The 60-Year-Old Scientific Screwup That Helped Covid Kill

Days later, the WHO released an updated scientific brief, acknowledging that aerosols couldn’t be ruled out, especially in poorly ventilated places. But it stuck to the 3- to 6-foot rule, advising people to wear masks indoors only if they couldn’t keep that distance. Jimenez was incensed. “It is misinformation, and it is making it difficult for ppl to protect themselves,” he tweeted about the update. “E.g. 50+ reports of schools, offices forbidding portable HEPA units because of @CDCgov and @WHO downplaying aerosols.”

While Jimenez and others sparred on social media, Marr worked behind the scenes to raise awareness of the misunderstandings around aerosols. She started talking to Kimberly Prather, an atmospheric chemist at UC San Diego, who had the ear of prominent public health leaders within the CDC and on the White House Covid Task Force. In July, the two women sent slides to Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases. One of them showed the trajectory of a 5-micron particle released from the height of the average person’s mouth. It went farther than 6 feet—hundreds of feet farther. A few weeks later, speaking to an audience at Harvard Medical School, Fauci admitted that the 5-micron distinction was wrong—and had been for years. “Bottom line is, there is much more aerosol than we thought,” he said. (Fauci declined to be interviewed for this story.)

Still, the droplet dogma reigned. In early October, Marr and a group of scientists and doctors published a letter in Science urging everyone to get on the same page about how infectious particles move, starting with ditching the 5-micron threshold. Only then could they provide clear and effective advice to the public. That same day, the CDC updated its guidance to acknowledge that SARS-CoV-2 can spread through long-lingering aerosols. But it didn’t emphasize them.

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That winter, the WHO also began to talk more publicly about aerosols. On December 1, the organization finally recommended that everyone always wear a mask indoors wherever Covid-19 is spreading. In an interview, the WHO’s Maria Van Kerkhove said that the change reflects the organization’s commitment to evolving its guidance when the scientific evidence compels a change. She maintains that the WHO has paid attention to airborne transmission from the beginning—first in hospitals, then at places such as bars and restaurants. “The reason we’re promoting ventilation is that this virus can be airborne,” Van Kerkhove says. But because that term has a specific meaning in the medical community, she admits to avoiding it—and emphasizing instead the types of settings that pose the biggest risks. Does she think that decision has harmed the public health response, or cost lives? No, she says. “People know what they need to do to protect themselves.”

Yet she admits it may be time to rethink the old droplet-airborne dichotomy. According to Van Kerkhove, the WHO plans to formally review its definitions for describing disease transmission in 2021.

Yuguo Li, an indoor-air researcher, set out to show that most respiratory diseases spread through aerosols.

 

Photograph: Yufan Lu

For Yuguo Li, whose work had so inspired Marr, these moves have given him a sliver of hope. “Tragedy always teaches us something,” he says. The lesson he thinks people are finally starting to learn is that airborne transmission is both more complicated and less scary than once believed. SARS-CoV-2, like many respiratory diseases, is airborne, but not wildly so. It isn’t like measles, which is so contagious it infects 90 percent of susceptible people exposed to someone with the virus. And the evidence hasn’t shown that the coronavirus often infects people over long distances. Or in well-ventilated spaces. The virus spreads most effectively in the immediate vicinity of a contagious person, which is to say that most of the time it looks an awful lot like a textbook droplet-based pathogen.

For most respiratory diseases, not knowing which route caused an infection has not been catastrophic. But the cost has not been zero. Influenza infects millions each year, killing between 300,000 and 650,000 globally. And epidemiologists are predicting the next few years will bring particularly deadly flu seasons. Li hopes that acknowledging this history—and how it hindered an effective global response to Covid-19—will allow good ventilation to emerge as a central pillar of public health policy, a development that would not just hasten the end of this pandemic but beat back future ones.

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