Thread by @rdumont99

From everything I've read, I truly believe that #covidisairborne, #safeschools and #vocs are all indelibly linked. I'm still putting the pieces all together, but maybe you can help. A LONG thread, please bear with me.
#bcpoli #bced 🧵

Let's get this out of the way: any debate of whether C-19 is airborne is stupid, because it has all the properties of an airborne pathogen. It rides on infectious airborne particles.

This article is old & dated now, but easily understood:

theatlantic.com/health/archive…

Here's a great illustration of how airborne spread of C-19 happens, and how both close exposure and duration of exposure combined with ventilation matter.

english.elpais.com/society/2020-1…

So, we all know "R0", but you need to understand COVID's "k" number - its dispersion. Essentially, most (69%) people don't transmit COVID forward at all, but of those that do, some *REALLY* spread it. Especially when conditions are favourable.

theatlantic.com/health/archive…

A big component of C-19's dispersion is that wild type (this is foreshadowing) is actually not that infectious. The spike protein repels human cell receptors. It evolved to be able to infect humans, but not well.

You have to receive a significant viral load to get sick

That significant viral load could be from short-term close contact, or prolonged exposure to a contaminated airspace. Or if you're really unlucky, surface-hand-mouth/nose contamination - theoretically (& actually unproven!)

https://twitter.com/rdumont99/status/1364253479535923207

Early on "experts" said we "don't produce aerosols." This is false. Most don't produce many, while some produce a LOT. 3 orders of magnitude difference!!! (Some produce 1000x more than others). Age, weight, and COVID infection are factors

https://twitter.com/JohnWalravenGA/status/1377964956877008899

Particularly, younger, lighter humans produce far fewer aerosols, especially if not singing/shouting, although again there's variance. This is a legitimate physiologically advantage for *most* children, especially when clustered together indoors.

journals.plos.org/plosone/articl…

So with all this above, we start to understand why COVID acts as it does: clusters of infections; indoor is dangerous, outdoors is safer until busy / high positivity rates; why so many places can't trace ~25-30% of infections' sources; why some think schools are safe.

It also explains why VCH found only 10% of school cases transmitted forward (warning: severe data collection bias due to no asymptomatic testing). However, those 10% of transmitters *could* be responsible for 20%, 40%, or more of the school exposures

vch.ca/about-us/news/…

It also explains why in some places, schools have actually been made safe - by focusing on everyone wearing masks, having great ventilation, and upgrading filtration: (image from @smjevnikar). 80% of schools required masks outdoors!

cdc.gov/mmwr/volumes/7…

With sufficient safety protocols combined with kids' physiological advantages and C-19's fairly poor infectiousness, viral exposure can be reduced & schools *can* be pretty safe.

But many places delude themselves into thinking they've done so, by not testing asymptomatics.

There are tons of high quality Wave 2 studies now, showing that we're missing lots of child cases due to test protocols, schools are amplifying cases in the community, living with children increases risk considerably, etc. E.g. here's one (of many!):

https://twitter.com/DGBassani/status/1366515747695001604

So - remember I foreshadowed that *wild type* C-19 isn't very good at infecting humans? VoCs change this. E.g. B.1.1.7 and P.1 both have far greater ability to infect cells. This means less viral exposure is required to get sick, and it spreads faster inside our bodies.

Schools had struck a point of balance, where transmissions were low enough that, combined with community interventions, cases didn't explode overall. But VoCs change all this.

spiegel.de/international/…

What we were seeing was that having a child infected with original C-19 in a classroom with decent ventilation and most wearing masks usually resulted in 0 or 1 or 2 others getting infected. Most often, 0.

But VoCs make us sicker faster, and require lower viral load to infect

With wild type, if we had adults crammed into buildings the way our schoolchildren are, there'd be crazy superspreader events. With VoCs, the advantage of child physiology is erased. Children catch & spread like adults used to. And take it home to parents who spread it even more

VoCs *can* be controlled. E.g. UK, Ireland, South Africa, to an extent Denmark - all have managed to control VoCs. But you know what they didn't do? Keep kids in schools.

NO region has controlled VoCs with schools open. NONE.

I used to be a huge proponent of keeping schools open safely. That is no longer possible - or rather, we have no examples of anywhere that's proved it's possible. This is a HUGE RED FLAG. This is not an experiment I want to conduct on BC's children, families, citizens.

So what do we need to do?
1) CRUCIAL! Schools go online except essential / safety students
2) Provincial lockdown, including restrictions on travel
3) Transparent data reporting and honesty from @bcndp
4) Proactive vaccination of high-risk, high-transmission areas

When? NOW.

Oh, and go for #zerocovid. With vaccines, yes, but not only via vaccines. It seems weird to say, but we should be avoiding avoidable deaths.

BTW - I didn't cover Long Covid at all, above. Covid can cause all sorts of chronic problems, including potentially-permanent organ damage. For many, surviving COVID isn't like surviving the flu.

Death isn't the only tragic outcome of COVID