THE MYTH OF CASUAL DISTANT TRANSMISSION OF COVID-19

Updated 10/17/20

I have not changed anything here since 9/29, but wanted to share two important new stories about the big picture during the fall and early next year:

HOW TO STAY HEALTHY DURING THE HOLIDAYS https://www.cnn.com/2020/10/17/health/covid-fall-surge-ways-to-stay-healthy-wellness/index.html

REASONS TO BE OPTIMISTIC ABOUT NEXT YEAR https://www.nytimes.com/2020/10/12/health/coronavirus-pandemic-vaccine-optimism.html

People are afraid to be near each other, lest they breathe in COVID-19 aka the coronavirus.

They scream at anyone at a store who comes within a six feet radius.

To prevent any exchange of dangerous air, at the register the masked clerk and customer are protected by a plastic shield.

A prominent doctor warns those who go out on a run to be sure to do it with a mask, lest they pass through a "viral cloud" left by someone else.

A video goes, well, viral, apparently showing that a sneeze can shoot out germs as far as 21 feet. 

The Primary Causes of Transmission And Exceptions

 A typical story breathlessly announced that "you may be able to spread coronavirus simply by breathing" near someone sick: https://www.sciencemag.org/news/2020/04/you-may-be-able-spread-coronavirus-just-breathing-new-report-finds. Only near the end did it mention that "not all experts agree" this is likely, noting that the World Health Organization (WHO) analyzed 75,000 cases in China and did not find a single one that could be evidence of transmission this way.

Other experts have pointed out that finding small droplets in the air at a distance does not mean the amount could be enough to cause someone to become sick: https://www.sciencealert.com/is-coronavirus-spread-by-talking-and-breathing

Most contagious disease specialists agree that sneezing and coughing are the primary ways the virus reaches people or surfaces within three feet (sometimes further, hence the advice to stay six feet away and not to touch eyes, mouth, or nostrils until hands are sanitized after any possible contact). Sneezing spews out about 200 million particles, while normal breathing could admit 50 to 5,000. WHO does acknowledge that airborne transmission can take place without coughing or sneezing when working with patients very closely, including just talking, which is why nurses, doctors and others involved are always supposed to wear what are known as surgical masks and sometimes eye protection: https://www.livescience.com/covid19-coronavirus-transmission-through-speech.html.               

There was news about a South Korean call center where 97 out of 216 workers became infected due to one who was asymptomatic. This did not address the many ways they could have been infected (I've worked in call centers), but it clearly isn't wise to pack people together talking loudly for hours. This is not, however, an example of how most of the public anywhere might be exposed. So. Korea has one of the lowest deaths-per-million rates in the world (8 vs America's 633).

The surprise is that there has not been news like this from other countries that have a tremendous concentration of call centers, have an extremely low deaths-per-million rate. However, it is known that, as in the case of medical settings, that if a someone who has the virus has a 10-15 min. conversation at very close range it is possible to infect so. Offices could easily limit the risk by distancing, taking breaks from talking closely, using masks and gloves, sanitizing surfaces, and making sure there is good ventilation. The foolishness of packing people close together where there are hours of intense talking without masks, whether a call center or bar, is obvious.

You may have recently seen articles like this reporting that 239 scientists signed a letter asserting that a major cause of COVID was airborne transmission near someone, sometimes just from breathing: https://www.nytimes.com/2020/07/30/opinion/coronavirus-aerosols.html (this was the controversy that recently surrounded the CDC's official position). What it doesn't tell you is that, as other media reported, most scientists around the world disagree this is a major cause (see the information below on how few COVID deaths there have been in the world's most crowded cities). But note several other things about this: it cites two peer-reviewed articles and five not peer-reviewed. There is a huge number of weasel words: maybe, perhaps, it is not clear, likely, possibly, etc. Ironically, the author admits that best practices for prevention are already known: social distancing, masks, avoid crowded rooms, provide ventilation,

Should You Worry About Contamination Outdoors or in Stores?

