Should we solely rely on Public Health/Infectious Disease doctrine to respond to the COVID-19 pandemic?
We have heard from the epidemiologists and the medical community on how to respond to the COVID-19 pandemic. Some have argued that we should allow the virus to spread through the population to promote herd immunity (the Great Barrington Declaration), hoping to minimize economic disruption. Others argue that we should aspire to have everyone follow established Public Health/Infectious Disease doctrine to control the pandemic (the John Snow Memorandum). Both arguments have valid points but ignore another important pathway toward vanquishing the pandemic - an engineering based approach, which we will call The Third Way.
In a pandemic which has hit our world like no other in over a century, our response has been to exclusively follow the Public Health/Infectious Disease doctrine. That approach, lead chiefly by the CDC, was to issue guidance that would “flatten the curve” to avoid overwhelming the medical system’s ability to treat those with serious infections until a vaccine or effective therapeutics could be developed. In the U.S., because of its federated system, the actual implementation fell mostly to State and County public health agencies.
States developed localized tiers of responses based on the severity of infection in the community. The most severe tier was to shut down activities deemed non-essential as well as schools. The response included Active Non-Pharmaceutical Interventions (ANPIs) such as hand washing, social distancing, face covering, testing and contact tracing. Over a period of months (too many), the infection metrics improved and restrictions eased although some sectors of the economy remain closed indefinitely while others are so restricted that their long term viability is in question.
No rational person would disagree that ANPIs (hand washing, social distancing, face covering, testing and contact tracing) decrease the spread of airborne viruses. These measures do, however, share a common weakness – their effectiveness depends on behavior modification. Not everyone is willing or able to avoid close contact or wear a mask and the practicality by authorities to uniformly enforce these measures is questionable. Many people are reluctant to share contact information with public health authorities. We are now seeing second and third waves of infections because of the reliance on behavior modification. Polling suggests that a significant portion of Americans will refuse to take it vaccines. Apparently, even vaccine acquired herd immunity relies on behavior modification.
Are public health agency guidelines the only response to the COVID-19 pandemic we can mount? The way it has been applied is a top down, one size fits all approach that comes with an enormous cost in lives and livelihoods from shuttering the economy. It comes with the incalculable costs of despair including increased poverty, homelessness, substance abuse, suicides, domestic abuse and a learning stunted generation of school aged children. And don’t forget the effects of inequality – how is it fair that the hardest working and lowest paid (essential) workers risk infection while those with the skills and a broadband connection can work from home? In less developed countries the economic dislocations are even worse.
We can see that even with the unprecedented speed that new vaccines have been produced, they will arrive too late to stop the initial waves of the pandemic. The losses from those initial waves did not have to happen. We could have done better. We can do better. We want to do for airborne pathogens what was done for waterborne disease a century ago. We don’t want last minute heroics. We want carefully planned interventions or Passive Non-Pharmaceutical Interventions (PNPIs) that prevent people from breathing the contaminated exhaled air of strangers. Imagine if we had no water or wastewater treatment plants but relied only on boiling or filtering water for drinking and having to avoid water contact to stem the spread of waterborne pathogens?
Consider that in the United States, the country with the greatest financial and technical resources in the world, our most effective weapon against COVID-19 is a flimsy face mask that costs a few dollars. To borrow a cliché, we are bringing a knife to a gunfight. All along, we have been ignoring other engineered PNPIs (or the guns) that are readily available and cost effective. And, most important, these measures do not rely on public behavior modification.
PNPIs include better ventilation, germicidal UV light fixtures and air filtration and are proven technical measures, backed up by years of scientific research, that can play a significant role in mitigating the spread of the airborne pathogens. Better ventilation is the easiest PNPI but is not always available due to HVAC, architectural or comfort limitations. Upper air germicidal UV is proven to decrease measles and TB spread in public spaces. The virus that causes COVID-19 is even more susceptible to germicidal UV than those pathogens. In room filter systems effectively remove pathogens from the air. Unfortunately, a business will not incur the cost of PNPIs unless their local Public Health agency recognizes their effectiveness and allows the business to return to some kind of normal operation. Schools and other institutional settings will also not adopt these measures and reopen unless their Public Health agencies approve their use.
Beyond helping our society reopen, widespread application of PNPI technologies could not only stop the current pandemic, but prevent future pandemics at a fraction of what has been spent on the COVID-19 response. These measures would also reduce seasonal outbreaks of colds and flu. Keep in mind, these technologies do not sterilize the entire airspace – they will never guarantee that no one will ever get sick. What they do, however, reduce the concentration of pathogens in the airspace thus reducing the chance of spreading infection. If one person can only infect only one other person (or fewer), the pandemic will fade away. Future novel viruses will not reach pandemic levels. Isn’t time we consider adopting Third Way PNPIs to complement and in some cases, replace public agency infectious disease doctrine?
