Welcome to the fourth issue of COVID Solutions Bulletin. Because of your expertise, you have been chosen part of a select audience to receive this e-mailed publication. Our mission is to educate influential Americans on innovative solutions to the COVID-19 crisis in America. We need to get back to work, to school, to play – to enjoying life. We can’t get there without thwarting the current pandemic and preparing for the likelihood of other pathogens to come.
One of our themes is this: Masks, distancing, testing, even vaccines are not enough. Environmental solutions have to be part of the effort – and that means technologies that neutralize pathogens, including the COVID virus, where they have the best chance to spread and infect – in interior settings. We hope you find this newsletter enlightening and will share your feedback.
In this issue:
Beyond COVID-19: The Need for Safe Air, Always
On April 7, the seven-day moving average of COVID deaths in the U.S. dropped to 642, the lowest figure in nine months. More recently, deaths and cases ticked up but then leveled off, and it appears that as vaccinations increase, the COVID threat is being contained. Some 88 million Americans, or one-quarter of the total population, have been fully vaccinated, as have two-thirds of those 65 and over.
But even when the pandemic disappears, the danger of pathogens – viruses, bacteria and molds – will remain. In fact, many of those pathogens are harder to neutralize than SARS-CoV-2, whose envelope is particularly vulnerable. (The Spaulding disinfection hierarchy places enveloped viruses at the bottom of its pyramid as easiest to inactivate, with spores and mycobacteria at the top.) The lesson Americans should take away from the COVID experience the lesson that air does not need to be merely clean but safe.
Influenza at a Record Low, a Condemnation of Traditional Ventilation
Consider influenza. The official flu season is over at the end of April. For 2020-21, the total hospitalization rate has been 0.7 per 100,000 Americans – or just 215 people, the lowest number since reliable data started being collected in 2005. According to the CDC, that is about one-eighth the rate during the last low-severity flu season, in 2011-12.
Only one – yes, just one – pediatric death has been reported in the 2020-21 flu season, compared with an average of 180 deaths of children in the preceding three flu seasons. In a single week during the 2019-20 flu season, 19 American children died.
What’s happening here? First, fewer people are mingling with other people in groups like classrooms or basketball arenas. Second, steps taken to mitigate COVID-19 also affect influenza. “Hand washing, social distancing, and wearing masks are certainly driving down cases of the flu,” said Dr. Casey Kelley, a family medicine physician and the founder and medical director of Case Integrative Health in Chicago, as quoted in a Healthline article.
But the results are also a condemnation of the poor state of indoor air over many years in our schools, factories and other gathering places, including homes. Because we weren’t there or because we were masked, we didn’t get infected by the flu virus, but if HVAC ventilation had been accompanied or supplanted by other technologies, we would have been saving lives for decades. And it’s not only the flu. Indoor air is needlessly contaminated by bacteria, mold, and other viruses.
Perhaps the most important lesson of the pandemic is that we have to make interior air safe – not just for COVID but for what’s already here and what may come.
Indoor Spaces are 'Prime COVID Hotspots'
Occasionally, a single article will perfectly capture a complex situation at precisely the right time. That is the case with the piece that appeared March 30 in the 152-year-old scientific journal Nature, carrying the headline, “Why indoor spaces are still prime COVID hotspots: Risks shoot up when virus particles accumulate in buildings, but it’s not clear how best to improve ventilation.”
Very late in the game, scientists and policy makers have come to the conclusion that the real danger in this pandemic is airborne transmission of the SARS-CoV-2 virus in interior spaces, writes Dyani Lewis, a journalist based in Melbourne, Australia. Now, the big question is what to do about it. Again, there’s growing realization that initial approaches – opening windows, ramping up ventilation, adding filters to HVAC systems – have been inadequate. The Nature article tells the story….
As late as March 28 of last year, the World Health Organization (WHO) was broadcasting this message on Twitter and Facebook: “FACT: 3COVID19 is NOT airborne.” It took another three months to produce even the soft admonition that airborne transmission in “crowded and inadequately ventilated spaces over a long period of time with infected persons cannot be ruled out.”
