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If air circulation is an important factor in an epidemic, especially in crowded places with poor ventilation, the consequences will be important for prevention. Masks may also be needed indoors in socially distant settings. Health care workers may require N95 masks that take care of coronovirus patients with even the smallest respiratory drops.
Ventilation systems in schools, nursing homes, residences and businesses may need to reduce re-circulating air and add powerful new filters. Ultraviolet light may be needed to kill viral particles floating indoors in small droplets.
The World Health Organization has long believed that coronovirus is primarily spread by large respiratory droplets, which, once expelled by infected people in coughs and sneezes, quickly fall to the floor.
In an open letter to WHO, 239 scientists in 32 countries have shown evidence that small particles can infect people and are calling on the agency to revise their recommendations. The researchers plan to publish their paper in a scientific journal.
Even in its latest update of coronovirus released on June 29, WHO stated that aerial transmission of the virus is possible only after medical procedures that produce aerosols, or drops smaller than 5 μm. (One micron is equal to 1 millionth of a meter.)
According to the WHO, proper ventilation and N95 masks are of concern only in those circumstances. Rather, its infection control guidance, prior to and during this epidemic, has greatly promoted the importance of handwashing as a primary prevention strategy, even though there is limited evidence for the transmission of viruses from surfaces. (The Centers for Disease Control and Prevention now says that surfaces are likely to play only a minor role.)
WHO’s technical head on infection control Drs. Benedetta Allegranzi said that the evidence for the virus that spread through the air was unrelated.
“Especially in the last few months, we have been saying many times that we consider airborne transmission possible but certainly not supported by concrete or clear evidence,” she said. “There is a strong debate going on.”
But interviews with about 20 scientists – including a dozen WHO advisors and several committee members who have prepared the guidance – and internal emails portray a picture of an organization that, despite good intentions, is out of step with science. is.
Whether by large droplets zooming through the air after a chintz, or by small droplets that divide the length of a room, these experts said, coronavirus is produced through the air and when people are infected Can infect.
Most of these experts expressed sympathy for the WHO’s growing portfolio and shrinking budget, and noted the tricky political relationship to manage it, particularly with the United States and China. He praised WHO staff for the daily briefing and worked tirelessly to answer questions about the epidemic.
But the Infection Prevention and Control Committee in particular, experts said, is tied to a rigorous and highly medical approach of scientific evidence, slow to update its guidance and at risk and some conservative voices to dispel dissent Allows
“They are defending their approach,” said a long-standing WHO consultant, who did not wish to be identified due to his continued work for the organization. Even its staunch supporters said that the committee should diversify its expertise and relax its norms, especially for the fast-spreading outbreak.
“I am disappointed with the issues of wind drift and particle size,” said committee member and epidemiologist Mary-Louise McLaws of the University of New South Wales, Sydney.
“If we started watching airflow again, we would have to be ready to change a lot,” she said. “I think it’s a good idea, a very good idea, but it would be a very big reason through the infection control society.”
In early April, a group of 36 experts on air quality and aerosols urged the WHO to consider mounting evidence on aerial transmissions of coronoviruses. The agency responded immediately, calling on the group’s leader and longtime WHO consultant, Lydia Morwaska, to arrange a meeting.
But the discussion was dominated by some experts who were staunch supporters of handwashing and felt that aerosols should be emphasized, according to some participants, and the committee’s advice remained unchanged.
Morwaska and others pointed to several incidents, indicating aerial transmissions of the virus, particularly in poorly ventilated and crowded indoor locations. He said the WHO was making an artificial distinction between small aerosols and large droplets, even though infected people produce both.
“We have known since 1946 that coughs and aerosols are produced,” said Lynsey Mara, an expert on airborne transmission of the virus at Virginia Tech.
Scientists have not been able to develop coronaviruses from aerosols in the laboratory. But this does not mean that aerosols are not contagious, Marr said: most of the samples in those experiments came from hospital rooms with good airflow that would dilute viral levels.
In most buildings, she said, “the air-exchange rate is usually very low, which causes the virus to accumulate in the air and is at greater risk.”
The WHO is also relying on the dated definition of airborne transmission, Marr said. The agency believes that an aerial pathogen, like the measles virus, is highly infectious and travels long distances.
People usually “think and talk silly about airborne transmissions,” said Bill Hange, a Harvard T.H. Chan School of Public Health.
