An Engineering Approach to Public Health:
Should we solely rely on public health agency doctrine to respond to the COVID-19 pandemic?
We've heard from the epidemiologists and the medical community. Some have argued that we should allow the COVID-19 virus to spread through the population to minimize economic dislocation to promote an informed herd immunity (the Great Barrington Declaration). Others argue that we should aspire to have everyone follow established medical doctrine to control the COVID-19 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 plagued our world seemingly like no other in over a century. our response has been to exclusively follow the public health agency infection control doctrine. That approach, led chiefly by the CDC and WHO, 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 broadly classified as non-essential and schools, and included 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 these measures (hand washing, social distancing, face covering, testing and contact tracing) decrease the rate of 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 alarming increases in infections because of the reliance on behavior modification. Polling suggests that when an effective vaccine becomes available, a significant portion of Americans will refuse to take it. Apparently, even vaccine acquired herd immunity relies on behavior modification.
Is the public health agency model 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 the enormous cost in lives and livelihoods of shuttering the economy. Add to that the less obvious 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 must risk infection while those with the skills and a broadband connection can work from home? In the second and third worlds, the effects of economic dislocation are even more dire.
We can see that even with the unprecedented speed that new vaccines have been produced, they will likely be arriving too late to stop the most destructive initial waves of the pandemic and could show up about the time the virus has entered its endemic phase. We need to do better. We think we can by changing our approach. We want to do for airborne pathogens what was done in the first world a century ago for waterborne disease. We don’t want last minute heroics. We want carefully planned mitigations that prevent people from breathing the contaminated exhaled air of strangers. Imagine if we had no waste water treatment or drinking water treatment but just tried to come up with vaccines and therapies for the diseases that would invariably permeate a community without those marvels of engineering? The result would be a series of epidemics.
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 seemingly 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 technical measures offered by the engineering community that are readily available and cost effective. And, most important, these measures do not rely on public behavior modification. They operate in the background. These measures stop the disease before it becomes pandemic.
Just for example, germicidal UV light fixtures and air filtration are two proven technical measures, backed up by years of scientific research, that can play a significant role in mitigating the spread of the virus. 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 microbes. In-duct UV and needlepoint bipolar ionization systems kill airborne pathogens as air is recirculated through the HVAC system without the energy cost of brute force massive air exchanges. In room filter systems effectively remove viruses from the air. Unfortunately, a business will not install any of this equipment unless their local Public Health agency recognizes its effectiveness and allows the business to return to some kind of normal operation. Likewise, schools and other institutional settings will not adopt these measures and reopen unless their public health agencies approve their use.
Beyond helping our society reopen, widespread application of these technologies could not only stop the current pandemic, but prevent future pandemics at a fraction of what has been spent on just the response to the SARS-CoV-2 virus. 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, is reduce the concentration of virus 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 have a chance to reach pandemic levels. Isn’t it time we consider The Third Way mitigation measures rather than only following the public health agency infectious disease dogma?
Signed and co-signed by:
Principal Lambent Hygienics
BS Microbiology, MS Environmental Engineering
BS Microbiology, MS Environmental Engineering
Principle Lambent Hygienics