(This article is longer than what usually appears on media websites.)
Last year, about 150 doctors and researchers signed a letter expressing "deep concern" about how the Canadian Broadcasting Corporation had been reporting on Dr. John Conly.
In 2020, Conly was the lead author on a paper maintaining that SARS-CoV-2, the virus that causes COVID-19, "is not spread by the airborne route to any significant extent".
This paper also insisted that "the use of particulate respirators offers no advantage over medical masks as a component of personal protective equipment for the routine care of patients with COVID-19 in the health care setting".
This perspective has made him a figure of controversy among those who support the use of N95 respirators in hospitals and other indoor settings.
Conly is a professor of medicine, microbiology, immunology and infectious diseases, pathology, and laboratory medicine at the University of Calgary.
He is co-director of the Snyder Institute for Chronic Diseases at the University of Calgary, a member of the Canadian expert advisory group on antimicrobial resistance and a member of the World Health Organization advisory group on integrated surveillance of antimicrobial resistance.
The signatories to the pro-Conly letter, which was part of a complaint to the CBC ombudsman about a 2021 article on its website, included the following physicians who listed links to the University of British Columbia:
* Dr. William Connors
* Dr. Dwight Ferris
* Dr. Jennifer Grant
* Dr. Jocelyn Srigley
* Dr. Alastair Teale
* Dr. Jan Hajek
* Dr. Alissa Wright
* Dr. Ted Steiner
* Dr. Katherine Plewes
* Dr. Laura Sauvé
* Dr. Natasha Press
* Dr. Ryan LeBlanc
* Dr. Lisa Li
Another signatory, Dr. Alison Lopez, listed her connection to B.C. Children's Hospital.
They accused CBC of spurring "a mob of trolls spewing hateful comments and propagating misinformation" through its coverage of Conly, which included reporting on a University of Calgary–sponsored webinar on how the SARS-CoV-2 virus is transmitted.
"While 2 panelists provided evidence favoring it to be predominantly airborne, Dr. Conly supported multiple modes of transmission based on available evidence and long-term infection control principles of contact and droplet transmission, accepting that airborne transmission also can occur in specific situations," the letter writers stated.
"This is the position of the CDC, WHO and Public Health Agency of Canada," they continued. "In coverage of the webinar and with additional CBC coverage which sought the views of others favoring predominantly long-range airborne transmission, Dr. Conly was attacked and painted as a villain who was responsible for WHO being hesitant in endorsing airborne transmission as the predominant mode of transmission.
"Facts were misconstrued, opinions misrepresented and a trusted Calgarian physician helping to lead the global fight against COVID-19 has been unjustly denigrated."
On March 22, CBC ombudsman Jack Nagler released a decision largely upholding the CBC's actions but noting that "some of the story's descriptions of Dr. Conly's positions failed the test of accuracy and fairness".
"To say that he 'denied' or 'refuted' the notion of aerosols as the primary transmission of COVID-19 was not sustained by the statements Dr. Conly made in the article itself," Nagler wrote. "Further, CBC has already acknowledged that it was not right to call his views on pregnant women and N95 masks as 'discredited'. That last point was clarified, but the clarification note that CBC issued was not up to standards. Ultimately, the portrayal of this nuanced debate would have benefited from more nuanced language on the part of CBC."
What else the letter stated
Here's another portion of the letter that was included in the complaint:
"At the heart of the matter is how SARS-C0V-2 is transmitted—the size of infectious particles and distance they can travel to cause an infection," the signatories wrote.
"SARS-CoV-2 transmission dynamics are very complex, situational and are of intense scientific inquiry because of the public health implications," they continued. "This distinction matters as the resulting infection control precautions in Canadian hospitals—and most of the world—are based on this understanding (where healthcare workers wear surgical masks, gowns, gloves and eyewear to protect themselves—except when aerosol generating procedures occur and an N95 mask is used).
"On the assumption that SARS-CoV-2 is mainly transmitted by long-range aerosols, others have argued for the continuous use of N95 masks in all health care, and potentially other indoor and crowded outdoor settings."
