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3. Coronavirus Disease 2019 and Airborne Transmission: Science Rejected, Lives Lost. Can Society Do Better?

Author

Morawska, Lidia, Bahnfleth, William, Bluyssen, Philomena M, Boerstra, Atze, Buonanno, Giorgio, Dancer, Stephanie J, Floto, Andres, Franchimon, Francesco, Haworth, Charles, Hogeling, Jaap, Isaxon, Christina, Jimenez, Jose L, Kurnitski, Jarek, Li, Yuguo, Loomans, Marcel, Marks, Guy, Marr, Linsey C, Mazzarella, Livio, Melikov, Arsen Krikor, Miller, Shelly, Milton, Donald K, Nazaroff, William, Nielsen, Peter V, Noakes, Catherine, Peccia, Jordan, Querol, Xavier, Sekhar, Chandra, Seppänen, Olli, Tanabe, Shin-ichi, Tellier, Raymond, Wai, Tham Kwok, Wargocki, Pawel, and Wierzbicka, Aneta

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Prevention, Good Health and Well Being, Humans, COVID-19, SARS-CoV-2, Pandemics, World Health Organization, Societies, airborne transmission, airborne infection spread, coronavirus, SARS-CoV-2 virus, Biological Sciences, Medical and Health Sciences, Microbiology, Clinical sciences
Abstract

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 about the potential significance of the airborne transmission of SARS-CoV-2 and the urgent need to control it, but our concerns were dismissed. Here we describe how this happened and the consequences. We hope that by reporting this story we can raise awareness of the importance of interdisciplinary collaboration and the need to be open to new evidence, and to prevent it from happening again. Acknowledgement of an issue, and the emergence of new evidence related to it, is the first necessary step towards finding effective mitigation solutions.

Published
2023

20. What were the historical reasons for the resistance to recognizing airborne transmission during the COVID‐19 pandemic?

Author

Jimenez, Jose L, Marr, Linsey C, Randall, Katherine, Ewing, Edward Thomas, Tufekci, Zeynep, Greenhalgh, Trish, Tellier, Raymond, Tang, Julian W, Li, Yuguo, Morawska, Lidia, Mesiano‐Crookston, Jonathan, Fisman, David, Hegarty, Orla, Dancer, Stephanie J, Bluyssen, Philomena M, Buonanno, Giorgio, Loomans, Marcel GLC, Bahnfleth, William P, Yao, Maosheng, Sekhar, Chandra, Wargocki, Pawel, Melikov, Arsen K, and Prather, Kimberly A

Subjects
Infectious Diseases, Infection, Good Health and Well Being, Air Pollution, Indoor, COVID-19, Humans, Pandemics, Respiratory Aerosols and Droplets, SARS-CoV-2, airborne transmission, disease transmission, droplet transmission, history, aerosols, droplets, transmission, Earth Sciences, Engineering, Medical and Health Sciences, Building & Construction
Abstract

The question of whether SARS-CoV-2 is mainly transmitted by droplets or aerosols has been highly controversial. We sought to explain this controversy through a historical analysis of transmission research in other diseases. For most of human history, the dominant paradigm was that many diseases were carried by the air, often over long distances and in a phantasmagorical way. This miasmatic paradigm was challenged in the mid to late 19th century with the rise of germ theory, and as diseases such as cholera, puerperal fever, and malaria were found to actually transmit in other ways. Motivated by his views on the importance of contact/droplet infection, and the resistance he encountered from the remaining influence of miasma theory, prominent public health official Charles Chapin in 1910 helped initiate a successful paradigm shift, deeming airborne transmission most unlikely. This new paradigm became dominant. However, the lack of understanding of aerosols led to systematic errors in the interpretation of research evidence on transmission pathways. For the next five decades, airborne transmission was considered of negligible or minor importance for all major respiratory diseases, until a demonstration of airborne transmission of tuberculosis (which had been mistakenly thought to be transmitted by droplets) in 1962. The contact/droplet paradigm remained dominant, and only a few diseases were widely accepted as airborne before COVID-19: those that were clearly transmitted to people not in the same room. The acceleration of interdisciplinary research inspired by the COVID-19 pandemic has shown that airborne transmission is a major mode of transmission for this disease, and is likely to be significant for many respiratory infectious diseases.

