Coronavirus: How worried should we be?

(cont.)
“The first thing I say to people is that it’s not a different virus. All the things we have learned about this virus still apply,” said Dr. Ashish K. Jha, dean of the Brown University School of Public Health. “It’s not like this variant is somehow magically spreading through other means. Anything risky under the normal strain just becomes riskier with the variant.”

And let’s face it, after months of pandemic living, many of us have become lax about our Covid safety precautions. Maybe you’ve let down your guard, and you’re spending time indoors and unmasked with trusted friends. Or perhaps you’ve been dining in restaurants or making more trips to the grocery store each week than you did at the start of lockdowns. The arrival of the variant means you should try to cut back on potential exposures where you can and double down on basic precautions for the next few months until you and the people around you get vaccinated.

“The more I hear about the new variants, the more concerned I am,” said Linsey Marr, professor of civil and environmental engineering at Virginia Tech and one of the world’s leading aerosol scientists. “I think there is no room for error or sloppiness in following precautions, whereas before, we might have been able to get away with letting one slide.”

 

(cont)
Should I upgrade my mask?
You should be wearing a high-quality mask when you run errands, go shopping or find yourself in a situation where you’re spending time indoors with people who don’t live with you, Dr. Marr said. “I am now wearing my best mask when I go to the grocery store,” she said. “The last thing I want to do is get Covid-19 in the month before I get vaccinated.”

Dr. Marr’s lab recently tested 11 mask materials and found that the right cloth mask, properly fitted, does a good job of filtering viral particles of the size most likely to cause infection. The best mask has three layers — two cloth layers with a filter sandwiched in between. Masks should be fitted around the bridge of the nose and made of flexible material to reduce gaps. Head ties create a better fit than ear loops.

If you don’t want to buy a new mask, a simple solution is to wear an additional mask when you find yourself in closer proximity to strangers. I wear a single mask when I walk my dog or exercise outdoors. But if I’m going to a store, taking a taxi or getting in the subway, I double mask by using a disposable surgical mask and covering it with my cloth mask.

Do I need an N95 medical mask?
While medical workers who come into close contact with sick patients rely on the gold-standard N95 masks, you don’t need that level of protection if you’re avoiding group gatherings, limiting shopping trips and keeping your distance from others.

“N95s are hard to get,” said Dr. Jha. “I don’t think people should think that’s what they need. Certainly there are a lot of masks out in the marketplace that are pretty good.”

If you’re working in an office or grocery store, or find yourself in a situation where you want added mask protection, you can get an alternative to the N95. Dr. Jha suggested using a KF94 mask, a type of mask made in South Korea that can be purchased easily online. It resembles an N95, with some differences. It’s made of a similar nonwoven material that blocks 94 percent of the hardest-to-trap viral particles. But the KF94 has ear loops, instead of elastic head bands, so it won’t fit as snugly as an N95.

The KF94 is also disposable — you can buy a pack of 20 for about $40 on Amazon. While you can let a KF94 mask air dry and reuse it a few times, it can’t be laundered and won’t last as long as a cloth mask. One solution is to save your KF94 mask for higher-risk situations — like riding a subway, spending time in a store or going to a doctor’s appointment. Use your cloth mask for outdoor errands, exercise or walking the dog.
Are there additional ways to reduce my risk?
Getting the vaccine is the ultimate way to reduce risk. But until then, take a look at your activities and try reducing the time and number of exposures to other people.

 

(cont.)
For instance, if you now go to the store two or three times a week, cut back to just once a week. If you’ve been spending 30 to 45 minutes in the grocery store, cut your time down to 15 or 20 minutes. If the store is crowded, come back later. If you’re waiting in line, be mindful of staying at least six feet apart from the people ahead of you and behind you. Try delivery or curbside pickup, if that’s an option for you.

If you’ve been spending time indoors with other people who aren’t from your household, consider skipping those events until you and your friends get vaccinated. If you must spend time with others, wear your best mask, make sure the space is well ventilated (open windows and doors) and keep the visit as short as possible. It’s still safest to take your social plans outdoors. And if you are thinking about air travel, it’s a good idea to reschedule given the high number of cases around the country and the emergence of the more contagious variant.

“The new variants are making me think twice about my plan to teach in-person, which would have been with masks and with good ventilation anyway,” Dr. Marr said. “They’re making me think twice about getting on an airplane.”

Will the current Covid vaccines work against the new variants?
Experts are cautiously optimistic that the current generation of vaccines will be mostly effective against the emerging coronavirus variants. Earlier this month, Pfizer and BioNTech announced that their Covid vaccine works against one of the key mutations present in some of the variants. That’s good news, but some data also suggest that variants with certain mutations, particularly the one first seen in South Africa, may be more resistant to the vaccines. While the data are concerning, experts said the current vaccines generate extremely high levels of antibodies, and they are likely to at least prevent serious illness in people who are immunized and get infected.

“The reason why I’m cautiously optimistic is that from what we know about how vaccines work, it’s not just one antibody that provides all the protection,” said Dr. Adam Lauring, associate professor of infectious disease at the University of Michigan. “When you get vaccinated you generate antibodies all over the spike protein. That makes it less likely that one mutation here or there is going to leave you completely unprotected. That’s what gives me reason for optimism that this is going to be OK in terms of the vaccine, but there’s more work to be done.”

If I catch Covid-19, will I know if I have the new variant?
Probably not. If you test positive for the coronavirus, the standard PCR test can’t definitively determine if you have the variant or the original strain. While some PCR test results can signal if a person is likely to be infected with a variant, that information probably won’t be shared with patients. The only way to know for sure which variant is circulating is to use gene sequencing technology, but that technology is not used to alert individuals of their status. While some public health and university laboratories are using genomic surveillance to track the prevalence of variants in a community, the United States doesn’t yet have a large-scale, nationwide system for checking coronavirus genomes for new mutations.

 

(cont)
Treatment for Covid-19 is the same whether you have the original strain or the variant. You can read more about what to do if you get infected here.

Are children more at risk from the new variant?
Children appear to get infected with the variant at about the same rate as the original strain. A large study by health officials in Britain found that young children are only about half as likely as adults to transmit the variant to others. While that’s good news, the highly contagious nature of the variant means more children will get the virus, even if they are still proportionately less contagious and less prone to getting infected than adults. You can learn more here.

