It’s happening again.
Not a global pandemic but the minimizing of airborne precautions for an event with human-to-human transmission of a deadly respiratory virus possibly spread by airborne transmission.
You’d think we’d have learned by now.
On May 8th, the World Health Organization (WHO) came out with recommendations for health-care workers dealing with patients with known or suspected Andes Hantavirus. Inexplicably, they are recommending “standard respiratory precautions,” meaning that until the transmission is specified by the WHO as airborne, wearing a medical mask, rather than an N95 or FFP2/3 respirator mask.
For a disease that has up to a 40-50 per cent mortality risk.
Hope for the best, plan for the worst is a cliché, for sure. But it is way better than hope for the best, plan for the best, which is what the WHO seems to be doing.
We’ve been here before. In 2003, SARS-1 ripped through several countries’ health-care systems, sickening and killing predominantly health-care workers, patients and their families. Fortunately, it didn’t spread widely amongst the public. Through the beginning of that event, in Toronto, only medical masks were used, though the spread only petered out when universal N95 respirator masks were instituted in early April 2003 (among other mitigation efforts).
Four years later, Justice Archie Campbell released the SARS Commission report. One of the most important recommendations? Treat all illnesses with pandemic potential and the precautionary principle: Presume airborne transmission until proven otherwise.
In March 2020, the WHO did exactly the opposite. FACT: COVID is not airborne is a tweet that still famously exists on the WHO’s X page. Twenty-five million (at least) deaths later, the WHO (and the U.S. Centres for Disease Control, the Public Health Agency of Canada and all other public health agencies) belatedly acknowledged airborne transmission. Some are even recommending airborne precautions when managing COVID (but curiously, not all).
Looking back, the WHO’s Jeremy Ferrar, referencing the airborne transmission error, said that it had resulted in an enormous number of deaths.
Echoing the Campbell report, the United Kingdom COVID inquiry quite recently released its Module 3 report, stating: “In future, such guidance should assume that all routes of transmission are possible until sufficient evidence emerges to prove otherwise.”
To add to the disarray, there is the 2020 NEJM report on the Andes Hantavirus variant (the same one that is on the cruise ship) that explicitly states the epidemiology is concerning for airborne transmission. Even more worrying: some transmission occurred in short, public exposures, like a birthday party and a wake. That’s in stark contrast to the assertions to the public that it “only happens” with very close, prolonged contact.
Thankfully both the European Centre for Disease Prevention and Control and the CDC have both put out advice for health-care workers to wear N95 respirator masks to prevent airborne transmission, Making it even harder to understand the WHO’s resistance to this application of the precautionary principle. This is a question best asked to its leadership.
The consequences, however, are profound.
It puts the health-care workers caring for these patients at unnecessary risk. It increases the chance that an outbreak, that could otherwise be managed adequately at an early stage, spreads further with very serious consequences for those infected. Maybe this outbreak won’t be the one that initiates a pandemic. But eventually another pandemic will occur, and its spread could be facilitated in part because of poor PPE guidance.
Unless we can learn.
Human infection with zoonotically transmitted hantaviruses occurs almost exclusively through inhalation of aerosolized virions from the dried urine, feces, or saliva of infected rodents.
Patient 0 has so far infected 9 other people.
Keep calm?