This authoritative article addresses the misconceptions that you might run into a virus-laden cloud outdoors (droplets would be dispersed), that hair might be a source of contamination, or that you might catch the coronavirus from handling the mail or clothing (unless they belong to someone who works in a healthcare environment involving patients who might have the virus): https://www.nytimes.com/2020/04/17/well/live/coronavirus-contagion-spead-clothes-shoes-hair-newspaper-packages-mail-infectious.html?action=click&module=Spotlight&pgtype=Homepage

Others analysts have concluded the produce is not a likely carrier, but you could clean anything after shopping if you're concerned, as well as wear gloves, clean your hands, and don't touch your face in the meantime.

As for the fear that coming within six feet of someone on a casual basis will cause you to catch the COVID-19, anyone who believes that has not observed the tens of millions of shoppers in grocery stores who necessarily pass by each other much closer in the aisles every day. Furthermore, no one wears eye covers, and since eyes are the most prominent mucous membranes, if the virus were easy to transmit to passersby the number of cases would be hundreds of millions higher globally. Even a proponent of the idea that extended talking in an enclosed space could be dangerous, like Prof. Erin Bromage, admits that "grocery shopping is low risk for infection." What the CDC actually advises is to wear masks if you cannot maintain social distancing, but has never said anyone would come down with COVID-19 simply by walking by them. This also raises a question about whether cities are being overly strict about the number of people allowed in a large store at one time, since their shopping can't be micromanaged. The long lines to get in and at registers certainly impact sales.

I have been a nutrition consultant in the supplement department of a natural food store for years (which is like working at a medical clinic in terms of potential exposure). I have been surprised that I have only very rarely seen anyone cough or sneeze. The people who are really sick apparently stay home, which raises the question as to how much good distancing, masks, and screens at registers really do. These certainly make communication between workers and customers very difficult. But at least the shopping cart handles are cleaned and many shoppers wear gloves, providing an environment that appears to be safe, making customers comfortable about coming back.               

Lessons From Other Countries

It is often noted in the media that there is a lag time between exposure and symptoms of COVID-19, usually 3 to 7 days, but as long as two weeks. Asymptomatic carriers "shed," infecting anything they touch before the deep, dry coughing starts, which is the main indicator of this virus. The claim is that we have no idea how many people are sick because of the lack of testing and that those who have died from this may be given another reason on the death certificate. But speculation about the numbers is not a compelling argument because we have the Asian experience since the identification of the virus in China in Dec. 2019. The more testing that is done is gradually revealing many who had mild cases and were asymptomatic, so it appears that the rate of death is going to go down as we have a clearer picture of how many were infected to some degree. An article 8/8 on CNN reported that New York state concluded after extensive testing an infection rate of just .93% (less than one transmission per infected individual).

The results of the first wave have played out and, according to the Worldometer tracking site https://www.worldometers.info/coronavirus/?utm_campaign=homeAdvegas1? many countries have had a lot of success in dealing with the challenge. Since the deaths-per-million is the most reliable comparison for results (most countries have similar diagnostic tools and more experience than we do), these are some eye-popping examples as of 9/28/20 (and allegations of misdiagnosis are not going to change the overall DPM numbers, especially as wider testing raises the number of those mildly infected, especially more young people). Compare these stats with the alarming news every five minutes about how other countries are doing in deaths-per-million of population (DPM):

As noted, the U.S. is at 633 (with 4% of the world's population, we have a quarter of the cases, despite having had two months of warning that the virus was coming)

Canada 245 (this article also mentions that the government's standard for distancing is to avoid infection by coughing and sneezing: https://www.123dentist.com/the-what-why-and-when-for-social-distancing/)

China 3 (Hong Kong 14; for skeptics about China's statistics, I would point to the record of other Asian countries; CEOs I have recently interviewed for a business column tell me the factories are fully operational again, so look at the actual DPM stats, not the news for an update on the results of the risk they are taking)

Japan 12 (despite having the oldest population in the world, which should make it especially vulnerable)

So. Korea 8

Taiwan .3

Indonesia 38

Vietnam .4

Thailand .8

Costa Rica 169

Guatemala 180

Germany 114

Greece 37

Norway 30

Austria 88

Israel 164

Turkey 95

UAE 42

Jordan 5

Egypt 57

Kenya 13

Tanzania .3

Ethiopia 10

There are a lot of theories about why there are so many disparities, especially comparing countries with clearly inadequate healthcare systems who have seemingly nearly escaped much suffering: https://www.nytimes.com/2020/05/03/world/asia/coronavirus-spread-where-why.html?action=click&module=Spotlight&pgtype=Homepage.