If I’ve already had Covid-19, am I likely to have the same level of immunity to the new strain?
Most experts agree that once you’ve had Covid-19, your body has some level of natural immunity to help fight off a second infection — although it’s not known how long the protection lasts. The variants circulating in Brazil and South Africa appear to have mutations that allow the virus to evade natural antibodies and reinfect someone who has already had the virus. The concern is based on lab tests using antibodies of people with a previous infection, so whether that translates to more reinfections in the real world isn’t known. The effect of the vaccine against these variants isn’t known yet either. While all of this sounds frightening, scientists are hopeful that even if the vaccines don’t fully protect against new variations of the virus, the antibodies generated by the vaccine still will protect people from more serious illness.

Well, The Times’s award-winning consumer health site. She won an Emmy in 2013 for the video series “Life, Interrupted” and is the author of “For Better: The Science of a Good Marriage.” @taraparkerpope

A version of this article appears in print on Jan. 24, 2021, Section D, Page 8 of the New York edition with the headline: Adapt to Variants Of the Coronavirus.
:- https://www.nytimes.com/2021/01/19/well/live/covid-b117-variant-advice.html?utm_source=pocket-newtab

 

Here Are the Side Effects to Expect from Your COVID Vaccine (and How to Deal With Them)

Elizabeth Yuko
4/02/21 4:45PM
You’ve probably heard about the COVID vaccines’ side effects, and by now are well aware that there is no “standard” reaction to the shots—everyone handles them differently. Still, it’s better to go into your appointment(s) armed with as much knowledge as possible—especially if it means preventing or reducing unpleasant side effects. Here’s what to know about dealing with the COVID-19 vaccines’ side effects both before and after your shot.
How common are COVID-19 vaccine side effects?
Before we go any further, we should note that experiencing side effects isn’t specific to the COVID vaccine: They can occur after a flu shot or other vaccination, and are a sign that your body is responding to the vaccine. Specifically, in the case of the COVID vaccine, that “your immune system is instructing your body to react in certain ways: it increases blood flow so more immune cells can circulate, and it raises your body temperature in order to kill the virus,” the World Health Organization (WHO) explains.

So, when someone experiences mild-to-moderate side effects following the COVID vaccine, it’s not uncommon for their doctors or family members to reassure them that not only is this normal, it’s also a good thing. It doesn’t mean that the vaccine is dangerous—it means that it’s doing its job.
But does that mean people who don’t experience side effects should be worried that their shot didn’t take? Well, no. “Experiencing no side effects doesn’t mean the vaccine is ineffective,” the WHO explains. “It means everybody responds differently.” It also means that as great as it would be to be able to prevent or control our COVID vaccine side effects, our body’s going to do its thing.

There are, however, ways to reduce the discomfort of the side effects (which we’ll get to in a minute), but Dr. Joel Kammeyer, an infectious disease specialist and assistant professor at The University of Toledo College of Medicine and Life Sciences, wants us to put things in perspective when we think about our chances of experiencing some type of post-vaccination pain or discomfort.

“We should recognize that more than 80% of study participants experienced side effects in the vaccine trials, most of which were fatigue and injection site reactions,” he tells Lifehacker. “Side effects are the norm—not the exception.”

 

(cont.)
What are the potential side effects of the COVID-19 vaccine?
According to the CDC, the most commonly reported side effects from the COVID-19 vaccines resolve after a few days, and include:

• Swelling, redness and pain at injection site
• Fever
• Headache
• Tiredness
• Muscle pain
• Chills
• Nausea

Though extremely rare, some people do have a severe allergic reaction—also known as anaphylaxis—to the COVID vaccine. If this appears to be the case, call 911 and seek immediate medical attention.

Preparing for the vaccine
The only thing vaccinated people enjoy more than recounting their inoculation experience—including any side effects—is giving yet-to-be vaccinated folks advice on preventing or dealing with side effects. But with so many pointers floating around, how do you know which to listen to and which to ignore?

Yes, the Centers for Disease Control and Prevention (CDC) does have some guidance on this—some being the operative word—leaving lingering questions what we actually can control in terms of COVID vaccine side effects. Here’s what we know so far, courtesy of the CDC and two infectious disease specialists.

Is it OK to take pain relievers before your appointment?
One thing the CDC is clear about is that we should avoid over-the-counter medicines—like ibuprofen, aspirin, acetaminophen, and antihistamines—before getting vaccinated for the purpose of trying to prevent vaccine-related side effects, including allergic reactions. The reasoning is that at this point, we’re still not sure how these medications might affect the vaccine’s effectiveness. Check with your doctor if you take any of these medicines as part of a regimen.

Does being super-hydrated prevent side effects?
As humans, we can feel helpless pretty easily—especially in health-related situations. So when in doubt, we start doling out advice to ourselves or others, which typically includes a recommendation to stay hydrated. Our quest for ways to prevent side effects from the COVID-19 vaccine is no exception.

In fact, the EMT who gave me my second dose of the vaccine instructed me to drink as much water as I possibly can “without being uncomfortable” to reduce the severity of any side effects. While it makes sense being dehydrated while experiencing side effects might make someone feel worse, is pumping ourselves with water before and after our vaccine going to provide us with some type of liquid protection shield? Kammeyer is not convinced.
“Staying well-hydrated is a good idea in general, but this is unlikely to prevent side effects,” he says. “Maintaining hydration certainly doesn’t hurt anything, but I would have no expectation that side effects could be prevented or limited by staying hydrated.”

The CDC does mention that having a beverage or snack may help prevent fainting after receiving a vaccine, but again we’re talking about a normal level of hydration (so no need to go overboard).
Is there an ideal time to schedule your appointment?
Most of the country isn’t yet in a place where we can schedule COVID vaccines like any other medical appointment, choosing a time and day that works best for us. Anyone who has ever gone through the online booking process knows how quickly those appointments go, and how little choice you usually have in their timing.

But let’s say you did have the option. Is there a certain time of day when people experience fewer side effects from the vaccine? Dr. Keith Armitage, an infectious disease specialist at University Hospitals in Cleveland, where he is also the medical director of the Roe Green Center for Travel Medicine & Global Health, says that he’s “not aware of any time of day that would be advantageous.”

