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When Will the Government Finally Start Taking Airborne Transmission of COVID-19 Seriously?

With doctors suspended from Twitter for raising the need for good ventilation systems, and Dominic Cummings telling MPs that the Government failed to properly explain to the public that the Coronavirus is an airborne virus, when will Boris Johnson’s administration face facts? asks Mike Buckley

A woman walks past a Coronavirus public information campaign poster in London, which focuses on hand washing, in 2020. Photo: Dinendra Haria/SOPA Images/Sipa USA

When Will the Government Finally Start Taking Airborne Transmission of COVID-19 Seriously?

With doctors suspended from Twitter for raising the need for good ventilation systems, and Dominic Cummings telling MPs that the Government failed to properly explain to the public that the Coronavirus is an airborne virus, when will Boris Johnson’s administration face facts? asks Mike Buckley

Earlier this month, consultant respiratory physician Dr Matthew Knight tweeted that to “get hospitality working safely in the UK, a significant investment is required in ventilation systems. COVID is airborne and ventilation a vital part of prevention”. 

Twitter banned his account in response, only to reinstate him after complaints from colleagues. 

“There’s something wrong with Twitter’s censorship function,” tweeted Kristen Coleman, an expert in emerging infection diseases. “An aerosol scientist and a respiratory physician have both been blocked from accessing their accounts for ‘spreading misleading and potentially harmful information related to COVID-19’. How is this misleading/harmful?”

Twitter is right to be concerned about COVID-19 misinformation. Social media is full of conspiracy theories, many questioning the severity of the pandemic and the effectiveness of vaccines. Few would argue with Twitter’s policy of removing accounts contributing to this.

But Dr Knight is an NHS doctor, not a conspiracy theorist, while the fact of airborne transmission of COVID-19 – whereby the virus transmits through small particulates through the air over time and distance – is accepted by the World Health Organisation (WHO), the US Centre for Disease Control, and most other health authorities. 

But Twitter is not alone. YouTube, Facebook and others have all banned accounts for promoting the idea that COVID-19 is airborne. In part, this reflects algorithms and staff members unaware of the science and unsure of how to apply company policy. But it also reflects that COVID-19’s status as an airborne virus was denied for too long by the WHO and others – creating the impression that scientists calling for it to be recognised are fringe figures.

Many in the scientific community believe that the fact that it took the WHO over a year to confirm that the Coronavirus is airborne will have cost many thousands of lives. 

Not Recognising the Risk

Aerosol researchers started warning that “the world should face the reality” of airborne transmission in April 2020. Then, in June, some claimed that it was “the dominant route for the spread of COVID-19”. But the WHO did not update its advice until 30 April 2021 – a full year after the alarm was first raised. 

Forbes science writer JV Chamary argues that the WHO’s statement was “too little, too late”. About 2.7 million people have died from COVID-19 since last summer. The WHO, he says, “failed to consider that practical advice – to recommend that the public use caution and wear face masks to block airborne droplets – has no major downsides when compared to the alternative, which is to potentially allow people to spread COVID”.

For the previous year, the Q&A section on the WHO’s website – in much of the world the top result in online searches for ‘Coronavirus transmission’ – did not reference airborne transmission, says primary healthcare expert Trish Greenhalgh. Health authorities and individuals looking for advice were left in the dark – putting their safety and that of others at risk. 

Many countries have taken the risk of airborne transmission seriously. Spain requires ventilation in schools and will continue to do so for the next academic year at least. Not only is teaching with ventilation safer, reducing the risk of infection to near zero if masks and distancing are also in place, reduces outbreaks which means that schools are more likely to stay open, increasing teaching time as well as preventing unnecessary illness and transmission to households. 

Japan took action right at the start of the pandemic, with its Government taking the view that, since infections were correlated with poor ventilation and crowded spaces, it seemed likely that the Coronavirus was airborne. “We ask that you take precautions even before scientific evidence for clear standards is found,” it said. This prompt and cautious policy, based on preliminary but rigorous science, has helped keep Japan’s death toll at a fraction of the UK’s.  

We should be concerned then that, here in the UK, there is still no reference to airborne transmission on the NHS website – despite calls from British experts to take seriously the threat to public safety.  NHS staff members themselves still do not have access to adequate ventilation or personal protective equipment, putting their lives in danger even as they work to save others. 

