WHO Overturns Dogma on Airborne Disease Spread. The CDC Might Not Act on It.
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The World Health Organization has issued a report that transforms how the world understands respiratory infections like covid-19, influenza, and measles.
Motivated by grave missteps in the pandemic, the WHO convened about 50 experts in virology, epidemiology, aerosol science, and bioengineering, among other specialties, who spent two years poring through the evidence on how airborne viruses and bacteria spread.
However, the WHO report stops short of prescribing actions that governments, hospitals, and the public should take in response. It remains to be seen how the Centers for Disease Control and Prevention will act on this information in its own guidance for infection control in health care settings.
The WHO concluded that airborne transmission occurs as sick people exhale pathogens that remain suspended in the air, contained in tiny particles of saliva and mucus that are inhaled by others.
While it may seem obvious, and some researchers have pushed for this acknowledgment for more than a decade, an alternative dogma persisted — which kept health authorities from saying that covid was airborne for many months into the pandemic.
Specifically, they relied on a traditional notion that respiratory viruses spread mainly through droplets spewed out of an infected person’s nose or mouth. These droplets infect others by landing directly in their mouth, nose, or eyes — or they get carried into these orifices on droplet-contaminated fingers. Although these routes of transmission still happen, particularly among young children, experts have concluded that many respiratory infections spread as people simply breathe in virus-laden air.
“This is a complete U-turn,” said Julian Tang, a clinical virologist at the University of Leicester in the United Kingdom, who advised the WHO on the report. He also helped the agency create an online tool to assess the risk of airborne transmission indoors.
Peg Seminario, an occupational health and safety specialist in Bethesda, Maryland, welcomed the shift after years of resistance from health authorities. “The dogma that droplets are a major mode of transmission is the ‘flat Earth’ position now,” she said. “Hurray! We are finally recognizing that the world is round.”
The change puts fresh emphasis on the need to improve ventilation indoors and stockpile quality face masks before the next airborne disease explodes. Far from a remote possibility, measles is on the rise this year and the H5N1 bird flu is spreading among cattle in several states. Scientists worry that as the H5N1 virus spends more time in mammals, it could evolve to more easily infect people and spread among them through the air.
Traditional beliefs on droplet transmission help explain why the WHO and the CDC focused so acutely on hand-washing and surface-cleaning at the beginning of the pandemic. Such advice overwhelmed recommendations for N95 masks that filter out most virus-laden particles suspended in the air. Employers denied many health care workers access to N95s, insisting that only those routinely working within feet of covid patients needed them. More than 3,600 health care workers died in the first year of the pandemic, many due to a lack of protection.
However, a committee advising the CDC appears poised to brush aside the updated science when it comes to its pending guidance on health care facilities.
Lisa Brosseau, an aerosol expert and a consultant at the Center for Infectious Disease Research and Policy in Minnesota, warns of a repeat of 2020 if that happens.
“The rubber hits the road when you make decisions on how to protect people,” Brosseau said. “Aerosol scientists may see this report as a big win because they think everything will now follow from the science. But that’s not how this works and there are still major barriers.”
Money is one. If a respiratory disease spreads through inhalation, it means that people can lower their risk of infection indoors through sometimes costly methods to clean the air, such as mechanical ventilation and using air purifiers, and wearing an N95 mask. The CDC has so far been reluctant to press for such measures, as it updates foundational guidelines on curbing airborne infections in hospitals, nursing homes, prisons, and other facilities that provide health care. This year, a committee advising the CDC released a draft guidance that differs significantly from the WHO report.
Whereas the WHO report doesn’t characterize airborne viruses and bacteria as traveling short distances or long, the CDC draft maintains those traditional categories. It prescribes looser-fitting surgical masks rather than N95s for pathogens that “spread predominantly over short distances.” Surgical masks block far fewer airborne virus particles than N95s, which cost roughly 10 times as much.
Researchers and health care workers have been outraged about the committee’s draft, filing letters and petitions to the CDC. They say it gets the science wrong and endangers health. “A separation between short- and long-range distance is totally artificial,” Tang said.
Airborne viruses travel much like cigarette smoke, he explained. The scent will be strongest beside a smoker, but those farther away will inhale more and more smoke if they remain in the room, especially when there’s no ventilation.
