di…

Well first of all there is little evidence on both sides of the argument here. There isn't much evidence in favor of aerosol transmission and there isn't much evidence against it either. I would hope that more research can be done on this matter. Perhaps I worded my statement poorly. Let me try to be more precise about the idea I was trying to express. If COVID really is more aerosol infectious than we have been assu…

If you're claiming there's "isn't much evidence" indicating aerosol transmission, I would once again encourage you to read the article closely. There are several well-documented case clusters cited in the article where infections could really ONLY be explained by some degree of aerosol transmission. But aerosols vs. droplets aren't a black-and-white situation: people expel a whole range of different particle sizes, and where we draw the line between droplets and aerosols is largely arbitrary (small droplets just above that line behave much the same as big aerosols just below it).

Small "droplets" can travel some distance too. 6 feet isn't a magical boundary beyond which droplets completely vanish. Nor do particles just below the aerosol vs droplet threshold magically become non-infectious. There's a continuum of behavior. Public health authorities KNOW all this, and have known it from the beginning. But they also know that the public needs simple, clear guidance to take action. So, they have to simplify their explanations and inevitably some detail will be lost.

What we know now is that smaller particles (short-distance aerosols) play a bigger role than initial data suggested. But the evidence still suggests SARS-CoV-2 usually requires pretty close contact or circumstances that concentrate aerosols: limited ventilation on cruise ships, for example, or people singing for an extended period (producing a much higher volume of aerosols).

> I don't deny that if someone with COVID coughs directly in your face which apparently was considered the dominant transmission vector at first

This is not even REMOTELY what "droplet transmission" means. If that was what it took, NOBODY would be getting sick. Droplet transmission can come from talking, or being near someone yelling a drink order in a bar, sharing a cab, attending a dinner party, etc. It just implies fairly close contact.

> Anyway my quibble with your post was the part about the guidelines being the same. They aren't really. The difference may be slight, but it could be critical.

Every single piece of public health advice is imperfect, because they have to simplify complex situations. None of the original safety measures were actually WRONG -- all help protect against short-distance aerosols. The new evidence just adds another layer to the situation, and places extra emphasis on certain measures.

If the public and politicians had actually followed the original public health guidance, the situation would look much better than it does today.

Re: Why aren’t we talking more about airborne transmission?

#265

I am still shocked: months after research has shown that SARS-CoV-2 is airborne stable in aerosol form for over 3 hours, we still aren’t telling the public that room air purifiers are a ‘good thing’ (for making indoor air like outdoor air - in regards to virion density per cubic air volume) The filter technology is essentially the same as in the N95, orders of magnitude more effective than cloth masks. Put these indo…

Added benefit: post-covid pandemic, improved indoor air quality with all the included benefits! Air quality associated with: Alzheimers: https://www.scientificamerican.com/article/the-new-alzheimer... Cancers, plural: https://www.aacr.org/patients-caregivers/progress-against-ca... Sperm Quality: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4443398/#sec995... Female Fertility: https://www.newscientist.com/article/2207…

Sperm Quality? That's it - the window stays open!

Re: Why aren’t we talking more about airborne transmission?

#266
post #247

Earlier quoted context omitted.

That's actually the opposite of what the evidence shows. Masks - even crappy ones, with poor mask protocol - dramatically cut infections https://arstechnica.com/science/2020/06/modeling-the-impact-... Citation: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00818 Remember: even if a mask doesn't effectively filter out very small particles, it still restricts the velocity of air passing through it. This means…

About your arstechnica link: if masks don't work all that effectively you need huge numbers of people to wear them to prevent a single infection. https://www.fhi.no/globalassets/dokumenterfiler/rapporter/20... > Non-medical facemasks include a variety of products. There is no reliable evidence of the effectiveness of non-medical facemasks in community settings. There is likely to be substantial variation in effective…

> There is no reliable evidence of the effectiveness of non-medical facemasks in community settings.

There has been only very limited study of non-medical (cloth) masks so far, because there was not a prior crisis that NEEDED them (where surgical mask supplies were insufficient). The fundamental problem with most of your points is that lack of research on effectiveness is NOT the same thing as proof of ineffectiveness.

We can assume that most cloth masks are probably not AS effective as surgical masks or N95 masks (although some materials can achieve surprisingly good filtration), but that's not the same thing as saying they're useless either. Especially true for models with good fit and the ability to install filters. But even a modest reduction in R-effective can greatly reduce the number of number of people infected over time.

The healthaffairs article shows that mask mandates reduced transmission: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00818

Beyond that, I'm not going to waste time going point by point in debate with someone determined to "disprove" guidance from the best available medical authorities.

Re: Why aren’t we talking more about airborne transmission?

