The new coronavirus can possibly be transmitted through the air in crowded indoor settings with poor ventilation such as restaurants, gyms, night clubs and offices, the World Health Organization (WHO) has said, as lockdown restrictions are being eased globally.
The health agency on Thursday published an updated scientific brief on the different modes of transmission of COVID-19, the highly contagious respiratory disease caused by the coronavirus, identifying the different locations and circumstances of virus spread.
According to the WHO, the coronavirus is primarily transmitted by droplets through direct or close contact with an infected person and indirect contact through contaminated surfaces, also known as fomite transmission.
But the possibility of airborne transmission, combined with droplet transmission, cannot be ruled out in specific settings and more research is needed, it said.
In an exclusive interview with Al Jazeera, the WHO’s technical lead on COVID-19, Maria Van Kerkhove, and the agency’s chief scientist, Soumya Swaminathan, talked about the possible ways of COVID-19 transmission, the risks and the preventive measures.
Al Jazeera: Can you explain how airborne transmission takes place exactly and under what circumstances and environments does it pose a higher risk?
Maria Van Kerkhove: Airborne transmission has to do with the size of the droplets that are expelled from people, how long they can be suspended in the air and the distance they can potentially travel. Because they are lighter than respiratory droplets, they can travel through the air further than heavier droplets that tend to fall to the floor much quicker.
We know there can be aerosol transmission in healthcare settings where specific medical procedures, called aerosol generating procedures, are conducted on sick patients.
There’s also the possibility that there could be these smaller particles that come out of people’s mouths when they talk, sing and engage in fitness activities.
Soumya Swaminathan: This is not a virus that’s just floating around in the air and is going to come and infect you – it does require prolonged contact with infected people.
We sometimes refer to these so-called airborne transmission events as super-spreading events, because in these closed environments there have been situations where people get infected – at the meat-packing plants, the choir practice, the night club, the dormitories.
These are spaces where people spend a lot of time together, in poorly ventilated settings and in close proximity. In that situation, if you have someone who is quite infectious and who is either coughing or even just singing even and talking loudly, droplet, contact and fomite transmission can occur, but small particles could be around in that air for some period of time – it’s being together in that environment that is risky.
Al Jazeera: From your research and the evidence collected, how much has the aerosol mode of transmission contributed to the pandemic so far and how do the risks of airborne spread compare with droplet transmission?
Van Kerkhove: From all the available data in all the observational and epidemiologic studies, and the experiences of member states that report to us, the predominant mode of transmission is through droplets and contact. There may be airborne transmission happening in specific closed settings but the extent of that seems to be small. However, there’s a lot of research ongoing in this area, and evidence supports that transmission is predominantly through the droplets and prolonged contact.
Al Jazeera: Is the possibility of airborne transmission a cause for additional concern for the public?
Swaminathan: It’s one more mode of [transmission]. We’ve been laying out the precautions that people need to take and also what the public health authorities need to do. With offices, workplaces and recreational places opening up, people need to remember that these are all the different modes of transmission that you need to be careful about and take precautions against.
While I think many people appreciate the importance of handwashing and respiratory etiquette, perhaps what they forget is that when they gather together in these closed and crowded settings that they can still transmit if they are not maintaining the appropriate physical distance.
This is not a virus that’s just floating around in the air and is going to come and infect you – it does require prolonged contact with infected people.
Soumya Swaminathan, WHO’s chief scientist
The first thing is to improve ventilation in closed settings like offices, shops and workplace settings. A simple way of doing this is by opening doors and windows and ensuring good air circulation.
If ventilation cannot be improved, then people should avoid such places or wear face masks when they are in close proximity to people – whether its public transport or in shops.
Al Jazeera: Are you reviewing your guidelines?
Van Kerkhove: Yes, constantly. As more information becomes available, we always look at the guidance and we aim to update all of our guidance regularly.
Swaminathan: In fact, we are working on the clinical treatment guidelines now and our guidelines’ development group people is meeting almost every day to provide an update on the use of steroids, on the use of hydroxychloroquine and other drugs.
Thanks to the huge volume of research on COVID-19, it is our endeavour to constantly keep up with emerging data, to analyse and synthesise the evidence and use that to update our guidance.
WHO Chief Scientist Soumya Swaminathan attends a news conference in Geneva Switzerland [File: Fabrice Coffrini/Pool via Reuters]
Al Jazeera: Specifically for airborne transmission, what potential measures are recommended to protect yourself?
Van Kerkhove: Where we know that there could be aerosol transmission, like in medical procedures, we recommend airborne precautions. These are specific types of Personal Protective Equipment that people who are actually performing the procedure and are working in that setting have to wear.
In other situations outside of healthcare facilities, there is a comprehensive package of measures that need to be adhered to in all countries. This starts with identifying cases – symptomatic and asymptomatic – so they could be isolated and cared for quickly.
It also includes identifying the close contacts of infected people so that they could be quarantined in appropriate facilities or safely at home. It includes the use of fabric masks in specific settings where you cannot do physical distancing, where you could have crowding and poor ventilation. We also recommend the usual hand hygiene and respiratory etiquette always – and trying to avoid crowded situations, to begin with.
This interview has been edited for brevity and clarity.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
