Front Burner - Is COVID-19 airborne? The CDC said yes, then no

Episode Date: September 23, 2020

This weekend, the U.S. Centers for Disease Control and Prevention sparked a major controversy after updating, then removing, a warning about the airborne spread of COVID-19. Today, CBC senior health writer Adam Miller joins us to explain why this has re-ignited questions about just how easily COVID-19 travels through the air and whether the CDC is being influenced by the president’s political goals.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hello, I'm Josh Bloch. It's been a dramatic few days at the U.S. Centers for Disease Control and Prevention. Confusion tonight from the CDC.

Backtracking on its new guidance about how the virus spreads. Having a switcheroo like this, I've been covering the CDC for the better part of 30 years. I have never seen anything like this. This weekend, the CDC sparked a major controversy after updating and then removing a warning about the airborne spread of COVID-19. Official guidance said airborne transmission is the primary way the virus is spread. Those aerosolized droplets could remain in the air longer and travel distances beyond six feet. My colleague Adam Miller is a CBC senior health writer. He's here with me now to explain why this has reignited questions about just how easily COVID-19 travels through the air and whether the Centers for Disease Control is being influenced by Donald Trump's political goals.

I'm Josh Bloch. This is FrontBurner. Hello, Adam. Hi, Josh. How are you? I'm well. Okay, I want to start with this serious drama from the CDC, from the U.S. Centers for Disease Control and Prevention. It all started on Friday. from the U.S. Centers for Disease Control and Prevention. It all started on Friday. Walk me through what happened. Right. So on Friday, the CDC quietly revises the guidelines on its website about how COVID-19 spreads in a pretty dramatic way. They had previously said that the virus spreads through respiratory droplets when an infected person coughs, sneezes, or talks, and close contact and surfaces. But the new guidelines said that the virus can also spread through small particles, including what are known as aerosols, which can actually be suspended in the air and inhaled. What was the reaction to that?

The reaction was pretty shocked. It's a huge shift in messaging, and it has some pretty dramatic implications on everything from hospitals to schools to long-term care homes. Scientific community has been fighting for months for these big public health institutions to acknowledge this as at least a possibility. And for these guidelines to appear, it was a big deal. Dr. Jha, thanks for joining us. What do you make of all this? First of all, the science on this is clear. Airborne transmission is not only just a real deal. Dr. Jha, thanks for joining us. What do you make of all this? First of all, the science on this is clear. Airborne transmission is not only just a real thing, it is probably the main way that this virus is transmitted. I was first relieved to see the CDC catching up to the science, felt to me like maybe the CDC scientists are actually getting a chance to speak and are no

longer being muzzled. I mean, on Friday, what they said was the main way the virus spreads is through droplets or small particles like aerosols. And that is not the way they described the transmission of the virus previously. Right. It's a total game changer. And it would completely change our approach to stopping the virus from spreading. We know that the virus spreads through the air, primarily through droplets like the flu does. But if we're saying that aerosols are a big part of this, or at least a significant part of how the virus spreads, that would be a pretty drastic shift in the way that we've been thinking about this. I mean, the CDC is obviously an American institution, but it is a significant institution. Presumably, this would have broader impact than just in the United States. I mean, how would it affect countries like Canada or beyond that? It would have a lot of implications

internationally, for sure. I mean, in Canada, we would have a lot of questions, I think, for our public health institutions to say, why haven't we been acknowledging this? Are you considering this? Are we going to update our protocols on how to stop the virus from spreading? And we'd really have to figure out, okay, are we doing enough to ensure that there's proper air filtration, that we're getting ventilation to make sure that the virus isn't lingering in the air? It would definitely alter our approach on almost every level to how we fight the virus. Okay, so that was what they posted on Friday. But then tell me about what happens on Monday. So on Monday, the CDC removes the virus. Okay, so that was what they posted on Friday. But then tell me about what happens on Monday.