#267
post #190

Short-distance aerosol transmission changes things a bit: * Social distancing isn't enough to guarantee safety in indoors spaces: bad news for bars, clubs, gyms, concerts, and restaurants * Outdoors spaces are probably safer than we previously thought * Indoor mask-wearing becomes CRITICAL in public spaces * Indoor ventilation becomes extra important, using fresh air from outside or filtered/UV-sanitized air * Indoor…

Indeed. Governments have been slow to draw these lessons unfortunately. My local government (quebec) lets you remove masks at indoors events when seated.

Governments are generally slow to change guidance when evidence is limited or ambiguous. The problem here is that while we have pretty solid evidence for short-distance aerosol transmission in some cases, it will take time to understand how BIG a factor it is.

One thing that is easy to forget as a layperson: when it comes to public health, the government only has a limited ability to influence public behavior. Think of it as having a limited number of cards to play. So if they spend a card convincing people to wear masks indoors at events, then they can't spend it convincing people not to hold dinner parties (a common source of super-spreading events).

Furthermore if the government emphasizes something that turns out to be ineffective, then they have even less ability to convince the public change their behavior in the future. This backlash gets worse if they appear to "change their mind" on something. Witness the backlash from health authorities shifting guidance on the importance of mask use in response to evidence of high pre-symptomatic/asymptomatic transmission of SARS-CoV-2.

A huge part of the challenge for public health workers is figuring out what measures to emphasize and how to communicate it.

I'm not saying the government responses are ideal: they almost never will be, especially with a new disease. But I can at least understand why they're slow to change their guidance.

Re: Why aren’t we talking more about airborne transmission?

#268

Earlier quoted context omitted.

There are no "microdroplets" which stay in the air for "30+" minutes. First, water DRIES OUT unless the humidity is very close to 100% which is relatively rare in western countries. The smaller droplet the faster this happens. Put a very, very small droplet on a flat surface like glass. Observe it disappear within couple of minutes. Then imagine that a smaller droplet is just larger droplet closer to drying out. Volu…

I appreciate the distinction you're making here. I don't have enough facts to prove or disprove it. But, I'd like to ask: are you suggesting that aerosolized droplets cannot be seriously spreading this disease because they will evaporate almost instantly? I ask because there is quite a bit of research suggesting that aerosolized droplets are spreading the disease, and can hang int the air for a substantial period of…

Well... I am not suggesting anything.

There are two types of viruses: airborne and not airborne. Airborne can survive for some time outside bodily fluids.

Aerosol == bodily fluid that is still liquid. It is just in the form of very small droplets that are now drying out. Depending on conditions this lasts very shortly. It spreads the virus, of course, but aerosol dries out quickly and viruses that are not airborne die (well.. viruses do not live in the usual sense, basically their proteins get damaged).

Of course if somebody coughs in your direction some of the aerosol can be inhaled or reach your retina or get on your hands and you can get infected.

No, I am not suggesting droplets cannot spread the disease, the opposite is true. Droplets are much better transmitter of disease if they can reach the target.

Re: Why aren’t we talking more about airborne transmission?

#269

After this pandemic, doctors and scientists are going to have to come up with more media-friendly terms from now on. The problem is that "airborne droplets" and "airborne" sound too similar and it's very hard for regular people to understand what that means. "Airborne droplets" means that viruses need saliva to transmit between people. "Airborne" means that the virus only needs dust particles to transmit to other peo…

More important would be fixing the messaging on masks and protection. (Most laymen aren't going to distinguish between droplet, aerosol, airborne, etc. and won't adjust behavior and risk profiles accordingly.) The CDC told people that masks were not important at the start of the pandemic, largely as a means of reserving stock for doctors and first responders. They then performed an uneven and awkwardly stilted 180 on…

> The birth of the anti-mask movement, etc.

Hogwash. Those people would have latched onto something else. The 1918 pandemic also had its "anti-mask" idiots.

Stupid is timeless and universal.

> You shouldn't lie to the public.

Agreed. Calling an active pandemic a "liberal hoax" started a huge problem.

Re: Why aren’t we talking more about airborne transmission?

#270
post #24

This is a good article. I work at a biotech company that studies virus transmission and helps others study it. It was clear from the very beginning that transmission was airborne. Why would it not be? That the WHO and some doctors were assuming it was not seriously damages their credibility as healthcare professionals. Current events should lead people to seriously question deference given to doctors. They need to be…

All professionals and experts should be held accountable for their actions: doctors are no exception. The issue with "needing to be held accountable" is that you're calling doctors a monolithic group and implying that they aren't already heavily screened and scrutinized. Doctors are, and should be, some of the most elite minds and highly respected scientists/caregivers. Like any group, they have inter-group controver…

>> Doctors are, and should be, some of the most elite minds and highly respected scientists/caregivers.

Hyperbolic sycophantry like the above only exaserbates the ego and credentialism problems which already plague the medical profession. Respect is earned.

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