Capitol Hill Blue Forums Science and Technology Health, Medicine & the healing Sciences Coronavirus: The Plague of The 21st Century?

A fairly straightforward open letter appearing in the BMJ from over a hundred public health professionals, scientists etc outlining the current problem with ongoing covid strategies and a list of 5 recommendations.

It’s first recommendation:

“ Unequivocally declare SARS-CoV-2 an airborne pathogen and stress the implications for preventing transmission.18 A clear message from the World Health Organisation will help to remove confusion that has been used to justify outdated policies”

A fairly straightforward and reasonable list of recommendations but na gunna happen. An open letter by a group of public health experts, clinicians, scientists

Well, there are some good ideas in their statement, that are already being done. But there are some idiotic things in there as well.

Everybody should be told to wear N95 or similar masks. Of course about a third of the US population thinks this is unacceptable as a violation of their freedom. So any idea how to get them to wear them?

It is time to go beyond opening windows and aim for a paradigm shift to ensure all public buildings are optimally designed, built, adapted, and utilised to maximise clean air for occupants—strategies which have been shown to reduce SARS-CoV-2 transmission. Building design and construction? Those take quite a long time. NOT a useful strategy for cutting transmission, when you can just put some big fans in all the windows within a few days.

Better contact tracing? I already explained exactly why contact tracing can't work with SARS-COV2 unless you lock everybody in the world up. And then everybody would starve to death. It's a characteristic of the virus that you get lots of asymptomatic cases who can still spread it. Contact tracing is miserable with this virus. Not because tracers don't try, but because they miss 90% of the infections.

Their "solution" is that if we had lower infection rates, it would be easier to deal with: DUH

BTW, did you know Peter Hotez's group at Baylor has just got an Indian EUA for a patent-free protein-based vaccine, and hooked up with an big Indian drug maker to mass produce it. It promises to be even cheaper than the Oxford AstraZeneca vaccine to make. Their strategy is to transfer the technology to anybody who can make it.

Everybody should be told to wear N95 or similar masks. Of course about a third of the US population thinks this is unacceptable as a violation of their freedom. So any idea how to get them to wear them?

Maybe start by telling them to wear an N95 mask. NOT by telling them masks aren’t needed, probably does more harm than good, then reverse yourself and saying you had to lie cuz people are children. Last I looked the CDC is still telling people to wear any mask but N95.

Better contact tracing? I already explained exactly why contact tracing can't work with SARS-COV2 unless you lock everybody in the world up. And then everybody would starve to death. It's a characteristic of the virus that you get lots of asymptomatic cases who can still spread it. Contact tracing is miserable with this virus. Not because tracers don't try, but because they miss 90% of the infections

I don’t think you understand the purpose of contact tracing being utilized with a robust public mitigation strategy. Also, how weird to say that it’s an either or proposition? Letting er rip or locking everyone up to starve..


It is time to go beyond opening windows and aim for a paradigm shift to ensure all public buildings are optimally designed, built, adapted, and utilised to maximise clean air for occupants—strategies which have been shown to reduce SARS-CoV-2 transmission. Building design and construction? Those take quite a long time. NOT a useful strategy for cutting transmission, when you can just put some big fans in all the windows within a few days.


Uhhhh… you get out much? How many commercial buildings do you see with sash windows? But there’s the rub. It would cost money. Yes, we can provide obscene amounts for the necessities of killing and incarceration, not so much for prevention and mitigation. In the meantime, can we get a simple Corsi box in a class room? By the way, shouldn’t you be arguing that it wouldn’t matter cuz droplets and surfaces?

Yeah, I’ve been following the Texas children’s hospital’s progress. I’m surprised/not surprised the government is caving to pharma’s insistence on profits from patents instead of an all out effort of global suppression/elimination. Have you seen the Cuban governments accomplishments? Not bad, considering they’re under an economic blockade. A good example of what can be done when corrupt lazy flop artists aren’t in control of government and theirs commitments to public goods and services.

You also seem to have a fixation on aerosol virus and N95 masks, as if wearing an N95 would protect you from aerosols. They won't. Aerosol virus goes right through N95 masks. This is why researchers experimenting on competent SARS-COV2 virus have to work in BSL-4 labs. The ones where they have to wear pressurized plastic suits and helmets with an external air supply. Masks block your droplets from escaping and infecting others. They do a pretty good job of that. Not perfect, like most reasonable public health measures, but pretty good.

