POST 160. May 13, 2021.CORONAVIRUS. “The CDC acknowledged Friday that airborne spread of COVID-19 among people more than 6 feet apart “has been repeatedly documented.”” Meanwhile states relax or eliminate indoor dining restrictions. HUH?

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Why it matters: This is “a change from the agency’s previous position that most infections were acquired through ‘close contact, not airborne transmission,'” the N.Y. Times reports.

The new guidance says airborne transmission is more common when people are close, but:

“These transmission events have involved the presence of an infectious person exhaling virus indoors for an extended time (more than 15 minutes and in some cases hours) leading to virus concentrations in the air space sufficient to transmit infections to people more than 6 feet away, and in some cases to people who have passed through that space soon after the infectious person left.”” (A)

Epidemiologists have pushed for worldwide recognition that the virus can be transmitted by inhalation, saying improved ventilation and other airborne-specific mitigation measures could curb outbreaks.” (B)

“As the pandemic unfolded last year, infectious disease experts warned for months that both the C.D.C. and the World Health Organization were overlooking research that strongly suggested the coronavirus traveled aloft in small, airborne particles. Several scientists on Friday welcomed the agency’s scrapping of the term “close contact,” which they criticized as vague and said did not necessarily capture the nuances of aerosol transmission.

“C.D.C. has now caught up to the latest scientific evidence, and they’ve gotten rid of some old problematic terms and thinking about how transmission occurs,” said Linsey Marr, an aerosol expert at Virginia Tech.

The new focus underscores the need for the federal Occupational Safety and Health Administration to issue standards for employers to address potential hazards in the workplace, some experts said.

“They hadn’t talked much about aerosols and were more focused on droplets,” said David Michaels, an epidemiologist at George Washington School of Public Health and head of OSHA in the Obama administration.” (C)

“This comes after months of infectious disease experts warning that the CDC and World Health Organization were focusing too much on the risk of picking COVID-19 from surfaces and emphasizing that “close contact” was needed for infection. That was despite increasing evidence that tiny virus particles could remain suspended in the air even after the infected person left a location. “C.D.C. has now caught up to the latest scientific evidence, and they’ve gotten rid of some old problematic terms and thinking about how transmission occurs,” Linsey Marr, an aerosol expert at Virginia Tech, tells the New York Times.

Despite the change, some aerosol experts continue to say the CDC hasn’t gone far enough because it continues to say that transmission from far away is “uncommon,” which Marr said was “misleading and potentially harmful” because “if you’re in a poorly ventilated environment, virus is going to build up in the air, and everyone who’s in that room is going to be exposed.” The CDC’s wording “will lead people to continue to think that maintaining distance is sufficient to prevent transmission,” reads an open letter signed by seven experts, including Marr. “We know that transmission at distances beyond 6 feet occurs because of superspreader events, careful studies of smaller outbreaks, and the physics of aerosols. It can easily happen indoors in a poorly ventilated environment, when people are not wearing masks.”” (D)

“The new information has significant implications for indoor environments, and workplaces in particular, Dr. Michaels said. Virus-laden particles “maintain their airborne properties for hours, and they accumulate in a room that doesn’t have good ventilation.”

“There’s more exposure closer up,” Dr. Michaels said. “But when you’re further away, there’s still a risk, and also these particles stay in the air.”

Donald Milton, an aerosol scientist at the University of Maryland, agreed that federal officials should provide better guidelines for keeping workplaces safe.

“We need better focus on good respirators for people who have to be close to other people for long periods of time,” Dr. Milton said. “A surgical mask, even if it’s tucked in on the edges, is still not really going to give you enough protection if you’re in a meatpacking plant elbow to elbow all day long with other people.”

Health care workers, bus drivers and other workers may also require respirators, Dr. Michaels said. Customers in retail stores should continue to maintain distance from one another and to wear masks, he added; good ventilation is paramount in these settings.” (E)

“They outlined 10 scientific reasons backing airborne transmission in a commentary published online April 15 in The Lancet:

The dominance of airborne transmission is supported by transmission across long distances observed at super-spreader events.

These so-called long-range transmissions have been reported among rooms at COVID-19 quarantine hotels, where infected people never spent time in the same room.

Asymptomatic individuals account for an estimated 33% to 59% of coronavirus transmission, and these patients could spread the virus through speaking, which produces thousands of aerosol particles and few large droplets.

Transmission outdoors and in well-ventilated indoor spaces is lower than in enclosed spaces.

Infections have been reported in health care settings where there protective measures against large droplets (such as masks and personal protection equipment) but not aerosols.

Viable coronavirus has been detected in the air of hospital rooms and in the car of an infected person.

Investigators found coronavirus in hospital air filters and building ducts.

It’s not just humans — infected animals can infect animals in other cages connected only through an air duct.

There is no strong evidence against airborne transmission, and contact tracing shows secondary transmission in crowded, poorly ventilated indoor spaces.

