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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  • ‘Disease X’: What it is (and isn’t)

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    What you need to know

    • In January 2024, the World Economic Forum hosted an event called Preparing for Disease X to discuss strategies to improve international pandemic response.
    • Disease X is a term used in epidemiology to refer to potential disease threats. It is not a real disease or a global conspiracy.
    • Preparation to prevent and respond to future pandemics is a necessary part of global health to keep us all safer.

    During the World Economic Forum’s 54th annual meeting in Davos, Switzerland, global health experts discussed ways to strengthen health care systems in preparation for future pandemics. Conspiracy theories quickly began circulating posts about the event and the fictional disease at its center, so-called Disease X. 

    What is Disease X?

    In 2018, the World Health Organization added Disease X to its list of Blueprint Priority Diseases that are public health risks. But, unlike the other diseases on the list, Disease X doesn’t exist. The term represents a hypothetical human disease capable of causing a pandemic. Although experts don’t know what the next Disease X will be, they can make educated guesses about where and how it may emerge—and how we can prepare for it.

    Why are we hearing about Disease X now?

    COVID-19 has been the deadliest infectious disease outbreak of the 21st century. It’s also an example of a Disease X: a previously unknown pathogen that spreads rapidly around the world, claiming millions of lives. 

    When the WEF hosted a panel of experts to discuss Disease X, it was the first exposure that many people had to a concept that global health experts have been discussing since 2018.

    Even before the routine pandemic preparedness event took place, online conspiracy theorists began circulating false claims that those discussing and preparing for Disease X had sinister motives, underscoring how widespread distrust of global health entities has become in the wake of the COVID-19 pandemic. 

    Why does Disease X matter?

    Epidemiologists use concepts like Disease X to plan for future outbreaks and avoid the mistakes of past outbreaks. The COVID-19 pandemic and the recent non-endemic outbreak of mpox highlight the importance of global coordination to efficiently prevent and respond to disease outbreaks.

    Pandemics are inevitable, but the scale of their destruction doesn’t have to be. Major disease outbreaks are likely to become more frequent due to the impacts of climate change. Preparing for a pandemic now helps ensure that the world is better equipped to handle the next one.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • The Truth About Vaccines

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The Truth About Vaccines

    Yesterday we asked your views on vaccines, and we got an interesting spread of answers. Of those who responded to the poll, most were in favour of vaccines. We got quite a lot of comments this time too; we can’t feature them all, but we’ll include extracts from a few in our article today, as they raised interesting points!

    Vaccines contain dangerous ingredients that will harm us more than the disease would: True or False?

    False, contextually.

    Many people are very understandably wary of things they know full well to be toxic, being injected into them.

    One subscriber who voted for “Vaccines are poison, and/or are some manner of conspiracy ” wrote:

    ❝I think vaccines from 50–60 years ago are true vaccines and were safer than vaccines today. I have not had a vaccine for many, many years, and I never plan to have any kind of vaccine/shot again.❞

    They didn’t say why they personally felt this way, but the notion that “things were simpler back in the day” is a common (and often correct!) observation regards health, especially when it comes to unwanted additives and ultraprocessing of food.

    Things like aluminum or mercury in vaccines are much like sodium and chlorine in table salt. Sodium and chlorine are indeed both toxic to us. But in the form of sodium chloride, it’s a normal part of our diet, provided we don’t overdo it.

    Additionally, the amount of unwanted metals (e.g. aluminum, mercury) in vaccines is orders of magnitude smaller than the amount in dietary sources—even if you’re a baby and your “dietary sources” are breast milk and/or formula milk.

    In the case of formaldehyde (an inactivating agent), it’s also the dose that makes the poison (and the quantity in vaccines is truly miniscule).

    This academic paper alone cites more sources than we could here without making today’s newsletter longer than it already is:

    Vaccine Safety: Myths and Misinformation

    I have a perfectly good immune system, it can handle the disease: True or False?

    True! Contingently.

    In fact, our immune system is so good at defending against disease, that the best thing we can do to protect ourselves is show our immune system a dead or deactivated version of a pathogen, so that when the real pathogen comes along, our immune system knows exactly what it is and what to do about it.

    In other words, a vaccine.

    One subscriber who voted for “Vaccines are important but in some cases the side effects can be worse ” wrote:

    ❝In some ways I’m vacd out. I got COVid a few months ago and had no symptoms except a cough. I have asthma and it didn’t trigger a lot of congestion. No issues. I am fully vaccinated but not sure I’ll get one in fall.❞

    We’re glad this subscriber didn’t get too ill! A testimony to their robust immune system doing what it’s supposed to, after being shown a recent-ish edition of the pathogen, in deactivated form.

