Thread by @MamaToronto

“COVID-19 and Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

From Clinical Infectious Diseases

🧵

watermark.silverchair.com/ciad068.pdf?to…

H/T @DFisman

“This is an account that should be heard of an important struggle: the struggle of a large group of experts who came together at the beginning of the Covid-19 pandemic to warn the world about the risk of airborne transmission and the consequences of ignoring it.”

“We alerted the World Health Organization (WHO) about the potential significance of the airborne transmission of SARS-CoV-2 & the urgent need to control it, but our concerns were dismissed.”

“Here we describe how this happened & the consequences. We hope that by reporting this story, we can raise awareness of the importance of interdisciplinary collaboration & the need to be open to new evidence, and to prevent it from happening again…

…Acknowledgement of an issue & the emergence of new evidence related to it, is the first necessary step towards finding effective mitigation solutions.”

“Viewpoint

The events described here happened during the first months of the pandemic, however, we continue to be asked by the public & the media about them, & so we think that this account should be made public…

to serve as a warning about what happens when scientific evidence is rejected in favour of beliefs that have become dogma without a firm evidence base.”

“One can say that these disturbing events are in the past; let’s move on. Yet the consequence of this “past” was the loss of many lives, along with huge economic consequences…

…Equally importantly, how can we safeguard society in situations when those in power, with responsibility for our health & wellbeing, opt to base their decisions on embedded beliefs or narrow ways of interpreting evidence that seriously misdirect policy making?”

“The beginning – the pandemic unfolds

In January 2020, we all watched the news about a virus causing a rapidly increasing number of respiratory cases and deaths in Wuhan. Many asked: “Can it be controlled?””

“In the minds of natural scientists, medical professionals, engineers, & experts from numerous related fields, who have devoted their careers to studying the many elements of airborne infection transmission & to developing solutions to control it…

… curtailing airborne transmission had to be on the table as one of the key elements in controlling the epidemic before it became a pandemic.”

“The first signs of a serious problem we detected by China. Professor Junji Cao from the Chinese Academy of Sciences was worried that the airborne transmission route of the virus might not be well recognized…

… He shared his concerns with Professor Lidia Morawska of Queensland University of Technology, Australia, on 7 February 2020.”

“This communication raised the ?n of what could be done. Should we contact the authorities & alert them to this situation?
The sitn was rapidly changing. Cao & Morawska collaborated on a commentary entitled “Airborne transmission of SARS-CoV-2: the world should face the reality””

“They aimed as high as they could, contacting the editors of 2 top journals, in turn, and argued for the need to spread this message, but to no avail.”

“The response from one of the editors on 1 April 2020 was: “We appreciate that it is important to take into consideration long-distance airborne transmission by covid-19…

… However, we feel that this possibility is acknowledged by authorities & by the scientific community alike, & is being considered in different publications.””

“It became clear that it would not be easy to get this message across as a publication (the paper was eventually published by Environment International on 7 April 2020)…”

“The virus continued spreading & dark clouds were gathering. By March 2020, Italy was the epicentre of the disease spread outside China, with an unprecedented number of lives lost…

… Professor Giorgio Buonanno from the University of Cassino & Southern Lazio was among the first to raise the alarm that the critical element of control – airborne transmission – was not being taken into account.”

“The Italian med community knew how to apply relevant PPE & did so “by the book”. But “the book” did not acknowledge that this virus was in the air, & that measures to protect against airborne transmission, such as protective respirators & adequate ventilation, should be used.”

“Discussing this on Sat evening 28 March 2020, with Morawska, Buonanno suggested to contact the Italian PH Authorities directly to tell them about the significance of airborne infection transmission of the virus.”

“We knew that it was unlikely that the voices of 2 scientists contacting the authorities directly would have any influence.”

“If at all, our voices are heard within the scientific community via publications in scientific & professional journals.”

“The next day, the WHO tweeted: “Fact check: COVID-19 is NOT airborne”, & on 29 March 2020, the Exec Dir of the WHO Health Emergencies Program, stated to CNN: “There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit”.”

“This broadcast statement made us realise that the authority of WHO was necessary to convey the critical message & provide guidance to countries around the world.”

“That evening a decision was taken to assemble a group of experts to help convey the vital message to the WHO. Time was of the essence as the pandemic was intensifying and people were dying.”

