Playing poker with infections

The aerosol debacle seemed to be closed, but at the OMT the penny still hasn't quite dropped (Maurice wrote about it yesterday). If you think "I know that story by now" but you know it poker experiment not, read on anyway, it is amusing and easy to retell. The reason for writing this was also something I hear more and more often: "viruses do not exist" and "infection between people is impossible": it would all be a big scam and never proven – while I have seen dozens of pieces in which contamination has indeed been demonstrated. For example, at the end of 2020 I read a very imaginative study that convincingly shows that contamination of respiratory viruses does indeed take place via the air. It seemed to me mustard after the meal, but apparently not everyone has finished eating yet. The experiment in question was done in 1987 and was later confirmed in various ways, including animal testing. The air emerged as the dominant route of infection in the spread of respiratory viruses. Against the prevailing virological paradigm. In other words, aerosols.

The study is extensively introduced with a list of decades of futile attempts to demonstrate that air contamination was possible. However, this was always done through experiments that, according to Elliot et al., did not offer the right conditions for a proper contamination. Until then, it was generally thought that 5 to 15 minutes in the vicinity of a sick person should be enough to cause infection. That had to change, they wrote:

It seems possible that the absence of transmission of rhinovirus in previous aerosol experiments alone was due to insufficient intensity, duration of exposure, or both.

Elliot C. Dick, Lance C. Jennings, Katby A. Mink, Catherine D. Wartgow en Stanley L. lnhorn, afdeling Preventieve Geneeskunde, University of Wisconsin Medica/ School, Madison, Wisconsin

In this experiment, the researchers had a different hypothesis: the duration had to be longer. As we will see, that was a big step in the right direction. Subsequently, extensive attention is paid to the strict measures that were taken to prevent contamination outside the experiment. Lunches were consumed separately, objects were disinfected. Everything seems to have been thought of and the precautions are reported in detail. And were even "trial recipients" who were only present in strategic places (when changing clothes, for example, everyone had to wear surgical sterile suits) to check that no infections could really take place there.

But how do you keep people going with each other for a long time, while they also occasionally have to pass on (contaminated) objects to each other? The answer is as simple as it is brilliant: card games with contaminated cards and chips.

The experiment consisted of poker tournaments, where the field of participants consisted of donors and recipients. The donors were infected with spray and drops inserted into the nose three days before the tournament date, again the day after. [Too bad they didn't measure the difference between those two methods, they did in other studies: the nasal doses were found to be many times higher than the sprayed ones to achieve the same effect].

The most cold participants were selected and placed at poker tables with receptive subjects, who tested negative for each session. The donors who were on the mend and whose cold symptoms were decreasing were immediately replaced by sicker poker players.

The participants always played poker together for 12 hours according to a tight rotation schedule, so that everyone spent a period at a table with everyone. And that three times, with always new supplies of fresh donors if necessary.

Poker was played in three settings.

Setting 1: Fomites only

In two strictly separate rooms, cards were played for 12 hours. In the first room 8 snot cold poker players, who were encouraged not to be afraid to smear the cards and the chips. In the other, secluded room, 12 negatively tested recipients played cards and chips that were brought fresh from the donor room every hour. To give an impression: the cards were sometimes too sticky to shake. The recipients were urged to touch their faces and noses at least every 15 minutes because they seemed to do so less than usual, which is not surprising with the apparent dirt on their hands.

Result: None of the 12 subjects caught a cold due to the intensive indirect contamination of snot and saliva via objects.

Setting 2: Fomites and aerosols

This was actually a normal setting. There were no special measures or restrictions, allowing all forms of contamination. The items were not handled very hygienically to give famite contamination a real chance.

Result: 12 of the 18 recipients caught a cold when they were both indirectly infected through objects and inhaled and exhaled from the same air as the donors.

Setting 3: Aerosols only

Donors and negatively tested recipients are just sitting in the same room. To prevent any kind of touch to the face of the recipients, the receivers were equipped with a large plastic collar (exp. A) or with arm braces (exp. B) preventing them from reaching their faces with their hands. In case of itching of the nose, they were helped by one of the assistants who tested negative. The entire setting was aimed at allowing only airborne contamination.

Result: 10 of the 18 recipients caught a cold due to respiratory contamination alone: inhaling aerosols.

Conclusion

Pharmacy transfer was not possible. The difference between aerosol transfer with and without fomites was negligible and no greater than could be expected by chance.

These results suggest that, contrary to current opinion, transmission of the rhinovirus, at least in adults, occurs primarily through the aerosol route.

Elliot C. Dick, Lance C. Jennings, Katby A. Mink, Catherine D. Wartgow en Stanley L. lnhorn, afdeling Preventieve Geneeskunde, University of Wisconsin Medica/ School, Madison, Wisconsin

This was a very brief summary. The study is available behind a paywall at The Journal of Infectious Diseases Vol. 156, No. 3 (Sep., 1987, pp. 442-448 (7 pages), Published By: Oxford University Press and costs $39,- to download.
The Abstract can be found here, including the text of this article, also as a Dutch version.
© 1987 by the University of Chicago. All rights reserved. 0022-1899/87/5603‐0004$01.00

Editor's postscript

With this knowledge from 1987, let's look at how 33 years later our policymakers (through Hugo de Jonge) and their prominent top advisors (OMT member Marion Coopers Koopmans) was explained.

"Yes, how do you call someone, well look, if you want to call someone, and that number starts, for example. with a five, then you have to put your finger in the hole where you see the five behind and then you have to turn to the right until you can't go any further because there is a pin there, that kind of stops you. Then you take your finger out of the hole and turn the next number."

Prof. Dr. Mario Coopmans, Head of Advanced Communication Sciences, Erasmus University

For example, the fallacies put forward by OMT members to reject the aerosol theory were.

• "Ferrets are not humans" (following animal testing)
• "we are here in the Netherlands" (for foreign research)
• "that has never been clinically proven" (in laboratory tests – which also turns out to be incorrect)
• "Corona is not the flu!" (in a punitive tone, after which the layman is embarrassedly silenced)
• "research into this would be frowned upon" (to indicate the unshakable dogmatics for which the scientific method had given way)

And now?

Trust in government officials and academics continues to decline, especially towards the health/pharmaceutical sector. They have an image problem that cannot be solved without structural changes because they really just can't do it. They are incapable of doing science, in which my confidence is undiminished. However, the scientific method is no longer applied and it starts with being transparent and always demanding the same transparency from others.

The failed respect is therefore what is due to them. Policymakers are no longer the sensible, competent people to whom we want to entrust leadership. Doctors have been played by their suppliers. Not to mention journalists.

In their desperate resistance to that reputational decay, they become increasingly fierce and vicious, like a bear being pushed further and further into the corner. It's going to lash out.

In the event of system failure, the actors themselves are unable to adjust the system. After all, that would be an acknowledgement of the fact that they have collectively made a mess of it. Because this failure is about egos, positions and careers, and not about the national interest or public health, they will fight their positions to the last gasp. We'll see which shore the ship will eventually turn.