 And how do we know these nations are reporting accurately? As the article says, it would be hard to ignore the bodies piling up if the claim is that few are dying.

Those who believe that the virus is easily transmitted in casual, brief social situations, such shopping or sharing an elevator need to explain why the most densely populated cities in the world have had a relatively low number of deaths (https://en.wikipedia.org/wiki/List_of_cities_proper_by_population_density:

The Philippines, which has 13 of the top 50 densely populated cities, including No. 1 Manila, is at 49 per million.

India, which has four on this list, including No. 5 Mumbai, is at 70 DPM.

Bangladesh. including No. 6 Dhaka, is at 31.

Haiti, including No. 9 Port-au-Prince, is 20.

This is an analysis of how densely-packed U.S. cities are more prone to a high number of cases and deaths because of the frequency of contacts with the infected (and note no mention of contagion simply by breathing the same air at a distance): https://stoneleighfoundation.org/opinion-crowding-and-the-coronavirus-the-key-to-reopening/

The Disastrous U.S. Response Thus Far and the Way Forward

This is a recent in-depth analysis of why the U.S. has done so badly compared with other countries, with lots of lessons: https://www.nytimes.com/2020/08/06/us/united-states-failure-coronavirus.html?action=click&module=Top%20Stories&pgtype=Homepage

For skeptics about the usefulness of face masks, this is a definitive examination of the evidence 8/9: https://www.nytimes.com/2020/08/06/us/united-states-failure-coronavirus.html?action=click&module=Top%20Stories&pgtype=Homepage

This is the latest evidence about the extent to which we should worry about young children infecting teachers (it's less than one might expect: https://www.nytimes.com/2020/08/12/opinion/coronavirus-schools-children.html?action=click&module=Opinion&pgtype=Homepage

Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases who heads the White House task force, has been all over the map in his predictions about cases, starting early March forecasting 1.5 million U.S. deaths based on a British estimate. He brought it down to 100,000-200,000 at the end of March and two week later was saying the University of Washington's Institute of Health Metrics and Evaluation model of 61,000-84,000 was credible, since the lockdowns were lowering the rate of new cases and deaths. One "authority" just announced that perhaps 70% of Americans would be infected, which would be 230 million vs 7.4 million today.

Then in the middle of April the enormous spikes in deaths began occurring, primarily at nursing homes, assisted living centers, prisons, and food processing plants. How is it that all the experts and government leaders did not foresee this and take stronger steps, given the awareness that nursing homes are filled with older people on poor diets, who are taking several drugs for a variety of illnesses and have compromised immune systems, cared for by poorly-paid and inadequately protected workers? These now constitute a quarter of the national toll. This is an article 8/11 about how California's Veterans Affairs Dept. dramatically reduced the numbers at homes it oversees: https://www.politico.com/news/2020/08/10/could-nursing-home-deaths-be-prevented-393131

It can be argued that no one was prepared in large part because of the federal government's failures to coordinate the acquisition of personal protective equipment and its lies about what was available, including testing kits that were functional. In fact, incredibly enough, its agents were stealing shipments that states and cities had ordered to add to the federal stockpile or all the president's men were incompetently trying to make their own deals, interfering with the professionals who should have been in charge.

But the fact is, the experts did not raise a major alarm about something could have been ameliorated. This is one proposal for managing the crisis at nursing homes comprehensively now: https://www.huffpost.com/entry/covid-nursing-homes-hazard-pay_n_5eac66d3c5b626fdfbc0bba9

All bets are off about the future, now that so many states, especially those governed by Republicans, are reopening their businesses, despite not meeting the recommendations of the Centers for Disease Control to qualify.