We now know better, and, in the Nature article, Lewis quotes Yuguo Li, a building environment engineer at the University of Hong Kong as saying, “We would have saved a lot of people” if WHO and others had recognized airborne transmission earlier.
WHO is still not going far enough. “Airborne transmission is dominant,” says Joseph Allen at Harvard’s T.H. Chan School of Public Health. Jose-Luis Jimenez, an atmospheric chemist at the University of Colorado, is quoted by Lewis as saying, “They don’t emphasize how important it is.” What the WHO needs to say is, “FACT: it goes through the air.”
In July, 239 scientists signed a letter that began:
We appeal to the medical community and to the relevant national and international bodies to recognize the potential for airborne spread of coronavirus disease 2019 (COVID-19). There is significant potential for inhalation exposure to viruses in microscopic respiratory droplets (microdroplets) at short to medium distances (up to several meters, or room scale), and we are advocating for the use of preventive measures to mitigate this route of airborne transmission.
Then in October, the Lancet, another venerable British scientific publication, reported that “growing evidence has highlighted that infective microdroplets are small enough to remain suspended in the air and expose individuals at distances beyond 2 m from an infected person. This knowledge is also corroborated by investigation of spread of cases between people who were not in direct or indirect contact, suggesting that airborne transmission was the most likely route.” Bigger droplets fall to the ground, where they are harmless, but tiny ones hang around.
Still, mitigation of interior spread has been sluggish, and governments slow to respond. As we noted in Issue No. 1 of this newsletter, in a remarkable letter on Feb. 16, a group of 13 U.S. health experts, including such members of President Biden’s own COVID task force as Rick Bright, the former director of the Biomedical Advanced Research and Development Authority, and Michael Osterholm, a highly regarded epidemiologist at the University of Minnesota, called for immediate action to “limit airborne transmission of the virus in high-risk settings like meatpacking plants and prisons.”
Still, these warnings are not being taken seriously enough. Jimenez, quoted in the Nature piece, points out that governments and businesses are spending vast sums on surface disinfection even though contaminated surfaces are rarely the source of transmission. “By contrast,” writes Lewis, “few countries have invested in measures to improve indoor air quality.”
How to Improve Air Quality
Then there’s the question of how to stop indoor spread. Lewis’s article makes clear that simple ventilation – which exchanges indoor for outdoor air – is not enough. Christian Kahler, a physicist who studies aerosols at the University of the Federal Armed Forces in Munich, says that few HVAC systems are powerful enough to use 100% outside air: “Most office spaces and classrooms around the world are supplied with just 20% outside air, with the remainder recirculated.”
A big problem is that increasing the exchange of air consumes a lot of energy – as does the addition of filters on HVAC systems. Lewis quotes Li as saying, “The environmental cost of increased ventilation should give people pause.” Cranking up ventilation also makes rooms drafty and noisy.
One answer, says Kahler, is “mobile air purifiers that filter out viruses and other airborne contaminants.” These units “could be readily deployed as part of the solution…and would be more energy-efficient than using extra heating or cooling on outside air,” Lewis writes. One scientist noted that air purifiers, “in some scenarios, outperformed the ventilation for removing aerosols.”
In fact, some mobile units not merely remove viral aerosols through filters – a slow and often ineffective process – they actually neutralize pathogens. In the technology used by the firm ActivePure, for example, submicroscopic particles are unleashed that quickly latch onto pathogens like SARS-CoV-2 and inactivate them.
Long-Term Troubles Even for Patients With Mild COVID-19
We know that 80% of patients hospitalized with COVID-19 exhibit persistent symptoms long after coming down with the disease. Now, a research letter published by JAMA on April 7 reports the results of a study of long-term symptoms in a group with mild COIVD symptoms. The results are troublesome: “A considerable portion of low-risk individuals with mild COVID-19 reported a diversity of long-term symptoms, and these symptoms disrupted work, social, and home life.”
