#15,374
The reality of our current pandemic is that it isn't going to go away anytime soon, that we can't stay locked down permanently - and that like it or not - we have to find safer ways to live and work while the virus continues to circulate.
You'll note, I didn't say `safe'. Regardless of how many precautions you take, there is no absolute guarantee you'll come out unscathed.
While I go out to the grocery store every week, have made a couple of doctor visits this summer, and have spoken - at a distance of 2 meters or more - to several neighbors, I'm avoiding crowds, always wear a mask/face cover when outside my home, and I carry (and use) hand sanitizer like a maniac.
I'm very lucky, however, in that I'm retired and don't have to go to a job every day. For many people that isn't an option. And many workers are reliant on public transportation (buses, trains, subways, etc.) to get to work and back.
As we've seen repeatedly over the years, public transportation - which by its very nature is typically enclosed and crowded - is often linked to respiratory disease transmission.
In 2008, we looked at Japan's testing of Social Distancing On Commuter Trains during a severe pandemic, and in 2011's Viruses With A Ticket To Ride, we looked at a study that appeared in BMC Infectious Diseases, that looked at the incidence of ARI (Acute Respiratory Infection) presenting within 5 days of train or tram travel in the UK.
They found that recent bus or tram use within five days of symptom onset was associated with an almost six-fold increased risk of consulting for ARI.
More recently, in 2018's J. Envir. Health: Link Between Public Transport Use & Airborne Transmission Of Infectious Disease, we looked at a study published in Environmental Health, that - using some pretty heavy statistical analyses that are well above my pay grade - suggests a link between travel on the London Underground and the spread of respiratory infections.
Analysing the link between public transport use and airborne transmission: mobility and contagion in the London underground
Lara Goscé Email author and Anders Johansson
Environmental Health201817:84
https://doi.org/10.1186/s12940-018-0427-5
© The Author(s) 2018
We revisited some of these studies five weeks ago, when England ordered Mandatory Face Coverings For Public Transport. Yesterday the ECDC released a 19-page guidance document providing protocols for safer operation of trains and train stations across the EU during this pandemic.
While much of this document is specific to EU Rail system operations, annex 1 (page 13) contains a summary of the ECDC's most current available scientific evidence on COVID-19, which could be of value to anyone.
I've only posted the summary, so follow the link to download and read the full report. I'll have a postscript when you return.
COVID-19 Rail Protocol: Recommendations for safe resumption of railway services in Europe
Protocol
21 Jul 2020
The European Union’s Agency’s for Railways (ERA), the European Commission, and the European Centre for Disease Prevention and Control (ECDC) have developed the following COVID-19 railway protocol, outlining the operational guidelines for the resumption of railway operations in Europe. This protocol reflects the current status of knowledge about the COVID-19 disease and its pandemic effect. It summarises preventive measures considered effective at the date of publication, and complements measures taken by the European Commission to support Member States in re-launching mobility and tourism across Europe.
Note: COVID-19 can be transmitted through close contact with infected persons or and with surfaces or objects that have been contaminated by the secretions of infected persons. Any activity or situation that involves the gathering together of people poses a risk for the transmission of infection. Thus, all forms of transport that bring people into close proximity, particularly in closed/indoor spaces, poses an increased risk of transmission. Such forms of transport include busses, trains, planes and ships.Measures to maintain appropriate physical distancing and avoidance of contact with contaminated surfaces, together with strict hand hygiene and cough/sneeze etiquette, hygiene will decrease the risk of transmission, although but some risk will remain.
With no end in sight with this pandemic - and the likelihood of having a safe, effective, and readily available vaccine for the public within the next six months pretty slim - we are going to have to find ways to reduce the risk of infection while still keeping vital parts of the economy open.
In the past we've looked at a number of other higher risk settings for flu and/or respiratory infection transmission, including:
Study: Simulated Influenza A Transmission In An Office Environment
ICAAC Video: How Quickly A Virus Can Spread In A Building
BMJ: Flu Transmission Risks On AirplanesAnd we have numerous examples of how efficiently COVID-19 spreads on crowded cruise ships, in churches, and communal housing.
CDC MMWR: Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide
MMWR Early Release: COVID-19 Superspreading Event In A Church Choir
Singapore: Over 2,500 New COVID-19 Cases In Last 48 HoursSimply put, anytime you put two or more people in an enclosed space, you are creating a target-rich environment for SARS-CoV-2.
But last week's MMWR report (below), suggests that using relatively simple NPIs (Non-pharmaceutical Interventions) - such as universal masking and hand hygiene - can provide a reasonable level of protection even in enclosed, and crowded spaces.
Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy — Springfield, Missouri, May 2020
Weekly / July 17, 2020 / 69(28);930-932
On July 14, 2020, this report was posted online as an MMWR Early Release.
M. Joshua Hendrix, MD1; Charles Walde, MD2; Kendra Findley, MS3; Robin Trotman, DO4
Summary(Continue . . . . )
What is already known about this topic?
Consistent and correct use of cloth face coverings is recommended to reduce the spread of SARS-CoV-2.
What is added by this report?
Among 139 clients exposed to two symptomatic hair stylists with confirmed COVID-19 while both the stylists and the clients wore face masks, no symptomatic secondary cases were reported; among 67 clients tested for SARS-CoV-2, all test results were negative. Adherence to the community’s and company’s face-covering policy likely mitigated spread of SARS-CoV-2.
What are the implications for public health practice?
As stay-at-home orders are lifted, professional and social interactions in the community will present more opportunities for spread of SARS-CoV-2. Broader implementation of face covering policies could mitigate the spread of infection in the general population.
For those who believe there are only two options for society in this pandemic - full lockdown or wide open - there is a 3rd viable option; opening while living and working smartly, using NPIs.
But for that 3rd option to work, we have to be willing - as a society - to accept the inconveniences and limitations of NPIs, and decide to use them consistently and correctly.
These types of measures are what has allowed Hong Kong, Taiwan, Japan and South Korea to avoid the worst of the lockdowns and economic losses while suffering only a tiny fraction of the number of cases and deaths we've seen in the United States, Europe, or South America.
NPIs aren't perfect, but they are our best hope for getting through the next 6 to 12 months with the least amount of damage.
