According to the Scientific Community, It’s Time for Change

If you couldn’t tell, I’ve been hinting at this for a while. In several posts over the past few months, there has been discussion amongst the medical community that has created controversy regarding the mode of transmission of COVID-19. Many providers of all disciplines have been very concerned about their contraction rates and that of their coworkers, even when utilizing the proper droplet precautions prescribed by national guiding agencies. Many healthcare providers felt they were being mislead and that COVID-19 was actually being transmitted by another means, other than droplets.

I mentioned this controversy in the Webinar I gave for the Michigan Physical Therapy Association. I was also very clear that we were still under droplet precautions at that time and we currently are STILL under those precautions now. However, as of July 6, 2020, over 1000 healthcare providers around the world have died from COVID-19. You can read about all of them here.

In addition to that, as of May 21, 2020, studies showed that only 1% of healthcare workers (outside of the US) contracted COVID-19. However, they found that a higher percentage of the healthcare workers that contracted it never worked in high risk areas or with positive patients than those who did not. They also found that as many as 93% of healthcare workers actually reported symptoms of COVID-19 but were never tested. This likely indicates that healthcare workers who worked in non-high risk places who did not utilize aerosol precautions in their PPE were more likely to contract COVID-19 from asymptomatic (and therefore untested) patients. The risk of nosocomial transmission was relatively low overall in high risk places because aerosol precautions were utilized.

And, let’s be very clear: TO DATE 94,097 healthcare workers have been confirmed positive with COVID-19 just in the US (per the CDC), with over 500 deaths. Here is a snapshot taken directly from their website today (July 8, 2020). As you can see, they only have data for a very small percentage of overall patient cases to determine employment status so this number is likely severely underestimated. You can also see they had just over half the data on deaths, so another likely underestimate.

I am not saying all of this to scare healthcare professionals, actually the opposite. I’m saying all of this because you all need to know your risk and you need to stand up for the proper safety equipment to protect yourselves. And you need the data to do it! Because some employers won’t put up for N95s or PAPRs or shields unless you have the data to back up your request. Thankfully, Ive been hearing from colleagues that many employers are now ordering the proper PPE for aerosol precautions. This also changes the definition of aerosol-generating procedures, as pretty much anything that produces breathing will now fall under this category for COVID-19. COVID-19 will join the ranks of airborne-transmission conditions along with tuberculosis and measles. And remember, these are things healthcare providers work with every single day.

Researchers all around the world have been working furiously to study the transmission of COVID-19 and their findings have been leaning a different direction. Many of them, including the MIT researchers I told you about in this post, are finding that live virus is easily aerosolized with activities as simple as talking, and especially when singing and exercising. But time and time again, this research has been ignored or shot down. To quote one of the researchers:

“…the importance of airborne transmission has not been considered in establishment of mitigation measures by government authorities.”

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So, the big news is that, just yesterday, a national guiding association has acknowledged the importance of this research. Maria Van Kerkhove and Bendetta Allegranzi, technical leads on the COVID-19 pandemic for The World Health Organization (WHO), announced that they have begun to assess the research being performed, funding more of it, and considering the implications this may have for their guidelines. They are considering the changes that may need to be made given the new information, not just for healthcare but for the world. The evidence they are considering is that, to date, 239 scientists in 32 countries have outlined evidence of aerosol transmission. That’s a pretty big stack of articles to read.

If all (or even a good chunk) of those studies were performed with the proper scientific rigor, I think we will be seeing a big change in the required precautions for healthcare workers as well as the general public when it come to COVID-19. Given this information, I don’t think face masks will be going away anytime soon!

You can view the new briefing with the representatives from the WHO here (specific discussion regarding aerosol-based transmission is at about 10:00):

You can also read the open letter sent to the WHO from the 239 researchers (many of whom are engineers) which is in the accepted manuscript formate in Clinical Infectious Disease HERE, available free from Oxford Academic. Remember how important these folks are in the prevention of disease transmission? If you need more info on this, check out this post on engineering controls.

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Do you feel you have the resources needed to ask for the proper equipment to protect yourself and your patients in your work setting? What else do you need? Let me know in the comments!

References

Centers for Disease Control and Prevention. (2020). Coronavirus Disease 2019: Cases in the US. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html on July 8, 2020.

Lidia Morawska & Donald K Milton. (2020). It is Time to Address Airborne Transmission of COVID-19, Clinical Infectious Diseases, ciaa939 [accepted manuscript], retrieved from https://doi.org/10.1093/cid/ciaa939

No Author. (July 8, 2020). WHO acknowledges ‘evidence emerging’ of airborne spread of COVID-19. The Economic Times: World News. Retrieved from https://m.economictimes.com/news/international/world-news/who-acknowledges-evidence-emerging-of-airborne-spread-of-covid-19/articleshow/76840850.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst

No Author. (April 1, 2020). In Memoriam: Healthcare Workers Who Have Died of COVID-19. Medscape. Retrieved from https://www.medscape.com/viewarticle/927976

World Health Organization. (2020). Media briefing on COVID-19 (July 7, 2020). Retrieved from https://www.youtube.com/watch?v=69jLmw0YB6s

Van Beusekom, M. (2020). Studies: 1% of healthcare workers had COVID-19. Center for Infectious Disease Research and Policy: CIDRAP News. Retrieve from https://www.cidrap.umn.edu/news-perspective/2020/05/studies-1-healthcare-workers-had-covid-19

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