Sebastian Haverall of the Karolinska Institute in Stockholm and two other Swedish researchers examined 323 seropositive (that is, tested positive for the SARS-CoV-2 virus) health care professionals with zero or mild previous COVID symptoms and 1,074 seronegative participants as a control. Some 26% of the seropositive subjects reported at least one moderate to severe symptom lasting for at least two months, compared with just 9% of the seronegative subjects. And 8% of the seropositive participants had a symptom lasting at least eight months, compared with 4% of the seronegative participants.
“Of the seropositive participants, 15% reported their long-term symptoms moderately to markedly disrupted their work life, compared with 6% of the control group. The most common symptoms were fatigue, shortness of breath, and loss of the senses of smell and taste. Those in the study were relatively young: a median age of 43.
From Sea Spray to COVID Aerosols
A recent article in EOS, a publication of the American Geophysical Union, highlighted the work of Kimberly Prather, a professor at the Scripps Institution of Oceanography in San Diego. “Prather usually spends her days looking at pollution in the ocean and its effects on human health,” writes Jenessa Duncombe. “But since the outbreak of the coronavirus, Prather has dedicated herself to understanding the airborne spread of the virus.”
Prather and 11 scientific colleagues have put together an exhaustive FAQ on “Protecting Yourself from COVID-19 Aerosol Transmission.” The 62-page document covers subjects like outdoor vs. indoor, spread by singing and musical instruments, and the effectiveness of ventilation, filters, portable air cleaners, and ultraviolet light. “I’ve gotten a ridiculous number of thank-you letters from all over the world saying how many lives I’ve saved,” Prather is quoted as saying. “That’s nice, but I want this thing to end.”
Prather was one of the 13 scientists who sent the Feb. 16 letter to CDC Director Rochelle Walensky, NIH’s Tony Fauci, and Jeffrey Zients, the White House Coronavirus Response Coordinator.
“We were all baffled that [public health agencies] didn’t take aerosol transmission as being more serious to begin with,” said Jorgen Jensen of the National Center for Atmospheric Research, quoted in the EOS article. “There were people who were hammering that, and they were not being heard for many, many months, and my feeling is that was a tragedy.”
Two Leading Infectious Disease Scientists Join Firms Fighting COVID
Further evidence of the importance of fighting SARS-CoV-2 indoors came last week with the announcement that Robert Redfield, the former director of the CDC, would be advising a Kentucky-based company called Big Ass Fans, known for its large ceiling fans. Big Ass sells a “smart fan” for $1,750 that uses UV light against pathogens.
In March, ActivePure Technology of Dallas, whose Medical Guardian device has been cleared by the FDA, announced that Deborah Birx, former director of the coronavirus response under President Trump and for seven years Global AIDS Coordinator at the State Department, had joined the company as Chief Medical and Scientific Advisor. Dr. Birx was in charge of PEPFAR, the largest single program by any nation in history to battle a single disease globally. PEPFAR has save more than 18 million lives.
In December, the University of Texas Medical Branch confirmed that the technology inside the ActivePure’s devices neutralizes over 99.9% of airborne SARS-CoV-2 within three minutes.
Both Dr. Redfield and Dr. Birx are physicians and former Army officers whose clinical research at the Walter Reed Army Medical Center, NIH, and elsewhere focused on the most virulent infectious disease of the time, HIV/AIDS. Now, they are turning their attention to novel solutions to COVID-19, which has already claimed 2,966,000 deaths worldwide.
COVID Solutions Bulletin
Our mission is to educate people on innovative solutions to the COVID-19 crisis in America. We need to get back to work, to school, to play – to enjoying life. We can’t get there without thwarting the current pandemic and preparing for the possibility of other pathogens to come.
COVID Solutions Bulletin is a publication providing regular updates on new and existing technologies that can help stop the spread of COVID-19, and help clear the air to open America back up.