Similarly, Kammeyer says that “nothing would be gained” by scheduling your vaccine appointment at a certain time of day in an attempt to prepare for or lessen the side effects. “We know from the original clinical trials for the vaccines that many side effects occur within 24 hours, but others may not occur for as long as a week,” he explains.

Having said that, if you’re concerned that you’ll feel fatigued after the dose, you could always schedule the shot for the end of the day, so you won’t have to worry about having to go back to work. And speaking of which...

Should you arrange to take a sick day the day after your appointment(s)?
Recognizing that not everyone has the privilege of being able to take a paid sick day to deal with potential side effects from a vaccine (or, ever), is doing so a good idea for those with that option?

According to Armitage, a significant number of people don’t feel like working after their second dose of either the Pfizer or Moderna vaccine. In fact, he says that it’s common for those in the medical profession to schedule their vaccine before a day off. “About one-third of people get a fever, and maybe half of those do not feel like working, so it is reasonable to plan [to take a sick day],” Armitage explains.
Dealing with side effects after getting vaccinated
So that’s what we can (and can’t) do to prevent side effects from the COVID-19 vaccine. But what about if you’re part of the 80% of people who are experiencing some type of pain or discomfort? Here’s how to handle some of the most frequently reported.

Arm pain and soreness
As one of the most common side effects of the COVID-19 vaccine, you may be wondering what you can do to help reduce pain or soreness in the arm that received the shot. The CDC recommends two things:

1. Applying a clean, cool, wet washcloth over the area
2. Using or exercising your arm

But what about massaging your arm at the injection site? This has been suggested as a way to deal with pain from other types of vaccines, but could it help with this one? Here’s Kammeyer’s take:

There are no official recommendations regarding massaging the injection site to reduce arm pain. This was not studied in the vaccine trials, but it is very unlikely that massaging the injection site would make a difference to the efficacy of the vaccine. Moving the arm frequently after receiving the injection may be more helpful than massage, but massage is unlikely to cause harm. If it helps, I would not object.

Fever
If you end up with a fever after your COVID vaccine, the CDC recommends drinking plenty of fluids, and “dress[ing] lightly.” So does that mean being exceptionally hydrated before your vaccine could have prevented this side effect?

Armitage doesn’t think so, noting that it’s just standard when treating fever. “Anytime you have an illness with any kind of fever, it is good to stay hydrated, because fever can increase your loss of fluids,” he explains. “I cannot think of any other reason why fluids would help [as a way to prevent vaccine side effects.]”

Fatigue
There’s a lot going on in your body post-vaccination, so it’s not surprising that fatigue is another common side effect. But is it better to listen to your body and sleep when you want to, or get through the rest of the day and stick to your usual sleep schedule? That’s up to you.

“The fatigue will come and go regardless,” Kammeyer explains. “The proper recommendation here would be individual-dependent. Naps are certainly fine, and pushing through and maintaining a typical sleep routine is also fine—whatever works for the individual. In a few days, the fatigue will be gone regardless of what you do.”

But what about the conventional wisdom that resting when we’re not feeling well is necessary in order to give your body the chance to heal? Does that mean that if someone is feeling fatigued after their vaccine and they don’t rest when they’re tired, it could make the vaccine less effective?

Nope. According to Armitage, continuing about your day without a nap will not decrease vaccine responsiveness, or pose a threat to a person’s overall health. “There is no harm in pushing through, if that is what people want to do,” he explains. “There is no long-term downside—although people may feel more tired in the short-term.”

Lumps
While we’re on the subject of side effects, this seems like a good time to mention that if you develop a new lump or tenderness under your arm, near your armpit, or on your neck after receiving the COVID vaccine, there’s no need to panic. It’s probably a swollen lymph node, and another way for our bodies to let us know that it’s getting ready to fight off what it perceives as SARS-CoV-2.

The CDC reports that 11.6% of vaccine recipients experienced swollen lymph nodes after their first COVID vaccine dose, and 16% after their second, noting that in most cases, swelling appeared between two and four days after vaccination. Physicians have observed that the lumps form on the same side of the body where a person received their shot.

“It’s a normal occurrence while your body is building an immune response to fight the virus,” Dr. Holly Marshall, division chief of Breast Imaging at University Hospital Cleveland Medical Center explains in a statement. “The swelling may be a sign that the body is making antibodies in response to the vaccine as intended.”

 

(cont.)
Is it safe to take pain relievers, and if so, what kind?
Yes, it’s safe to take pain relievers to deal with arm pain, fever, muscle aches and other side effects—but there’s some nuance. According to the CDC, it’s fine to take over-the-counter medicines—like ibuprofen, acetaminophen, aspirin, or antihistamines—to help manage side effects, provided “you have no other medical reasons that prevent you from taking these medications normally.” That same paragraph also includes the usual “talk to your doctor” language regarding taking any of the OTC medicines for vaccine side effects, which is a good idea if you have any questions.

While the CDC gives the green light to take ibuprofen (e.g. Advil or Motrin), acetaminophen (e.g. Tylenol), or aspirin (e.g. Bayer) for vaccine side effects, many people have been instructed by their doctors—or the person administering their vaccine—to stick with Tylenol.

You may have also seen headlines over the past few months indicating that taking non-steroidal anti-inflammatory drugs (NSAIDs) after receiving the vaccine could dampen the response of a person’s immune system. (Both ibuprofen and aspirin are NSAIDs.) So does that mean no Advil, after all?

Most of those news stories were reporting on a recent study published in the Journal of Virology that found that using NSAIDs to treat COVID-19 may dampen the inflammatory response and production of protective antibodies in mice. Though the authors note that more research needs to be done in order to determine whether the same response could occur in humans, their findings “raise the possibility that NSAIDs may alter the immune response to SARS-CoV-2 vaccination.” But again: this is early research just done in mice so far.