In a pandemic which has hit our world like no other in over a century, our response has been to exclusively follow the Public Health/Infectious Disease doctrine. That approach, lead chiefly by the CDC, was to issue guidance that would “flatten the curve” to avoid overwhelming the medical system’s ability to treat those with serious infections until a vaccine or effective therapeutics could be developed. In the U.S., because of its federated system, the actual implementation fell mostly to State and County public health agencies.
States developed localized tiers of responses based on the severity of infection in the community. The most severe tier was to shut down activities deemed non-essential as well as schools. The response included Active Non-Pharmaceutical Interventions (ANPIs) such as hand washing, social distancing, face covering, testing and contact tracing. Over a period of months (too many), the infection metrics improved and restrictions eased although some sectors of the economy remain closed indefinitely while others are so restricted that their long term viability is in question.
No rational person would disagree that ANPIs (hand washing, social distancing, face covering, testing and contact tracing) decrease the spread of airborne viruses. These measures do, however, share a common weakness – their effectiveness depends on behavior modification. Not everyone is willing or able to avoid close contact or wear a mask and the practicality by authorities to uniformly enforce these measures is questionable. Many people are reluctant to share contact information with public health authorities. We are now seeing second and third waves of infections because of the reliance on behavior modification. Polling suggests that a significant portion of Americans will refuse to take it vaccines. Apparently, even vaccine acquired herd immunity relies on behavior modification.
Are public health agency guidelines the only response to the COVID-19 pandemic we can mount? The way it has been applied is a top down, one size fits all approach that comes with an enormous cost in lives and livelihoods from shuttering the economy. It comes with the incalculable costs of despair including increased poverty, homelessness, substance abuse, suicides, domestic abuse and a learning stunted generation of school aged children. And don’t forget the effects of inequality – how is it fair that the hardest working and lowest paid (essential) workers risk infection while those with the skills and a broadband connection can work from home? In less developed countries the economic dislocations are even worse.
We can see that even with the unprecedented speed that new vaccines have been produced, they will arrive too late to stop the initial waves of the pandemic. The losses from those initial waves did not have to happen. We could have done better. We can do better. We want to do for airborne pathogens what was done for waterborne disease a century ago. We don’t want last minute heroics. We want carefully planned interventions or Passive Non-Pharmaceutical Interventions (PNPIs) that prevent people from breathing the contaminated exhaled air of strangers. Imagine if we had no water or wastewater treatment plants but relied only on boiling or filtering water for drinking and having to avoid water contact to stem the spread of waterborne pathogens?
Consider that in the United States, the country with the greatest financial and technical resources in the world, our most effective weapon against COVID-19 is a flimsy face mask that costs a few dollars. To borrow a cliché, we are bringing a knife to a gunfight. All along, we have been ignoring other engineered PNPIs (or the guns) that are readily available and cost effective. And, most important, these measures do not rely on public behavior modification.
PNPIs include better ventilation, germicidal UV light fixtures and air filtration and are proven technical measures, backed up by years of scientific research, that can play a significant role in mitigating the spread of the airborne pathogens. Better ventilation is the easiest PNPI but is not always available due to HVAC, architectural or comfort limitations. Upper air germicidal UV is proven to decrease measles and TB spread in public spaces. The virus that causes COVID-19 is even more susceptible to germicidal UV than those pathogens. In room filter systems effectively remove pathogens from the air. Unfortunately, a business will not incur the cost of PNPIs unless their local Public Health agency recognizes their effectiveness and allows the business to return to some kind of normal operation. Schools and other institutional settings will also not adopt these measures and reopen unless their Public Health agencies approve their use.
Beyond helping our society reopen, widespread application of PNPI technologies could not only stop the current pandemic, but prevent future pandemics at a fraction of what has been spent on the COVID-19 response. These measures would also reduce seasonal outbreaks of colds and flu. Keep in mind, these technologies do not sterilize the entire airspace – they will never guarantee that no one will ever get sick. What they do, however, reduce the concentration of pathogens in the airspace thus reducing the chance of spreading infection. If one person can only infect only one other person (or fewer), the pandemic will fade away. Future novel viruses will not reach pandemic levels. Isn’t time we consider adopting Third Way PNPIs to complement and in some cases, replace public agency infectious disease doctrine?
Signed and co-signed by:
Principal Lambent Hygienics
BS Microbiology, MS Environmental Engineering
BS Microbiology, MS Environmental Engineering
Principle Lambent Hygienics
BS/MSEE
BS/MSEE