Justin Ling: Vaccines, masks and ventilation systems are all working. So why should the government continue to double down on measures that cannot effectively stop COVID?
On April 29, 2020, a grocery store worker is cleaning up the work space and plexiglass partitions in downtown Vancouver (Jonathan Hayward/CP)
When a burst of guilt hits, you open the door and prepare to go out, as if leaving the house itself is an illegal act.
You go to the grocery store: an employee wearing a face mask points to a can of hand sanitizer, while another employee at the cash register wipes the conveyor belt frantically. You grab the shopping cart that is sticky with the disinfectant and walk along the peeling arrow sticking to the floor.
Later, you go to the gym: half of the machines are still unavailable, and they are covered with signs that read: closed to achieve social distancing. Similar signs are hung on the drinking fountains, as are half of the lockers in the locker room. The hair dryer is gone, ostensibly for the same reason.
You take the bus to meet some friends for lunch: you choose a rare seat that does not cover the social distance with duct tape. You sit at a table, staring through the plexiglass barrier that surrounds you, waiting for your friend to walk in. In the corner, a karaoke machine appeared to be covered with spider webs, which is a memory of a bygone era. Here comes your favorite song: this is your song. The beat moves you, you stand up and start moving your hips. A kind manager walks straight to your seat and puts his hand on your shoulder forcefully, forcing you to return to the seat. No dancing.
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Your doctor still does not see the patient in person. You need to make a reservation to renew your passport. Every time you touch a pen at the bank, the cashier will throw it in the nearest trash can. Leaving this country may mean no less than three nasal swabs: a test that makes you poor for $200. Your hands have been dry and cracked for a year and a half.
Some or all of them may sound very familiar. Daily life in the latter part of the pandemic consists of a series of rituals that were once comforting, but now it feels very memorable—perhaps utterly absurd.
It has been a long time since our government and public health officials have started to get out of this epidemic by providing the public with policies and advice that actually follow science instead of relying on superstition.
It took some time, but we now know — and have known it for a while, very sure — that COVID-19 is mainly spread through aerosol particles.
Of course, we initially thought that the virus was mainly spread by droplets, if not all. We are told that the main risk comes from catching these droplets in our mouths or noses, or spreading them through contaminants: touching the same surface with the patient and transferring the droplets to our respiratory system. The initial belief was well-intentioned, but it was wrong. Numerous studies have shown that surface transmission is somewhere between unlikely and almost impossible. A recent study of hamsters found that the transmission of COVID-19 through contact with surfaces is much less infectious and less serious. In August last year, microbiologist Emanuel Goldman reviewed the existing literature and concluded: “The chance of transmission through inanimate surfaces is very small, and only when an infected person coughs or sneezes. When other people touch the surface shortly after coughing or sneezing."
Fixing this error means that we can stop sanitizing our groceries and wiping letters-anyway, most of us do.
We actually know why we made such a mistake: it involves a half-century-old mathematical error that tells epidemiologists that COVID-19 is too big to float in the air. Correcting this error means realizing that virus particles will not fall immediately after leaving our mouth or nose, but they can actually float and spread some distance.
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Some governments and public health professionals in Canada are reluctant to admit that this is a reality, as I wrote with some frustration in April last year. Since then, the situation has only improved slightly. The Public Health Agency of Canada now recognizes that COVID-19 is spread "through respiratory droplets and aerosols" and recommends good ventilation in the indoor environment. However, at the same time, the agency stated that the virus can also be spread by "touching something with the virus and then touching your mouth, nose or eyes with unwashed hands."
There is overwhelming evidence that airborne transmission is the main cause of the COVID-19 outbreak. We still don’t know how often people get sick from touching their eyes: what we do know is that the probability of contact with the eyes is orders of magnitude lower than the probability of infection through the air. Placing the two interpretations side by side would produce a completely wrong view that they are equally likely.
But a closer look at the recommendations of the Public Health Agency of Canada for Canadians to defeat the virus, this is completely out of reality.
The guide recommends that “high-touch surfaces and objects such as toilets, bedside tables, light switches, door handles, and children’s toys (to physically remove dirt) should be cleaned first, and then disinfected frequently.” This uses you as effectively as nailing a horseshoe to a door frame time.
The proposal also sparked fears about public buses and subways, warning that “certain populations are more likely to rely on public transport and therefore may increase the risk of exposure to public transport.”