 

(cont.)
According to Armitage, people who experience side effects following their second dose of one of the mRNA vaccines (i.e. Pfizer or Moderna) can safely take NSAIDs or acetaminophen.
---------------------------------------------------------------------------------------------
Dr. Elizabeth Yuko is a bioethicist and adjunct professor of ethics at Fordham University. She has written for The New York Times, The Washington Post, The Atlantic, Rolling Stone, CNN & Playboy.
:- https://vitals.lifehacker.com/here-are-the-side-effects-to-expect-from-your-covid-vac-1846602583

 

India Covid Cases Surpass 20 Million, Deaths Top 220,000 as Crisis Worsens

Bloomberg Quicktake: Now
May 4, 2021

 

India’s Epidemic of False COVID-19 Information
As patients and families frantically seek treatment, elected officials—and some physicians—have fuelled denialism and specious talk of miracle cures.
By Rahul Bhatia

May 10, 2021



On April 4th, three days after the commencement of the Kumbh Mela, during which millions of Hindu pilgrims converged in the town of Haridwar to bathe in the Ganges, servers at one of India’s most popular online health services registered an uptick in searches that displayed an alarming pattern. The site, myUpchar, is a destination for residents of India’s smaller cities and towns, where doctors and health-care providers have long been in short supply. Each day, more people arrived at the site with questions about COVID-19.

As the virus’s second wave washed over India, and hospital beds and oxygen grew scarce, visitors to the site frantically hunted for medicines rumored to treat the disease: Fabiflu, remdesivir, azithromycin, ivermectin, doxycycline. Then, on April 28th, those search terms were all overshadowed—by a factor of three—by queries for an obscure homeopathic nasal spray. The popularity of the treatment baffled Manuj Garg, the site’s co-founder, who had never heard of it. Then he saw a viral WhatsApp clip of a sickly old man lying on his side, his finger in an oximeter. A caregiver seated beside him made a specious claim: the nasal spray was a miracle cure that obviated the need for oxygen. “We gave him the spray five minutes ago. That’s how fast this is,” the person promised. “Anyone, anyone whose oxygen levels are falling, go and get this spray. You won’t need to run around for an oxygen cylinder.” When Garg looked up where the online queries were coming from, he saw that they spanned the country. “This is a sign of desperation,” Garg told me. “When there’s no information, bad information finds a way.”

Read The New Yorker’s complete news coverage and analysis of the coronavirus pandemic.
At the onset of the pandemic, Indians relied on briefings by the Ministry of Health and Family Welfare to make sense of where the virus was headed. But officials rarely gave reporters a chance to ask questions—or get meaningful answers. “The briefings weren’t designed to be useful,” Anoo Bhuyan, a health reporter at IndiaSpend, a data-journalism nonprofit, recalled. “It was theatre. It was frustrating.” Officials presented PowerPoint slides of self-serving government talking points, and tried to blame the outbreak on a gathering of Muslims in Delhi. “There was denialism, and a resistance to share information and be transparent,” Bhuyan said.

As the virus has spread, the chief minister of the state where the Kumbh Mela was held said that “Maa Ganga’s blessings are there in the flow. So, there should be no corona.” A legislator in another state claimed that the purifying properties of cow urine and dung would combat the virus. The chief minister of Uttar Pradesh, India’s most populous state, said that a fit mind and yoga were effective preventative measures. Harsh Vardhan, India’s health minister, attended the product launch of “the first evidence-based medicine for COVID-19,” which, according to the event’s organizers, had been sanctioned by the World Health Organization. (The W.H.O. immediately denied the claim.) And, in one of his monthly addresses to the nation, Prime Minister Narendra Modi played images from a viral video, in which a doctor suggested that a nebulizer was a viable alternative to an oxygen machine. After an outcry from medical experts, the government removed the images from its coronavirus materials.

As confusion spread, desperate patients began taking drugs of any kind. “Indians are self-prescribing steroids,” Sakshi Pandit, a molecular biologist, told me. Some physicians have peddled false elixirs as well. “Doctors seem to be prescribing everything under the sun,” Pandit said. “My dad was given azithromycin ‘just to be on the safe side.’ And don’t even get me started on plasma transfusions. People are taking cancer drugs. They’re running around taking antivirals and antibiotics right now. What if they stop being effective? I don’t know what’s happening. Nobody is being held accountable.”

Video From The New Yorker

What Artichokes Teach Us About the Pandemic

At first, as COVID-19 overwhelmed other nations, it seemed to miss India, giving rise to theories about the superior immunity of its citizens, the secret advantages of its climate, and the effectiveness of its leaders. In January, as daily cases remained low, Modi declared that India had “saved humanity from a big disaster by containing corona effectively.” Soon after, election officials announced that state-assembly elections would take place in March and April, including eight phases of voting in West Bengal—with an estimated population of a hundred million. (A judge later assailed the move, telling election-commission officials that they “should be put up on murder charges.”) Campaigning in the state proceeded. In April, as the second wave grew, Modi held a rally for his supporters and told them, “Today, I see people in every direction. It’s the first time I’ve seen such a crowd. You have shown such strength that wherever I look I can see people. You have done something wonderful.”

In a matter of weeks, the coronavirus has torn through the country’s social safety net. It has seemingly spread everywhere, to every family; the wealthy flew abroad, the rest of us hunkered down in fear. Each of the fourteen people I interviewed for this article knew someone who had been infected. I asked one source when a particular acquaintance had died. He replied with one date, then corrected himself: “Wait, last Saturday was another friend. She died the previous week.”

Twitter became a stream of S.O.S.s. Someone’s wife’s father needed plasma, someone needed oxygen, someone else medicines, another an ambulance. Hospital administrators tweeted appeals for oxygen. On the morning of April 29th, administrators at a children’s hospital in Delhi posted that the facility had less than twenty minutes’ worth of liquid oxygen left. Help arrived. Three days later, officials at the same hospital tweeted that their supply was again nearly exhausted. Twelve hours later, they announced that the hospital would no longer accept patients who required oxygen, “due to inconsistent liquid oxygen supply.” On April 28th, seven patients died when hospitals in Uttar Pradesh ran out of oxygen. Three days later, twelve patients died when a hospital in New Delhi did as well. Dr. Prashant Mishra, a senior administrator at a hospital in Lucknow, told me that doctors were rationing oxygen. “Now everybody wants oxygen. I’m working in the capital of a state and here we have managed those things, but in the interior there would have been an issue, because no one was prepared for such a massive outbreak,” he said. “We’re trying to manage the maximum patients with the available resources.” He told me that, on average, he received forty to fifty calls a night from COVID-19 patients or their families.