The US already is "vaccination+". It makes sense to stress the things that make the biggest differences, and the things we can do easily. Yes, there have been some major screw-ups. But most of those were from Trump fighting public health messages coming from the CDC. Sometimes those messages have changed as new data emerges, but that's how science and medicine work. Yes, it would be much nicer and a lot cheaper if we all had single-payer, but the government's response all along has been mostly single-payer! Including the approved vaccines, approved MABs, and approved anti-viral drugs.

The biggest impediment has been politicians: Fighting vaccination mandates. Promoting anti-vax and anti-mask claims for political gain. Promoting "snake-oil" cures. And as a result, one third of the US population sees all efforts to stop the spread of the virus as some sort of Liberal plot to curtail their freedom. Nothing in that open letter addresses this elephant in the room.

Aerosols are the main route of infection. That’s not obsessing, it’s simply stating reality. Again, public health mitigation requires a scientific based theory of disease spread. That’s not me talking but the pros in the field. It does make sense to me as I operate in a world of the 6 P’s. ‘Proper planning prevents piss poor performance.

But don’t take my word for it. Here’s a round robin critique from a recent Politico piece. A sample:


“Rapid tests can stop public super-spreading by keeping very infectious people home. Better indoor air quality and ventilation/air filtration measures can pull infectious aerosols out of the air regardless of what variant they are carrying. And high-filtration masks can stop people who are contagious from exhaling as much virus in the air and prevent uninfected people from inhaling that virus-laden aerosol, regardless of variant.

“It feels like we are caught unprepared again. The CDC still won’t address why respirators aren’t being recommended or provided to the public despite a 2008 mask model by 3M that was meant exactly for a pandemic virus emergency. (I wear a relative of that model daily, and it’s very comfortable.) By putting most eggs in the vaccine basket, we are where we are again.” — Abraar Karan, infectious disease fellow at Stanford University“

How Biden could have prepped for Omicron

Biden’s covid numbers are no better than Trumps. One can make the argument that Trump was more proactive and managed the crises better, in spite of himself, than Biden. It truly reveals the incompetence and fecklessness of the PMC political party.

You still feel confident with this one:

“As for "super transmission ability" claims for Omicron (and every earlier variant), I doubt them.”

If aerosols were the main route of infection, then countries where everybody wears masks would not have lower infection rates. Because aerosols go right through even N95 masks completely unimpeded. Contact tracers analyzed 75,000 cases of transmission in China, and found zero cases where aerosol transmission occurred. I've read papers where they talk about finding viral RNA floating in the air of hospital rooms, or rooms where workers remove PPE, but they found zero cultural virus! You have to be careful reading such papers because being outside of a droplet and exposed to air denatures competent viruses into RNA fragments that are detected by PCR, but are not infectious. PCR is a lot easier than culturing viruses and running plaque assays, but quite often is not the right assay for what they are investigating.

Certainly aerosol transmission does occur, when superspreaders are inside with poor ventilation and in crowds without masks. I remember one paper talking about an indoor wedding reception where everybody at tables adjacent to a spreader got infected, hardly anybody two tables away, and nobody at the other tables. They were all in there talking, dancing, eating, etc. for hours and if aerosol transmission was significant, more people far away from that spreader would have gotten infected. But the infected were within droplet range.


Yes, if one completely ignored exponential spread, the politicization of anti-vax and anti-mask efforts, governors proclaiming public health efforts illegal, people deciding they are tired of being careful, etc. But one would have to be a troll to do that. The one good thing Trump did regarding SARS-COV2 was to see that vaccine development had enough money to remove the risk of doing all required steps in parallel, and that resulted in the vaccines you seem to despise.

Let's apply a little common sense. The vast majority of COVID-19 infections come by way of droplets. How do we know this? "Small aerosols are more susceptible to be inhaled deep into the lung, which causes infection in the alveolar tissues of the lower respiratory tract, while large droplets are trapped in the upper airways (Thomas, 2013). For easy apprehension, aerosols can be defined as suspensions of solid or liquid particles in the air, which can be generated by either natural or anthropogenic phenomena (Judson and Munster, 2019; Tellier, 2009)." Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy (ncbi)

"Respiratory particles may often be distinguished to be droplets or aerosols based on the particle size and specifically in terms of the aerodynamic diameter (Hinds, 1999). One could dispute that, unlike larger droplets, aerosols may pose a greater risk of the spread of the COVID-19 disease among many susceptible hosts positioned far from the point of origin. Nevertheless, it has been proven that viral disease outbreaks via aerosol transmission are not as severe as one would think, because of dilution and inactivation of viruses that linger for extended periods in the air (Shiu et al., 2019)."