The letter writers accused CBC of "selectively" citing two papers, as well as a 2020 letter published in the Clinical Infectious Disease journal. This letter to the journal was signed by 239 scientists, calling for COVID-19 to be declared an airborne infectious disease.
The Conly supporters pointed out that this letter in Clinical Infectious Disease had only two Canadian signatories who were infectious disease physicians or medical microbiologists. (In total, there were 10 people who cited affiliations to Canadian universities.)
"However, the CBC does not comment on those that have pushed back against this assertion—including a letter published in the same journal signed by hundreds of leading scientists and clinicians from all over the world—including 168 Canadian infectious disease physicians and medical microbiologists," they declared. "Nor does CBC comment on the hundreds of papers which don't support this argument."
The B.C. signatories pushing back against the assertion that COVID-19 should be declared an airborne infectious disease in 2020 were:
* Dr. Srinavas Murthy and Dr. Jennifer Grant of the UBC Faculty of Medicine
* Dr. David Patrick of the UBC School of Population and Public Health and B.C. Centre for Disease Control
* Dr. Jim Hutchinson of the UBC Faculty of Medicine and Vancouver Island Health Authority
* Dr. Pamela Kibsey of the Vancouver Island Health Authority and Royal Jubilee Hospital
* Dr. Jocelyn Srigley and Dr. Laura J. Sauvé of the UBC Faculty of Medicine and B.C. Children's and B.C. Women's hospitals
* Dr. John Galbraith of the UBC Faculty of Medicine and Vancouver Island Health Authority
* Dr. Troy Grennan of the UBC Faculty of Medicine and B.C. Centre for Disease Control
* Dr. Edith Blondel-Hill of the UBC Faculty of Medicine and Interior Health
* Dr. Ghada Al-Rawahi of the UBC Faculty of Medicine and B.C. Cancer Agency and B.C. Children's and Women's hospitals.
A fair number of these signatories, though not all, are clinical professors in the UBC department of pathology and laboratory medicine. It suggests there's a significant contingent of pathologists, including those in public-health agencies, who reject the view that the airborne route via aerosols is the dominant form of COVID-19 transmission.
The 10 Canada-based signatories to the 2020 letter calling for COVID-19 to be declared an airborne infectious disease were:
* Dr. Raymond Teller, associate professor in the McGill University department of medicine
* Prof. Jonathan Abbatt of the University of Toronto department of chemistry
* Prof. Alan Bertram of the UBC department of chemistry
* Prof. Caroline Duchaine of the Université Laval biochemistry, microbiology, and bio-informatics department
* Prof. Greg Evans of the Southern Ontario Centre for Atmospheric Aerosol Research at the University of Toronto
* Prof. Fariborz Haghighat of the building, civil and environmental engineering department at Concordia University
* Prof. Nelson Lee in the division of infectious diseases at the University of Alberta department of medicine
* Prof. David Miller in the Carleton University department of chemistry
* Research scientist Roya Mortazavi of McGill University in atmospheric and oceanic sciences
* Prof. Jeffrey Siegel in the University of Toronto department of civil and mineral engineering
A paper published earlier this year in Environmental Science & Technology is among those arguing in favour of the primacy of airborne transmission of COVID-19.
"Measles outbreaks occur at much lower risk parameter values than COVID-19, while tuberculosis outbreaks are observed at higher risk parameter values," the paper noted. "Because both diseases are accepted as airborne, the fact that COVID-19 is less contagious than measles does not rule out airborne transmission."
One of the authors, Jose-Luis Jimenez, is a University of Colorado, Boulder aerosol scientist who describes the difference between aerosols and droplets in this way:
* aerosols are smaller than 100 microns and the majority are smaller than five microns; their trajectory is largely influenced by airflow and ventilation and they can be inhaled, reaching in and being deposited in the bronchiolar and alveolar regions of the lungs;
* droplets are larger than 100 microns and are produced through coughing and sneezing; their trajectory is dictated by gravity and they cannot be inhaled.