The coronavirus’s second wave in India has been accompanied by packed hospital wards, oxygen shortages, and viral videos of purported cures.Photograph by Parveen Kumar / Hindustan Times / Getty

 

(cont.)
News of one Gujarati family’s experience spread rapidly online, exacerbating fears of poor care and hidden COVID deaths. According to press reports, Rupal Thakkar, a forty-eight-year-old mother of a toddler, grew weak and her condition began to deteriorate. Days before, her husband had tested positive for the coronavirus. Her family began searching for hospital beds and found one in a private hospital. After she was admitted on April 16th, hospital officials told her family that Thakkar’s oxygen levels were dropping and that the family should move her to a facility with more resources. Several hours later, a doctor called to say that her heart had stopped. (A hospital spokesperson told a local news outlet that Thakkar “was admitted in the hospital within time and proper treatment was given to her by the medical team.”) The death certificate issued by the hospital listed “sudden cardiac death” as the cause. A document issued by a crematorium described her cause of death as an “attack.” After Indian newspapers began looking into Thakkar’s case, the hospital issued a new death certificate, which described COVID-19 as a contributing cause.

Across India, journalists have reported that COVID-19 deaths are being undercounted. Recently, in Gujarat, so many mourners crowded crematoriums that police threatened to beat them if they did not disperse. One reporter likened the Indian government’s response to that of Soviet officials during the Chernobyl disaster, calling it a “Soviet system where you hide one number, and then cover up another number to hide the first. And then you create policy based on the fake number.”

As India’s recorded death count surpasses the two-hundred-thousand mark, and its daily official case count rises above three hundred thousand, pressure on Modi is growing. Judges have ordered the government to insure that Delhi is supplied with the oxygen it needs. Longtime critics of Modi have called for the Prime Minister to resign or, at least, to answer growing questions about the oxygen shortages, a troubled immunization policy, and his role in encouraging superspreader events. In response, the Prime Minister’s aides assure citizens, on a regular basis, that he is personally looking into the “oxygen situation.” The country’s foreign minister, according to a local news report, urged Indian diplomats to counter a “one-sided narrative” being spread by international media about the country’s management of the pandemic. The Ministry of Information and Broadcasting hosted a workshop to help civil servants better convey “information that concerns the government’s efforts to manage and address the ongoing Covid pandemic.” Indians will have more information, just not the kind they need.
*Rahul Bhatia is a journalist based in Mumbai.
:- https://www.newyorker.com/news/disp...covid-19-information?utm_source=pocket-newtab

 

Megan Molteni

Backchannel
05.13.2021 06:00 AM
The 60-Year-Old Scientific Screwup That Helped Covid Kill
All pandemic long, scientists brawled over how the virus spreads. Droplets! No, aerosols! At the heart of the fight was a teensy error with huge consequences.
Early one morning, Linsey Marr tiptoed to her dining room table, slipped on a headset, and fired up Zoom. On her computer screen, dozens of familiar faces began to appear. She also saw a few people she didn’t know, including Maria Van Kerkhove, the World Health Organization’s technical lead for Covid-19, and other expert advisers to the WHO. It was just past 1 pm Geneva time on April 3, 2020, but in Blacksburg, Virginia, where Marr lives with her husband and two children, dawn was just beginning to break.

Marr is an aerosol scientist at Virginia Tech and one of the few in the world who also studies infectious diseases. To her, the new coronavirus looked as if it could hang in the air, infecting anyone who breathed in enough of it. For people indoors, that posed a considerable risk. But the WHO didn’t seem to have caught on. Just days before, the organization had tweeted “FACT: #COVID19 is NOT airborne.” That’s why Marr was skipping her usual morning workout to join 35 other aerosol scientists. They were trying to warn the WHO it was making a big mistake.

Over Zoom, they laid out the case. They ticked through a growing list of superspreading events in restaurants, call centers, cruise ships, and a choir rehearsal, instances where people got sick even when they were across the room from a contagious person. The incidents contradicted the WHO’s main safety guidelines of keeping 3 to 6 feet of distance between people and frequent handwashing. If SARS-CoV-2 traveled only in large droplets that immediately fell to the ground, as the WHO was saying, then wouldn’t the distancing and the handwashing have prevented such outbreaks? Infectious air was the more likely culprit, they argued. But the WHO’s experts appeared to be unmoved. If they were going to call Covid-19 airborne, they wanted more direct evidence—proof, which could take months to gather, that the virus was abundant in the air. Meanwhile, thousands of people were falling ill every day.

On the video call, tensions rose. At one point, Lidia Morawska, a revered atmospheric physicist who had arranged the meeting, tried to explain how far infectious particles of different sizes could potentially travel. One of the WHO experts abruptly cut her off, telling her she was wrong, Marr recalls. His rudeness shocked her. “You just don’t argue with Lidia about physics,” she says.

Morawska had spent more than two decades advising a different branch of the WHO on the impacts of air pollution. When it came to flecks of soot and ash belched out by smokestacks and tailpipes, the organization readily accepted the physics she was describing—that particles of many sizes can hang aloft, travel far, and be inhaled. Now, though, the WHO’s advisers seemed to be saying those same laws didn’t apply to virus-laced respiratory particles. To them, the word airborne only applied to particles smaller than 5 microns. Trapped in their group-specific jargon, the two camps on Zoom literally couldn’t understand one another.

When the call ended, Marr sat back heavily, feeling an old frustration coiling tighter in her body. She itched to go for a run, to pound it out footfall by footfall into the pavement. “It felt like they had already made up their minds and they were just entertaining us,” she recalls. Marr was no stranger to being ignored by members of the medical establishment. Often seen as an epistemic trespasser, she was used to persevering through skepticism and outright rejection. This time, however, so much more than her ego was at stake. The beginning of a global pandemic was a terrible time to get into a fight over words. But she had an inkling that the verbal sparring was a symptom of a bigger problem—that outdated science was underpinning public health policy. She had to get through to them. But first, she had to crack the mystery of why their communication was failing so badly.
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Marr spent the first many years of her career studying air pollution, just as Morawska had. But her priorities began to change in the late 2000s, when Marr sent her oldest child off to day care. That winter, she noticed how waves of runny noses, chest colds, and flu swept through the classrooms, despite the staff’s rigorous disinfection routines. “Could these common infections actually be in the air?” she wondered. Marr picked up a few introductory medical textbooks to satisfy her curiosity.

