Thread by @ARISense_AQ

#AAAR2022 Panel 1 - Lesson Learned from the COVID- 19 Pandemic and Panel 2 - Gaps in the Aerosol Science Identified During the COVID-19 Pandemic

1. Lessons
2. Gaps

Here we go! Hope I can learn some stuff.. 1/

Provide opportunity to have discussion. Recording video and audio to hopefully later -

@huffman just gave me permission to live tweet all this. Phew.

@PollittKrystal is tag-teaming on moderation.

Key thing you learned -

- Expect the unexpected. In beginning we focused on healthcare facilities.. fitness centers.. restuarants - realized homes bc of poor ventilation were highest problem areas for virus aerosols.

Expect what you don't expect

- The thing that most surprised me was the high degree of variability person to person - I felt like there should be a common metric w. hospitalized patients - and high degree of person to person makes the messaging difficult and complex. Learned that trying to communicate

complex science in the public is a lot more difficult than I thought.

I think about new tech a lot. Something that's forgotten is what are the existing tools, simple tools.. filtration for example, source control via masks. These are simple things. But not easy to implement in a confused communication thread to translating to action

High variability of different studies... varying results - hard to get clear and concise message on stuff. Looking into different technologies and judging tech as being safe or not safe - hopefully we can all stay on track and not be lost in the weeds of public opinion

(Eben thoughts will be in para)

What things are we confident about but uncertain about - what data do we need / in this community / outside this community to convince ourselves.

Common method or approach to virus and infectivity - gold standard that we go by - trying to figure out how to advance this science - having COVID brought infectious disease to the forefront, maybe this science will progress further.

I wrestle with - how does infectiousness work with people that are sick with anything. I think there's a commonly held opinion that people sick with COVID look like pig-pen from peanuts. And it doesn't work that way. There's this variability that we don't adequately understand

I think there needs to be some standard for sampling and analysis. When you talk about collecting and analyzing virus aerosol particles - there are so many different samplers, how you analyze it - there's no standard - and it leads to confusion.

end up with really hard to make coherent conclusions study to study.

Evaluating mitigation strategies - often done in controlled lab settings and not the real world - need those real world conditions and real, used, occupied indoor environments.

(me: MOD-PM, yes please)

Superspreaders: What do we need to do to predict and avoid these events?

Same thought process - feel strongly that we all have the potential to all be superspreaders - depends on your infection and what we do - data that I've seen on who is and is not a superspreader -

It's all timing and activity - not so much the person / specific thing about that individual person.

Evaluating people's emissions - 20% of the people in the study emitted a larger proportion of particles than the other 80% of people in the study. Where they just loud talkers?

Heavy breathers? Lung fluid stuff.. / really hard to predict.

(me: I've always wanted to do breath-a-lizers for aerosol generation)

Multi-disciplinary work is critical. The process of this pandemic - what did you learn about a discipline outside of your own area of strength. Early career people here - help them understand the ability to keep learning.

Research is incredibly inter-disciplinary. Lot of time spent with lots of different people (incl. lawyers now too..).

Through all that - talking to a bunch of regulatory folks, what are the laws, what can be done, it's really important to consider those constraints.

How you implement stuff - means that you have to legally be able to implement it.

Lucky to work with lots of people who know stuff that I don't know. Medical health care professionals. Is this english? Do I understand it. Takes multiple conversations and discussions, repeated - to keep talking and learning. Droplets and droplet mode mean very diff

things to diff people.

Aerosol science requires some inter disciplinary aspects - my experience working with HC community - those providing care - it's a much diff perspective. We can understand all this science - but if you can't put it into the practice of HC, you can't make

the situation better. How to take into account what the user needed to know to do their job more safely - and focus my studies around answering their questions.

During COVID - working on teams - you def get the engineers have one perspective on how to solve problem..

Collaborators must be able to work well together.

Collaborations: Control technologies.. what do we still need to learn about these technologies?

I think there's a lot of really exciting technologies on the market that have been used historically. My concern is that there is a big challenge with the reg framework right now. These things are considered devices and don't go through pre-market review. There's no standard

test method - and that makes identifying a false or misleading claim really really difficult.

We have to have a baseline for comparison.

We have to think about how the reg framework can support the end user and the industry.

If the industry bring a POS kit to the market - it's not good for anyone.

Novel control technologies.. lot of people got burned by snake oil salespeople. There's going to be backlash to new and proven tech as result.

Layered effects of control technologies are critical. We've tried to message all this stuff - nothing we do is perfect...

Q: Lots of questions coming in..

What tech advances do we need to understand infectious virus aerosol?

Right now - you collect and culture these samples. It's a lot of effort and requires high scales - you need BSL3 labs, it's mad complicated. We need to develop a new method that doesn't require the current type of culturing.

Tech is rapidly advancing.. past 10y - genome stuff - tech will exist soon - to id a virus alive or not.

Talk yesterday - looking at bacteria or fungus - using microwave and lasers to determine viability.

Culturing alternatives could be pretty clutch.

It's really like the dependence on us understanding infectiousness based on collecting and culturing process - even if you have the best technical hands in the world, stuff still fails. Need better way to id potentially infectious stuff.

Best characterized risk.

Warmed up! Let's go big for a second:

Q: It took a year for COVID to be accepted as aerosol-spread, why? How to avoid this from happening ever again?

I honestly think that we didn't fail to communicate this clearly at the beginning. There were barriers. Widely held beliefs that were wrong. These were held by people in positions of power at teh policy level. Need better connection between policy messaging and lab bench.

