If Aerosols Transmit Covid-19, It Is Even More Prudent to Wear Masks

(p. A1) The coronavirus is finding new victims worldwide, in bars and restaurants, offices, markets and casinos, giving rise to frightening clusters of infection that increasingly confirm what many scientists have been saying for months: The virus lingers in the air indoors, infecting those nearby.

If airborne transmission is a significant factor in the pandemic, especially in crowded spaces with poor ventilation, the consequences for containment will be significant. Masks may be needed indoors, even in socially-distant settings. Health care workers may need N95 masks that filter out even the smallest respiratory droplets as they care for coronavirus patients.

Ventilation systems in schools, nursing homes, residences and businesses may need to minimize recirculating air and add powerful new filters. Ultraviolet lights may be needed to kill viral particles floating in tiny droplets indoors.

The World Health Organization has long held that the coronavirus is spread primarily by large respiratory droplets that, once expelled by infected people in coughs and sneezes, fall quickly to the floor.

But in an open letter to the W.H.O., 239 scientists in 32 countries have outlined the evidence showing that smaller particles can infect people, and are calling for the agency to revise its recommendations. The researchers plan to publish their letter in a (p. A5) scientific journal this week.

. . .

Dr. Benedetta Allegranzi, the W.H.O.’s technical lead on infection control, said the evidence for the virus spreading by air was unconvincing.

. . .

But interviews with nearly 20 scientists — including a dozen W.H.O. consultants and several members of the committee that crafted the guidance — and internal emails paint a picture of an organization that, despite good intentions, is out of step with science.

Whether carried aloft by large droplets that zoom through the air after a sneeze, or by much smaller exhaled droplets that may glide the length of a room, these experts said, the coronavirus is borne through air and can infect people when inhaled. Continue reading “If Aerosols Transmit Covid-19, It Is Even More Prudent to Wear Masks”

Many Men “in the West” View Mask-Wearing to Be “a Sign of Weakness”

(p. A4) As countries begin to reopen their economies, face masks, an essential tool for slowing the spread of coronavirus, are struggling to gain acceptance in the West. One culprit: Governments and their scientific advisers.

Researchers and politicians who advocate simple cloth or paper masks as cheap and effective protection against the spread of Covid-19, say the early cacophony in official advice over their use—as well as deeper cultural factors—has hampered masks’ general adoption.

There is widespread scientific and medical consensus that face masks are a key part of the public policy response for tackling the pandemic. While only medical-grade N95 masks can filter tiny viral particles and prevent catching the virus, medical experts say even handmade or cheap surgical masks can block the droplets emitted by speaking, coughing and sneezing, making it harder for an infected wearer to spread the virus.

. . .

Male vanity . . . appears to be a powerful factor in rejecting masks. A study by Middlesex University London, U.K., and the Mathematical Sciences Research Institute in Berkeley, Calif., found that more men than women agreed that wearing a mask is “shameful, not cool, a sign of weakness, and a stigma.”

For the full story, see:

Bojan Pancevski, Jason Douglas. “Mask-Wearing Still Meets Resistance.” The Wall Street Journal (Monday, June 29, 2020): A4.

(Note: ellipses added.)

(Note: the online version of the story was updated June 29, 2020, and has the title “Masks Could Help Stop Coronavirus. So Why Are They Still Controversial?”)

“All You Need Is a Pair of Eyes”

(p. 1) MUNICH — Dr. Camilla Rothe was about to leave for dinner when the government laboratory called with the surprising test result. Positive. It was Jan. 27 [2020]. She had just discovered Germany’s first case of the new coronavirus.

But the diagnosis made no sense. Her patient, a businessman from a nearby auto parts company, could have been infected by only one person: a colleague visiting from China. And that colleague should not have been contagious.

The visitor had seemed perfectly healthy during her stay in Germany. No coughing or sneezing, no signs of fatigue or fever during two days of long meetings. She told colleagues that she had started feeling ill after the flight back to China. Days later, she tested positive for the coronavirus.

. . .

