A Concerned Scientist @BE@qoto.org

@shonin

I know in my H5N1 thread I have skewed towards more dense science and it's not exactly accessible to everyone. I've had a hard time finding time to summarize everything.

If I could synthesize this preprint, plus other papers I read into a short(er) talking point, it would be this:

"Human IAVs preferentially bind SA-α2,6 (human receptor)"

https://www.biorxiv.org/content/10.1101/2024.05.03.592326v1.full.pdf (The paper cited in the CNN article)

"Ferrets are widely used as animal models for the study of influenza A infection because they have a similar distribution of SA α2,3-Gal and SA α2,6-Gal receptors in the respiratory tract as humans."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915228/

"Influenza A viruses are transmitted via the air from the nasal respiratory epithelium of ferrets"

https://www.nature.com/articles/s41467-020-14626-0

"Airborne Transmission of Influenza A/H5N1 Virus Between Ferrets"

https://www.science.org/doi/10.1126/science.1213362

@croissant

I guess you're asking me if I care whether there's pressure on the CDC to accept airborne transmission of pathogens?

I do, because change is only going to happen through insurance actuaries and courtrooms. The CDC declaring airborne transmission would eventually end in airborne precautions. The CDC citing "disagreement in the scientific community" and refusing to acknowledge airborne transmission will end with zero precautions.

I don't accept that public health is *eternally* dead. Progress is progress.

@croissant

Yes, I couldn't agree more.

So, rather than being happy that the WHO has put the aerosol people in charge, at least enough to acknowledge airborne transmission FOR ALL PATHOGENS going forward, and then pushing the CDC to make the same admission, we're instead going to quibble with terminology and give the CDC cover to ignore it?

@croissant

Correct. I have yet to see anyone argue they did the right thing.

@croissant

No one can justify their initial response.

The WHO - COVID is not airborne.

Everyone for 4 years - Declare it airborne!

The WHO - Here's a 66 page document painstakingly detailing how COVID is airborne titled "Indoor airborne risk
assessment in the context of SARS-CoV-2" followed by a 33 page document bringing the droplet people and aerosol people under one umbrella explaining how droplets can go through the air and be deposited AND aerosols can fly long distances through the air. To make both happy we'll put transmission in two subcategories:

Airborne transmission/inhalation and direct deposition.

Everyone - No, not like that!

I have chosen to die on this hill, and so I will continue. I was going to ignore this new opinion piece in The Lancet, but, I can't help myself in the end.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00244-7/fulltext

The first time I read it I gave up on the first paragraph.

Read this carefully:

"The report proposes that use of the unqualified terms airborne and airborne transmission in the context of infectious disease transmission should be avoided."

Followed by:

"It introduces new terms matched to specific definitions, including “through-the-air transmission”, “infectious respiratory particles”, “airborne transmission/inhalation”, “direct deposition”, “semi-ballistic”, and “puff cloud”. "

What this, literally, says is that we should replace "airborne transmission" with "airborne transmission/inhalation." This is what everyone is fighting over.

After it came across my timeline for the 20th time I decided I'd give the rest a read.

Paragraph two. Two examples of airborne being used in papers in the last 127 years to show that there was no confusion regarding the term "airborne"?

Compare that to the extensive writing of Prof. Jimenez on the history of the droplet dogma and decide if you think everyone understands this.

https://www.researchgate.net/publication/354772435_Echoes_Through_Time_The_Historical_Origins_of_the_Droplet_Dogma_and_its_Role_in_the_Misidentification_of_Airborne_Respiratory_Infection_Transmission

https://royalsocietypublishing.org/doi/full/10.1098/rsfs.2021.0049

https://onlinelibrary.wiley.com/doi/full/10.1111/ina.13070

Paragraph 3. Finally something we agree on. The WHO botched the last 4 years horribly.

The next paragraph is where this falls off the rails for me.

"This new WHO report appears to assume that because some infectious disease experts believe that the SARS-CoV-2 virus is airborne only “situationally” (ie, under unusual conditions),1"

I, for one, read this and went directly to the report itself because I was appalled. Guess what? The quoted word, "situationally", never once appears in the document, which is cited. Nor does "under unusual conditions." So now it's just quoting things that don't exist and citing them.

To be clear, it's citing a document titled "Global technical consultation report
on proposed terminology
for pathogens that transmit
through the air" not the document actually about COVID(https://iris.who.int/bitstream/handle/10665/376346/9789240090576-eng.pdf), while complaining about COVID.

I don't see a need to continue.

Mark my word. The CDC delayed their response to this document, whether or not they would go along and declare COVID airborne, because people are making it "controversial" and giving them cover to.

@theothersimo @trendless

I recently tried to find anything that had actually passed and was permanent, outside of emergency declaration, and couldn't find it. There was a lot of talk around it, but I don't think any of it was put into law federally. Some states took up laws around COVID liabilities for businesses, though.

I welcome any information otherwise as I'd like to look through any laws that may have passed that I missed.

@PacificNic

So, anyway, I've then seen a couple medical/science people I follow here seemingly using the terms interchangeably, and I think classically that would be fine. The belief would generally be "You're not testing positive so you have cleared the virus."

However, when the "COVID cautious" community discusses this I think the terminology is important. Having SARS-CoV-2 viral persistence is not going to be tested by PCR.

@PacificNic

I boost stuff without reading it all, too. I mean, to be clear in this case itself I read a few of the 18 cited papers about viral shedding, but not all of them.

References 92-110 are about viral shedding. 94, for instance, "SARS-CoV-2 prolonged infection during advanced HIV disease evolves extensive immune escape" discusses PCR testing a patient across 216 days post-COVID diagnosis.

It's a good discussion to have, because I know people are hyper focused on viral persistence right now. Understanding that when people say "viral clearance" it is almost always supported by nasopharyngeal swab PCR testing is key to the discussion, IMO.

@PacificNic

I didn't want to call that one out specifically(TACT), because I wasn't sure if that was what people are responding to, or if it was responding to someone else first, but I did have a look over the paper linked to in Nature. That gives citations to 18 other papers regarding HIV positive patients shedding viral COVID.

I did not look at all 18 to be clear, but, I pulled up the first couple and they both refer to PCR testing.