So on Monday, the CDC removes the guidelines and comes out with a statement that says that they were a draft version of proposed changes that were posted in error. And this causes a huge stir since a lot of the CDC's own published research points to the fact that aerosol transmission is at least a possibility. There are studies from hospitals, restaurants, summer camps, call centers, choir practices that all speak to this. Valley emergency medicine doctor Frank Lavecchio says this is not only confusing. How could a big organization like that just post something on a website by accident? I don't know. I don't know who's allowed to do that. It just doesn't seem like a valid excuse. We can say clearly it is airborne. Unfortunately, it hurts the public. It hurts their credibility and it hurts physicians reviewing this sort of data. You know, so the scientific community is pretty angry about this one,

especially the aerosol experts who've been saying this for months. And the CDC has come out and said it's updating its recommendations, which is good, but they haven't said when those new guidelines will be posted, and we don't know if aerosols are going to be part of that. So we're all kind of just holding our breath right now. I think a lot of the scientific community is as well. Well, one of the questions that people seem to have right now is whether they pulled down those guidelines because of political interference. There's been accusations of political interference with the CDC in the past.

I mean, I know Politico reported earlier this month that Trump appointed communications aides at the health department were interfering with CDC's weekly reports. weekly reports. And then the New York Times reported that a guideline that was issued by the CDC that if you had contact with someone with COVID and you didn't exhibit symptoms yourself, you didn't have to go get a test. In a joint statement tonight, the governors of New York, New Jersey and Connecticut say they're not following these guidelines either. They accuse the administration of substituting sound science-based public health guidance with the president's misinformation. And it later came out that this was dictated by an official in the Trump administration, not one of the CDC scientists. So I wonder, in this case, are people concerned that what's going on here is more about political interference than some mistake?

Absolutely, that's a concern, right? The CDC has its own reasons for carefully handling the rollout of this information. It's a pretty big mistake if this actually was just an error in a draft that was posted. But yes, I mean, there's been huge allegations of political interference with this organization and other public health organizations in the U.S. I mean, you saw the controversy with the FDA earlier this summer as well with regard to the blood plasma treatment. This is a powerful therapy that transfuses very, very strong antibodies from the blood of recovered patients to help treat patients battling a current infection. It's had an incredible rate of success. The head of the FDA actually had to come out and sort of apologize and walk back that statement.

Scientists had widely criticized him for claiming the treatment saved 35 out of 100 people. Well, it turns out the commissioner confused absolute risk reduction with relative risk reduction. So there's been allegations of political interference, absolutely. You know, at the very least, we've seen it with the World Health Organization, and even here in Canada, thinking back to early in the pandemic with masks, right? The initial thinking was that masks weren't beneficial, or that people would wear them wrong, or that we would cause a run on personal protective equipment for hospitals and healthcare workers. And at this point in the pandemic, we realize, okay, we don't have all the science and research on this,

but clearly masks are beneficial. So, you know, should we have erred on the side of caution from the beginning? Probably, but at the very least, it's clear that this information comes out in a very strategic way. Well, I want to ask you a bit more about that, because there is this growing chorus of scientists that argue that COVID-19 is possibly airborne. Tell me about the research that backs that up. It's a great question. To what extent does aerosol transmission happen

with this virus? You really need to look at all sides of the research that's out there. It's kind of evolved throughout the pandemic quickly. We know from previous pandemics and illnesses that respiratory droplets can spread a lot of virus, right? Now, when it comes to aerosols, it's unclear how much of the virus transmission is happening in the air, specifically very small microscopic particles that are suspended in the air, right? The research is still evolving. The World Health Organization acknowledges that. They're at least saying it's a possibility. We've seen through some studies that these particles can spread simply by talking and coughing and loud singing, you know, which is

why we've seen studies where we've seen infection in those types of close contact settings where there's a lot of respiratory droplets being spread around. So I'm curious to hear more. I mean, I feel like that the when people talk about this possible airborne transmission, they often refer to that example of a choir in Washington where one person infected 52 people. I mean, why was that such a significant example? What is that example? Well, the thing with this is we don't know all the details, right? So, yes, there was a choir practice in Washington state. An infected individual showed up. They sang together loudly in close contact. We sent out a broadcast email to everyone in the group. If you are ill, don't come to the rehearsal. You were greeted with hand sanitizers. Nobody shared music. We set up folding chairs for our rehearsals, three times the distance between chairs as we normally have. I heard from 20 people probably within a day or two that they were all getting sick also. So there's a lot of different

