In case there's doubt that the virus can spread through respiratory particles that float in air and travel far, I wanted to share these studies:

1. Indoor airborne event: plant worker transmits virus to those 24ft away in area w/re-circulated air 1/n
papers.ssrn.com/sol3/papers.cf…
2. Super-spreader at choir: of 27 participants, 70% diagnosed w/COVID-19; 36% hospitalized; 21% ICU.

It was indoors w/no ventilation. Spread was likely through both big droplets that fall to the ground & airborne aerosols that float 2/n
medrxiv.org/content/10.110…
3. JAMA: super-spreader infects 23 on bus: "Airborne spread of SARS-CoV-2 seems likely to have contributed to the high attack rate in the exposed bus" The AC unit was set to "re-circulation mode" 3/n
jamanetwork.com/journals/jamai…
4. CDC: Another choir super-spreading event: following practice, 32 confirmed; 20 probable secondary cases. "The act of singing, itself, might have contributed to transmission through emission of aerosols, which is affected by loudness of vocalization" 4/n
cdc.gov/mmwr/volumes/6…
5. Coronavirus is in the air: 94 employees (out of 216) were infected in a call center in South Korea, a 43.5% attack rate! Nearly all of them sat on the same side of the building, suggesting airflow as culprit 5/n
wwwnc.cdc.gov/eid/article/26…
6. Another study pointing to coronavirus in the air: an asymptomatic individual sitting at a table in a restaurant infected people sitting at two other tables that were facing an Air Conditioning unit, pointing to recirculated air as the culprit 6/n
wwwnc.cdc.gov/eid/article/26…
7. NATURE: virus captured from aerosols: Aerosols emitted by SARS-CoV-2 patients contain the virus and the virus can infect cells 7/n
nature.com/articles/s4159…
8. Another study shows viable SARS-CoV-2 captured from air samples, this time 2-5 meters away with COVID-19 patients. Virus is stable and in respiratory aerosols that can float far. 8/n
medrxiv.org/content/10.110…
9. CDC: Virus is stable in air: once airborne, SARS-CoV-2 retains ability to infect for at least 16 hrs. It's hardier in aerosols than SARS-1 or MERS

This helps explain why airborne route could be major culprit 9/n

wwwnc.cdc.gov/eid/article/26…
10. Scientists have been saying this for a long time.

@DrLaPook to @kprather88:How sure are you that the virus is significantly spread through aerosolization? 10/n
11. But US and WHO officials have been slow to update guidance.

In contrast, the National Health Commission of China highlighted the possibility of aerosol transmission 6 months ago! 11/n

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More from @AliNouriPhD

22 Sep
VIRUS RESURGING, and it's not even winter yet: after crushing the curve, France🇫🇷/Spain🇪🇸 recording more cases than during prior peak. Consequence of ill-prepared reopening, travel, spread among youth, bar-goers...In some place ICUs almost at saturation: wapo.st/3ck8qgl🧵
In the meantime, as Israel's cases soar, it became the first country to enter into a second lockdown. With some hospitals at capacity and turning patients away, the military is stepping in to set up field hospitals: bit.ly/3kBoTj7 2/4
Iran🇮🇷is in trouble: Among earliest to be hit, now in its 3rd wave. Each wave's baseline worse than last. Iran also coming off holiday travel & inadequate masking:bit.ly/2EmFuI5
“We no longer have orange and yellow, the whole country is in red" - Dep. Health Minister 3/4
Read 4 tweets
21 Sep
CDC: the coronavirus is airborne.

CDC finally acknowledged what scientists have been saying for months:

The virus isn't just spreading through large repiratory droplets that fall under gravity (6ft rule) but on small ones too that can travel farther. 1/3
newsweek.com/cdc-coronaviru…
This highlights the need for ventilation, in addition to masks, physical distancing, and hygiene. There are numerous examples of longer-distance aerosol transmission in indoor spaces. A few examples here: 2/3
This has been the defacto view in many countries. The Feb 3rd scientific study that characterized the virus even says "we propose that the disease could be transmitted by airborne transmission.."

The question is why it took us so long to accept it. 3/3
nature.com/articles/s4158…
Read 5 tweets
20 Sep
1. CDC: nearly 11,000 exposed to coronavirus on flights. Agency investigated 1,600 cases of people who flew while at risk of spreading the coronavirus, identifying nearly 11,000 people who potentially were exposed to the virus on flights 🧵
washingtonpost.com/local/traffica…
2. According to story, CDC contends viruses don't spread easily on planes w/air filtration systems, but being in close proximity to people for long periods is a problem. CDC’s guidance for travel is that staying home is safest. Indeed, in-flight transmission has been observed...
3. Yesterday researchers published an example of SARS-CoV-2 spread on planes. In March, a super-spreading event on a 10-hour London to Hanoi flight led to 16 Infections due to what is thought to be airborne transmission on the aircraft...
Read 5 tweets
20 Sep
1. Japan has a remarkably low death rate despite avoiding harsh lockdowns. That's because it a) recognized early that the virus doesn't just transmit at close distances, but also long-range & b) its public adheres to public health guidance. Western nations should emulate these 🧵
2. One feature of the virus is super-spreading where small minority can infect many others, often in crowded, poorly ventilated places. Few examples below👇. While @CDCgov, @WHO, others ignored or were too slow to acknowledge this, Japan embraced it early.
3. It did that by advocating for the 3 Cs: avoid close contact, crowded places, and closed spaces WITH POOR VENTILATION. In other words, the virus doesn't just come out of your mouth and fall to the ground within 6 ft, but can float in the air you breathe, so mix in fresh air.
Read 5 tweets
18 Sep
1. CDC: Super-spreading event on a 10-hour London➡️Hanoi flight w/16 Infections very likely acquired on board✈️.

"This finding...is generally in line with the mounting evidence that airborne transmission of SARS-CoV-2 is a major yet under-recognized transmission route"🧵
2. Authors go on: industry classifies in-flight transmission risk as very low & recommends only use of face masks w/o additional measures to increase physical distance, such as blocking the middle seats. "Our findings challenge these recommendations."
wwwnc.cdc.gov/eid/article/26…
3. This is why @FAScientists have asked the airlines to block the middle seat. It won't make the problem of long-range aerosols go away but will reduce the risk of short-range transmission: mailchi.mp/fas.org/airlin…
Read 6 tweets
16 Sep
1st completed Randomized Clinical Trial for Convalescent Plasma finds NO IMPROVEMENT in mortality or progression to severe disease. Preprint: bit.ly/3iE1Qnd

You'll recall after pressure from President, FDA authorized the therapy in August: bit.ly/3c5sHGp 🧵 1/6
During that announcement the President, Sec. Azar & Commissioner Hahn all falsely claimed the therapy reduces mortality by 35%. Hahn later retracted.

Azar: "We dream in drug development of something like a 35% mortality reduction" 2/6

nytimes.com/2020/08/24/hea….
FDA authorization was based on a NON-randomized Mayo study that showed some improvement.

But the new study out of India, the first completed randomized trial, found no mortality reduction. Separately, a randomized Netherlands study was discontinued, having found no benefit. 3/6
Read 6 tweets

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