There is only limited evidence that the coronavirus spreads through other ways, such as clothes, furniture and other objects, or through large droplets.” (F)

As the vaccinated percentage of the population increases, you may be wondering whether now is finally the time to enjoy a meal that isn’t homemade or takeout.

Indoor dining and drinking at restaurants and bars is riskier than some other places for a few reasons, according to the US Centers for Disease Control and Prevention: Not only are people from different households gathering in the same space, but you have to take your mask off to eat and drink.

“You still have to be very careful with being in these areas,” said Dr. Ada Stewart, a family physician with Cooperative Health in Columbia, South Carolina, and the president of the American Academy of Family Physicians. “You’re in a crowd, and you don’t know the status of many of these individuals.”

Because of the layout of restaurants, maintaining social distancing may be hard. And since restaurants can be noisy, people might talk louder and more forcefully, which could increase the chance of spreading coronavirus through respiratory droplets. Depending on a restaurant’s ventilation flow, respiratory droplets and air potentially laden with coronavirus can accumulate or spread beyond 6 feet.”  (G)

Indoor dining is higher risk than many activities, explains Pierre, “because that involves sitting indoors in situations where there might be not as great ventilation, with people of mixed or unknown vaccination status.”

Find out if the restaurant has good ventilation and spacing between tables and if staff are wearing masks. These practices protect not just you but the staff and any unvaccinated customers. “You can go dine wherever you’d like if you’re vaccinated, but it’s more of the community-mindedness that might want to stop you from eating at a place where they’re not following rules,” says Landon.

And remember, people who are vaccinated may still be able to transmit.

“I would feel very guilty if I harbored it and then gave it to somebody which was not vaccinated, if I was that patient zero,” adds Kullar.

Still, most of our experts said they would eat indoors in a restaurant unless they live in a place experiencing very high community spread. Do wear your mask when the server takes your order, or when walking through the space to the rest room or exit. And if you’ve got unvaccinated kids, leave them at home, Landon says — or dine outside instead.” (H)

“Dr. Anthony S. Fauci said on Sunday that he was open to relaxing indoor masking rules as more Americans are vaccinated against the virus, just two days after the Centers for Disease Control and Prevention belatedly emphasized the danger of airborne transmission.

Dr. Fauci, President Biden’s chief medical adviser for the pandemic, said that as vaccinations climb, “we do need to start being more liberal” in terms of rules for wearing masks indoors, though he noted that the nation was still averaging about 43,000 cases of the virus daily. “We’ve got to get it much, much lower than that,” he said…

Dr. Fauci’s comments on Sunday came in response to a question about comments that Dr. Scott Gottlieb, the former head of the Food and Drug Administration, made last week on CNBC. Dr. Gottlieb said that relaxing indoor mask mandates now — “especially if you’re in environments where you know you have a high level of vaccination” — would give public health officials “the credibility to implement them” again in the fall or winter if cases surge.

Dr. Fauci, asked by George Stephanopoulos on ABC’s Sunday program “This Week” whether he agreed, said: “I think so, and I think you’re going to probably be seeing that as we go along, and as more people get vaccinated.”

“The C.D.C. will be, almost in real time, George, updating their recommendations and their guidelines,” Dr. Fauci continued. “But yes, we do need to start being more liberal as we get more people vaccinated.”…

In a separate interview on Sunday, on CNN’s “State of the Union,” Jeffrey Zients, Mr. Biden’s Covid response coordinator, was somewhat more circumspect than Dr. Fauci when asked about Dr. Gottlieb’s comments.

“I think everyone is tired, and wearing a mask is — it can be a pain,” Mr. Zients said. “But we’re getting there. And the light at the end of the tunnel is brighter and brighter. Let’s keep up our guard. Let’s follow the C.D.C. guidance. And the C.D.C. guidance across time will allow vaccinated people more and more privileges to take off that mask.” (I)

“Governor Andrew M. Cuomo today announced that New York City indoor dining will expand to 75 percent capacity beginning Friday, May 7. This brings New York City in line with the rest of New York State. The Governor also announced that hair salons, barber shops and other personal care services will expand to 75 percent capacity beginning May 7. New York City gyms and fitness centers will expand to 50 percent capacity beginning May 15. All changes are subject to state public health guidance including social distancing and masks…

“After a long and incredibly difficult fight, New York State is winning the war against COVID-19, and that means it’s time to loosen some restrictions put in place to protect the public health and help our local businesses,” Governor Cuomo said. “There’s no doubt that restaurants have been among the pandemic’s hardest hit businesses, and New York City’s thriving restaurant industry has found it challenging to keep staff and maintain profits. We’re easing restrictions on restaurants, personal care services and gyms to put more money in the pockets of small business owners and working people in New York City, which was hit so hard by the pandemic but, I have no doubt, will come back stronger than ever.”” (J)


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