Likewise, people open windows when they burn toast so that smoke dissipates before filling the kitchen and setting off an alarm. “You think viruses stop after 3 feet and drop to the ground?” Tang said of the classical notion of distance. “That is absurd.”
The CDC’s advisory committee is comprised primarily of infection control researchers at large hospital systems, while the WHO consulted a diverse group of scientists looking at many different types of studies. For example, one analysis examined the puff clouds expelled by singers, and musicians playing clarinets, French horns, saxophones, and trumpets. Another reviewed 16 investigations into covid outbreaks at restaurants, a gym, a food processing factory, and other venues, finding that insufficient ventilation probably made them worse than they would otherwise be.
In response to the outcry, the CDC returned the draft to its committee for review, asking it to reconsider its advice. Meetings from an expanded working group have since been held privately. But the National Nurses United union obtained notes of the conversations through a public records request to the agency. The records suggest a push for more lax protection. “It may be difficult as far as compliance is concerned to not have surgical masks as an option,” said one unidentified member, according to notes from the committee’s March 14 discussion. Another warned that “supply and compliance would be difficult.”
The nurses’ union, far from echoing such concerns, wrote on its website, “The Work Group has prioritized employer costs and profits (often under the umbrella of ‘feasibility’ and ‘flexibility’) over robust protections.” Jane Thomason, the union’s lead industrial hygienist, said the meeting records suggest the CDC group is working backward, molding its definitions of airborne transmission to fit the outcome it prefers.
Tang expects resistance to the WHO report. “Infection control people who have built their careers on this will object,” he said. “It takes a long time to change people’s way of thinking.”
The CDC declined to comment on how the WHO’s shift might influence its final policies on infection control in health facilities, which might not be completed this year. Creating policies to protect people from inhaling airborne viruses is complicated by the number of factors that influence how they spread indoors, such as ventilation, temperature, and the size of the space.
Adding to the complexity, policymakers must weigh the toll of various ailments, ranging from covid to colds to tuberculosis, against the burden of protection. And tolls often depend on context, such as whether an outbreak happens in a school or a cancer ward.
“What is the level of mortality that people will accept without precautions?” Tang said. “That’s another question.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Peanuts vs Pecans – Which is Healthier?
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Our Verdict
When comparing peanuts to pecans, we picked the peanuts.
Why?
Peanuts are an oft-underrated nut!
In terms of macros, peanuts have more than 2.5x the protein and slightly more carbs, while pecans have very slightly more fiber and a lot more fat, of which, mostly healthy monounsaturated and polyunsaturated fats, though it’s worth noting that peanuts’ fats are equally healthy and have a similar general profile, just, less fat per 100g than pecans do. There’s a lot going for both of these very different nuts here, so we’ll call this category a tie.
In the category of vitamins, peanuts have more of vitamins B2, B3, B5, B6, B7, B9, E, and choline, while pecans have more of vitamins C and K (of which they are still not a very good source, but peanuts have none so they can technically claim it for those two vitamins); thus, a clear win for peanuts here, especially as most of its vitamins had very large margins of difference over pecans, and peanuts are a good source of all the vitamins mentioned for them.
When it comes to minerals, peanuts have more calcium, iron, magnesium, phosphorus, potassium, and selenium, while pecans have more manganese and zinc. Another win for peanuts!
Adding up the sections makes for a clear win for peanuts, but by all means enjoy either or both (diversity is good), unless you are allergic, in which case, please don’t!
Want to learn more?
You might like:
Why You Should Diversify Your Nuts
Enjoy!
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Planning Festivities Your Body Won’t Regret
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The Festive Dilemma
For many, Christmas is approaching. Other holidays abound too, and even for the non-observant, it’d be hard to escape seasonal jollities entirely.
So, what’s the plan?
- Eat, drink, and be merry, and have New Year’s Resolutions for the first few days of January before collapsing in a heap?
- Approach the Yuletide with Spartan abstemiousness and miss all the fun while simultaneously annoying your relatives?
Let’s try to find a third approach instead…
What’s festive and healthy?