No country has established any significant link between public transportation and the spread of COVID-19. France carefully tracked the epidemic and never found any connection with its beloved transportation system. A meta-analysis of existing studies by the Ontario Ministry of Public Health found that a small number of studies (mainly from the early stages of the pandemic) did not find clear evidence that public transportation is responsible for the significant spread of COVID-19. A particularly interesting case is that in Zhejiang Province, China, one-third of the passengers on a bus tested positive for COVID-19-but being closer to those who might be responsible for the outbreak only corresponds to those who were infected with the virus. The risk is slightly higher. This means that the culprit may be the recirculated air on the bus, not because it is not getting enough washing.
Recently, the Department of Public Health issued a guideline on indoor filtration. It is essential that it includes recommendations for HEPA filters-simple and inexpensive filters that can be deployed in large buildings or in your home. We Know that it can actually capture COVID-19 particles in the air. But confusion remains: Should Canadians infer that air filtration is more important or less important than scrubbing a child's teddy bear with bleach?
Recently, I was discussing COVID-19 documents with someone in the government. Why not give up all the nonsense about surface transmission? I asked. They sighed and explained the attitude within the government: taking tougher measures against the reality of airborne transmission means acknowledging that constant reminders to wash hands and touch faces—although relatively good advice is provided during normal flu seasons—but to fight back This epidemic is ineffective. People will feel cheated. Trust will plummet.
Government regulation and funding continue to disproportionately support these unscientific pandemic solutions.
When I asked the Canadian government how much support was allocated to actually fund good ventilation, the Canadian Ministry of Infrastructure pointed out the $150 million in funding announced in April to install new ventilation systems in hospitals, schools, public buildings, and aboriginal communities. . That's very good! But the Canadian government spends more than twice as much on hand sanitizer. CBC found that Ottawa spent nearly $1 billion a day throughout the pandemic. More than a year ago, governments at all levels should give priority to improving airflow and improving filtration. they do not.
The huge expenditure on personal protective equipment reached about 6 billion U.S. dollars. Before, Canada was seriously lacking in the critical masks, protective clothing and other equipment needed by health care and frontline workers. However, since then, PPE requirements have remained basically unchanged-COVID-19 patients in hospitals are still in droplet isolation, which means that patients and medical staff usually need to wear protective clothing, gloves, masks and face shields. The absolute cost of constantly replacing PPE is staggering. Even if money is not an object, money is not infinite. It is important to prioritize the whereabouts of these dollars, especially two years after the crisis.
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Let's talk about the massive plexiglass barriers lined up in bars, restaurants and shops: they are a monument to the idea that the spread of tiny virus droplets and pollutants is the cause of the pandemic. The government requires them to be installed in spaces where people cannot be separated by two meters. In reality, however, this outdated way of thinking may make things worse.
In a study in the United Kingdom, researchers simulated what role these barriers actually play: They found that when two people are facing each other, the screen can block larger droplets-we don’t necessarily need to model to figure this out. . But, more importantly, they found that these screens and barriers may “increase the risk of aerosol transmission by blocking/changing the airflow pattern or forming a poorly ventilated area behind the screen.” In other words: we are spreading droplets again The risk of aerosol transmission is higher than that of aerosol transmission.
Then there is constant cleaning and hand disinfection. I feel that every surface in the world, from our hands to countertops, rental car steering wheels and door handles, is constantly being disinfected.
This comes at a price. Leaving aside the environmental impact of all these clean wastes, we are actually destroying public infrastructure.
In Toronto, TTC spent an additional US$12 million on cleaning in 2020 and requested an additional US$15 million in 2021. But that's not all: "The corrosive nature of approved products has caused corrosion and damage to vehicle surfaces and equipment," TTC's chief vehicle officer wrote in September. The constant cleaning and disinfection of buses also imposes huge costs and delays on commuters in Toronto: this in turn will exacerbate congestion.
Throughout the pandemic, the incompetence of many of our provincial governments has led to double compliance with these regulations as the situation worsens. When the decisions of François Legault, Jason Kenney or Doug Ford led to a surge in cases, they yelled at us about hand washing and shutting down services. These services are never particularly dangerous—the apparent action always outweighs the action of efficacy. . As I wrote last month, this should make us very angry.
But it doesn't have to be this way.
We are not in the midst of the worst epidemic in a century because people are sneezing. We came here because the whole room is full of people who might get sick: the terrible super-spreader incident. When the prevalence of the virus in the air increases to the point where just breathing is risky, a large-scale infection will occur. We know that the solution to this problem is to exchange and (ideally) filter the air. Wearing a mask seems to reduce the amount of virus particles we inhale and exhale, and is a good mitigation measure.
