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This was by far and away the most important news story yesterday in NZ... however the NZ media appears to have given it only cursory exposure. Maybe they do not understand the significance of the admission that #COVIDisAirborne (Thread) https://twitter.com/DamianTheAussie/status/1356040350075240448?s=20
The Director General of Health @AshBloomfield admits that the community cases from last week, were most likely exposed in the Pullman Hotel via Airborne Transmission!!
Now it was clear last week that this was a very likely possibility, but official confirmation is a massive step forward, the importance of which can not be overstated. https://twitter.com/UCUltrasound/status/1353996539765477379?s=20
However there will be no benefit unless this acknowledgement is matched by significant actions to mitigate the risk of airborne transmission at the border and in isolation facilities, and to put into place airborne contingencies for a possible future community outbreak
Very few people in NZ seem to be talking about airborne transmisson of COVID. Maybe our privileged position has lulled us into a sense of security. But if we are to be prepared for a possible re-emergence in the community it is vital we understand this.
From the beginning of the pandemic we have been consistently told to wash our hands, distance and not touch our faces.
https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-health-advice-public/about-covid-19
https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-health-advice-public/about-covid-19
This was based on the assumption that the primary modes of transmission of SARS COV2 is via large droplets when in close contact with an infected person, and contact with contaminated surfaces.
However while COVID has been detected on surfaces, “there are no specific reports which have directly demonstrated fomite transmission” https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions
Aerosol transmission on the other hand was categorically denied as a route of transmission by the WHO in March 2020 https://twitter.com/WHO/status/1243972193169616898?s=20
Prior to yesterday (and possible still) the @minhealthnz has accepted that airborne transmission can occur, but that it is “unlikely”… https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-health-advice-public/about-covid-19
However there is substantial evidence to suggest that COVID is emitted in aerosols by infected persons, which can remain suspended for prolonged periods, and that inhalation of these aerosols is a significant mode of transmission.
Aerosols are fine particles which are suspended in air. They have the potential to travel short or long distances and be inhaled causing infection. https://www.journalofhospitalinfection.com/article/S0195-6701(21)00007-4/fulltext
"direct visualization demonstrates how normal speech generates airborne droplets that can remain suspended for tens of minutes or longer and are eminently capable
of transmitting disease in confined spaces". https://www.pnas.org/content/117/22/11875
of transmitting disease in confined spaces". https://www.pnas.org/content/117/22/11875
"SARS-CoV-2 is released directly into the air via breathing by COVID-19 patients. Levels in exhaled breath could reach 105–107 copies/m3 if an average breathing rate of 12 L/min is assumed" https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa1283/5898624
Moreover "The aerosol resulting from 30 s of continued speech has settling time and a viable viral dose an order-of-magnitude higher than in a short cough."
https://royalsocietypublishing.org/doi/10.1098/rspa.2020.0584
https://royalsocietypublishing.org/doi/10.1098/rspa.2020.0584
Also, intubation, long held up as one of the "aerosol generating procedures" with the potential to produce aerosol transmission, has been shown to be significantly less likely to generate aerosol than coughing!! …https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15292
"Aerosol and fomite transmission of SARS-CoV-2 is plausible, since the virus can remain viable and infectious in (mechanically generated) aerosols for hours
and on surfaces up to days" https://www.nejm.org/doi/10.1056/NEJMc2004973
and on surfaces up to days" https://www.nejm.org/doi/10.1056/NEJMc2004973
"SARS-CoV-2 generally maintains infectivity at a respirable particle size over short distances…SARS-CoV-2 is resilient in aerosol form"
https://wwwnc.cdc.gov/eid/article/26/9/20-1806_article
https://wwwnc.cdc.gov/eid/article/26/9/20-1806_article
Covid is dispersed by ventilation systems: "SARS-CoV-2 has ability to disperse from patients to ward vent openings as well as detection of viral RNA in ventilation exhaust filters located at least 50 m from patient room vent openings" https://www.nature.com/articles/s41598-020-76442-2
Not only that but “viable SARS-CoV-2 can be present in aerosols generated by a COVID-19 patient in a hospital room in the absence of an aerosol-generating procedure" https://www.ijidonline.com/article/S1201-9712(20)30739-6/fulltext
Epidemiological studies have time and time again illustrated the likelihood of aerosol transmission...
The Skagit Valley Chorale Cluster https://onlinelibrary.wiley.com/doi/10.1111/ina.12751
The Skagit Valley Chorale Cluster https://onlinelibrary.wiley.com/doi/10.1111/ina.12751
A Korean apartment block.. https://www.ijidonline.com/article/S1201-9712(20)32558-3/fulltext
For a more complete list of epidemiological case studies see this thread https://twitter.com/Orla_Hegarty/status/1352913377094475776?s=20
In NZ aerosols have also previously been suggested as a probable cause of transmission in cases in an isolation facility in Christchurch https://www.stuff.co.nz/national/health/coronavirus/124026191/poor-ventilation-and-doublebunking-led-to-health-workers-contracting-covid19
Why is the acknowledgement of the airborne route of transmission of Covid important?
Because in order for NZ to remain Covid free, procedures at our borders and isolation facilities must mitigate against all routes of transmission to avoid further community spread.
tbc...
Because in order for NZ to remain Covid free, procedures at our borders and isolation facilities must mitigate against all routes of transmission to avoid further community spread.
tbc...
For Isolation facilities, ensuring adequate ventilation of indoor spaces, distancing and masking are vital. This does not include confining potentially infected persons in buses to be transported across town for exercise. https://www.stuff.co.nz/national/health/coronavirus/124087086/covid19-bussing-miq-returnees-across-auckland-for-exercise-stupid-prof-says
It may also include consideration of the ventilation of lifts and corridors in MIQ facilities https://onlinelibrary.wiley.com/doi/10.1111/ina.12744
For healthcare workers, the recognition of the reality of airborne transmission and appropriate mitigation of this risk is literally a matter of life and death!!
850 dead in the UK
3000 dead in the USA https://blogs.bmj.com/bmj/2021/01/29/up-the-line-to-death-covid-19-has-revealed-a-mortal-betrayal-of-the-worlds-healthcare-workers/
850 dead in the UK
3000 dead in the USA https://blogs.bmj.com/bmj/2021/01/29/up-the-line-to-death-covid-19-has-revealed-a-mortal-betrayal-of-the-worlds-healthcare-workers/
And the general public needs to be given the correct information about transmission risks to be able to protect themselves in case of another community outbreak –
#CovidisAirborne so Masking, Avoiding indoor spaces, Adequate Ventilation and Distancing
#CovidisAirborne so Masking, Avoiding indoor spaces, Adequate Ventilation and Distancing
We have the benefit of time to prepare and the advantage of observing overseas experience.
We must not let the public and the healthcare system down by continuing to understate the importance of airborne transmission.
We must not let the public and the healthcare system down by continuing to understate the importance of airborne transmission.