things that could have happened there. But because of the fact that they were singing loudly in really close contact, and 52 people got infected, that really raises the possibility that aerosols could be happening to some extent. And there's also the case of that restaurant in China where people were sitting at tables that were further than six feet apart, and yet the virus was still transmitted to them. It was another case that people point to with evidence that the virus was behaving in a way that didn't fit with it only being on these heavier droplets that would fall to the ground within two meters. Exactly. Yeah. I mean, that was a case where we had an infected individual at a restaurant at a separate table, no physical contact with the other tables.

They were more than two meters apart in some cases. And the direction that the air conditioning blew actually may have led to other infections at other tables. We saw numerous people get infected in that situation. It was a small study, and again, we don't know everything that happened there, but it definitely speaks to the idea that, yes, obviously this virus is spreading through the air, but, you know, possibly spreading beyond that two-meter threshold where respiratory droplets would be your main issue. If people are getting infected beyond that two meters,

that means that aerosols are a real possibility. So this is why we saw 239 scientists sign this open letter in late June that was pressing WHO to consider the risk of airborne transmission and to take it more seriously. Dr. Don Milton co-wrote the letter signed by scientists from around the world. What would you like the WHO to do? Acknowledge that the risk goes beyond six feet. What implication does that have for somebody in their home

or in their office indoors? You need to have everybody wearing masks and that you need to have good ventilation. Yeah, exactly. That came from a place of frustration. I interviewed some of those scientists, aerosol experts who signed that letter. They had said that they just wanted the World Health Organization to acknowledge it as a possibility that the virus can spread not only through respiratory droplets, but through aerosolized particles. This idea that the virus can suspend in the air and infect people in beyond that two meter physical distancing rule, and that we're dealing with something much more

serious. And how did the WHO respond to that letter? The WHO ended up revising its messaging to say that while more research needs to be done, that aerosol transmission is at least a possibility, right? And how would that change the way that we fight COVID-19? It would have some pretty serious implications on pretty much everything that we do. It would mean that we would have to do everything that we're doing now and then more, right? Mask wearing, physical distancing, proper hand hygiene. But in addition to that, we're looking at air filtration, retrofitting HVAC systems in schools and nursing homes and hospitals, making sure that we're getting proper ventilation as much as possible in these settings as well. But also it would just have some pretty serious implications on physical distancing, right? If you think that two meters is enough

to protect you, well, if aerosolized particles are a way that this virus can spread, that's not necessarily the case. We need to be looking at masking up in all public settings. We need to be looking at ensuring that enough time passes before someone who may be infectious in a room, you want to give the proper amount of time before someone else goes into that room, right? So in all kinds of settings, we're looking at doing much more than we're currently doing if this is the case. And then we know that it's probably not the primary route, aerosols, of transmission for this virus.

But at the same time, it's possible. And if the CDC acknowledges that, and the World Health Organization acknowledges that, and the Public Health Agency of Canada acknowledges that, you know, we've got to change the way that we stop this virus from spreading. Right. So there are certain kinds of airborne viruses, like the measles, like chickenpox, which are clearly airborne, which spread, which are very, very contagious. The scientists are not suggesting that they're the same as those viruses, but they are saying, look, there are certain cases where we have evidence of this kind of airborne transmission, and we need to take that into consideration when we consider the risk that people are putting

themselves at. Yeah, I mean, airborne means that the virus can travel through the air and infect people. You know, there's droplets landing on a person, that person can breathe them in or touch their face. Aerosols are microscopic. They're more like a vapor, they can linger in the air, and they can be inhaled. So the flu is something that mainly spreads through droplets, while measles is something that can be infectious through aerosols. And measles can live up for two hours in the air after an infected person coughs or sneezes in an area. So if we're talking about that with COVID-19 and the virus that causes it, that has some pretty huge implications on what we need to do. You can understand why you would want to be careful and you would want to have all your ducks in a row before you came out and said this, before you revise your guidelines,