Dr. Rothe and her colleagues were among the first to warn the world. But even as evidence accumulated from other scientists, leading health officials expressed unwavering confidence that symptomless spreading was not important.

In the days and weeks to come, politicians, public health officials and rival academics disparaged or ignored the Munich team. Some actively worked to undermine the warnings at a crucial moment, as the disease was spreading unnoticed in French churches, Italian soccer stadiums and Austrian ski bars. A cruise ship, the Diamond Princess, would become a deadly harbinger of symptomless spreading. Continue reading ““All You Need Is a Pair of Eyes””

Mainstream Science, and Governments, Rejected Early Evidence of Symptomless Transmission

(p. 1) MUNICH — Dr. Camilla Rothe was about to leave for dinner when the government laboratory called with the surprising test result. Positive. It was Jan. 27 [2020]. She had just discovered Germany’s first case of the new coronavirus.

But the diagnosis made no sense. Her patient, a businessman from a nearby auto parts company, could have been infected by only one person: a colleague visiting from China. And that colleague should not have been contagious.

The visitor had seemed perfectly healthy during her stay in Germany. No coughing or sneezing, no signs of fatigue or fever during two days of long meetings. She told colleagues that she had started feeling ill after the flight back to China. Days later, she tested positive for the coronavirus.

. . .

Dr. Rothe and her colleagues were among the first to warn the world. But even as evidence accumulated from other scientists, leading health officials expressed unwavering confidence that symptomless spreading was not important.

In the days and weeks to come, politicians, public health officials and rival academics disparaged or ignored the Munich team. Some actively worked to undermine the warnings at a crucial moment, as the disease was spreading unnoticed in French churches, Italian soccer stadiums and Austrian ski bars. A cruise ship, the Diamond Princess, would become a deadly harbinger of symptomless spreading.

. . .

(p. 10) Though estimates vary, models using data from Hong Kong, Singapore and China suggest that 30 to 60 percent of spreading occurs when people have no symptoms.

. . .

After two lengthy phone calls with the woman, doctors at the Robert Koch Institute were convinced that she had simply failed to recognize her symptoms. They wrote to the editor of The New England Journal of Medicine, casting doubt on Dr. Rothe’s findings.

Editors there decided that the dispute amounted to hairsplitting. If it took a lengthy interview to identify symptoms, how could anyone be expected to do it in the real world?

“The question was whether she had something consistent with Covid-19 or that anyone would have recognized at the time was Covid-19,” said Dr. Eric Rubin, the journal’s editor.

“The answer seemed to be no.”

The journal did not publish the letter. But that would not be the end of it.

. . .

On Monday, Feb. 3, the journal Science published an article calling Dr. Rothe’s report “flawed.” Science reported that the Robert Koch Institute had written to the New England Journal to dispute her findings and correct an error.

. . .

Dr. Rothe’s report quickly became a symbol of rushed research. Scientists said she should have talked to the Chinese patient herself before publishing, and that the omission had undermined her team’s work. On Twitter, she and her colleagues were disparaged by scientists and armchair experts alike.

“It broke over us like a complete tsunami,” Dr. Hoelscher said.

. . .

If Dr. Rothe’s paper had implied that governments might need to do more against Covid-19, the pushback from the Robert Koch Institute was an implicit defense of the conventional thinking.

Sweden’s public health agency declared that Dr. Rothe’s report had contained major errors. The agency’s website said, unequivocally, that “there is no evidence that people are infectious during the incubation period” — an assertion that would remain online in some form for months.

French health officials, too, left no room for debate: “A person is contagious only when symptoms appear,” a government flyer read. “No symptoms = no risk of being contagious.”

. . .

(p. 11) Dr. Rothe, . . ., was shaken. She could not understand why much of the scientific establishment seemed eager to play down the risk.

“All you need is a pair of eyes,” she said. “You don’t need rocket-science virology.”

. . .

While public health officials hesitated, some doctors acted. At a conference in Seattle in mid-February, Jeffrey Shaman, a Columbia University professor, said his research suggested that Covid-19’s rapid spread could only be explained if there were infectious patients with unremarkable symptoms or no symptoms at all.

