Fomites vs. droplets vs. aerosols: a senseless battle
One cannot foster fools. Sadly, media provide full coverage to conspiracy theorists for the sake of short-lived news value regarding the issues of the day. Media who commit themselves to such kind of 'news distribution' are nothing more than a serving hatch. Unfortunately, influenceable people are not able to see through true (mostly monetary) motives of the pseudoscientists and cult leaders they choose to believe. It goes to show that a vast amount of people support their insincere intentions. Why is that? In turbulent times, it seems comforting to some to cling to the one who skillfully plays on the sentiment. Someone who knows exactly what people want to hear; a sounding board. And this sounding board knows how to engage his target group. He only needs a topic to exploit, in order to give his followers the impression that he knows what he's talking about. A topic that has been heavily exploited by pseudoscientists since May 2020, is the illusory debate on "airborne transmission" vs. "droplet and fomite transmission" of SARS-CoV-2. This debate does not contribute in any way to what really matters: prevention of transmission of SARS-CoV-2.
One cannot foster fools. Sadly, media provide full coverage to conspiracy theorists for the sake of short-lived news value regarding the issues of the day. Media who commit themselves to such kind of 'news distribution' are nothing more than a serving hatch. Unfortunately, influenceable people are not able to see through true (mostly monetary) motives of the pseudoscientists and cult leaders they choose to believe. It goes to show that a vast amount of people support their insincere intentions. Why is that? In turbulent times, it seems comforting to some to cling to the one who skillfully plays on the sentiment. Someone who knows exactly what people want to hear; a sounding board. And this sounding board knows how to engage his target group. He only needs a topic to exploit, in order to give his followers the impression that he knows what he's talking about. A topic that has been heavily exploited by pseudoscientists since May 2020, is the illusory debate on "airborne transmission" vs. "droplet and fomite transmission" of SARS-CoV-2. This debate does not contribute in any way to what really matters: prevention of transmission of SARS-CoV-2.
The imaginary battle among "transmission camps" was instigated by pseudoscientists and copy-pasters
The recent bizarre battle between "airborne transmission" versus "fomite (surface contamination) transmission" camps is solely an imaginary one. Transmission of SARS-CoV-2 takes place through multiple transmission routes. Excluding either transmission route is pointless. The debate about an adequate approach to coronavirus transmission has been hijacked and turned into a severely marginal discussion that lacks any scientific basis.
The hijackers of the debate are not scientists nor visionaries, but pseudoscientists and obsessives who are also referred to as 'gurus'. What is really mean, is that these people, who falsely present themselves as 'scientists', have copied and pasted unverified, non-reviewed studies on airborne transmission of the virus and presented the results of their copy-paste-skills as their own hypotheses. Fabricated facts and circular reasoning are presented as "evidence" and used for political and personal monetary purposes. The frequently heard "I'm right" makes it obvious that it is not about science. It is neither interesting nor relevant to know "who was the first to discuss aerosol transmission of SARS-CoV-2" (really interested in the scientists who investigated aerosol transmission of SARS-CoV-1 and SARS-CoV-2? Look up Van Doremalen, ir. L. Marr, Morawska and Bourouiba, search by name via NCBI (PubMed)).
The recent bizarre battle between "airborne transmission" versus "fomite (surface contamination) transmission" camps is solely an imaginary one. Transmission of SARS-CoV-2 takes place through multiple transmission routes. Excluding either transmission route is pointless. The debate about an adequate approach to coronavirus transmission has been hijacked and turned into a severely marginal discussion that lacks any scientific basis.
The hijackers of the debate are not scientists nor visionaries, but pseudoscientists and obsessives who are also referred to as 'gurus'. What is really mean, is that these people, who falsely present themselves as 'scientists', have copied and pasted unverified, non-reviewed studies on airborne transmission of the virus and presented the results of their copy-paste-skills as their own hypotheses. Fabricated facts and circular reasoning are presented as "evidence" and used for political and personal monetary purposes. The frequently heard "I'm right" makes it obvious that it is not about science. It is neither interesting nor relevant to know "who was the first to discuss aerosol transmission of SARS-CoV-2" (really interested in the scientists who investigated aerosol transmission of SARS-CoV-1 and SARS-CoV-2? Look up Van Doremalen, ir. L. Marr, Morawska and Bourouiba, search by name via NCBI (PubMed)).