We’re doing this article this week, because many people will be shopping already, making plans, and so forth. So here are some things to bear in mind:
Make your own mindful choices
Coca-Cola company really did a number on Christmas, but it doesn’t mean their product is truly integral to the season. Same goes for many other things that flood the stores around this time of year. So much sugary confectionary! But remember, they’re not the boss of you. If you wouldn’t buy it ordinarily, why are you buying it now? Do you actually even want it?
If you really do, then you do you, but mindful choices will invariably be healthier than “because there were three additional aisles of confectionary now so I stopped and looked and picked some things”.
Pick your battles
If you’re having a big family gathering, likely there will be occasions with few healthy options available. But you can decide what’s most important for you to avoid, perhaps picking a theme, e.g:
- No alcohol this year, or
- No processed sugary foods, or
- Eat/drink whatever, but practice intermittent fasting
Some resources:
Fight inflammation
This is a big one so it deserves its own category. In the season of sugar and alcohol and fatty meat, inflammation can be a big problem to come around and bite us in the behind. We’ve written on this previously:
Positive dieting
In other words, less of a focus on what to exclude, and more of a focus on what to include in your diet. Fruity drinks and sweets are common at this time of year, but you know what’s also fruity? Fruit!
And it can be festive, too! Berries are great, and those tiny orange-like fruits that may be called clementines or tangerines or satsumas or, as Aldi would have it, “easy peelers”. Apple and cinnamon are also a great combination that both bring sweetness without needing added sugar.
And as for mains? Make your salads that bit fancier, get plenty of greens with your main, have hearty soups and strews with lentils and beams!
See also: Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
Your gut will thank us later!
Get moving!
That doesn’t mean you have to beat the New Year rush to the gym (unless you want to!). But it could mean, for example, more time in your walking shoes (or dancing shoes! With a nod to today’s sponsor) and less time in the armchair.
See also: The doctor who wants us to exercise less; move more
Lastly…
Remember it’s supposed to be fun! And being healthy can be a lot more fun than suffering because of unfortunate choices that we come to regret.
Take care!
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Managing Sibling Relationships In Adult Life
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Managing Sibling Relationships In Adult Life
After our previous main feature on estrangement, a subscriber wrote to say:
❝Parent and adult child relationships are so important to maintain as you age, but what about sibling relationships? Adult choices to accept and move on with healthier boundaries is also key for maintaining familial ties.❞
And, this is indeed critical for many of us, if we have siblings!
Writer’s note: I don’t have siblings, but I do happen to have one of Canada’s top psychologists on speed-dial, and she has more knowledge about sibling relationships than I do, not to mention a lifetime of experience both personally and professionally. So, I sought her advice, and she gave me a lot to work with.
Today I bring her ideas, distilled into my writing, for 10almonds’ signature super-digestible bitesize style.
A foundation of support
Starting at the beginning of a sibling story… Sibling relationships are generally beneficial from the get-go.
This is for reasons of mutual support, and an “always there” social presence.
Of course, how positive this experience is may depend on there being a lack of parental favoritism. And certainly, sibling rivalries and conflict can occur at any age, but the stakes are usually lower, early in life.
Growing warmer or colder
Generally speaking, as people age, sibling relationships likely get warmer and less conflictual.
Why? Simply put, we mature and (hopefully!) get more emotionally stable as we go.
However, two things can throw a wrench into the works:
- Long-term rivalries or jealousies (e.g., “who has done better in life”)
- Perceptions of unequal contribution to the family
These can take various forms, but for example if one sibling earns (or otherwise has) much more or much less than another, that can cause resentment on either or both sides:
- Resentment from the side of the sibling with less money: “I’d look after them if our situations were reversed; they can solve my problems easily; why do they resent that and/or ignore my plight?”
- Resentment from the side of the sibling with more money: “I shouldn’t be having to look after my sibling at this age”
It’s ugly and unpleasant. Same goes if the general job of caring for an elderly parent (or parents) falls mostly or entirely on one sibling. This can happen because of being geographically closer or having more time (well… having had more time. Now they don’t, it’s being used for care!).
It can also happen because of being female—daughters are more commonly expected to provide familial support than sons.
And of course, that only gets exacerbated as end-of-life decisions become relevant with regard to parents, and tough decisions may need to be made. And, that’s before looking at conflicts around inheritance.