In the audience that day was Steven Chu, the Nobel-winning physicist and former U.S. energy secretary. “If left to its own devices, this disease will spread through the whole population,” he remembers Professor Shaman warning.

Afterward, Dr. Chu began insisting that healthy colleagues at his Stanford University laboratory wear masks. Doctors in Cambridge, England, concluded that asymptomatic transmission was a big source of infection and advised local health workers and patients to wear masks, well before the British government acknowledged the risk of silent spreaders.

The American authorities, faced with a shortage, actively discouraged the public from buying masks. “Seriously people — STOP BUYING MASKS!” Surgeon General Jerome M. Adams tweeted on Feb. 29.

. . .

By the end of the month [March 2020], the U.S. Centers for Disease Control announced it was rethinking its policy on masks. It concluded that up to 25 percent of patients might have no symptoms.

Since then, the C.D.C., governments around the world and, finally, the World Health Organization have recommended that people wear masks in public.

Still, the W.H.O. is sending confusing signals. Earlier this month, Dr. Van Kerkhove, the technical lead, repeated that transmission from asymptomatic patients was “very rare.” After an outcry from doctors, the agency said there had been a misunderstanding.

“In all honesty, we don’t have a clear picture on this yet,” Dr. Van Kerkhove said. She said she had been referring to a few studies showing limited transmission from asymptomatic patients.

Recent internet ads confused the matter even more. A Google search in mid-June for studies on asymptomatic transmission returned a W.H.O. advertisement titled: “People With No Symptoms — Rarely Spread Coronavirus.”

For the full story, see:

Matt Apuzzo, Selam Gebrekidan and David D. Kirkpatrick. “How the World Missed Covid’s Symptom-Free Carriers.” The New York Times, First Section (Sunday, June 28, 2020): 1 & 10-11.

(Note: ellipses, and bracketed dates, added.)

(Note: the online version of the story was updated June 27, 2020 and has the title “How the World Missed Covid-19’s Silent Spread.”)

Modern Physics Puts Elegance and Beauty Over Practical Value

(p. C9) Fundamental physics, says David Lindley, has lost its way. “I am ready to declare that research in this area, no matter its intellectual pedigree and exacting demands, is better thought of not as science but as philosophy.” His book aims to show how physics emerged out of airy speculation in the 17th century and, in recent years, has sunk back into it. “The Dream Universe” is not a book that will please philosophers, nor indeed historians, though physicists will find the argument a familiar one.

The problem, says its author, has been an excessive reliance on “mathematical elegance and beauty and whatnot” in fields such as “particle physics, the unification of gravity with quantum mechanics, and cosmology.” . . .

“The Higgs mechanism is no one’s idea of beautiful mathematics,” Mr. Lindley writes. “There’s nothing natural or inevitable about it, certainly nothing elegant. But it does its job.” The same applies, it appears, to one of the biggest breakthroughs in astronomy of recent decades, the confirmed reality of a previously theorized quantity driving universal expansion at an accelerating rate. “The beauty or otherwise of the cosmological constant is a non-issue,” the author writes. “It has practical value, and that’s what matters.”

. . .

The modern rot set in, he maintains, with theoreticians such as Hermann Weyl and Paul Dirac, who spoke of beauty as well as truth in physics. “Galileo would have been aghast,” Mr. Lindley writes. “He had no patience with mystical blather.”

. . .

Mr. Lindley complains that “the more physics pushes into the subatomic world, the more arcane the mathematical tools it draws upon.”

For the full review, see:

Andrew Crumey. “Pulling on a String.” The Wall Street Journal (Saturday, June 13, 2020): C9.

(Note: ellipses added.)

(Note: the online version of the review has the date June 12, 2020, and has the title “‘The Dream Universe’ Review: Pulling on a String.”)

The book under review, is:

Lindley, David. The Dream Universe: How Fundamental Physics Lost Its Way. New York: Doubleday, 2020.

Anti-Hydroxychloroquine Lancet Study Retracted by Authors

(p. A7) Two major studies casting doubt on the ability of antimalaria drugs to treat Covid-19 patients based on data from a little-known Chicago company, Surgisphere Corp., were retracted Thursday [June 4, 2020].