The only topic of relevance: take adequate measures to stop the transmission of SARS-CoV-2
I have repeatedly brought this to the attention since March 2020: in order to limit transmission of the coronavirus, it should be acknowledged that measures must be taken against aerogenous transmission. Aerogenous transmission requires additional measures compared to transmission via fomites or direct droplets. Direct droplet infection occurs when large droplets travel over a distance of about 3 meters from a person. Plexiglass fences in public spaces and plastic face masks in medical care serve to ward off direct droplerts. Transmission via fomites takes place by contracting solid particles, for example poo and slime, on surfaces.
Aerosols are droplets that are emitted by breathing / talking / singing. The dividing line between direct droples and fomites cannot always be drawn, because poo and slime can also become airborne, for example through an air conditioner or vacuum cleaner that swings small particles into the air ('sling poo'). Aerosols are moved via gas and they are capable of being transported by air over a distance of 8 meters. Note that aerosols accumulate in closed spaces. No distance rule helps against the accumulation of viral aerosols in an enclosed space. Therefore, aerogenous transmission should be limited with face masks and good ventilation. The advantage of good ventilation and mouth masks is that these measures can also help to limit direct droplet transmission.
What is the importance of limiting aerogenous transmission of SARS-CoV-2?
1. SARS-CoV-2 can remain stable in the air for up to 3 hours (Van Doremalen, 2020; see also Morawska, 2020). Accumulation and duration of the presence of viral aerosols increase the chance of successful infection of individuals;
2. Of all viruses tested, SARS-CoV-2 is the most stable in aerogenous form. SARS-CoV-2 aerosols can be infectious for up to 16 hours (Persistence of SARS-CoV-2 in Aerosol Suspensions, Emerging Infectious Diseases, Vol. 26, Number 9, September 2020);
3. The airborne transmission route influences the severity of the disease caused by SARS-CoV-2. Aerosols are small enough to directly reach the alveoli (alveoli). This can make the infection more serious, because the virus is not detected and the body fails to trigger an immune response in time (Particle size and pathogenicity in the respiratory tract, Virulence, 4 (8) (2013), see also "COVID -19 vulnerability: the impact of genetic susceptibility and airborne transmission ", Human Genomics, 2020; 14:17).
I have repeatedly brought this to the attention since March 2020: in order to limit transmission of the coronavirus, it should be acknowledged that measures must be taken against aerogenous transmission. Aerogenous transmission requires additional measures compared to transmission via fomites or direct droplets. Direct droplet infection occurs when large droplets travel over a distance of about 3 meters from a person. Plexiglass fences in public spaces and plastic face masks in medical care serve to ward off direct droplerts. Transmission via fomites takes place by contracting solid particles, for example poo and slime, on surfaces.
Aerosols are droplets that are emitted by breathing / talking / singing. The dividing line between direct droples and fomites cannot always be drawn, because poo and slime can also become airborne, for example through an air conditioner or vacuum cleaner that swings small particles into the air ('sling poo'). Aerosols are moved via gas and they are capable of being transported by air over a distance of 8 meters. Note that aerosols accumulate in closed spaces. No distance rule helps against the accumulation of viral aerosols in an enclosed space. Therefore, aerogenous transmission should be limited with face masks and good ventilation. The advantage of good ventilation and mouth masks is that these measures can also help to limit direct droplet transmission.
What is the importance of limiting aerogenous transmission of SARS-CoV-2?