“The focus on the WHO: science rejected

On 29 March, Morawska drafted a message in the form of a petition to the WHO DG & compiled a list of experts – colleagues of high international standing from around the world …

… whom she knew had been working on airborne transmission for many years from various angles , including aerosol physics, virology, public health, clinical medicine, infection prevention & control, building engineering, & facility management.”

“She had worked on this broad topic over the years with several of these individuals. The next day she contacted all the identified experts, explaining the problem, presenting the draft, & asking if they would like to support the petition…

… Every one of them did so, & some suggested names of additional experts to include.”

“The list expanded to 36 names, a sizable group; although we knew that many more experts could have been enlisted given more time this was a manageable group who represented a breadth of expertise from around the world. This is how “Group 36” was born.”

“On 1 April, Morawska emailed the petition directed to the WHO DG to his management team in the Geneva WHO Health Emergencies Program. There was an agreement within Group 36 not to engage with the media at this stage.”

“The hope was that the WHO would consider & act upon this message, without the need for any additional pressure, such as that created by the media.”

“Within just an hour, Morawska received a phone call from a member of the WHO Health Emergencies Program wanting to talk to her about the petition.”

“There was some tension during the conversation; Morawska thought that the WHO was reacting defensively rather than constructively to the arguments that were being presented.”

“The conclusion from that call was that another call would be organised, this time open to the participation of the entire Group 36; this call took place two days later, on 3 April.”

“That call was even more uncomfortable for Morawska, & indeed for all the participating members of Group 36. It is described in the first paragraphs of Molteni, 2021: “The 60-Year Scientific Screwup That Helped Covid Kill”.”

wired.com/story/the-teen…

“In addition to the members of the WHO Health Emergencies Program & Group 36, several other expert participants were invited by the WHO. The overwhelming impression was that these experts & the WHO team were trying to undermine or reject the message of our petition.”

“We were backed into a defensive position during the call, while we tried to make our points. After the call finished, disappointed & frustrated, we wondered: Why are they acting like this? Why are they so bluntly rejecting our arguments?”

“Nevertheless, the WHO undertook to provide a response to our petition. Before the response was received, on 6 April, we sent extended comments/clarifications on many points touched upon during the teleconference, saying:…

…“During the teleconference a number of points were raised, to which we were not able to respond, as time was limited. To address these points, and to clarify our explanations & recommendations, we have prepared a new document, please see attached.””

“A written response from the WHO was provided on 16 April, which stated: “In conclusion, we recognize that this is a complex and evolving area...

… Supported by many independent international experts, we maintain our view expressed above that the role of airborne transmission for SARS-CoV-2 is predominantly opportunistic & mainly limited to aerosol generating procedures”.”

“We replied on 17 April…“As you may have seen in the initial reactions from colleagues who signed the petition, we are disappointed that WHO will not consider airborne spread of SARS-CoV-2 as one of the routes of infection transmission & will not rec measures to mitigate this..

…Of course, we are keen to cont the discussion w/ your team & look forward to possible collaboration on this important topic. Please let us know how you would like to proceed…

… At the same time, we believe that the matter is so important & urgent that we will have to consider any avenues available to bring it to the attention of the general public, the medical community and authorities in charge of public health.””

“In response, a member from the WHO Health Emergencies Program commented on the same day: “I’m afraid that you have misunderstood. We have always considered the possibility of airborne transmission in the context of HC settings where aerosol generating procedures are conducted…

…Our guidance clearly reflects this, & has included this since the first version that was published on 10 Jan. I will let the IPC team respond directly to the questions from the group.””

“Time was passing, & while there was an appearance of a dialogue, it became clear to Group 36 that direct communication with the WHO was not going to achieve anything. What could we do?”

“One option we discussed was to go directly to a top media outlet in an English-speaking country... But it turned out that doing it this way would exclude many of our Group 36 medical colleagues who, as government employees, could not participate in a campaign through the media.”

“We decided to recast the petition in a slightly longer form, & to direct it not only at the WHO but also to national public health authorities, by approaching a top international scientific journal.”