Published
2022

22. An exploration of the political, social, economic and cultural factors affecting how different global regions initially reacted to the COVID-19 pandemic.

Author

Tang, Julian, Caniza, Miguela, Dinn, Mike, Dwyer, Dominic, Heraud, Jean-Michel, Jennings, Lance, Kok, Jen, Kwok, Kin, Li, Yuguo, Loh, Tze, Marr, Linsey, Nara, Eva, Perera, Nelun, Saito, Reiko, Santillan-Salas, Carlos, Sullivan, Sheena, Warner, Matt, Watanabe, Aripuanã, and Zaidi, Sabeen

Subjects
COVID-19, SARS-CoV-2, government, guidance, lockdown, pandemic response
Abstract

Responses to the early (February-July 2020) COVID-19 pandemic varied widely, globally. Reasons for this are multiple but likely relate to the healthcare and financial resources then available, and the degree of trust in, and economic support provided by, national governments. Cultural factors also affected how different populations reacted to the various pandemic restrictions, like masking, social distancing and self-isolation or self-quarantine. The degree of compliance with these measures depended on how much individuals valued their needs and liberties over those of their society. Thus, several themes may be relevant when comparing pandemic responses across different regions. East and Southeast Asian populations tended to be more collectivist and self-sacrificing, responding quickly to early signs of the pandemic and readily complied with most restrictions to control its spread. Australasian, Eastern European, Scandinavian, some Middle Eastern, African and South American countries also responded promptly by imposing restrictions of varying severity, due to concerns for their wider society, including for some, the fragility of their healthcare systems. Western European and North American countries, with well-resourced healthcare systems, initially reacted more slowly, partly in an effort to maintain their economies but also to delay imposing pandemic restrictions that limited the personal freedoms of their citizens.

Published
2022

25. Cross-Infection Risk Between Two People in Different Temperature Surroundings Studied by Aerosol Dynamics

Author

Nielsen, Peter V., Zhang, Chen, Frandsen, Kirstine M., Jensen, Rasmus L., Hundevad, Patrick, Madsen, Simon, Luckenwald, Tonje, Popalzai, Najim, Li, Yuguo, Qian, Hua, Xu, Chunwen, Liu, Li, Förstner, Ulrich, Series Editor, Rulkens, Wim H., Series Editor, Wang, Liangzhu Leon, editor, Ge, Hua, editor, Zhai, Zhiqiang John, editor, Qi, Dahai, editor, Ouf, Mohamed, editor, Sun, Chanjuan, editor, and Wang, Dengjia, editor

Published
2023
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28. A paradigm shift to combat indoor respiratory infection

Author

Morawska, Lidia, Allen, Joseph, Bahnfleth, William, Bluyssen, Philomena M, Boerstra, Atze, Buonanno, Giorgio, Cao, Junji, Dancer, Stephanie J, Floto, Andres, Franchimon, Francesco, Greenhalgh, Trisha, Haworth, Charles, Hogeling, Jaap, Isaxon, Christina, Jimenez, Jose L, Kurnitski, Jarek, Li, Yuguo, Loomans, Marcel, Marks, Guy, Marr, Linsey C, Mazzarella, Livio, Melikov, Arsen Krikor, Miller, Shelly, Milton, Donald K, Nazaroff, William, Nielsen, Peter V, Noakes, Catherine, Peccia, Jordan, Prather, Kim, Querol, Xavier, Sekhar, Chandra, Seppänen, Olli, Tanabe, Shin-Ichi, Tang, Julian W, Tellier, Raymond, Tham, Kwok Wai, Wargocki, Pawel, Wierzbicka, Aneta, and Yao, Maosheng

Subjects
Influenza, Infectious Diseases, Prevention, Vaccine Related, Biodefense, Pneumonia & Influenza, Emerging Infectious Diseases, 2.2 Factors relating to the physical environment, Aetiology, Infection, Good Health and Well Being, Air Microbiology, Air Pollution, Indoor, Communicable Disease Control, Facility Design and Construction, Guidelines as Topic, Humans, Policy Making, Respiratory Tract Infections, Risk Factors, Ventilation, General Science & Technology
Abstract