Whatever the final count is, the crisis needs to be put into perspective. There are states and localities that have done a remarkable job in preventing what happened in New York: https://www.worldometers.info/coronavirus/country/us/. That state has had 170 deaths per million so far vs California's 39 or Oregon's 13.

Immunity After Having COVID-19, Vaccinations, and the Future

For those concerned whether having COVID provides immunity, these two articles provide some assurance: https://www.cnn.com/2020/07/30/health/t-cells-coronavirus-study-wellness/index.html

https://www.nytimes.com/2020/07/31/opinion/coronavirus-antibodies-immunity.html?action=click&module=Opinion&pgtype=Homepage

I have written on the history of epidemics and vaccination and most Americans have been living in a 21st century ivory tower, with few traveling to other countries and most have little knowledge of world history I recommend Jared Diamond's Guns, Germs, and Steel or Charles Mann's 1493). To put our current situation in perspective, smallpox killed 300 million in the 20th century alone. The global COVID-19 mortality rate, if you just divide the number of deaths by the cases, despite our inadequate management, minimal testing, little contact tracing, and the refusal of many to follow expert guidance on prevention: 2.9% By comparison, tuberculosis has a 15% fatality rate.

What would help Americans to resist any disease would be improving their overall personal health. The AARP Bulletin for May 2020 has lots of solid advice on this, from doing more exercise and losing weight, but much of what is says about how to boost the immune system and its anti-inflammatory powers will be news to most people:

https://www.aarp.org/health/conditions-treatments/info-2020/coronavirus-immunity-age-risk.html

I know from my own background (having lived in Europe in the 1970s, traveled to many countries as a writer, worked for notable doctors and nutritionists, and edited three health magazines) that the rest of the world uses a broad approach to pragmatically using anything that can prevent disease. That can mean in India including Ayurvedic remedies in the curriculum at medical schools (considered some of the best in the world) or in Germany providing an education in herbs and homeopathy for pharmacists and physicians. America's approach is very narrow and decades behind the cutting-edge research, emphasizing primarily drug treatment of symptoms, rather than providing cures for the root causes (skeptics should consult Phyllis Balch's study of the clinical evidence in Prescription for Nutritional Healing, the handbook for integrative medical clinics).

That is certainly a factor in why we rank No. 37 (Cuba is 39) among nations on the Healthcare Access & Quality Index. According to the American Public Health Association, the U.S ranks 34th in life expectancy at birth: https://www.apha.org/topics-and-issues/health-rankings. Our calorie-rich, nutrient-poor diets are a major contributor to this: according to The Whole Foods Diet by Alona Pulde, M.D., Matthew Lederman, M.D., and John Mackey, Americans on average consume 151 pounds of sugar a year (one third of our population is diabetic or pre-diabetic and 69% of adults are overweight, 36% obese).

Thomas Friedman, the brilliant economic op-ed columnist for the New York Times, explains how we can intelligently reopen the economy by treating the virus as two different entities, one that is very deadly for the vulnerable who need special protection, while respecting its potential for killing anyone who is not careful: https://www.nytimes.com/2020/04/25/opinion/coronavirus-immunity-trump.html?smid=fb-share&fbclid=IwAR12zki-iDXGS6OJCOvqbhOGbxPAj1c9v_DZ0ZHzZ0RZmAJpjPSND9L12B4

More recently, this is an op-ed by experts on how Republicans could lead the fight against COVID-19 by copying other market economies that have successfully contained it: https://www.nytimes.com/2020/06/29/opinion/republicans-coronavirus.html?action=click&module=Opinion&pgtype=Homepage

I'm an optimist about the long-term results of the battle because I have written about the resilience of the human species' resilience (Europeans even bounced back after the Black Death killed a third of the entire population in the 14th century). But Americans are the most willful and willfully ignorant people in history, led by a science-denying elite that also believes that climate change is a media-promoted lie. God only knows what will happen next, but we do have it in our power to prevent the worst.