1. SARS-CoV-2 can remain stable in the air for up to 3 hours (Van Doremalen, 2020; see also Morawska, 2020). Accumulation and duration of the presence of viral aerosols increase the chance of successful infection of individuals;
2. Of all viruses tested, SARS-CoV-2 is the most stable in aerogenous form. SARS-CoV-2 aerosols can be infectious for up to 16 hours (Persistence of SARS-CoV-2 in Aerosol Suspensions, Emerging Infectious Diseases, Vol. 26, Number 9, September 2020);
3. The airborne transmission route influences the severity of the disease caused by SARS-CoV-2. Aerosols are small enough to directly reach the alveoli (alveoli). This can make the infection more serious, because the virus is not detected and the body fails to trigger an immune response in time (Particle size and pathogenicity in the respiratory tract, Virulence, 4 (8) (2013), see also "COVID -19 vulnerability: the impact of genetic susceptibility and airborne transmission ", Human Genomics, 2020; 14:17).
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| The importance of taking adequate measures against airborne transmission of SARS-CoV-2 |
The importance of clear policies and good communication
Unfortunately, the policies issued by the Institute for Public Health, which are based on the considerations of the Outbreak Management Team (OMT), do not excel in clarity. The aerosol transmission of SARS-CoV-2 is still dismissed (as of July 2020) and the reasoning behind this biased dismissal is incomprehensible. A completely normal physical phenomenon is denied, while aerogenous transmission of pathogens has never been a controversial topic among engineers and biochemists. Moreover, the circular reasoning is in fact highly unscientific:
1. The non-validated preprint that discusses transmission routes of SARS-CoV-2 on the Diamond Princess indicates that aerogenous transmission was not the primary transmission route. The substantiation of the scientific relevance of the study expresses that good ventilation techniques should be recognized. The outdoor fresh air supply on the Diamond Princess operated on 50% to 100% outdoor air in shared spaces. The hypothesis that aerogenous transmission was not the main transmission route, can be explained by the application of adequate ventilation techniques. It is all the more remarkable that the Health Institute discards adjustment of ventilation policies while quoting specifically this paragraph of the Diamond Princess preprint;
2. According to the OMT and Public Health Institute, it is more plausible that fomite transmission is the main transmission route for all infections. Transmission of SARS-CoV-2 via fomites has in fact never been demonstrated. There is literally no scientific basis to support the assumption that contamination via fomites is the main route of SARS-CoV-2-transmission;
3. According to the Public Health Institute, the viral load of aerosols is "probably" not infectious, even though this assumption has not been proven;
4. Face masks are not recommended as they should not replace the 1.5 meter spacing rule. Why do the OMT and National Institute for Public Health present distancing and face masking policies as alternative opposites, instead of cumulative measures?
Unfortunately, the policies issued by the Institute for Public Health, which are based on the considerations of the Outbreak Management Team (OMT), do not excel in clarity. The aerosol transmission of SARS-CoV-2 is still dismissed (as of July 2020) and the reasoning behind this biased dismissal is incomprehensible. A completely normal physical phenomenon is denied, while aerogenous transmission of pathogens has never been a controversial topic among engineers and biochemists. Moreover, the circular reasoning is in fact highly unscientific:
1. The non-validated preprint that discusses transmission routes of SARS-CoV-2 on the Diamond Princess indicates that aerogenous transmission was not the primary transmission route. The substantiation of the scientific relevance of the study expresses that good ventilation techniques should be recognized. The outdoor fresh air supply on the Diamond Princess operated on 50% to 100% outdoor air in shared spaces. The hypothesis that aerogenous transmission was not the main transmission route, can be explained by the application of adequate ventilation techniques. It is all the more remarkable that the Health Institute discards adjustment of ventilation policies while quoting specifically this paragraph of the Diamond Princess preprint;
2. According to the OMT and Public Health Institute, it is more plausible that fomite transmission is the main transmission route for all infections. Transmission of SARS-CoV-2 via fomites has in fact never been demonstrated. There is literally no scientific basis to support the assumption that contamination via fomites is the main route of SARS-CoV-2-transmission;
3. According to the Public Health Institute, the viral load of aerosols is "probably" not infectious, even though this assumption has not been proven;
4. Face masks are not recommended as they should not replace the 1.5 meter spacing rule. Why do the OMT and National Institute for Public Health present distancing and face masking policies as alternative opposites, instead of cumulative measures?
