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The Health 202

A newsletter briefing on the health-care policy debate in Washington.

Ventilation is crucial, but until recently it took a backseat to other covid measures

The Health 202

A newsletter briefing on the health-care policy debate in Washington.

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Happy Tuesday, and thanks for reading. This is McKenzie Beard, The Health 202 researcher, bringing you the first of a two-part series on improving indoor air quality as a coronavirus control measure. 

Today’s edition: Senate negotiators expect to release the legislative text of a gun deal today, and children under 5 across the United States will start receiving coronavirus vaccines. But first … 

The White House was slow to stress ventilation as a primary covid precaution

For more than two years, scientists and researchers have known the coronavirus often infects people through ultra-tiny particles that hang out in the air — not just the bigger droplets that masks are supposed to protect against.

But it wasn’t until March that the White House pivoted its strategy to stress ventilation measures, in addition to face coverings, as a primary method of slowing the spread of the virus. It’s a prime example of how, throughout the pandemic, federal agencies have been slow to fold the latest scientific findings into their policy recommendations. But the science behind how the virus spreads has also fluctuated, particularly in the early days of the pandemic when so much was unknown. 

  • It was a science communications disaster,” said Don Milton, a University of Maryland environmental scientist who has advised the White House and others on airborne transmission.
Timeline

For much of the pandemic, the federal government heavily promoted the notion that the coronavirus primarily spreads through large droplets expelled from infected individuals by sneezing or coughing that fall to the earth quickly. 

“The control measures that followed were to stay six feet away and wash your ketchup bottle,” said Joseph G. Allen, director of Harvard’s Healthy Buildings program. “It was foolish, and it all starts with asking how [the virus] spreads.”

But for just as long, some researchers had been finding that the primary spreader was instead microscopic particles — measuring about the width of a strand of hair — that can linger in the air for hours after an infected person has left. Here’s a timeline:

March 17, 2020: Officials from the Centers for Disease Control and Prevention, the National Institute of Allergy and Infectious Diseases and other researchers published a letter detailing findings that the coronavirus remained viable in aerosols for several hours.

April 1, 2020: A scientific panel wrote in a letter to former president Donald Trump’s White House that research shows the coronavirus can spread not just by sneezing or coughing, but also “normal breathing.”

July 6, 2020: More than 230 scientists publish a letter urging the World Health Organization and other public health agencies to acknowledge evidence about the likelihood that the coronavirus can spread through the air. They cautioned that control measures like social distancing are “insufficient to provide protection from the virus.”

Aug. 26, 2020: National Academies holds a workshop on covid-19 transmission, where researchers resoundingly agree there is ample evidence the virus is airborne. Anthony S. Fauci, head of the National Institute of Allergy and Infectious Diseases, notes in a presentation that the coronavirus could be transmitted “via particles that remain in the air over time and distance.”

Sept. 18, 2020: The CDC for the first time updates its website to say that covid-19 could be spread through “respiratory droplets or small particles, such as those in aerosols” and that “indoor environments without good ventilation increase this risk.” The agency added a kicker:This is thought to be the main way the virus spreads.”

Sept. 21, 2020: CDC removes information about aerosols, saying a draft version of the proposed changes had been posted in error

Oct. 5, 2020: CDC says the virus can infect people at a distance greater than six feet under “limited, uncommon circumstances.”

May 7, 2021: CDC states that inhalation is one of the main ways that the virus is spreading and shifts away from the emphasis on the risk of picking it up from surfaces. In the fall, the White House identified improving indoor air quality as an important tool to curb the spread of covid-19 in the American Pandemic Preparedness plan.

March 23, 2022: The White House formally acknowledges for the first time that aerosol transmission has been the primary driver of the pandemic. 

Kimberly Prather, atmospheric chemist: 

Ventilation

Viruses can travel in several ways. In the early days of the pandemic, researchers at the White House's Office of Science and Technology Policy (OSTP) said their focus was largely concentrated on assessing the effectiveness of control measures like masking or vaccines. 

But in January this year, their attention shifted toward improving the nation’s indoor air as a strategy to combat the virus’s spread as Americans entered a new phase of the pandemic and began pushing for ways to keep schools and businesses open. 

“Sometimes it takes a little bit longer than you want in the government [to offer answers],” said Georgia Lagoudas, senior adviser for biotechnology and bioeconomy at the OSTP. 

  • Agreeing on the science, Lagoudas added, takes time, collaboration and feedback from all of the nation's leading public health agencies so the federal government can speak with one voice.
  • The CDC didn’t respond to multiple requests for comment.
Why it matters

The government’s declaration of how the virus spreads has significant influence over the way people protect themselves. Frequently changing and sometimes inconsistent guidance from authorities left many schools, churches, restaurants and other gathering places to navigate the most effective way to protect their visitors from covid-19 alone. As a result, many simply urged masking and six feet of distance. 

Had the science been followed more quickly, more effective, other solutions could’ve been recommended: opening windows to improve ventilation and installing portable filters in homes to clean the air. 

