A Weak Army Fighting an All-Out War

Aerosol is the ONLY way to explain superspreading

In digging deep into the world of aerosol SARS-CoV-2 transmission (small airborne particles that travel more than six feet and linger in the air for hours), I am flabbergasted. We’re in an all-out war with COVID, spending trillions, but we’re uneducated, disorganized, and divided. Throughout the U.S., deadly health orders prioritize rare surface transmission and fail to mention aerosol.

Pre-COVID, I played goaltimate frisbee at Palo Alto’s Greer Park with my buddy Frank Vigil. We both had sports and professional interests in COVID. We both want to get safely back on the grass at Greer, but goaltimate has enough panting and close contact to be problematic until every player is vaccinated. Frank, a Mechanical Engineer, comes from an Intel cleanroom background and is on the leading edge of the indoor air safety technology space. My work serves COVID-vulnerable populations.

Frank and I climbed the COVID transmission knowledge ladder together. We were able to access national and local experts {Professors Michael Osterholm, Shelly Miller, Jose-Luis Jimenez, and Erin Bromage; ASHRAE (American Society of Heating, Refrigerating and Air-Conditioning Engineers); a scrupulous local HVAC professional; four commercial property managers managing over 30M square feet; public transit safety staff}.

I listened to struggling Palo Alto merchants lament arbitrary health orders: “Indoor dining open at 25% makes no sense because ventilation varies.” “The public health officer said my napkin holder was dangerous.”

On 8/13/20, Silicon Valley Leadership Group (SVLG) had a Zoom with Santa Clara County Public Health’s (SCCPH’s) Dr. Sarah Rudman. Contradicting current science, she claimed, “We’re finding that transmission is from face-to-face contact, not from virus floating around in the air. So Heating Ventilation Air Conditioning (HVAC) would be a lower priority item, and we need to focus on high priority items.” Dr. Rudman’s comment led me to advocate for aerosol transmission prioritization with SCCPH, Santa Clara County Board of Supervisors (Supervisors Simitian and Chavez), SVLG, Joint Venture Silicon Valley (JVSV), UC Berkeley, City of Palo Alto, etc.

Advocacy is about persuading leaders. Leadership is about vetting ideas and then asking the right questions (“Are we doing enough to prevent transmission in vulnerable populations?”). Any of the leaders could have invested a couple of hours in asking the right questions to make a difference — leaders delegate. During Purple, I was given one frustrating answer, “We are too busy dealing with ICU under-capacity to worry about reducing ICU demand via improved public health orders.” Leadership is also about caring more about vulnerable populations. I finally broke through with one leader who will soon initiate some welcome action.

It’s tricky to be an effective advocate with limited power and zero scientific credibility. On the other hand, this is an issue where you can invest a few hours with the upside of saving lives weighed against the reputational risk of being labeled an annoying kook. On 12/9/20, I succeeded in persuading the world’s number one transmission expert, Prof Shelly Miller, to credibly advocate to Silicon Valley, and that made the difference. [1]

There are 448,000 U.S. public health staff and 3,400 epidemiologists who study many topics in school. [1] They don’t receive aerosol transmission training, whereas HVAC cleanroom experts suck tiny, dangerous particles out of the air. I presumed public health staff and epidemiologists participated in communities of practice that curate content, including:

  • CDC’s case studies (1/24/20 Guangzhou restaurant, Diamond Princess, Skagit Valley Chorale, etc.)
  • The latest scientific literature, including pre-publication articles
  • Dr. Fauci and CDC’s 8/26/20 Airborne Transmission Workshop [2]
  • Prominent articles in the press about aerosol transmission that commenced in May.

Aerosol transmission is the ONLY way to explain EVERY CDC superspreading case study. [1] My presumption was incorrect because, given the overwhelming evidence, the 451,400 didn’t advocate for improved health orders to save lives.

There are about 20 aerosol scientists with university labs that undertake primary research on live virus particles. Before SARS-CoV-2, virus aerosol transmission was well-understood by the scientists, but the World Health* Organization and Centers for Disease Control* deliberately ignored that science. [3] “Health” and “Control” should be followed by asterisks. The aerosol scientists have grown increasingly frustrated because they knew how to avoid the winter holiday spike in cases.

On 2/24/21 at JVSV’s State of the Valley Conference, SCCPH’s Dr. Sara Cody stated, “We now know much of COVID transmission is AEROSOL or airborne, a bit of it is droplets, and very little on surface.” [4] But then she failed to explain the need to update public health orders to increase safety. Though nine months late, Dr. Cody still might have made the first statement of this sort by the 448,000. I’ll take ten percent credit for her statement.

RECOMMENDATIONS:

Japan is an example of a country that understands the danger of stagnant indoor air — when everyone’s exhalation builds up in a room, multiplying aerosol menace. Per-capita, Japan is 13X more COVID-safe than the U.S. They display an indoor air stagnancy metric (CO2) at the front door of every building. (Indoors, keeping CO2 below 700 ppm is COVID-safe. Outdoors, letting CO2 increase beyond 350 ppm is species-limiting.)

Social media makes it impossible to provide high-quality COVID education to the general public. Still, public health orders should condition entry into buildings covered by health orders on completing high-quality COVID education. It takes one three-minute youtube to explain COVID transmission. [5] Once people understand, “It’s like smoke, and you want to breathe as little smoke as possible, they very quickly figure out what they need to do in their specific situations.” [6] Education would have prevented winter holidays’ Purple COVID Level.

We’ve left everyone on their own to figure out masking, and that’s failed. A casino survey found more than half with unsafe masking, featuring air gaps and visible nostrils. In a place where vulnerable people go to gamble and shout for eight hours, there is a duty to educate and ensure safe masking as a condition of entry.

It should be straightforward to enlist and train optometrists and eyeglass store personnel to provide expert mask fitting and outfitting (where they maintain an inventory of masks and comfort-increasing “mask brackets.”) Take a small group (optometrists) up the learning curve, then provide expert service to everyone to ensure comfortable masking without glasses fogging. (Fit the masks outside because it’s very COVID-safe. Out of 7,324 cases, 7,322 were indoors and only two were outdoors. [7])

There are many other examples where organizations have been given vague health orders that delegate figuring out actionable details to the organization, causing a massive and inconsistent duplication of effort for school reopenings, etc.

In Silicon Valley, the public, private, and academic sectors haven’t formed an effective COVID collaboration. A ready army of talent and labor should be created and kept in place for future crises.

(Granted, vaccine development has been a remarkable human achievement, as has been the testing/tracing/isolation in better-governed countries.)

(These views are my own, not the views of Palo Alto Transportation Management Association.)

[1] Prof. Shelly Miller’s 12/9/20 message to Santa Clara County

[2] Airborne Transmission of SARS-CoV-2: A National Academy of Science Virtual Workshop, 8/26/20

[3] FAQs on Protecting Yourself from COVID-19 Aerosol Transmission, Section 1.2

[4] Dr. Cody: COVID-19 & Silicon Valley’s Path Back to Health, JVSV State of Valley, 2/24/21, @10:16

[5] “Office Safety: Prevent COVID-19 Airborne Transmission,” three-minute youtube

[6] Medium.com: Six Deadly COVID Transmission Myths by Steve Raney

[7] Indoor transmission of SARS-CoV-2 by Hua Qian, in Intl Jrnl of Indoor Envt & Health

Medium people tags: Yasmin Tayag, Robert Roy Britt, Kate Green Tripp, Dana G Smith, Coronavirus Blog Team

Executive Director at Palo Alto Transportation Mgmt Assoc.

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