A study of American schools published in the journal Science found that mandatory wearing of masks is the most effective strategy to reduce the spread of COVID-19. Closing cafeterias, desk shields, closing playgrounds: these strategies correspond to higher case rates.
In July, researchers in New York published a study on communication in sports classes. "We report that when masks, social distancing, and HEPA ventilation are used in a high-intensity exercise environment, there is no known spread of the virus, and shouting/loud noises are related to the rapid spread of COVID-19."
Another study conducted in Brazil investigated people’s use of masks and social distancing and found that “adults who reported moderate or greater adherence to the distance recommendations reduced the chance of infection by one-half to two-thirds. , And those who reported using masks when they went out reduced their risk by 87%."
All three studies involved people who had not yet been vaccinated.
Mass vaccination and strictly restricting those who are fully vaccinated from entering a high-risk environment is obviously one of our most effective strategies. Even if the vaccinated person has a breakthrough case of COVID-19, the prevalence of the virus in their system may be very low, which means that the amount of virus particles they breathe into the air will be very low. This means that other people in the room who are also vaccinated are less likely to get sick-if they get sick, it will almost certainly be a milder case, which in turn will reduce the infectivity of their cases.
But even since the mass vaccination campaign, it is clear that we still need to retain some core strategies. On July 30, New Brunswick—one of the most vaccinated areas in the country—abandoned the requirement to wear masks indoors. From the beginning of August, the province's cases began to show an alarming increase. By the end of September, this was the most severe period of the pandemic in the province, with an increase of nearly 100 cases every day. Since August, 68 people have died and the situation is still deteriorating. (The vast majority of cases, serious illnesses and deaths are people who have not been vaccinated.)
In the next door, Nova Scotia, which is still masked, tiny signs of new cases appeared in the fall. Since August, only 7 people have died of COVID-19.
It is difficult to say with absolute certainty that masks—even ordinary cloth masks—are unique manufacturers in terms of new COVID-19 cases. State is a complex system, and separating variables is notoriously difficult. But convincing evidence definitely shows that there is a causal relationship between good indoor mask use and fewer cases.
Widely available rapid testing can further reduce the risk by catching outbreaks and breakthrough cases. However, good luck: quick tests in Canada are rare, and this is an indescribable idiot. In the United States, anyone can purchase two packs of valid and accurate COVID-19 tests for $20. In Canada, trying to track and detect quickly is like trapping a rare butterfly.
If we can persist in wearing masks, expand vaccination, deploy rapid testing and improve ventilation, the number of cases will continue to decline. Focusing on those core, effective strategies means that we can re-do some routine things: like dancing. For example, karaoke.
And, in the end, we won’t have to wear masks at all.
I asked Andrew Morris, a professor of medicine, an expert in antimicrobial management, and a member of the Ontario Science Table, about what works and what does not work.
Morris said, first of all, the promotion of vaccines needs to maintain "quantity." In addressing the transmission problem, he said the priorities are clear: shelter, ventilation and filtering, rapid testing, and better work and study flexibility, including sick pay.
Morris told me that it was time to "get rid of low-value things." This means that we need to "no longer emphasize cleanliness, physical barriers and hand hygiene." He pointed out that these things may be helpful, but they are nowhere near as effective as the clear strategies we know in science.
Some people, including those in public health posts across the country, will argue that out of caution, we must continue to wash our hands and set up plexiglass barriers.
But this is not science. Science requires us to test-and pursue effective methods, abandon ineffective methods. In fact, what the government of this country asks us to do is to have confidence in these strategies. If the number of cases rises, it is because we did not wash our hands. If the number of cases drops, it is because we wash our hands more often.
This is not science. It is not even an epidemic theater. It's superstition. It is not harmless.
"It diverts energy from other high-yield interventions," Morris said. It may also confuse something we have sorely lacked in the past two years: clear information delivery. Morris suggested that the public can be simple, such as "stay at home when you are sick and breathe clean air-if you can't, please wear a high-quality mask."
We are not so clear.
More importantly, we risk COVID-19 fatigue. Instead of focusing on effective strategies, and not giving up ineffective strategies, we just piled suggestions on the ceiling. Ordinary people no longer know what is effective and what is useless. Some still wear masks outside. Others are still pressure washing their groceries. Some people believe that face masks are more effective than masks. (they are not.)
We have had a truly miserable two years. But this is not in vain: we know what works. We know what is not. The more we can get rid of the latter and focus on the former, the sooner we can get rid of the rules of laissez-faire, stop applying irritating chemicals on our poor hands, and end the constant brain poking.