King Kong and Godzilla faced off above the city skyline. With his teeth, Godzilla rips a hunk from the skyscraper, flinging it in Kong’s direction. Kong bats it away, sending it spinning down onto the city streets below where mere humans, trapped in the drama, scurry helplessly. It’s been like that.
Keeping up with the news stories on the pandemic the past year and a half, you may have noticed there seemed to be two major threads. I’m not talking about “it’s the end of the world” vs. “it’s all a myth.”
I’m talking about the droplet vs. aerosol transmission controversy, asking the question “How does the virus pass from one person to the next?” Does it primarily pass via particles that quickly fall to the ground or to a nearby surface, or can it linger in the air, potentially traveling longer distances before infecting someone?
The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) mostly represent the medical profession and the research generated by the medical profession. They have their turf. But there are other relevant professions out there such as physics, engineering and those whose work spans multiple disciplines. When one group doesn’t acknowledge the other, it’s more than just a turf war. It could be tens of thousands of seniors dying. It could be the seniors we loved and cared for who died.
Public health policy coming from the CDC and WHO camped on a historical view of the droplet transmission side with its handwashing and six-foot social distancing. They only tended to consider aerosol transmission during certain specific medical procedures, such as intubation. But there were impressive studies showing that aerosol transmission was happening in other more normal settings.
This is a serious difference. A life and death difference. Hand washing and a mere six-foot distance wouldn’t be enough to prevent aerosol transmission. Ventilation has to be addressed. Maybe that’s why when COVID got into our facility, we were helpless to stop it. Our building was not designed to prevent aerosol transmission. While we were washing our hands, wearing non-N95 surgical masks and nagging the residents not to sit near each other, was the virus wafting slowly down the hallways behind us?
Wired magazine published an article by Megan Molteni, entitled The 60-Year-Old Scientific Screwup That Helped Covid Kill, on May 13, 2021. She documented some of the back-and-forth drama that was taking place over our heads.
According to Molteni, the medical profession had taken some numbers that applied to tuberculosis and coal mine dust and, for the past 60 years, applied them incorrectly to almost all respiratory germs. They assumed that any virus/water particle bigger than 5µ across would only travel through the air in droplet form and would fall out of the air in a few feet.
But in reality, particles 20 times that size can go aerosol, linger in the air and float down the hallway. Quite a difference. Unfortunately, the 5µ mistake had become so entrenched that it was like heresy to challenge it.
It was April 3, 2020, when a group of aerosol scientists arranged a Zoom meeting to formally challenge the WHO about droplet transmission. It wasn’t until March of 2021, a year later, when the WHO issued its “Roadmap to improve and ensure good indoor ventilation in the context of COVID-19”. In June, the CDC issued theirs, Ventilation in Buildings, stating that:
“CDC recommends a layered approach to reduce exposures to SARS-CoV-2, the virus that causes COVID-19. This approach includes using multiple mitigation strategies, including improvements to building ventilation, to reduce the spread of disease and lower the risk of exposure. In addition to ventilation improvements, the layered approach includes physical distancing, wearing face masks, hand hygiene, and vaccination.”
Both finally acknowledged that the aerosol scientists might be right, that aerosol transmission might be a culprit in the spread of COVID outside of the intensive care unit. So, the question is at what point did the threads merge to produce coherent policy that would help us protect our residents?
Answer: they haven’t yet. The vaccines arrived before Kong got on the same side as Godzilla. When the vaccines were the answer, why bother with expensive or maintenance-intensive improvements to the physical plant? But now we know that we can’t rely on vaccines when vaccines are not universally accepted or available. The virus continues to circulate in this country and around the world.
Has your facility or corporate office reviewed the WHO and CDC guidelines for ventilation mitigation strategies? Have your environmental or maintenance staff been brought up to date on what they can do to decrease the likelihood of aerosol transmission using their current equipment?
Are you taking this change of direction seriously, or just doubling down on handwashing, masks, social distancing and keeping our residents isolated from loved ones and the meaningful activities that are their right?
Donna Stuart has worked as an activity professional in long-term care for the past 10 years. She previously worked as a high school science teacher and a field linguist/language surveyor.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
