Physical actions to inhibit COVID-19 infection

Figure 4 from Ai & Melikov, 2017

Politicians in many countries are fond of claiming that they are following scientific advice when telling us what we can or cannot do in an effort to prevent the spread of the coronavirus, COVID-19.  However, neither they nor the journalists who report their statements tell us what scientists have actually established.  So, I have been reading some of the literature.

A paper by Leung et al [1] published this month in Nature Medicine reports that surgical face masks could prevent transmission of human coronavirus and influenza viruses from symptomatic individuals.  Their conclusions were based on a study of 246 individuals ranging in age from 11 to more than 65 years old of which 59% were female.  Sande et al [2] in 2008, found that any type of general mask is likely to decrease viral exposure and infection risk on a population level; with surgical masks being more effective than home-made masks and children being less well protected.  The relative ineffectiveness of fabrics used in home-made masks, including sweatshirts, T-shirts, towels and scarfs, was demonstrated in 2010 by Rengasamy et al [3], who found that these fabrics had 40-97% instantaneous penetration for monodisperse aerosol particles in the 20 to 1000 nm range.  While in the same year, Cowling et al [4] conducted a systematic review of the subject and concluded there was some evidence to support the wearing of masks or respirators during illness to protect others, and public health emphasis on mask wearing during illness may help reduce influenza virus transmission.  There were fewer data to support the use of masks or respirators to prevent becoming infected.  So, the rational conclusion appears to be that we should wear face masks to protect society as a whole and remember they do not necessarily protect us as individuals.

The emphasis on social distancing is causing widespread economic distress and also appears to be causing a decrease in mental health.  It perhaps should be called physical distancing because that is what we asked to do – to keep 2 m apart or 1.5 m in some places.  In 2017, a team of engineers from the University of Hong Kong and Aalborg University in Denmark [5], concluded that a threshold distance of 1.5 m distinguished between two basic transmission processes of droplets, i.e. a short-range mode and a long-range airborne route.  They reviewed the literature, conducted experiments and performed computational simulations before concluding the risk of infection arising from person-to-person interactions was significantly reduced when people were more than 1.5 m apart because droplets greater than 60 microns in diameter are not transmitted further than 1.5 m; however, smaller droplets are carried further.  In the same year, Ai & Melikov [6] reviewed the airborne spread of expiratory droplets in indoors environments; they found inconsistent results due to different boundary conditions used in computer models and the available instrumentation being too slow to provide accurate time-dependent measurements.  However, it would appear, based on several investigations, that the risk of cross-infection is decreased sharply at distances of 0.8 to 1.5 m (see graphic).  Indoors, the flow interactions in the human microenvironment dominate airborne transmission over short distances (<0.5 m) while the general ventilation flow is more important over longer distances.  Hence, at short distances, the posture and orientation of individuals is important; while at longer distances, if the rate of change of air in the room is high enough then the risk of cross-infection is low.

These findings would seem to suggest that there is some scope to balance restarting social and economic activity with protecting people from the coronavirus by relaxing ‘social’ distancing from 2 m to 1.5 m unless you are  wearing a mask.  After all, we would simply following the example of Taiwan where there are almost no new cases.

References

[1] Leung NH, Chu DK, Shiu EY, Chan KH, McDevitt JJ, Hau BJ, Yen HL, Li Y, Ip DK, Peiris JM, Seto WH. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nature Medicine. 2020 Apr 3:1-5.

[2] van der Sande M, Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One. 2008;3(7).

[3] Rengasamy S, Eimer B, Shaffer RE. Simple respiratory protection—evaluation of the filtration performance of cloth masks and common fabric materials against 20–1000 nm size particles. Annals of occupational hygiene. 2010 Oct 1;54(7):789-98.

[4] Cowling BJ, Zhou YD, Ip DK, Leung GM, Aiello AE. Face masks to prevent transmission of influenza virus: a systematic review. Epidemiology & Infection. 2010 Apr;138(4):449-56.

[5] Liu L, Li Y, Nielsen PV, Wei J, Jensen RL. Short‐range airborne transmission of expiratory droplets between two people. Indoor Air. 2017 Mar;27(2):452-62.

[6] Ai ZT, Melikov AK. Airborne spread of expiratory droplet nuclei between the occupants of indoor environments: A review. Indoor air. 2018 Jul;28(4):500-24.

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