So, all that seems quite bleak, but it doesn’t have to be like that.
Practical advice
As siblings age, working on communication about feelings is key to keeping siblings close and not devolving into conflict.
Those problems we talked about are far from unique to any set of siblings—they’re just more visible when it’s our own family, that’s all.
So: nothing to be ashamed of, or feel bad about. Just, something to manage—together.
Figure out what everyone involved wants/needs, put them all on the table, and figure out how to:
- Make sure outright needs are met first
- Try to address wants next, where possible
Remember, that if you feel more is being asked of you than you can give (in terms of time, energy, money, whatever), then this discussion is a time to bring that up, and ask for support, e.g.:
“In order to be able to do that, I would need… [description of support]; can you help with that?”
(it might even sometimes be necessary to simply say “No, I can’t do that. Let’s look to see how else we can deal with this” and look for other solutions, brainstorming together)
Some back-and-forth open discussion and even negotiation might be necessary, but it’s so much better than seething quietly from a distance.
The goal here is an outcome where everyone’s needs are met—thus leveraging the biggest strength of having siblings in the first place:
Mutual support, while still being one’s own person. Or, as this writer’s psychology professor friend put it:
❝Circling back to your original intention, this whole discussion adds up to: siblings can be very good or very bad for your life, depending on tons of things that we talked about, especially communication skills, emotional wellness of each person, and the complexity of challenges they face interdependently.❞
Our previous main feature about good communication can help a lot:
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Beetroot vs Eggplant – Which is Healthier?
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Our Verdict
When comparing beetroot to eggplant, we picked the beetroot.
Why?
It’s close!
In terms of macros, they’re equal on fiber, while beetroot has slightly more protein and carbs. In both cases, despite being quite firm vegetables when raw, they are nevertheless both mostly water. We’re calling this category a tie.
In the category of vitamins, beetroot has more of vitamins A, B2, B9, and C, while eggplant has more of vitamins B3, B5, B6, E, and K. That’s a marginal victory for eggplant.
When it comes to minerals, however, beetroot has more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc, while eggplant is not higher in any minerals. A clear and easy win for beetroot this time.
In terms of polyphenols, both have good-but-different health-giving polyphenols to share, including the quercetin in beetroot and caffeic acid in eggplant—nothing that would tip one ahead of the other, though.
All in all, the categories added up are balanced, but beetroot won the minerals category much more convincingly than eggplant won the vitamins category, so we’re giving this one to beetroot, even if only on tie-breakers!
Of course, enjoy either or both; diversity is good 😎
Want to learn more?
You might like to read:
Beetroot For More Than Just Your Blood Pressure ← more beetroot benefits
Take care!
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At The Heart Of Women’s Health
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A woman’s heart is a particular thing
For the longest time (and still to a large degree now), “women’s health” is assumed to refer to the health of organs found under a bikini. But there’s a lot more to it than that. We are whole people, with such things as brains and hearts and more.
Today (Valentine’s Day!) we’re focusing on the heart.
A quick recap:
We’ve talked previously about some of these sex differences when it comes to the heart, for example:
Heart Attack: His & Hers (Be Prepared!)
…but that’s fairly common knowledge at least amongst those who are attentive to such things, whereas…
…is much less common knowledge, especially with the ways statins are more likely to make things worse for a lot of women (not all though; see the article for some nuance about that).
We also talked about:
What Menopause Does To The Heart
…which is well worth reading too!
A question:
Why are women twice as likely to die from a heart attack as their age-equivalent male peers? Women develop heart disease later, but die from it sooner. Why is that?
That’s been a question scientists have been asking (and tentatively answering, as scientists do—hypotheses, theories, conclusions even sometimes) for 20 years now. Likely contributing factors include:
- A lack of public knowledge of the different symptoms
- A lack of confidence of bystanders to perform CPR on a woman
- A lack of public knowledge (including amongst prescribers) about the sex-related differences for statins
- A lack of women in cardiology, comparatively.
- A lack of attention to it, simply. Men get heart disease earlier, so it’s thought of as a “man thing”, by health providers as much as by individuals. Men get more regular cardiovascular check-ups, women get a mammogram and go.