According to the medical canon, nearly all respiratory infections transmit through coughs or sneezes: Whenever a sick person hacks, bacteria and viruses spray out like bullets from a gun, quickly falling and sticking to any surface within a blast radius of 3 to 6 feet. If these droplets alight on a nose or mouth (or on a hand that then touches the face), they can cause an infection. Only a few diseases were thought to break this droplet rule. Measles and tuberculosis transmit a different way; they’re described as “airborne.” Those pathogens travel inside aerosols, microscopic particles that can stay suspended for hours and travel longer distances. They can spread when contagious people simply breathe.

The distinction between droplet and airborne transmission has enormous consequences. To combat droplets, a leading precaution is to wash hands frequently with soap and water. To fight infectious aerosols, the air itself is the enemy. In hospitals, that means expensive isolation wards and N95 masks for all medical staff.

The books Marr flipped through drew the line between droplets and aerosols at 5 microns. A micron is a unit of measurement equal to one-millionth of a meter. By this definition, any infectious particle smaller than 5 microns in diameter is an aerosol; anything bigger is a droplet. The more she looked, the more she found that number. The WHO and the US Centers for Disease Control and Prevention also listed 5 microns as the fulcrum on which the droplet-aerosol dichotomy toggled.
There was just one literally tiny problem: “The physics of it is all wrong,” Marr says. That much seemed obvious to her from everything she knew about how things move through air. Reality is far messier, with particles much larger than 5 microns staying afloat and behaving like aerosols, depending on heat, humidity, and airspeed. “I’d see the wrong number over and over again, and I just found that disturbing,” she says. The error meant that the medical community had a distorted picture of how people might get sick.


Linsey Marr stands in front of a smog chamber in her laboratory at Virginia Tech. For years, she says, the medical establishment treated her as an outsider.

Photograph: Matt Eich
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Epidemiologists have long observed that most respiratory bugs require close contact to spread. Yet in that small space, a lot can happen. A sick person might cough droplets onto your face, emit small aerosols that you inhale, or shake your hand, which you then use to rub your nose. Any one of those mechanisms might transmit the virus. “Technically, it’s very hard to separate them and see which one is causing the infection,” Marr says. For long-distance infections, only the smallest particles could be to blame. Up close, though, particles of all sizes were in play. Yet, for decades, droplets were seen as the main culprit.

Marr decided to collect some data of her own. Installing air samplers in places such as day cares and airplanes, she frequently found the flu virus where the textbooks said it shouldn’t be—hiding in the air, most often in particles small enough to stay aloft for hours. And there was enough of it to make people sick.

In 2011, this should have been major news. Instead, the major medical journals rejected her manuscript. Even as she ran new experiments that added evidence to the idea that influenza was infecting people via aerosols, only one niche publisher, The Journal of the Royal Society Interface, was consistently receptive to her work. In the siloed world of academia, aerosols had always been the domain of engineers and physicists, and pathogens purely a medical concern; Marr was one of the rare people who tried to straddle the divide. “I was definitely fringe,” she says.

Thinking it might help her overcome this resistance, she’d try from time to time to figure out where the flawed 5-micron figure had come from. But she always got stuck. The medical textbooks simply stated it as fact, without a citation, as if it were pulled from the air itself. Eventually she got tired of trying, her research and life moved on, and the 5-micron mystery faded into the background. Until, that is, December 2019, when a paper crossed her desk from the lab of Yuguo Li.

An indoor-air researcher at the University of Hong Kong, Li had made a name for himself during the first SARS outbreak, in 2003. His investigation of an outbreak at the Amoy Gardens apartment complex provided the strongest evidence that a coronavirus could be airborne. But in the intervening decades, he’d also struggled to convince the public health community that their risk calculus was off. Eventually, he decided to work out the math. Li’s elegant simulations showed that when a person coughed or sneezed, the heavy droplets were too few and the targets—an open mouth, nostrils, eyes—too small to account for much infection. Li’s team had concluded, therefore, that the public health establishment had it backward and that most colds, flu, and other respiratory illnesses must spread through aerosols instead.

Their findings, they argued, exposed the fallacy of the 5-micron boundary. And they’d gone a step further, tracing the number back to a decades-old document the CDC had published for hospitals. Marr couldn’t help but feel a surge of excitement. A journal had asked her to review Li’s paper, and she didn’t mask her feelings as she sketched out her reply. On January 22, 2020, she wrote, “This work is hugely important in challenging the existing dogma about how infectious disease is transmitted in droplets and aerosols.”

Even as she composed her note, the implications of Li’s work were far from theoretical. Hours later, Chinese government officials cut off any travel in and out of the city of Wuhan, in a desperate attempt to contain an as-yet-unnamed respiratory disease burning through the 11-million-person megalopolis. As the pandemic shut down country after country, the WHO and the CDC told people to wash their hands, scrub surfaces, and maintain social distance. They didn’t say anything about masks or the dangers of being indoors.
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A few days after the April Zoom meeting with the WHO, Marr got an email from another aerosol scientist who had been on the call, an atmospheric chemist at the University of Colorado Boulder named Jose-Luis Jimenez. He’d become fixated on the WHO recommendation that people stay 3 to 6 feet apart from one another. As far as he could tell, that social distancing guideline seemed to be based on a few studies from the 1930s and ’40s. But the authors of those experiments actually argued for the possibility of airborne transmission, which by definition would involve distances over 6 feet. None of it seemed to add up.


Scientists use a rotating drum to aerosolize viruses and study how well they survive under different conditions.

Photograph: Matt Eich
Marr told him about her concerns with the 5-micron boundary and suggested that their two issues might be linked. If the 6-foot guideline was built off of an incorrect definition of droplets, the 5-micron error wasn’t just some arcane detail. It seemed to sit at the heart of the WHO’s and the CDC’s flawed guidance. Finding its origin suddenly became a priority. But to hunt it down, Marr, Jimenez, and their collaborators needed help. They needed a historian.

Luckily, Marr knew one, a Virginia Tech scholar named Tom Ewing who specialized in the history of tuberculosis and influenza. They talked. He suggested they bring on board a graduate student he happened to know who was good at this particular form of forensics. The team agreed. “This will be very interesting,” Marr wrote in an email to Jimenez on April 13. “I think we’re going to find a house of cards.”

The graduate student in question was Katie Randall. Covid had just dealt her dissertation a big blow—she could no longer conduct in-person research, so she’d promised her adviser she would devote the spring to sorting out her dissertation and nothing else. But then an email from Ewing arrived in her inbox describing Marr’s quest and the clues her team had so far unearthed, which were “layered like an archaeology site, with shards that might make up a pot,” he wrote. That did it. She was in.