The Lancet first pulled a study published late last month that found antimalarials provided no benefit as a treatment for Covid-19 infections while increasing the risk of heart problems and death. The New England Journal of Medicine then retracted a separate article, published in early May, that examined the impact of cardiovascular and blood-pressure drugs in Covid-19 patients.

. . .

Three of the Lancet paper’s authors said they decided to retract the paper after Surgisphere refused to share the full data set as part of a review triggered by concerns raised by outside researchers. The Lancet published a correction to the study on May 29.

“We always aspire to perform our research in accordance with the highest ethical and professional guidelines,” the authors, Drs. Mehra, Patel and Frank Ruschitzka said in a statement. “We can never forget the responsibility we have as researchers to scrupulously ensure that we rely on data sources that adhere to our high standards. Based on this development, we can no longer vouch for the veracity of the primary data sources.”

. . .

Following the study, the World Health Organization paused enrolling patients in clinical trials of hydroxychloroquine, although this week the organization said it resumed the trials.

In the days following publication of the study, however, other researchers began to raise questions about the Surgisphere data, first on social media and in emails, then in an open letter to The Lancet and the study’s authors. More than 100 researchers signed on to the letter.

For the full story, see:

Jared S. Hopkins and Russell Gold. “Antimalaria Drug Studies Are Retracted.” The Wall Street Journal (Friday, June 5, 2020): A7.

(Note: ellipses, and bracketed date, added. In the passages quoted above, where the online version differs from the print version, the quoted passages follow the online version.)

(Note: the online version of the story was updated June 5, 2020, and has the title “Hydroxychloroquine Studies Tied to Data Firm Surgisphere Retracted.”)

Hydroxychloroquine Clinical Trials Suspended on Basis of Lancet Article Containing “Major Inconsistencies”

(p. A11) A group of scientists who raised questions last week about a study in The Lancet about the use of antimalarial drugs in coronavirus patients have now objected to another paper about blood pressure medicines in the New England Journal of Medicine, which was published by some of the same authors and relied on the same data registry.

Moments after their open letter was posted online Tuesday morning [June 2, 2020], the editors of the N.E.J.M. posted an “expression of concern” about the paper, and said they had asked the paper’s authors to provide evidence that the data are reliable.

The Lancet followed later in the day with a statement about its own concerns regarding the malarial drugs paper, saying that the editors have commissioned an independent audit of the data.

. . .

In their letter to the N.E.J.M., critics of the work wrote: “Serious, and as yet unanswered, concerns have been raised about the integrity and provenance of these data.”

The letter points out “major inconsistencies” between the number of coronavirus cases recorded in some countries during the study period and the number of patient outcomes reported by the researchers over the same period.

. . .

Many of the scientists who first raised concerns about the database are involved in clinical trials of chloroquine and hydroxychloroquine, and they were forced to pause the studies for safety reviews after The Lancet study was published.

James Watson, a senior scientist with MORU Tropical Health Network, said his unit had to immediately suspend work on a large randomized clinical trial to see if chloroquine or hydroxychloroquine can protect health care workers exposed on the job to the coronavirus from infection.

“I saw very quickly this paper didn’t hold up to much scrutiny at all,” he said. “We started wondering, ‘Who’s been collecting this data, and where did it come from?’ We were quite surprised to see a global study with only four authors listed and no acknowledgment of anyone else.”

. . .

David Glidden, a professor of biostatistics at University of California, San Francisco, who reads all new publications about Covid-19 antiviral therapies as a member of a National Institutes of Health clinical guidelines panel, said he was immediately struck by the vagueness of the descriptions in both papers.

For the full story, see:

Roni Caryn Rabin. “Scientists Question Medical Data From Single Company Used in Two Studies.” The New York Times (Wednesday, June 3, 2020): A11.

(Note: ellipses, and bracketed date, added.)

(Note: the online version of the article was updated June 2, 2020, and had the title “Scientists Question Medical Data Used in Second Coronavirus Study.”)