“In addition, we decided to extend the group supporting this message by including other experts as co-authors or supporters…

… Members of Group 36 identified additional internationally acclaimed experts, & we established an online platform through which the invited experts could sign their support”

“Because we wanted to submit the petition – an open letter, as it came to be called – as soon as possible, we asked these experts to sign if they agreed with the text in its current form, & if they wanted to be part of this initiative.”

“The immediate & overwhelmingly positive response to support the open letter was a demonstration of consensus on the topic within the global expert community.”

“The submitted paper was rejected on 28 May by a top journal following a review by two advisors. Subsequently the paper was submitted to a second international journal on June 5, & again was rejected after review on 17 June, with comments…

..the manuscript “raises fear by warning against a mode of SARS-CoV-2 transmission for which the evidence so far is very weak. In numerous countries around the 🌎,#C19 cases are now decreasing w/out taking any measures to prevent virus spread through the air over several meters..

…Most countries recommend 1, 1.5 or 2 meters of physical distance between people & several do not recommend facemasks or only under specific conditions, let alone facemasks that filter small droplets or aerosol…

…Despite the ltd measures that have been taken (& are currently advised by the WHO) the case counts are dropping rapidly in many of these countries…

… thus providing reasonable assurance that #C19 is predominantly transmitted via direct or indirect contact & perhaps via large droplets over short distances. I would object to several arguments used by the authors as follows.”

We now know how wrong this reviewer was.”

“The paper was submitted a third time, to Clinical Infectious Diseases on June 26 &, after editorial comments were addressed, it was accepted on 1 July & published online on 6 July”

“This was a full three months after the first petition had been sent to the WHO. The paper was made available to the media under embargo & attracted a global media blitz after the embargo was lifted.”

“Just before pub of the paper we sent a 2nd petition to the WHO, saying: “We appeal again for WHO to join these scientists & nat HC orgs to acknowledge the new data & update their stance, by acknowledging that aerosol spread is one of the main modes of transmission of SARS-CoV-2”

“This will provide urgent & much needed global leadership to unify the multiple & varied approaches required to control the spread of SARS-CoV-2, as new clusters continue to break out across the world.””

“The WHO reacted during a media conference the next day on 7 July, accepting airborne transmission…

“The WHO modified its brief on 9 July 2020: “This section briefly describes possible modes of transmission for SARS-CoV-2, including contact, droplet, airborne, fomite, faecal-oral, bloodborne, mother-to-child, and animal-to-human transmission.”…

…& “Airborne transmission is defined as the spread of an infectious agent caused by the dissemination of droplet nuclei (aerosols) that remain infectious when suspended in air over long distances and time”.”

“The brief, however, used much more certain language for droplets & a much more uncertain description for aerosols.”

“As cases grew, new variants emerged, more data appeared showing poorly ventilated spaces were assoc w/ transmission & particularly superspreading events, & the wider sci community started to accept evidence more readily from those who studied respiratory aerosols…

… there were further modifications to the brief. The one posted on 23 December 2021, made the wording more complicated…

… by separating inhalation of the virus in close proximity to an infected person (“this is often called short-range aerosol or short-range airborne transmission”) & inhalation elsewhere in the room (“this is often called long-range aerosol or long-range airborne transmission”).”

“This flags a wider challenge around terminology. Airborne infection transmission occurs by inhalation of an infectious pathogen from the air; the mechanism is the same regardless of the location of a susceptible person in relation to the infectious person.”

“However, in medical fields the word airborne is typically reserved for transmission over longer distances, leading to incorrect assumptions that close-range transmission is only by large droplets...

… Intervention opportunities to control airborne transmission overlap but are not coincident between the short-range and longer-range transmission paths.”

“The WHO did publish several documents on ventilation, in particular the “Roadmap to improve and ensure good indoor ventilation in the context of COVID-19” which was released on 1st March 2021, & sought the expertise of Group 36 to review this document…

…However, by not directly connecting “ventilation” with “airborne transmission”, the message to national public health authorities and the public was not clearly delivered.”

“Group 36 continues to be an active force to combat airborne infection transmission & to shift the paradigm of the approach to clean and healthy indoor air in general, with an influential paper published in 2021 & a total of 45 collaborative papers about the pandemic.”

“However, our voice was ignored by WHO at the beginning of the pandemic, which was the most critical time for action.”

“Can society do better?

