Researchers say it's a scandal that health officials delayed recognizing airborne transmission of COVID-19

British Columbia was cited as one of the case studies in a non-peer-reviewed paper published online this month

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      A paper published by Wellcome Open Research has tried to explain scientific and public bodies' "failure to acknowledge and act on the evidence base" for airborne transmission of COVID-19 in a timely manner.

      In "Orthodoxy, illusio, and playing the scientific game: a Bourdieusian analysis of infection control science in the COVID-19 pandemic", the three authors described this as "a mystery and a scandal".

      And they highlight British Columbia's response to the pandemic as one of the case studies to advance their argument.

      The lead author is Trisha Greenhalgh, a professor of primary care at Oxford University. Her Twitter feed is called #CovidIsAirborne.

      The other authors are Brunel Business School professor of organizational behaviour Mustafa Ozbilgin, and Damien Contandriopoulos, a University of Victoria nursing professor who won the Canadian Institutes of Health Research Article of the Year Award in 2010-11.

      Their new paper appeared online on May 24 and is awaiting peer review.

      "From the very beginning of the pandemic, British Colombia [sic] based its prevention measures on an explicit contact, droplet, and fomite theory of transmission," they write. "A tweet posted by from British Colombia’s [sic] Centre for Disease Control (source C1, Table 1) on 11th February 2020, for example, linked to a video by a physician epidemiologist and stated: 'The new #coronavirus is spread by droplets that come from the mouth or nose. The droplets don’t stay floating in the air. This is not an airborne virus.' " 

      This image appeared at the top of Martin Dunphy's Georgia Straight article last July.
      CDC Public Health Image Library

      Straight raised airborne transmission last July

      The researchers pointed out that "as evidence on airborne transmission accumulated during the late spring and summer of 2020, pressure from workers’ unions, supported by aerosol scientist researchers, mounted for the province to adopt measures to reduce airborne spread."

      Georgia Straight senior editor Martin Dunphy cited some of this research last July in an article entitled "Ten COVID-19 facts that should scare you into wearing a mask".

      He reported that a July 8 article in the journal Nature highlighted a "growing body of evidence" that COVID-19 could be spread by aerosols. These particles are much smaller than droplets and are exhaled while breathing and talking.

      "If the airborne-transmission model becomes widely accepted, the wearing of more effective and better-fitting masks in public will become even more important," Dunphy noted.

      B.C.'s provincial health minister, Dr. Bonnie Henry, said last July that the debate over aerosol versus droplet transmission was a "little bit of a tempest in a teapot".

      The authors of the recent Wellcome Open Research paper noted that B.C. health authorities have "long resisted the idea of airborne transmission".

      "It was not until early January 2021 that the British Columbia Center for Disease Control (BCCDC) edited its guidelines to include the risk posed by 'smaller droplets' (which may be a euphemism for aerosols)," they wrote.

      The authors suggest that provincial health officer Dr. Bonnie Henry "appears at least partly driven by the urge to quell panic and maintain calm". Moreover, they claim that this might explain "her reluctance to embrace theories about the dominance of aerosol transmission".

      In her briefings over the past year, Henry repeatedly reiterated the language of the World Health Organization. It long advanced the argument that droplets were responsible for transmission, even well after atmospheric chemistry experts were arguing that COVID-19 was airborne.

      Renyi Zhang, Yixin Li, Annie L. Zhang, Yuan Wang, and Mario J. Molina published a paper last June identifying airborne transmission as the dominant route for spread of COVID-19.

      Here's the significance: droplets fall to the ground and surfaces whereas aerosols remain in the air for much longer periods of time. If the COVID-19 virus is indeed airborne, that elevates the risk of transmission through the air and may even diminish risks of transmission by touching counters or tables.

      On April 30, the World Health Organization adjusted its statement on transmission to say:

      "Current evidence suggests that the virus spreads mainly between people who are in close contact with each other, typically within 1 metre (short-range). A person can be infected when aerosols or droplets containing the virus are inhaled or come directly into contact with the eyes, nose, or mouth. The virus can also spread in poorly ventilated and/or crowded indoor settings, where people tend to spend longer periods of time. This is because aerosols remain suspended in the air or travel farther than 1 metre (long-range).”

      This led health bodies around the world, including in British Columbia, to change their descriptions about the transmission of COVID-19.

      Jose-Luis Jimenez, an expert on aerosols and atmospheric chemistry at the University of Colorado, helped formulate a commentary in Clinical Infectious Diseases last July urging public-health authorities to consider the possibility of airborne transmission of COVID-19.

      More recently, Jimenez posted a long Twitter thread explaining the history of infectious diseases. This provided context around why so many health organizations missed the mark on airborne transmission for so long.

      In the Wellcome Open Research paper, the three authors declared that political and policy actors at the international, national, and regional levels predominantly aligned themselves with the "medical scientific orthodoxy", which promoted the droplet theory of transmission.

      This medical orthodoxy "considered aerosol transmission unproven or of doubtful relevance", they added.

      Moreover, the wrote that this medical orthodoxy emerged from a "dominant scientific sub-field centred around the clinical discipline of infectious disease control, in which leading actors were hospital clinicians aligned with the evidence-based medicine movement".

      "Aerosol scientists—typically, chemists, and engineers—representing the heterodoxy were systematically excluded from key decision-making networks and committees," the researchers stated. "Dominant discourses defined these scientists’ ideas and methodologies as weak, their empirical findings as untrustworthy or insignificant, and their contributions to debate as unhelpful."

      Stephen Hui

      Class-action lawsuits?

      Earlier this month in another article on airborne transmission of COVID-19, the Straight raised the issue of class-action lawsuits against governments. This passage is repeated below:

      "How will they defend themselves from class-action lawsuits filed by lawyers who claim that their clients died because public-health experts ignored evidence of airborne COVID-19 transmission?

      "How will these public-health experts respond to claims that they had a personal as well as a public duty of care?

      "It's not just public-health experts who could find themselves in court.

      "Police agencies that have refused to ticket antimask demonstrations, including in Vancouver, could also conceivably find themselves answering questions in court. This is especially so if any deaths can be linked to refusals to enforce laws around public gatherings for ideological reasons.

      "The issue of airborne transmission of COVID-19 is a legal minefield. And it's one that the City of Vancouver, Vancouver Police Department, and the B.C. government would be wise to pay attention to in the future."