Since most SARS-CoV-2 infections occur in the upper airways, droplets are the primary culprit. Omicron may be more amenable to airborne transmission, which may be why it is more transmissible, but it could also be because it replicates so much faster.

Masks, especially KN/N95s, reduce all transmission - droplets and aerosols. The better the fit and the better the material, the more reduction. The 95 addresses particles of .3 microns or larger. Aerosols don't become aerosols until their host material evaporates, so if they're trapped before that, they don't aerosolize.

Here’s a nonsense article from SCRIPPS that does a pretty good job of corralling what we know of viral infection and aerosol spread:

“The majority of aerosols produced by respiratory activities are smaller than 5 µm, which allows them to travel deep into the bronchiolar and alveolar regions and deposit there. Studies find that viruses are more enriched in aerosols smaller than 5 µm,” said Josué Sznitman, a pulmonary physiologist of Technion, Israel.

IT’S NOT JUST SARS-COV-2: MOST RESPIRATORY VIRUSES SPREAD BY AEROSOLS

We can have a symantic debate all day between droplets vs aerosol. How about we agree that Covid is airborne and air quality is a major factor for its spread

If you can wrap your head around that, you have public health policy implications. I see very little here other than vaxvaxvax and a few drugs to help with the infection. Not so much for mitigating the chance of infection, My suspicion is not enough profit in that direction.

I know, "profit" is a dirty word. But the people promoting public health policies have very little connection with vaccine makers profits. I think vaxvaxvax because vaccination is the most successful thing we have. In the last two years, people have spent all of maybe 6 hours to get vaccinated two or three times, and it keeps almost all of them from getting seriously ill, from dying, or from getting Long Covid. Nothing else takes less time and is so successful, by far. On the other hand, people get tired of isolating after several thousand hours. They get tired of wearing masks every time they are out of the house, some for hours a day being essential workers. They get tired of staying six feet apart. They get tired of never getting together with family. So they take calculated risks, and sometimes that doesn't work out the way they wanted.

People who are vaccinated can't get tired of that protection and take a risk to do without it. Antibody levels contract naturally, but T and B-cell memory remains.

As for the aerosol vrs droplet question: If smaller aerosol particles travel deep into the lungs, and aerosol is the major route of SARS-COV2 infection, then why are so many infections asymptomatic or occurring in the nose? Simple: Most infections are through droplets, that primarily stop in your nose. Deep lung infections are present in about 1% of SARS-COV2 infections.

Dr. John Campbell says about 15% of the population of the UK now has Covid-19. In the US we have over 1 million active cases. He also showed a graph the other day estimating Rt (the current spread rate) at around 2.

Based on these numbers, I can make certain predictions: (Cassandra time)

1) The UK is within a week or two of every immunologically naive person being infected. The doubling time has to be around five days, so within a week, 15% becomes 30%. After another week, that becomes 60%. Before that happens everybody gets immunity (or goes on to die), through either vaccination or infection.

2) The US currently has 1 million infected. We have somewhere under 100 million naive. Assuming a five day doubling period, it goes 2 million, 4 million, 8 million, 16 million, 32 million, and then 64 million. So within 30 days everybody is immune, through vaccination or infection. Unfortunately, about a million more people die, mostly the unvaccinated. We have a very limited supply of MABs and anti-viral drugs, so those are not going to make any meaningful dent in that number.

Even at 1 million some hospitals are on the verge of collapse. Scripps Hospital in North San Diego County says they have over 700 staff members out with positive tests. I think they are going to have to change their policy, and let positive asymptomatic staff members attend patients who are already positive for Covid. They have tents setup outside their ER, but they will run out of space soon.

The next month is going to be a very dangerous time for the unvaccinated who never were infected. Hospitals are going to be unable to help them, so the death rate might actually be higher. Anybody with a heart attack, broken leg, gall bladder inflammation, appendicitis, etc. is going to be SOL. Anybody unvaccinated, limited protection begins on day 11 after the first vaccination, so you can still do something. For those of us vaccinated, it won't be particularly bad. Just very very sad.

Caveat: My predictions are my own, nobody else's. If we have less than 2 million cases by 1/10/22, then I'm wrong.