Experts called on the Prime Minister in February to review protections in light of evidence that COVID-19 is airborne. “Measures to reduce airborne spread in high-risk health and care settings, which are mission-critical to the pandemic response, have thus far been inadequate,” they said. “There is now no scientific doubt that COVID-19 spreads via the airborne route.”

Dame Donna Kinnair, chief executive of the Royal College of Nursing, said earlier this year: “Our members are telling us they feel unprotected. Some nurses providing end-of-life care are working overnight in a patient’s home, with no ventilation, in close proximity to family members where the risk of Coronavirus may be high. The equipment they are provided with needs to match the risk they are facing.”

The Department of Health and Social Care has said simply that good ventilation “is listed in guidance to help businesses and health and care settings stay COVID-secure”. Essentially, NHS staff were told to do it themselves. 

Many scientists believe that the Government will have to recognise and respond to the airborne nature of the virus if the country is to work its way out of the pandemic. 

Trish Greenhalgh argues that “14 months after Japan first introduced its policy, it’s high-time the UK introduced measures that did more to acknowledge the evidence on the airborne nature of this virus and that will help prevent a catastrophic third wave”.

At a minimum, she says, effective ventilation of indoor spaces should be prioritised and resourced; physical distancing should continue to be enforced; and wearing masks in indoor spaces, which works moderately well against both droplet and airborne transmission, should continue. 

Continuing Resistance

For now, the UK Government remains resistant, at least in part because it is unwilling to accept the responsibility that will follow in having to provide adequate ventilation in schools and public buildings. 

It is refusing to publish reports on the condition of school buildings, despite having the data and pleas that doing so would enable companies to better support schools to identify minor repairs that could improve protection against the virus.

In his seven-hour testimony this week, Dominic Cummings, former chief advisor to Johnson, warned MPs that the Government had “failed” to properly explain to the public that COVID-19 was an airborne virus. “Even now, even today, the Government communications are still over-stressing ‘wash your hands’ and under-stressing ‘airborne’,” he told a joint hearing of Parliament’s Science and Technology and Health Committees.

But the Government can only hide from reality for so long. The virus is airborne; we are going to have to reckon with the need for adequate ventilation if we are to move beyond the pandemic – just as we are going to have to introduce effective border controls to prevent the import of new variants and establish working test, trace and isolation systems. 

Without these protections, the virus will always be one step ahead. Vaccines work and save lives, but they do not work for everyone and nor can every person take a vaccine. Without recognition that vaccines alone are not enough, at least until the whole world has been vaccinated and transmission dramatically cut, further mitigations will be required to enable some kind of normality. 

Doctor and researcher Dominic Pimenta believes that, eventually, we will have to move to an elimination strategy. “We won’t tolerate young people getting sick in substantial numbers, or vaccinated people getting sick from [variants],” he tweeted. “When we realise that, we will realise the only long-term route to normal life is elimination.” Adequate ventilation will be an essential part of that strategy. 

Lidia Morawska, a physicist and an aerosol expert at the Queensland University of Technology in Australia who has advised the WHO on the spread of airborne pathogens, believes that the Coronavirus pandemic gives us the opportunity to take airborne infections seriously. 

“Governments have for decades promulgated a large amount of legislation and invested heavily in food safety, sanitation, and drinking water for public health purposes,” she and her co-authors observed. “By contrast, airborne pathogens and respiratory infections, whether seasonal influenza or COVID-19, are addressed fairly weakly, if at all, in terms of regulations, standards, and building design and operation, pertaining to the air we breathe.”

She compares the shift to clean air to the shift to clean water in the 19th Century: we would not accept dirty water in a restaurant, nor should we accept poor air quality.  

“We don’t have to accept that we get sick due to respiratory [viruses that spread easily in poorly ventilated indoor air], she believes. “We should do something about it.” And cost should not be an impediment. “It will cost money in an initial investment, but as we try to assess the cost, this would be incomparably small to the cost of infection.” 

The emerging consensus on the importance of airborne spread, says Trish Greenhalgh, requires coordinated measures at individual, organisational and national policy levels to make spaces safe. It is a ‘better late than never’ opportunity for the Prime Minister to demonstrate leadership. For all our sakes, we must hope he takes it. 

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