Need to build the necessary interpersonal relationship problem that we need to fix.

I have diff view: Definition of the terms. Droplet or aerosol terms were very confusing with diff definitions in diff fields. Clear message gets lost in all that.

When COVID started and there was a debate about terminology, I didn't even realize there was a debate.

Assumed that everyone understood aerosols as aerosols. Was taken by surprise that it was all that confusing to these other fields of scientists.

I think initially - scientists wanted to say it was similar to SARS-COV-1 and close contacts and fomites/surface - and same

mitigation could be applied (or at least they hoped).

Dis-infection means different things to different people.

Hopefully we can be motivated to overcome some of these communication issues.

When I started working on flu aerosol 8y ago - this is aerosol. This has to be less than 5 um. I said why? I followed their conventions - but at this point if I had the opportunity - there's something wrong about this definitiion (In the medical community specifically)

Communication stuff... what would you suggest we do to overcome the multi-disciplinary level.. or communicating the public level. People sitting in this room - top level people in this room may have connections at politically powerful levels.. but what should us regular people

do?

Panel: Getting people together - and encouraging folks to talk to and engage with people at all levels in all fields. Esp. those making the regulations and recommendations. Best way to do that - being together.

This field may be some of the least guilty of being multi-disciplinary.

Do bio-aerosols have a role in climate? But it's true. They do. bio-aerosols have more to do with life than just infectious disease. In this community we come and broaden our perspectives / grow as comm

Q: Big question. Real time detection. Is this possible?

Define real-time? Real-time detection of these aerosols. There are some posters out here today looking at this stuff - there's all kinds of future detection technologies - putting together tech that we have and building towards the holy grail of single particle real time detect

As we get rapid developing technologies.. and more science.. that just leads towards the lack of our standard. So it's a double edge sword. You want to find better way of doing something AND need to standardize it. Otherwise - it's a total S-show.

Deviate form topic a bit...

Literature review is very important. Lot of info (tech side, process side) available - and we are not really doing a good job knowing what's available. We are re-inventing the wheel, when all we need to do is read some papers.

We need to do our homework and not waste resources re-inventing the wheel.

Q: If you were given a magic wand - what would you fund in the short run and long-run to avoid and improve these PH challenges / transmission challenges?

Ans: Standards. Got to have these.

Ans: Long-term, an easy infectious detection technique

Two types of standards: Sampling/Culturing and Mitigation technology.

Standardization is critical to move all of these things forward. Need a basis for COMPARISON. CRITICAL.

Improving the understanding of what we need to have standards for... splitting hairs. I think about this - control technology standards - but we also need to have standards to understand secondary effects (think SOA, OH, O3).

Q: Building upon wish-list of standards - how could we actually do this? If we had standards - we wouldn't have the issues - standards for what constitutes an infectious virus - we would have had acceptance early on. Some common sense process about what constitutes infectious

Public policy, perceptions, false information, people believing false information, trying to encourage thoughtful science.

Another critical need - what appropriate surrogate organisms could we use? Good catalogue of useable stuff - to roll out more quick research to non-BL3 labs.

Standard method - allows you to spend your energy on the data outcomes rather than the data trustworthy-ness

Q: More practical side of this - Lot of communication... if you had a bunch of business leaders and school leaders - wanting to hear some kind of advice from you what would you tell them - how best to keep their folks safe?

Ans: Layered protection is important to help you save money and to get kids in an environment where they can learn well. You don't need to lock them in their home. Emphasize the cost savings!

Ans: Filtration and source control we know these are safe, we know these work, we know that the secondary effects are minimal, safe and effective and widely implemented without heartburn.

A lot of these technologies that are too good to be true are likely TOO GOOD TO BE TRUE.

SHOW ME THE DATA!

Real world data. Evidence. Use the tried and true methods here folks.

Ans: Cost and logistical concerns. I think sometimes - perfect is the enemy of the good is really appropriate here. We need to give people guidelines that they are capable of actually doing. We have to be reasonable when we communicate guidelines.

Ans: Huge energy consumption concern (This is not actually a true energy cost consideration, but person on panel apparently things it's prohibitively expensive to run box fans on low)...

Q: Who is responsible for setting these standards and how can #AAAR20222 contribute?

Ans: New method comes out, people just jump on it and say that's what we'll use. NO clear leader. Standards need to have some sort of government acceptance. This community could be the ones to set it. We could develop and propose these standards. ASHRAE could/should.

Ans: National Institute of Standards and Technology..

Ans: Mitigation control strategies.. EPA could regulate this - chemical pesticide products being proposed to treat indoor space (WHAT?!?!?)

EPA is not currently working on standards.. but some minimum testing framework stuff that they are doing on the chemical cleaning side

VERY VERY SLOW MOVING PROCESS (EPA, duh).

Q: What's not getting enough attention in all this?

Ans: A lot that can be done to move bench scale to field scale research and demonstration. Standards are supposed to be representative of how stuff is deployed in the real-world. Complicated problem. Lab to Field.

Ans: If I were to do it again - talk more to religious leaders, political leaders - help them understand what we are facing. And then let them do the messaging after they understand what I have to tell them.

Also business leaders.

Ans: We do a great job talking to people that listen to us. We suck at talking to people that dont' want to listen to us at all. We get all our positive feedback from our echo chambers. All our negative feedback form those who are reticent.

Need more effective communication

Panel #1 - END.