What course would the pandemic have taken if airborne transmission had been recognised at the beginning of April 2020 & guidelines on the mitigation of airborne transmission had been provided?”

“How many cases would have been prevented, how many long COVID cases & how many lives would have been saved?”

Of course, we will never know for sure as there is no reliable counterfactual, yet it is clear that there was a delay to messaging to manage airborne exposures & that funding was prioritised for other measures.”

“And why, after 3 years, is acceptance of the science of airborne infection transmission still a challenge? Several historical reasons are discussed by Jimenez et al. 2022, but historical errors should not shape the future.”

“One may say that the delay was only 3 months; perhaps that is only a short interval considering that we are now in the 3rd yr of the pandemic. However, those early 3 mths were critical, b/c this was when control measures were being developed & introd in countries around the 🌎”

“This was also the time when public interest was most acute & messages around transmission were embedded into the actions that millions of people took in their daily lives.”

“The “hygiene theatre”… was established, & for at least the next 12 months, 🤲 were disinfected countless times during the day; surfaces in pub spaces were deep cleaned; groceries from supermarkets were disinfected; & gloves were worn to avoid surface virus”

“But the virus was principally in the air, with even now limited evidence that fomites or hard surfaces play a significant role in transmission.”

“The initial misguidance & subsequent mixed messages have delayed practical implications from being implemented as vigorously as they should have been, from recognizing the importance of airborne transmission to implementing controls demonstrated to be effective.”

“Can the consequences of this misguided history be quantified, not only to provide an account of the past, but to help set the right course for respiratory infection control in the future?”

“Such knowledge would motivate the use of existing technologies & knowledge to minimize future loss of life due to airborne infection transmission & to reduce morbidity, economic costs, & other impacts.””

“It is a tragic situation for our society that scientific fact is not timely adopted in public health decision-making. We recognize that when setting policy, decision-makers must weigh numerous considerations: scientific, economic, social, ethical, & others…

…However, science must not besidelined in the process, which unfortunately is the case in many other decisions critical to the wellbeing of our society. We believe that as a society, we can & should do much better & we recommend how to do it.”

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

H/T @DoctorsInUnite 🧵

https://twitter.com/DoctorsInUnite/status/1621178688233697280?s=20&t=px1ziy0T4jOfvo6N2qNgGA

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

H/T @CPita3

https://twitter.com/CPita3/status/1623318494430351360?s=20&t=Qmr8ZhjgxUBAr2Lima-0Dg

cbc.ca/news/health/ca…

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

https://twitter.com/kprather88/status/1386765972485201920?s=20&t=Bzj1w08hnVpWKW7Fc8SVUQ

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

🧵

https://twitter.com/jmcrookston/status/1624173638361444352?s=20&t=5pk7BDwYlduJB8mjJANU4g

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

https://twitter.com/DFisman/status/1624495451578703881?s=20&t=Dx3af1BuO5dlv7kbB2Tl2w

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

🧵

https://twitter.com/MamaToronto/status/1621176257475149825?s=20&t=XQNiPqnKhwF407ES9XQhVg

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

🧵

https://twitter.com/MamaToronto/status/1619746184096256000?s=20&t=LJa-tp23q_BglZgJP0EyWg

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

🧵

https://twitter.com/MamaToronto/status/1606227079149670400?s=20&t=qNCb13rQqbLUxjk7MlTbYA

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

🧵

https://twitter.com/MamaToronto/status/1613300087207395343?s=20&t=17gwMD_RA6Njo2JmzCALGA

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

🧵

https://twitter.com/MamaToronto/status/1618964275724443648?s=20&t=rUjabABquuTgAPHOgI6x4A

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

🧵

https://twitter.com/jeffgilchrist/status/1619669345323610112?s=20&t=JGFRdnL1f1vbkOZS2k5t_A

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

https://twitter.com/O_S_P_E/status/1611389403984691202?s=20&t=rUjabABquuTgAPHOgI6x4A

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir

Re “COVID-19 & Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?”

Yes

🧵

https://twitter.com/jeffgilchrist/status/1618223851212767232?s=20&t=NKqt2jh8BHluuXZsGI9Arg

#RealityCheck
#DavosSafe

#LongCovid
#LongCovidKids

#CovidIsNotOver
#WeAllShareIndoorAir