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| The Diamond Princess preprint from MedRxiv: ventilation operated on 50 to 100% outdoor air in shared spaces. Nonetheless, the Public Health Institute quotes this exact paragraph to discard adequate ventilation techniques. |
1.5 m social distancing and the "disappearing causality trick"
Subsequently, causality questions have been given the cold shoulder to "prove" that the 1.5 meter distance rule was the right measure to prevent further transmission of SARS-CoV-2: "Because we stick to the 1.5 meter distancing rule, there are so few infections" (search the archive of NOS.nl, Monday 22 June 2020, 11:14). That a "1.5 meter distancing"-rule is not an adequate measure against transmission should not be questioned. The OMT's arguments also disregard that measures should be maintained cumulatively.
The precarious policy considerations have given some citizens the impression that "freedom rights" are being deliberately violated. I have also spoken to benevolent people who, because of the many contradictions, are not sure what precautions and measures have to be taken. It is therefore important to clarify how to ensure adequate measures.
Which measures must be taken?
1. The 1.5 meter distancing rule is not sufficient. A safe distance to minimize direct droplet transmission of SARS-CoV-2 stars at 3 m between each person;
2. Non-medical face masks actually help to restrain direct droplet transmission and aerosol transmission. FFP2 / FFP3 / KN95 certified face masks protect both the wearer and others against transmission;
3. Plexiglass screens can ward off direct droplet transmission, but they should not be arranged so that aerosols can accumulate. Ventilation to refresh the air is required;
4. Arrows and duct tape are of no use as long as people are not required to wear face masks;
5. Queueing customers and patients without requiring them to wear face masks is of no use, as long as respiratory droplets can be inhaled in the process;
Subsequently, causality questions have been given the cold shoulder to "prove" that the 1.5 meter distance rule was the right measure to prevent further transmission of SARS-CoV-2: "Because we stick to the 1.5 meter distancing rule, there are so few infections" (search the archive of NOS.nl, Monday 22 June 2020, 11:14). That a "1.5 meter distancing"-rule is not an adequate measure against transmission should not be questioned. The OMT's arguments also disregard that measures should be maintained cumulatively.
The precarious policy considerations have given some citizens the impression that "freedom rights" are being deliberately violated. I have also spoken to benevolent people who, because of the many contradictions, are not sure what precautions and measures have to be taken. It is therefore important to clarify how to ensure adequate measures.
Which measures must be taken?
1. The 1.5 meter distancing rule is not sufficient. A safe distance to minimize direct droplet transmission of SARS-CoV-2 stars at 3 m between each person;
2. Non-medical face masks actually help to restrain direct droplet transmission and aerosol transmission. FFP2 / FFP3 / KN95 certified face masks protect both the wearer and others against transmission;
3. Plexiglass screens can ward off direct droplet transmission, but they should not be arranged so that aerosols can accumulate. Ventilation to refresh the air is required;
4. Arrows and duct tape are of no use as long as people are not required to wear face masks;
5. Queueing customers and patients without requiring them to wear face masks is of no use, as long as respiratory droplets can be inhaled in the process;
6. To disinfect surfaces, such as shopping trolleys, use an emulsion with at least 60% alcohol / ethanol. This emulsion should not be wiped off;
7. Hand hygiene is important to remove faecal virus particles. Hand soap or another degreasing soap helps destabilize SARS-CoV-2;
8. Ventilation is the most effective method of limiting the spread of SARS-CoV-2 via multiple transmission routes. Side notes are that people and objects should not be placed directly in an air stream and recirculation of polluted air through mechanical ventilation systems and leaks in HVAC systems should be avoided.
7. Hand hygiene is important to remove faecal virus particles. Hand soap or another degreasing soap helps destabilize SARS-CoV-2;
8. Ventilation is the most effective method of limiting the spread of SARS-CoV-2 via multiple transmission routes. Side notes are that people and objects should not be placed directly in an air stream and recirculation of polluted air through mechanical ventilation systems and leaks in HVAC systems should be avoided.