Statistically, women are much more likely to die from heart disease than breast cancer:
- Breast cancer kills around 0.02% of us.
- Heart disease kills one in three.
And yet…
❝In a nationwide survey, only 22% of primary care doctors and 42% of cardiologists said they feel extremely well prepared to assess cardiovascular risks in women.
We are lagging in implementing risk prevention guidelines for women.
A lot of women are being told to just watch their cholesterol levels and see their doctor in a year. That’s a year of delayed care.❞
Source: The slowly evolving truth about heart disease and women
(there’s a lot more in that article than we have room for in ours, so do check it out!)
Some good news:
The “bystanders less likely to feel confident performing CPR on a woman” aspect may be helped by the deployment of new automatic external defibrillator, that works from four sides instead of one.
It’s called “double sequential external defibrillation”, and you can learn about it here:
A new emergency procedure for cardiac arrests aims to save more lives—here’s how it works
(it’s in use already in Canada and Aotearoa)
Gentlemen-readers, thank you for your attention to this one even if it was mostly not about you! Maybe someone you love will benefit from being aware of this
On a lighter note…
Since it’s Valentine’s Day, a little more on affairs of the heart…
Is chocolate good for the heart? And is it really an aphrodisiac?
We answered these questions and more in our previous main feature:
Chocolate & Health: Fact or Fiction?
Enjoy!
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What You Don’t Know Can Kill You
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Knowledge Is Power!
This is Dr. Simran Malhotra. She’s triple board-certified (in lifestyle medicine, internal medicine, and palliative care), and is also a health and wellness coach.
What does she want us to know?
Three things:
Wellness starts with your mindset
Dr. Malhotra shifted her priorities a lot during the initial and perhaps most chaotic phase of the COVID pandemic:
❝My husband, a critical care physician, was consumed in the trenches of caring for COVID patients in the ICU. I found myself knee-deep in virtual meetings with families whose loved ones were dying of severe COVID-related illnesses. Between the two of us, we saw more trauma, suffering, and death, than we could have imagined.
The COVID-19 pandemic opened my eyes to how quickly life can change our plans and reinforced the importance of being mindful of each day. Harnessing the power to make informed decisions is important, but perhaps even more important is focusing on what is in our control and taking action, even if it is the tiniest step in the direction we want to go!❞
~ Dr. Simran Malhotra
We can only make informed decisions if we have good information. That’s one of the reasons we try to share as much information as we can each day at 10almonds! But a lot will always depend on personalized information.
There are one-off (and sometimes potentially life-saving) things like health genomics:
The Real Benefit Of Genetic Testing
…but also smaller things that are informative on an ongoing basis, such as keeping track of your weight, your blood pressure, your hormones, and other metrics. You can even get fancy:
Track Your Blood Sugars For Better Personalized Health
Lifestyle is medicine
It’s often said that “food is medicine”. But also, movement is medicine. Sleep is medicine. In short, your lifestyle is the most powerful medicine that has ever existed.
Lifestyle encompasses very many things, but fortunately, there’s an “80:20 rule” in play that simplifies it a lot because if you take care of the top few things, the rest will tend to look after themselves:
These Top Few Things Make The Biggest Difference To Overall Health
Gratitude is better than fear
If we receive an unfavorable diagnosis (and let’s face it, most diagnoses are unfavorable), it might not seem like something to be grateful for.
But it is, insofar as it allows us to then take action! The information itself is what gives us our best chance of staying safe. And if that’s not possible e.g. in the worst case scenario, a terminal diagnosis, (bearing in mind that one of Dr. Malhotra’s three board certifications is in palliative care, so she sees this a lot), it at least gives us the information that allows us to make the best use of whatever remains to us.
See also: Managing Your Mortality
Which is very important!
…and/but possibly not the cheeriest note on which to end, so when you’ve read that, let’s finish today’s main feature on a happier kind of gratitude:
How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
Want to hear more from Dr. Malhotra?
Showing how serious she is about how our genes do not determine our destiny and knowledge is power, here she talks about her “previvor’s journey”, as she puts it, with regard to why she decided to have preventative cancer surgery in light of discovering her BRCA1 genetic mutation:
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Take care!
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