Randall had studied citation tracking, a type of scholastic detective work where the clues aren’t blood sprays and stray fibers but buried references to long-ago studies, reports, and other records. She started digging where Li and the others had left off—with various WHO and CDC papers. But she didn’t find any more clues than they had. Dead end.
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She tried another tack. Everyone agreed that tuberculosis was airborne. So she plugged “5 microns” and “tuberculosis” into a search of the CDC’s archives. She scrolled and scrolled until she reached the earliest document on tuberculosis prevention that mentioned aerosol size. It cited an out-of-print book written by a Harvard engineer named William Firth Wells. Published in 1955, it was called Airborne Contagion and Air Hygiene. A lead!

In the Before Times, she would have acquired the book through interlibrary loan. With the pandemic shutting down universities, that was no longer an option. On the wilds of the open internet, Randall tracked down a first edition from a rare book seller for $500—a hefty expense for a side project with essentially no funding. But then one of the university’s librarians came through and located a digital copy in Michigan. Randall began to dig in.
In the words of Wells’ manuscript, she found a man at the end of his career, rushing to contextualize more than 23 years of research. She started reading his early work, including one of the studies Jimenez had mentioned. In 1934, Wells and his wife, Mildred Weeks Wells, a physician, analyzed air samples and plotted a curve showing how the opposing forces of gravity and evaporation acted on respiratory particles. The couple’s calculations made it possible to predict the time it would take a particle of a given size to travel from someone’s mouth to the ground. According to them, particles bigger than 100 microns sank within seconds. Smaller particles stayed in the air. Randall paused at the curve they’d drawn. To her, it seemed to foreshadow the idea of a droplet-aerosol dichotomy, but one that should have pivoted around 100 microns, not 5.

The book was long, more than 400 pages, and Randall was still on the hook for her dissertation. She was also helping her restless 6-year-old daughter navigate remote kindergarten, now that Covid had closed her school. So it was often not until late at night, after everyone had gone to bed, that she could return to it, taking detailed notes about each day’s progress.

One night she read about experiments Wells did in the 1940s in which he installed air-disinfecting ultraviolet lights inside schools. In the classrooms with UV lamps installed, fewer kids came down with the measles. He concluded that the measles virus must have been in the air. Randall was struck by this. She knew that measles didn’t get recognized as an airborne disease until decades later. What had happened?

Part of medical rhetoric is understanding why certain ideas take hold and others don’t. So as spring turned to summer, Randall started to investigate how Wells’ contemporaries perceived him. That’s how she found the writings of Alexander Langmuir, the influential chief epidemiologist of the newly established CDC. Like his peers, Langmuir had been brought up in the Gospel of Personal Cleanliness, an obsession that made handwashing the bedrock of US public health policy. He seemed to view Wells’ ideas about airborne transmission as retrograde, seeing in them a slide back toward an ancient, irrational terror of bad air—the “miasma theory” that had prevailed for centuries. Langmuir dismissed them as little more than “interesting theoretical points.”
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But at the same time, Langmuir was growing increasingly preoccupied by the threat of biological warfare. He worried about enemies carpeting US cities in airborne pathogens. In March 1951, just months after the start of the Korean War, Langmuir published a report in which he simultaneously disparaged Wells’ belief in airborne infection and credited his work as being foundational to understanding the physics of airborne infection.

How curious, Randall thought. She kept reading.

In the report, Langmuir cited a few studies from the 1940s looking at the health hazards of working in mines and factories, which showed the mucus of the nose and throat to be exceptionally good at filtering out particles bigger than 5 microns. The smaller ones, however, could slip deep into the lungs and cause irreversible damage. If someone wanted to turn a rare and nasty pathogen into a potent agent of mass infection, Langmuir wrote, the thing to do would be to formulate it into a liquid that could be aerosolized into particles smaller than 5 microns, small enough to bypass the body’s main defenses. Curious indeed. Randall made a note.


When she returned to Wells’ book a few days later, she noticed he too had written about those industrial hygiene studies. They had inspired Wells to investigate what role particle size played in the likelihood of natural respiratory infections. He designed a study using tuberculosis-causing bacteria. The bug was hardy and could be aerosolized, and if it landed in the lungs, it grew into a small lesion. He exposed rabbits to similar doses of the bacteria, pumped into their chambers either as a fine (smaller than 5 microns) or coarse (bigger than 5 microns) mist. The animals that got the fine treatment fell ill, and upon autopsy it was clear their lungs bulged with lesions. The bunnies that received the coarse blast appeared no worse for the wear.

For days, Randall worked like this—going back and forth between Wells and Langmuir, moving forward and backward in time. As she got into Langmuir’s later writings, she observed a shift in his tone. In articles he wrote up until the 1980s, toward the end of his career, he admitted he had been wrong about airborne infection. It was possible.

A big part of what changed Langmuir’s mind was one of Wells’ final studies. Working at a VA hospital in Baltimore, Wells and his collaborators had pumped exhaust air from a tuberculosis ward into the cages of about 150 guinea pigs on the building’s top floor. Month after month, a few guinea pigs came down with tuberculosis. Still, public health authorities were skeptical. They complained that the experiment lacked controls. So Wells’ team added another 150 animals, but this time they included UV lights to kill any germs in the air. Those guinea pigs stayed healthy. That was it, the first incontrovertible evidence that a human disease—tuberculosis—could be airborne, and not even the public health big hats could ignore it.

The groundbreaking results were published in 1962. Wells died in September of the following year. A month later, Langmuir mentioned the late engineer in a speech to public health workers. It was Wells, he said, that they had to thank for illuminating their inadequate response to a growing epidemic of tuberculosis. He emphasized that the problematic particles—the ones they had to worry about—were smaller than 5 microns.
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Inside Randall’s head, something snapped into place. She shot forward in time, to that first tuberculosis guidance document where she had started her investigation. She had learned from it that tuberculosis is a curious critter; it can only invade a subset of human cells in the deepest reaches of the lungs. Most bugs are more promiscuous. They can embed in particles of any size and infect cells all along the respiratory tract.

