Aerosols are the “main mode of transmission and probably the only important mode of transmission. Yet, we encounter these public health officials following outdated theories.” – Prof. Jose-Luis Jimenez
Behind the scenes, mostly out of the public eye, two camps of global scientists are fighting over competing theories about how COVID-19 infects people. Think of the heated battle as the Establishment vs. the Reformers. Canadian battles are being fought on social media. Which side wins will have serious consequences for public health policy. In fact, it already does for Alberta and British Columbia, provinces where hospitals are overwhelmed by COVID-19 outbreaks.
The Establishment hews to the 100-year old view that infectious diseases are spread by respiratory droplets that fall to the ground within six feet (hence the early emphasis on social distancing) and contact (citizens urged to wash hands frequently). Generations of doctors learned this theory in medical school. It is the orthodoxy in public health from the World Health Organization down to provincial public health officers. Defenders say it is supported by extensive and sound medical science.
The Reformers come from other sections of the scientific community, most notably engineers and chemists. They argue that COVID-19 is spread by aerosols, tiny drops that hang in the air for hours like cigarette smoke.
Two recent peer-reviewed papers (here and here) about airborne (aerosol) transmission shed light on the controversy. The authors argue that the Establishment view has become “dogma,” with public health officials heavily invested in the science they have accepted throughout their careers. That science is based on randomized controlled trials, which they consider the gold standard. Case studies, laboratory experiments, and animal studies conducted by the Reformers are considered to be inferior.
What are the implications of this dispute for public health policy?
Take the example of school classrooms. If COVID-19 is spread by aerosols, mitigation strategies would rely more heavily upon ventilation and filtration. Yet, many Alberta and BC school districts refuse to allow teachers or concerned parents to install individual air purifiers in classrooms, even at their own expense, arguing that Chief Medical Officers have not provided the necessary guidance and that school HVAC systems are adequate. New ideas like do-it-yourself Corsi/Rosenthal purifiers anyone can build for $70 are actually banned.
Another example: currently, healthcare workers are required to wear N95 respirators only when performing “aerosol generating medical procedures” like autopsies. Calgary ER doctor Joe Vipond thinks hospital staff on COVID-19 wards and ICUs should all wear N95 instead of commonly used (and leaky) surgical masks.
Imagine if aerosols were considered the primary means of transmitting the virus, then better filtration and ventilation would be required in schools, restaurants, gyms, movie theatres – any place where citizens gather, whether they are vaccinated or not. The cost to businesses large and small would be significant.
Healthy debate between scientists is essential to evidence-based public health policy and its implementation. But scientists and medical professionals are human and we know that new ideas, like new technologies, will be embraced early by Innovators and Early Adopters and late by Laggards. The Establishment in Alberta and BC are by no means Laggards, at least not yet, but given that American jurisdictions are beginning to accept the Reformers’ arguments they could be considered Late Majority Adopters or perhaps higher up the curve as Early Majority Adopters.
That isn’t good enough given the crises confronting Alberta and BC.
Alberta NDP Leader Rachel Notley has a good idea. A few days ago, she proposed an “independent COVID-19 science advisory table made up of medical experts and health professionals.” The problem is that Alberta Health Services already has a Science Advisory Group designed to provide exactly the same function. But the Group illustrates the tension between the Establishment and Reformers within Alberta, with healthcare professionals routinely criticizing co-chair Dr. Lynora Saxinger for her news media and social media comments.
Therefore, if an independent advisory table has any merit, it will have to be created outside the Alberta government. Perhaps one of the advocacy groups formed by healthcare professionals or a university might be an appropriate forum?
Hold panel debates between proponents of the two camps. Broadcast them live over Facebook and YouTube. Let journalists ask questions of the experts. Air the dispute – and the science – in public instead of behind closed doors and share the results with everyone instead of a few bureaucrats and policymakers.
However and wherever it takes place, the conflict between the Establishment and the Reformers over droplets/touch and aerosol transmission needs to be addressed. If aerosol transmission is the primary means of COVID-19 infection, then provincial public health policy should change to reflect the new scientific understanding.
Time is of the essence.
Rising infections among children and the onerous burden on the BC and Alberta hospitals demands that the dispute between the warring camps be resolved – and public policy changed if a new scientific consensus emerges – much sooner than later.
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