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Brittany's avatar

Your work has been invaluable to me and my team at the local public health level. I have referred to your articles and references 100x more than I have referred to the CDC when trying to make decisions and explain things to others. However, the lack of information on aerosols and ventilation from the CDC and WHO has done great harm to us at the local level, when we know and understand these things, but cannot put it into practice because we don't have the backing of the CDC and are required to follow and implement their guidelines and practices. We have not been able to compel quarantine or testing for people who have not been within 6 feet of a case for more than 15 minutes, even if they were 7 feet apart for 2 hours in a poorly ventilated space. We have gotten sued several different times, and doing anything that strays from what CDC says puts us in a precarious and vulnerable position. We have tried to implement some form of backwards contact tracing with absolutely no assistance or learning community opportunities from the CDC or our state health department but instead have had to reach out to other public health workers and academics we've found via Twitter or other random forums. We had to cobble together information from lots of different sources to come up with various metrics and thresholds for reopening (and reclosing) businesses and activities in our county since CDC and our state health department have been slow to respond and make changes based on the latest findings and have had a considerable lack of bold stances and forceful recommendations and requirements. With all of this conflicting information floating around everywhere we have lost the trust of some in our community and get taken less seriously. I had hoped that the Biden administration would improve the situation at CDC, and perhaps it has, but the "recommendations" they put out continue to be confusing, somewhat outdated, and not very helpful to us at a local level when we have to move much more quickly than the pace that they release information. I hope there is some intense and thoughtful after action review at all levels to prevent this mess from happening again (I know we have been engaging in after action review for a while now already). And I hope we actually fund public health infrastructure, data systems, technology, and staff to the appropriate level, but that's probably wishful thinking.

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David Zager's avatar

The metaepistemological "tell" to the article is "Why did it take so long to accept that SARS-CoV-2 was being transmitted through aerosols, respiratory particles that are small enough to remain suspended in the air, rather than through short-range respiratory droplets that could not travel more than a few feet because of their (bigger) size?" And it leaves me scratching my head.

I'm just a lay person when it comes to things medical, and I rely on those with training and insider knowledge to keep me informed.

I was out for a beer with a radiologist friend when it first became clear that the virus had reached the States. He told me I should stop at the hardware store on my way home to pick up an N95 or KN95 mask, which would be in the painting section, because there would soon be a run on them and they'd be scarce commodities. Given the known patterns of infection from the cruise ships and from other sources, it was clear to him that aerosols were involved, and that only an N95 mask would be protective against them.

My thought at the time was that this was overkill. There were no other recommendations to get masks from any public health authorities, let alone N95 masks (a term that was new to me). And the stories that were coming out from people who had had Covid-19 were that it was like a bad flu, and would affect most people who were infected with little consequence.

Clearly the possibility of aerosol delivery of the infection was not a secret, or the dream child of a radiologist with a glass of beer. Equally clearly, rather than trusting my friend, I was swayed by the lack of corresponding recommendations from authorities. But what's not clear to me is why, if it was obvious to a radiologist, aerosols were not the first line of inquiry among public health researchers. He cannot have been the only one who recognized that aerosols were the main risk. Why was the opinion you've ascribed to Dr Chapin so much more compelling? And why did "measurements concerned with the size of infectious particles and where they could reach in the respiratory tract got conflated with size at which the particle could float." There's a disconnect here that's correctly fodder for the sociology of science, but to a lay person is just bizarre.

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