Building ventilation systems must get much better

Published
2021

29. Dismantling myths on the airborne transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)

Author

Tang, Julian W, Bahnfleth, William P, Bluyssen, Philomena M, Buonanno, Giorgio, Jimenez, Jose L, Kurnitski, Jarek, Li, Yuguo, Miller, Shelly, Sekhar, Chandra, Morawska, Lidia, Marr, Linsey C, Melikov, Arsen Krikor, Nazaroff, William W, Nielsen, Peter V, Tellier, Raymond, Wargocki, Pawel, and Dancer, Stephanie J

Subjects
Biodefense, Prevention, Vaccine Related, Emerging Infectious Diseases, Lung, Infection, Good Health and Well Being, Adult, Aerosols, Aged, Aged, 80 and over, Air Microbiology, COVID-19, Female, Humans, Infection Control, Male, Middle Aged, Pandemics, SARS-CoV-2, Ventilation, Virus, Air, Transmission, Aerosol, Clinical Sciences, Public Health and Health Services, Epidemiology
Abstract

The coronavirus disease 2019 (COVID-19) pandemic has caused untold disruption throughout the world. Understanding the mechanisms for transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is key to preventing further spread, but there is confusion over the meaning of 'airborne' whenever transmission is discussed. Scientific ambivalence originates from evidence published many years ago which has generated mythological beliefs that obscure current thinking. This article collates and explores some of the most commonly held dogmas on airborne transmission in order to stimulate revision of the science in the light of current evidence. Six 'myths' are presented, explained and ultimately refuted on the basis of recently published papers and expert opinion from previous work related to similar viruses. There is little doubt that SARS-CoV-2 is transmitted via a range of airborne particle sizes subject to all the usual ventilation parameters and human behaviour. Experts from specialties encompassing aerosol studies, ventilation, engineering, physics, virology and clinical medicine have joined together to produce this review to consolidate the evidence for airborne transmission mechanisms, and offer justification for modern strategies for prevention and control of COVID-19 in health care and the community.

Published
2021

37. How can airborne transmission of COVID-19 indoors be minimised?

Author

Morawska, Lidia, Tang, Julian W, Bahnfleth, William, Bluyssen, Philomena M, Boerstra, Atze, Buonanno, Giorgio, Cao, Junji, Dancer, Stephanie, Floto, Andres, Franchimon, Francesco, Haworth, Charles, Hogeling, Jaap, Isaxon, Christina, Jimenez, Jose L, Kurnitski, Jarek, Li, Yuguo, Loomans, Marcel, Marks, Guy, Marr, Linsey C, Mazzarella, Livio, Melikov, Arsen Krikor, Miller, Shelly, Milton, Donald K, Nazaroff, William, Nielsen, Peter V, Noakes, Catherine, Peccia, Jordan, Querol, Xavier, Sekhar, Chandra, Seppänen, Olli, Tanabe, Shin-Ichi, Tellier, Raymond, Tham, Kwok Wai, Wargocki, Pawel, Wierzbicka, Aneta, and Yao, Maosheng

Subjects
Infection, Aerosols, Air Microbiology, Betacoronavirus, COVID-19, Coronavirus Infections, Crowding, Disinfection, Filtration, Humans, Inhalation Exposure, Pandemics, Pneumonia, Viral, SARS-CoV-2, Ventilation, Environmental Sciences
Abstract

During the rapid rise in COVID-19 illnesses and deaths globally, and notwithstanding recommended precautions, questions are voiced about routes of transmission for this pandemic disease. Inhaling small airborne droplets is probable as a third route of infection, in addition to more widely recognized transmission via larger respiratory droplets and direct contact with infected people or contaminated surfaces. While uncertainties remain regarding the relative contributions of the different transmission pathways, we argue that existing evidence is sufficiently strong to warrant engineering controls targeting airborne transmission as part of an overall strategy to limit infection risk indoors. Appropriate building engineering controls include sufficient and effective ventilation, possibly enhanced by particle filtration and air disinfection, avoiding air recirculation and avoiding overcrowding. Often, such measures can be easily implemented and without much cost, but if only they are recognised as significant in contributing to infection control goals. We believe that the use of engineering controls in public buildings, including hospitals, shops, offices, schools, kindergartens, libraries, restaurants, cruise ships, elevators, conference rooms or public transport, in parallel with effective application of other controls (including isolation and quarantine, social distancing and hand hygiene), would be an additional important measure globally to reduce the likelihood of transmission and thereby protect healthcare workers, patients and the general public.

Published
2020

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