because the implications are massive. Right. Well, and it's not just the CDC here. I mean, there's a lot of infectious disease specialists who have been really cautious about this, if not outright pouring cold water on the idea that COVID-19 is airborne. I mean, why is airborne transmission like this third rail issue to talk about? It's a pretty divisive issue for sure. There are those who think that this is readily transmitting through the air and that aerosols are a big part of that, or at least, you know, a significant part of that. But there are others who say, well, if that were the case, we'd have a situation like measles where it would be out of control and, you know, our current

precautions wouldn't work. Highly unlikely with COVID-19, says Dr. Allison McGeer. If this were usually or most commonly transmitted by the airborne route, then we would know it by now. If we had an outbreak of measles and we spent non-immune healthcare workers into those rooms wearing a mask, if they spent an hour in the room, they would all get infected. I think it's somewhere in the middle. I think we're in a situation where aerosols are a possibility. Airborne probably is the main route of transmission through droplets, but I think the truth lies somewhere in the middle. In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization.

Empowering Canada's entrepreneurs through angel investment and industry connections. Hi, it's Ramit Sethi here. You may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income? That's not a typo, 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision

together. To listen to this podcast, just search for Money for Couples. Together, to listen to this podcast, just search for Money for Cops. How are Canadian public health officials responding to this question about airborne transmission of COVID-19? You know, we're putting questions to them on this today. We know that, you know, from the Public Health Agency of Canada's own recommendations, aerosols are not really mentioned outside of hospital settings. Certain procedures like intubations that can be risky for the transmission of the virus. Other than that, we don't really talk about aerosols in Canada in our public health guidelines. You know,

the Public Health Agency of Canada still says that surfaces are a route of transmission. And yet, that has largely been disproven, or at least there's been no evidence to suggest that that is a main route of transmission. And yet it's still there in our guidelines, right? Right. There's been a lot of talk about this so-called hygiene theater where you have this whole performance of washing down surfaces and quarantining your mail. Exactly. And it seems like the science would suggest that those things are not that effective in terms of stopping transmission. Right. There's just no evidence to suggest that this is a main source of transmission and that this is a threat that needs to be prioritized. I was speaking with a former CEO of St. Michael's Hospital who's been involved in COVID protocols.

And he gave me this really interesting or useful acronym to assess the risk of transmission. It's DATA, D-A-T-A. And it's in the order of importance. So the D is for the distance you are from someone. A is for the air or the environment. Are you outside or inside? Is there ventilation? T is the amount of time that you're spending in that environment. And then A, the final A is the activity. Are you singing or doing exercise? And presumably that would affect the kind of droplets that are coming out of people's mouths. Does that square with the kind of public health advice that you think people should be focused on right now? I think so. Yeah. I mean, absolutely. Japan as well came out with this concept of three Cs,

right? Closed spaces with poor ventilation, crowded places with many people nearby and close contact settings. That was their approach early on. And they've done much better in this than most countries, right? So I think we just need to expand our public health guidelines. I think there's a lot of confusion from the general public about, okay, so what exactly should I be doing? What's changing? I think we need clear, strong messaging from our public health institutions that explain exactly what the threat is. And I think waiting, like we did early on with masks, had some pretty serious implications. And we now know that that was a mistake so i think we should just sort of err on the side of caution i'm not saying that every school needs to be retrofitted right this second but i really think that we need to look at okay maybe we should keep those windows open while

the weather's still warm enough to do so or let's take class outside or you know let's really think about i'm not 100 safe just because I'm two meters away from you. Maybe I should just really think about these types of things and the possibility of them just to be extra cautious. Adam, thank you so much for speaking with me. Thanks, Josh. All right, that is all for today. Make sure to join us again tomorrow for our analysis of today's throne speech and the Prime Minister's address to the nation. If you want to tune into those events live today, and the Prime Minister's Address to the Nation.

If you want to tune into those events live today, CBC News will have special coverage from Parliament Hill in Ottawa starting at 1.30pm Eastern Time. And you can catch the Prime Minister's Live Address at 6.30pm Eastern Time. I'm Josh Bloch. Thanks for listening to FrontBurner. For more CBC Podcasts, go to cbc.ca slash podcasts.