    It’s very reasonable to start wondering: “surely I’m vaccinated enough by now”

    And, hopefully, you are! But, as any given pathogen mutates over time, we eventually need to show our immune system what the new version looks like, or else it won’t recognize it.

    See also: Why Experts Think You’ll Need a COVID-19 Booster Shot in the Future

    So why don’t we need booster shots for everything? Often, it’s because a pathogen has stopped mutating at any meaningful rate. Polio is an example of this—no booster is needed for most people in most places.

    Others, like flu, require annual boosters to keep up with the pathogens.

    Herd immunity will keep us safe: True or False?

    True! Ish.

    But it doesn’t mean what a lot of people think it means. For example, in the UK, “herd immunity” was the strategy promoted by Prime Minister of the hour, Boris Johnson. But he misunderstood what it meant:

    • What he thought it meant: everyone gets the disease, then everyone who doesn’t die is now immune
    • What it actually means: if most people are immune to the disease (for example: due to having been vaccinated), it can’t easily get to the people who aren’t immune

    One subscriber who voted for “Vaccines are critical for our health; vax to the max! ” wrote:

    ❝I had a chiropractor a few years ago, who explained to me that if the general public took vaccines, then she would not have to vaccinate her children and take a risk of having side effects❞

    Obviously, we can’t speak for this subscriber’s chiropractor’s children, but this raises a good example: some people can’t safely have a given vaccine, due to underlying medical conditions—or perhaps it is not available to them, for example if they are under a certain age.

    In such cases, herd immunity—other people around having been vaccinated and thus not passing on the disease—is what will keep them safe.

    Here’s a useful guide from the US Dept of Health and Human Services:

    How does community immunity (a.k.a. herd immunity) work?

    And, for those who are more visually inclined, here’s a graphical representation of a mathematical model of how herd immunity works (you can run a simulation)!

    Stay safe!

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  • What Mattress Is Best, By Science?

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    The Foundations of Good Sleep

    You probably know the importance of good sleep for good health. If not, here’s a quick refresher:

    You should also definitely check out this quite famous book on the topic:

    Why We Sleep – by Dr Matthew Walker

    What helps, to get that good sleep

    We’ve covered this a little before too, for example:

    How to level-up from there

    One of the biggest barriers to good sleep for many people is obstructive sleep apea:

    Healthier, Natural Sleep Without Obstruction!

    We covered (in the above article) a whole lot of ways of mitigating/managing obstructive sleep apnea. One of the things we mentioned as beneficial was avoiding sleeping on one’s back, and this is something Mayo Clinic’s Dr. Somers agreed with:

    Back Sleeping, And Sleeping Differently After 50

    “But side-sleeping is uncomfortable”

    If this is you, then chances are you have the wrong mattress.

    If your mattress is too firm, you can get around it by using this “five pillow” method:

    Click Here If The Embedded Video Doesn’t Load Automatically

    If your mattress is too soft, then sorry, you really just have to throw that thing out and start again.

    The Goldilocks mattress

    While different people will have different subjective preferences, the science is quite clear on what is actually best for people’s spines. As this review of 39 qualified scholarly articles concluded:

    ❝Results of this systematic review show that a medium-firm mattress promotes comfort, sleep quality and rachis alignment❞

    ~ Dr. Gianfilippo Caggiari et al.

    Read in full: What type of mattress should be chosen to avoid back pain and improve sleep quality? Review of the literature

    Note: to achieve “medium-firm” that remains “medium firm” has generally been assumed to require a memory-foam mattress.

    How memory-foam works: memory-foam is a moderately thermosoftening material, designed to slightly soften at the touch of human body temperature, and be firmer at room temperature. This will result in it molding itself to the form of a human body, providing what amounts to personalized support for your personal shape and size, meaning your spine can stay exactly as it’s supposed to when you’re sleeping on your side, instead of (for example) your hips being wider meaning that your lumbar vertebrae are raised higher than your thoracic vertebrae, giving you the equivalent of a special nocturnal scoliosis.

    It will, therefore, stop working if

    • the ambient temperature is comparable to human body temperature (as happens in some places sometimes, and increasingly often these days)
    • you die, and thus lose your body temperature (but in that case, your spinal alignment will be the least of your concerns)

    Here’s a good explanation of the mechanics of memory foam from the Sleep Foundation:

    Sleep Foundation | What is Memory Foam?

    An alternative to memory foam?

    If you don’t like memory foam (one criticism is that it doesn’t allow good ventilation underneath the body), there is an alterative, the grid mattress.

