Open letter to the medical line
In one of the countless discussions on Facebook, I once again saw that someone wanted to put things in order in a long comment with a story about corona and, in this specific case, face masks. The story showed that there was a bell ringing somewhere in that head, but the clapper had lost its way. To be able to feel that, I try to trace something like that back to the type of person in the first place. I saw well-intentioned misconceptions, pedantic without special knowledge, fragments of (often outdated) insights or, and this is more difficult to do something about: wrongly combining 'scientific facts'. Then they have read something about it but still don't really understand it. So I went to his profile page: How old, what does such a person listen/read, what does his timeline look like. I didn't get very far because to my dismay I also saw what his profession was: ICU nurse. Really shocking.
You can say 'Yes, but it's not a doctor, it's just a nurse'. Doctors have that disdain, but I'm not a doctor. In addition, everyone, regardless of his profession, must 'understand' how he/she (may I say he for convenience?) how to protect himself and arm himself against virus infections. If someone who works in the ICU is already walking around with wrong concepts about infection, what does that say about their education? About his colleagues, his managers, the doctors, about the whole culture in the ICU, in the hospital...? Such a man works daily among the contaminated aerosols!
Intubations
Until recently, aerosol studies were almost exclusively about aerosol-generating actions in the ICU: intubations. Apparently there is a lot of chattering and splashing involved and the contaminated air from the lungs comes out through a tube, without having to bypass bends, valves, folds or wetness. Almost invisible splashes land on the face. The researchers did not look any further. The few studies that showed airborne transmission of viruses were not addressed. Aerosols were the domain of the ICU, they didn't need anyone else so no one had to interfere with that.
There are now piles of publications on virus transmission. And they still just don't know how it works in hospitals. Now I am not out to ridicule people, not even doctors. They really work hard and want the best for their patients. But for that you have to master the material. I find it worrying that it falls short in this.
It seemed as if only the RIVM/OMT was terribly behind. There are signs that the situation has not yet penetrated the entire medical line, with a few exceptions.
Below is the lesson from the ICU. He responds to someone who makes a fair comparison between breath through a (double-layered, I imagine) mouth mask on the one hand and a wind through underpants/pants on the other:
Do you know what you smell when someone farts? These are also aerosols. There may be virus in it, in sick patients. Why the advice to flush the toilet with the lid closed? The most dangerous aerosols do not attach themselves to anything, they float like a gas and can then be easily inhaled. The ICU assumes the opposite: that particles should be able to attach themselves to something in order to 'lead a life of their own'. That is exactly wrong. If particles attach themselves to something, they become harmless sooner. Contamination via objects is rare and outbreaks in this way are certainly rare. Which does not alter the fact that personal hygiene - and awareness of how you spread yourself - helps with virus control.
Then he mentions filtering the breath. In doing so, he forgets an important distinction. Nasal breathing filters, mouth breathing hardly does. Virus that lingers in the nasal mucous membranes gives the immune system more time to react. The mucous membranes are equipped for that function, they immediately alert the immune system and work the junk out again. The deeper in the airways, the more difficult that becomes, especially with stuff that reacts with lung cells.
With air filtering, you don't have to wait until you breathe in. Think of ionization, UV-C, HEPA filters, humidity. Or simply: open windows.
Another aspect: The smaller and lighter the aerosols, the more difficult to filter. You can imagine that larger aerosols fly out of control against mucous membrane folds or get stuck in the nose hairs. The smallest hitches a ride effortlessly with your breath and end up unhindered directly (deep) in the lungs. Those lungs are equipped to process clean air and try to extract what can be extracted from it. Almost the opposite of mucous membrane. "Being infected through the mucous membrane" is therefore also far too short-sighted or it is just completely wrong. You get sickest from virus that is precisely what not in the mucous membrane.
By the way, these are not special properties of corona, as the IC person states, this applies to all respiratory viruses and was discovered decades ago, if you look back. This has more to do with mechanics than with medicines. Doctors sometimes have difficulty with that. Just like they used to think they didn't have to wash their hands. "How can a doctor's hand infect someone of the people?" That was unthinkable. Fortunately, that is a thing of the past, although you can still see traces of that mentality in doctors like Andreas Voss. "How can a doctor's hand infect someone of the people? That doesn't matter..." you can hear him say it.
What is it that makes doctors pretend that corona would be so different from other respiratory viruses. Interestingness? The agreements were already known in January.
Face masks revisited
A face mask is a very coarse grille, compared to a virus. If you can smell cigarette smoke or fog a mirror through a face mask, aerosols will pass through. Do you put on a face mask against the smoke in a smoky room? At the end of the evening, you can smell how much smoke it has captured from the face mask. Nevertheless, you have ingested much more.
One and a half meters: Usually wrong
Another misconception: "The more distance, the less chance of infection". A dangerous half-truth that you really can't count on indoors, especially in winter. Just as an entire room stinks of smoke, it can also be contaminated with virus particles, even those of someone who has already left (talk about one and a half meters!). You breathe in those virus particles anyway, with every breath. Your personal viral dose threshold determines after how many breaths you get sick. That differs per person, per moment.
Then suddenly bacteria are mentioned in the ICU's explanation, but that is different from a virus, isn't it? That misses the mark here, but I am shocked that an ICU nurse uses those words interchangeably. (My mother taught 'Health Science' at the 'Domestic Science School', she really knew better.)
As an ICU, you also know a thing or two about the aerosol-generating intubations (I hope anyway). A face mask stops larger saliva and snot droplets. Unfortunately, those droplets do not cause many illnesses because it is difficult to inhale them. Those barely visible splash droplets during intubations were traditionally called aerosols.
The invisible 'gaseous' aerosols remained unaffected. Except for manufacturers of nebulizers and the medicines for nebulizers. If you read studies about this, you understand how infectious aerosols are. A dose of medicine administered by inhalation should be 20 to 50 times lower than other doses. And we're just talking about gas, not about 'droplets that are big enough to take on a life of their own'.
Appeal to all nurses and doctors who recognize themselves in the misconceptions: for God's sake, read up. There is so much more knowledge than that shown by the RIVM. And that also applies (I fear) to practicing doctors, medical managers, advisors. Much more effective measures can really be devised with fewer side effects. But if you get stuck in old views and confirm each other and even teach each other with outdated knowledge, then it will take generations before anything improves.
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