“We have the impression that air broadcasting means droplets hanging in the air that are capable of infecting you after several hours, flowing down the streets, through letter boxes and finding their way into homes everywhere, “Haines said.
Experts all agree that coronovirus does not behave that way. Marr and others said coronovirus seemed to be the most contagious when people were in prolonged contact at close range, especially indoors, and even more so in superspreader events – exactly the same as when Scientists would expect aerosol transmission.
The WHO has found differences with groups of scientists more than once during this epidemic.
The agency lags behind most of its member countries in covering the public face. While other organizations including the CDC have long acknowledged the importance of transmission by people without symptoms, WHO still maintains that asymptomatic transmission is rare.
“At the country level, a lot of WHO technical staff are scratching their heads,” said a consultant from a regional office in South-East Asia, who did not wish to be identified because he was concerned about losing his contract. “It’s not giving us credibility.”
The consultant recalled that the WHO personnel in his country were the only ones to go undercover, as the government supported them.
Many experts said the WHO should embrace what some called “precautionary principles” and others “needs and values” – also the idea that without definitive evidence, the agency should consider the virus to be the worst, common sense. Implement and recommend the best protection possible.
“There is no anecdotal evidence that SARS-CoV-2 is significantly dispatched by travel or aerosols, but there is no evidence that it is not at all,” said Dr Trish Greenhalgh, a primary care doctor at Oxford University in the UK is. ”
“We are faced with uncertainty at the moment, and have to make decisions about my goodness, if it goes wrong it will be a disastrous decision.” “Then why not just for a few weeks, just in case?”
Ultimately, WHO is willing to accept without evidence that the virus can be transmitted from surfaces, he and other researchers noted, even other health agencies have stepped back from emphasizing this route. Are pulled
“I agree that fomite transmission has not been demonstrated directly for this virus,” Elegrenzi, WHO’s technical lead on infection control, said referring to items that may be contagious. “But it is well known that other coronaviruses and respiratory viruses are transmitted, and are transmitted, through exposure to phytite.”
The agency should also consider the needs of all its member states, including those with limited resources, and ensure that its recommendations are tempered by “availability, feasibility, compliance, resource implications”.
Aerosol may play some limited role in spreading the virus, Drs. Said Paul Hunter, member of the Infection Prevention Committee and professor of medicine at the University of East Anglia in Britain.
But if the WHO were to insist on stricter control measures in the absence of evidence, hospitals in low- and middle-income countries may be forced to divert scarce resources from other critical programs.
He said, “An institution like WHO has to achieve balance. “” It’s the easiest thing in the world to say, ‘we should follow the precautionary principle’ and ignore the costs of that opportunity. ”
In interviews, other scientists criticized this view. “We’re not going to say what we really think, because we think you can deal with it,” said Don Milton, an aerosol expert at the University of Maryland. I do not think this is correct.
Even cloth masks, if worn by everyone, can significantly reduce transmission, and the WHO must say so clearly, he said.
Many experts criticized the epidemic of WHO’s message, stating that employees award scientific perspectives on clarity.
“What you say is designed to help people understand the nature of a public health problem,” Dr. Said William Aldis, a longtime WHO associate in Thailand. “This is different from scientifically describing a disease or virus.”
WHO stated that to describe “absence of evidence as evidence of absence”, Aldis said. For example, in April, the WHO stated, “There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from another infection.”
The purpose of this statement was to indicate uncertainty, but this fantasy caused disquiet in the public and rebuked many experts and journalists. The WHO later retracted its comments.
In a less public example, the WHO stated that “there is no evidence to suggest” that people with HIV were at increased risk from coronavirus. After Joseph Aman, a long-time WHO associate and director of global health at Drexel University in Philadelphia, reported that the phraseology was misleading, with the WHO changing it to say the risk level was “unknown”.
But WHO staff and some members said critics did not give enough credit to their committees.
“Those have been discouraged who cannot take cognizance of the way the WHO expert committees work, and they work slowly and deliberately,” McLavs said.
WHO’s leading scientist Dr. Soumya Swaminathan said that the agency’s employees are attempting to evaluate new scientific evidence as fast as possible, but without sacrificing the quality of their reviews. He said that the agency would try to broaden the expertise and communication of the committees to ensure that all are heard.
“We take it seriously when a journalist or scientist or anyone challenges us and says we can do better than this,” she said. “We definitely want to do better.”
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