    It’s very much “the new kid on the block” and the science is young for this, but for example this recent (April 2024) study that concluded:

    ❝The grid mattress is a simple, noninvasive, and nonpharmacological intervention that improved adults sleep quality and health. Controlled trials are encouraged to examine the effects of this mattress in a variety of populations and environments.❞

    ~ Dr. Heather Hausenblas et al.

    Read in full: Effectiveness of a grid mattress on adults’ sleep quality and health: A quasi-experimental intervention study

    However, that was a small (n=39) uncontrolled (i.e. there was no control group) study, and the conflict of interest statement is, well, interesting:

    ❝Heather A. Hausenblas, Stephanie L. Hooper, Martin Barragan, and Tarah Lynch declare no conflict of interest. Michael Breus served as a former consultant for Purple, LLC.❞

    ~ Ibid.

    …which is a fabulous way of distracting from the mention in the “Acknowledgements” section to follow, that…

    ❝Purple, LLC, provided financial support for the study❞

    ~ Ibid.

    Purple is the company that invented the mattress being tested. So while this doesn’t mean the study is necessarily dishonest and/or corrupt, it does at the very least raise a red flag for a potential instance of publication bias (because Purple may have funded multiple studies and then pulled funding of the ones that weren’t going their way).

    If you are interested in Purple’s mattress and how it works, you can check it out herethis is a link for your interest and information; not an advertisement or an endorsement. We look forward to seeing more science for this though, and echo their own call for randomized controlled trials!

    Summary

    Sleep is important, and while it’s a popular myth that we need less as we get older, the truth is that we merely get less on average, while still needing the same amount.

    A medium-firm memory-foam mattress is a very good, well-evidenced way to support that (both figuratively and literally!).

    A grid mattress is an interesting innovation, and/but we’d like to see more science for it.

    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:

    1. Long-term rivalries or jealousies (e.g., “who has done better in life”)
    2. 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:

    Save Time With Better Communication

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  • Healthy Made Simple – by Ella Mills

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    Often, cookbooks leave a gap between “add the beans to the rice, then microwave” and “delicately embarrass the green-shooted scallions with assiduous garlic before adding to the matelote of orrazata flamed in Sapient Pear Brandy”. This book fills that gap:

    It has dishes good for entertaining, and dishes good for eating on a Tuesday night after a long day. Sometimes, they’re even the same dishes.

    It has a focus on what’s pleasing, easy, healthy, and consistent with being cooked in a real home kitchen for real people.

    The book offers 75 recipes that:

    1. Take under 30 minutes to make*
    2. Contain 10 ingredients or fewer
    3. Have no more than 5 steps
    4. Are healthy and packed with goodness
    5. Are delicious and flavorful

    *With a selection for under 15 minutes, too!

    A strength of the book is that it’s based on practical, real-world cooking, and as such, there are sections such as “Prep-ahead [meals]”, and “cook once, eat twice”, etc.

    Just because one is cooking with simple fresh ingredients doesn’t mean that everything bought today must be used today!

    Bottom line: if you’d like simple, healthy recipe ideas that lend themselves well to home-cooking and prepping ahead / enjoying leftovers the next day, this is an excellent book for you.

    Click here to check out Healthy Made Simple, enjoy the benefits to your health, the easy way!

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  • Blind Spots – by Dr. Marty Makary

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    From the time the US recommended not giving peanuts to infants for the first three years of life “in order to avoid peanut allergies” (whereupon non-exposure to peanuts early in life led to, instead, an increase in peanut allergies and anaphylactic incidents), to the time the US recommended not taking HRT on the strength of the claim that “HRT causes breast cancer” (whereupon the reduced popularity of HRT led to, instead, an increase in breast cancer incidence and mortality), to many other such incidents of very bad public advice being given on the strength of a single badly-misrepresented study (for each respective thing), Dr. Makary puts the spotlight on what went wrong.

    This is important, because this is not just a book of outrage, exclaiming “how could this happen?!”, but rather instead, is a book of inquisition, asking “how did this happen?”, in such a way that we the reader can spot similar patterns going forwards.

    Oftentimes, this is a simple matter of having a basic understanding of statistics, and checking sources to see if the dataset really supports what the headlines are claiming—and indeed, whether sometimes it suggests rather the opposite.

    The style is a little on the sensationalist side, but it’s well-supported with sound arguments, good science, and clear mathematics.

    Bottom line: if you’d like to improve your scientific literacy, this book is an excellent illustrative guide.

    Click here to check out Blind Spots, and eliminate yours!

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