What must have happened, she thought, was that after Wells died, scientists inside the CDC conflated his observations. They plucked the size of the particle that transmits tuberculosis out of context, making 5 microns stand in for a general definition of airborne spread. Wells’ 100-micron threshold got left behind. “You can see that the idea of what is respirable, what stays airborne, and what is infectious are all being flattened into this 5-micron phenomenon,” Randall says. Over time, through blind repetition, the error sank deeper into the medical canon. The CDC did not respond to multiple requests for comment.

In June, she Zoomed into a meeting with the rest of the team to share what she had found. Marr almost couldn’t believe someone had cracked it. “It was like, ‘Oh my gosh, this is where the 5 microns came from?!’” After all these years, she finally had an answer. But getting to the bottom of the 5-micron myth was only the first step. Dislodging it from decades of public health doctrine would mean convincing two of the world’s most powerful health authorities not only that they were wrong but that the error was incredibly—and urgently—consequential.
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While Randall was digging through the past, her collaborators were planning a campaign. In July, Marr and Jimenez went public, signing their names to an open letter addressed to public health authorities, including the WHO. Along with 237 other scientists and physicians, they warned that without stronger recommendations for masking and ventilation, airborne spread of SARS-CoV-2 would undermine even the most vigorous testing, tracing, and social distancing efforts.

The news made headlines. And it provoked a strong backlash. Prominent public health personalities rushed to defend the WHO. Twitter fights ensued. Saskia Popescu, an infection-prevention epidemiologist who is now a biodefense professor at George Mason University, was willing to buy the idea that people were getting Covid by breathing in aerosols, but only at close range. That’s not airborne in the way public health people use the word. “It’s a very weighted term that changes how we approach things,” she says. “It’s not something you can toss around haphazardly.”


The mannequins in this chamber were used to test the efficacy of masks.

Photograph: Matt Eich
Days later, the WHO released an updated scientific brief, acknowledging that aerosols couldn’t be ruled out, especially in poorly ventilated places. But it stuck to the 3- to 6-foot rule, advising people to wear masks indoors only if they couldn’t keep that distance. Jimenez was incensed. “It is misinformation, and it is making it difficult for ppl to protect themselves,” he tweeted about the update. “E.g. 50+ reports of schools, offices forbidding portable HEPA units because of @CDCgov and @who downplaying aerosols.”

While Jimenez and others sparred on social media, Marr worked behind the scenes to raise awareness of the misunderstandings around aerosols. She started talking to Kimberly Prather, an atmospheric chemist at UC San Diego, who had the ear of prominent public health leaders within the CDC and on the White House Covid Task Force. In July, the two women sent slides to Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases. One of them showed the trajectory of a 5-micron particle released from the height of the average person’s mouth. It went farther than 6 feet—hundreds of feet farther. A few weeks later, speaking to an audience at Harvard Medical School, Fauci admitted that the 5-micron distinction was wrong—and had been for years. “Bottom line is, there is much more aerosol than we thought,” he said. (Fauci declined to be interviewed for this story.)

Still, the droplet dogma reigned. In early October, Marr and a group of scientists and doctors published a letter in Science urging everyone to get on the same page about how infectious particles move, starting with ditching the 5-micron threshold. Only then could they provide clear and effective advice to the public. That same day, the CDC updated its guidance to acknowledge that SARS-CoV-2 can spread through long-lingering aerosols. But it didn’t emphasize them.
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That winter, the WHO also began to talk more publicly about aerosols. On December 1, the organization finally recommended that everyone always wear a mask indoors wherever Covid-19 is spreading. In an interview, the WHO’s Maria Van Kerkhove said that the change reflects the organization’s commitment to evolving its guidance when the scientific evidence compels a change. She maintains that the WHO has paid attention to airborne transmission from the beginning—first in hospitals, then at places such as bars and restaurants. “The reason we’re promoting ventilation is that this virus can be airborne,” Van Kerkhove says. But because that term has a specific meaning in the medical community, she admits to avoiding it—and emphasizing instead the types of settings that pose the biggest risks. Does she think that decision has harmed the public health response, or cost lives? No, she says. “People know what they need to do to protect themselves.”

Yet she admits it may be time to rethink the old droplet-airborne dichotomy. According to Van Kerkhove, the WHO plans to formally review its definitions for describing disease transmission in 2021.


Yuguo Li, an indoor-air researcher, set out to show that most respiratory diseases spread through aerosols.

Photograph: Yufan Lu
For Yuguo Li, whose work had so inspired Marr, these moves have given him a sliver of hope. “Tragedy always teaches us something,” he says. The lesson he thinks people are finally starting to learn is that airborne transmission is both more complicated and less scary than once believed. SARS-CoV-2, like many respiratory diseases, is airborne, but not wildly so. It isn’t like measles, which is so contagious it infects 90 percent of susceptible people exposed to someone with the virus. And the evidence hasn’t shown that the coronavirus often infects people over long distances. Or in well-ventilated spaces. The virus spreads most effectively in the immediate vicinity of a contagious person, which is to say that most of the time it looks an awful lot like a textbook droplet-based pathogen.

For most respiratory diseases, not knowing which route caused an infection has not been catastrophic. But the cost has not been zero. Influenza infects millions each year, killing between 300,000 and 650,000 globally. And epidemiologists are predicting the next few years will bring particularly deadly flu seasons. Li hopes that acknowledging this history—and how it hindered an effective global response to Covid-19—will allow good ventilation to emerge as a central pillar of public health policy, a development that would not just hasten the end of this pandemic but beat back future ones.

To get a glimpse into that future, you need only peek into the classrooms where Li teaches or the Crossfit gym where Marr jumps boxes and slams medicine balls. In the earliest days of the pandemic, Li convinced the administrators at the University of Hong Kong to spend most of its Covid-19 budget on upgrading the ventilation in buildings and buses rather than on things such as mass Covid testing of students. Marr reviewed blueprints and HVAC schematics with the owner of her gym, calculating the ventilation rates and consulting on a redesign that moved workout stations outside and near doors that were kept permanently open. To date, no one has caught Covid at the gym. Li’s university, a school of 30,000 students, has recorded a total of 23 Covid-19 cases. Of course Marr’s gym is small, and the university benefited from the fact that Asian countries, scarred by the 2003 SARS epidemic, were quick to recognize aerosol transmission. But Marr's and Li’s swift actions could well have improved their odds. Ultimately, that’s what public health guidelines do: They tilt people and places closer to safety.
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