Where to go from here?
There is a significant number of B.C. physicians and health-care workers who believe that the most common way COVID-19 is transmitted from one person to another is through tiny airborne particles of the virus hanging in indoor air for minutes or hours after an infected person has been there. They subscribe to the Greenhalgh-Jimenez view of transmission.
In fact, this is the precise language used by the head of the White House Office of Science and Technology Policy, Alondra Nelson, in a public statement issued on March 23.
Some of these B.C. physicians and health-care workers who accept this are part of a group called Protect Our Province B.C. It has been vehemently critical of the policies being advanced by the B.C. NDP government, arguing that it's elevating risks for the immunocompromised and those with underlying cardiovascular conditions.
Canada's chief public health officer, Dr. Theresa Tam, also appears to share the view of the White House Office of Science and Technology Policy, judging from this Twitter thread from last November.
These debates over the role of airborne transmission have been occurring in scientific journals and over social media for more than two years.
It played out earlier this year when two of Conly's B.C. defenders, Lopez and Srigley of B.C. Children's Hospital, wrote a letter to the Lancet. They challenged the conclusion of an earlier paper asserting that the airborne route is likely the dominant mode of transmission.
The coauthors of the earlier paper—Dr. Trisha Greenhalgh, Jimenez, Kimberly A. Prather, Zeynep Tufekci, and David Fisman—promptly fired back with their own letter.
They alleged that "misconceptions" raised by Lopez and Srigley "reflect a widely held but fundamentally flawed paradigmatic view among infection control clinicians".
"A predominantly droplet mode (ie, spread mainly via coughing and sneezing) cannot explain the epidemiological pattern of this pandemic: transmission is far lower outdoors; asymptomatic or presymptomatic spread is common; superspreading is almost solely indoors; and when comprehensive studies are done, transmission beyond droplet distance of 1·8 m occurs commonly, sometimes with only fleeting exposure," the original authors stated in their letter.
The stakes are incredibly high for the public.
If the B.C. government were to embrace policies that flow out of the Greenhalgh-Jimenez perspective, it would likely lead to a far greater emphasis on wearing N95 respirators indoors. It would also naturally lead to greater public expenditures on indoor-air ventilation. As well, it would likely result in the promotion of HEPA filters and carbon-dioxide monitors in classrooms and public-awareness campaigns about the airborne nature of COVID-19.
But as long as the B.C. government and many influential B.C. physicians continue to embrace the Conly view of the spread of COVID-19, we won't see anywhere near the same emphasis on wearing respirators in most hospital settings. To date, there haven't been advertising campaigns in B.C. comparing the distribution of aerosols carrying the SARS-CoV-2 virus to the spread of tobacco smoke throughout a room.
This is at the heart of the debate that's raging over social media. It's highly emotional because lives are on the line.
It cries out for a disinterested person to hold a public inquiry, given that the COVID-19 death toll has surpassed 42,000 in Canada.
Politicians in this country have demonstrated that they don't have the guts to order this, notwithstanding the number of fatalities.
It takes a great deal of courage and intellect—and a considerable amount of public funds—to issue subpoenas to a whole bunch of medical and chemistry experts and politicians, demand them to supply evidence supporting their views, and then sift through the evidence to draw conclusions about whether current policies discriminate against those with compromised immunity.
There aren't many other people in this country who have legal authority to do this beyond the politicians.
But one person with this power is B.C. Human Rights Commissioner Kasari Govender. Under section 47.15 of the Human Rights Code, she can order an inquiry if she is of the opinion that this would "promote or protect human rights".
Under the Universal Declaration of Human Rights signed in Paris on December 10, 1948, "everyone has the right to life, liberty and security of person."
This language is also included in section 7 of the Canadian Charter of Rights and Freedoms.
So it's pretty clear that simply living on this planet is a human right. And COVID-19 poses a threat to this human right to thousands upon thousands of people.
It's hard to think of any subject more worthy of a public inquiry than that.