But spreading the message of covid spread through aerosol droplets was especially challenging. Up until now, the field of indoor air science has largely been left out of training for the medical profession, Milton said, so modern public health has lacked a deep understanding of what aerosols are and how they behave. 

“We need building engineers to sit alongside the MD’s and the epidemiologists when they do a cluster investigation and say, ‘Let’s evaluate what’s happening with ventilation and filtration,’ ” Allen added.

Krystal Pollitt, environmental health sciences assistant professor at Yale School of Public Health:

On the Hill

👀 Likely today: Senate negotiators expected to release gun bill text

The group of four senators writing the legislation worked through the weekend and had hoped to be done yesterday, our pals at The Early 202 report. But the process took longer, and now the expectation is the text will be released today. Mental health advocates have been waiting to see the final provisions that make it into the text, particularly as the framework was vague on details when it came to telehealth, mental health services in schools and other supports.

Politico reports that there's a hangup over inserting language from the Hyde Amendment, which bars the use of federal funds to pay for abortion in most cases. But the big question is whether the Senate has time to pass the package this week. Senate Majority Leader Chuck Schumer’s office says yes, but it depends on Republicans.

Coronavirus

The quest to vaccinate the youngest kids begins this week

The Biden administration is cautioning that it will take a few days to ramp up the last leg of the country’s campaign to vaccinate Americans against the coronavirus. 

Over the weekend, federal regulators gave final sign-off to two vaccines for the roughly 19 million children under age 5, one from Moderna and another from Pfizer and its German partner, BioNTech. Vaccines began arriving in some places Sunday, with many more likely reaching their destinations yesterday and today. 

Due to the federal holiday yesterday, some providers are just beginning to open up vaccination slots today. There will likely be more availability Wednesday and Thursday, Ashish Jha, the White House coronavirus coordinator, wrote in a tweet thread. 

On tap today: President Biden and first lady Jill Biden are slated to visit a coronavirus vaccination clinic hosted by D.C.'s Health Department. Biden will then deliver remarks at the White House on the availability of safe and effective vaccines.

More from Jha's 🧵:

Reproductive wars

Here’s what overturning Roe could look like

Last September, Texas began implementing the most restrictive abortion law to take effect in the United States in nearly 50 years. Nearly 10 months later, women have started to have babies they might not otherwise have carried to term. 

In a deeply reported piece, The Post’s Caroline Kitchener tells the story of Brooke Alexander, an 18-year-old who learned she was pregnant just 48 hours before Texas’s abortion ban took effect. Her story offers a glimpse of what roughly half the country would face if the Supreme Court overturns Roe v. Wade’s decades-old protections in the coming days or weeks, as is widely expected.

  • “Sometimes Brooke imagined her life if she hadn’t gotten pregnant, and if Texas hadn’t banned abortion just days after she decided that she wanted one. She would have been in school, rushing from class to her shift at Texas Roadhouse, eyes on a real estate license that would finally get her out of Corpus Christi.” …
  • “Looking at her [twin] daughters, Brooke struggled to articulate her feelings on abortion. On one hand, she said, she absolutely believed that women should have the right to choose what’s best for their own lives. On the other, she knew that, without the Texas law, her babies might not be here,” Caroline writes.

More from Caroline:

In other health news

  • White House national security adviser Jake Sullivan tested positive for the coronavirus on Saturday, the Associated Press reports. He was last in contact with Biden early in the week.
  • In Iowa: The state Supreme Court cleared the way for lawmakers to limit or ban abortion in the state on Friday when it ruled that residents aren’t guaranteed the right to the procedure under the Iowa Constitution, per the Associated Press.
  • More than 20 members of Congress are asking Google to crack down on misleading search results that direct people looking for an abortion to places that don’t perform the procedure and dissuade people from ending a pregnancy, The Post’s Kim Bellware reports.

Daybook

On tap this week: The House is slated to vote on a bill that would expand health-care and disability benefits to veterans exposed to toxic burn pits during their military service, as well as legislation on mental health and Biden’s new agency to speed up biomedical breakthroughs

Wednesday: A House Veterans Affairs subcommittee will meet to discuss legislation on mental and reproductive health care, among other items. 

Thursday: Deborah Birx, the Trump administration’s White House coronavirus response coordinator, will testify before a House panel probing the federal response to covid-19; the Senate Special Committee on Aging will discuss strengthening support for grandfamilies during the pandemic.

Also on Thursday: A panel of experts convened by the World Health Organization is expected to meet to consider whether the monkeypox outbreak should be considered a public health emergency of international concern.

Health reads

Inside One Abortion Clinic, Signs of Nationwide Struggles (By Gabriela Bhaskar and Abby Goodnough | The New York Times)

‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents ( by Usha Lee McFarling | STAT)

Despite Another Covid Surge, Deaths Stay Near Lows (by Benjamin Mueller | The New York Times)

Sugar rush

Thanks for reading! See y'all tomorrow.

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