Interview with Professor Jose Jimenez PhD about aerosol transmission of the coronavirus. We discuss the difference between an aerosol and a droplet. How the laws of Physics dictate how aerosols and droplets are propagated. How vocalisation increases transmission and the different numbers of aerosols produced by breathing, talking, shouting, singing. We touch on simple ways to protect yourself with then knowledge that SARS-CoV-2 is airborne. The sociology and politics around why the scientific evidence that shows that a coronavirus transmitted by aerosols is not widely accepted and acted upon.

Watch the full interview here: https://youtu.be/s2EWblCCKyM

Learn more at: https://kojalamedical.com/covid19theanswers/

Ten Scientific Reasons in Support of Airborne transmission of SARS-CoV-2”- https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00869-2/fulltext

Airborne transmission of Respiratory Viruses - https://www.science.org/doi/10.1126/science.abd9149

Kojala Medical presents Covid 19 The  Answers. The show that delivers the

scientific evidence-based knowledge that can  safely return us all to our pre-Covid lives.

My name is Dr. Funmi Okunola  and I'll be hosting the show.

Every week you can listen to me  interview a highly respected professional

about the science that can reduce your risk  of becoming infected with this coronavirus.

Hello listeners and welcome to COVID 19 The  Answers and our episode, SARS-CoV- 2 is airborne,

part 1. I'd like to introduce you to all  to Professor Jose Jimenez PhD. Professor

Jimenez is a distinguished Professor and institute  fellow for the cooperative institute for research

in environmental scientists sciences at the  University of Colorado at Boulder in the USA.

Professor Jimenez has been awarded the honor of  most highly cited researcher from 2014 to 2019

recognizing him as being one of the world's most  influential researchers of the past decade with

his research ranking in the top one percent by  citations for field in year in the web of science

with over 20 years of research experience in  aerosols he is in the top 10 most knowledgeable

environmental scientists in the world on  this subject matter which has led him to

research the transmission of disease during  this pandemic. Welcome! Thanks for having me

so Jose, I'm curious what led a Mechanical  Engineer into the world of Environmental Science

well I was interested in that I was studying  engineering as an undergrad in spain and not being

too sure about what to do you know once once I  graduated but then I was worried about environment

and pollution and climate change and I realized  that there were things I could do about it

so I started working in in that area and  that that brought me to aerosols and to

mass spectrometers and you know once you know  about aerosols then you understand or you can

help with disease transmission and that's why  we're talking today fantastic so I'm going to

get right into the questions. So Jose, you were a contributor to a paper entitled

10 scientific reasons in support of  airborne transmission of SARS-CoV-2

published in May 2021 in the lancet and to another  paper airborne transmission of respiratory viruses

published in science in august 2021 on  which most of my questions are based upon

I strongly advise the audience to read  these papers as they are very understandable

we will provide links to them in the show notes  so to limit transmission we have largely been

told to keep a six foot distance wash our hands  and wear a mask we have been informed by public

health that the coronavirus is spread through  respiratory droplets and surface or fomite

transmission what is your definition of  our title SARS-CoV- 2 is airborne. Okay,

so indeed we we were told especially at the  beginning of the pandemic in March 2020 that

the virus was spread in one or two ways we  were touching some someone's hand or a surface

like a door handle where the virus was  and then touching the inside of our eyes

the inside of our nose or the inside of our  mouth and that's how we were getting infected

or it was this these large droplets these  projectiles that we are talking to someone

and then they cough or they top very certainly and  these projectiles fly through the air and again

they can hit you inside the eyes inside nostrils  inside the mouth and if they don't hit you and

they miss you then they fall to the ground very  quickly right and that's why if you kept six feet

that was safe right now that's what we were  told and we were all you know disinfecting our

groceries or whatnot now you know two years  into the pandemic we know that was wrong

that was erroneous those two ways of  transmission they can happen but they are minor

there is one major way of transmission  which is we're breathing the virus in

we're inhaling it you can only and anything you  can breathe in this is basic physics doesn't fall

to the ground very quickly. Because if it's forced  to the ground very quickly, it falls so quickly, that

you can pull it up basically by breathing,  right?! So it's really this transmission through

the air that we call airborne is the main mode  of transmission, so this is really a huge change

in the pandemic. I has been I mean  scientifically it's clear and it's been

clear since really August of 2020 I would say,  but you know it hasn't been accepted everywhere

and you know but that's more sociological or  political reasons than scientific ones. Thank you

So I'm going to get right down to bare bones here  can you please explain the difference between a

droplet and an aerosol in addition please  provide your opinion on the controversy in

the scientific world on what size of tiny droplet  constitutes an aerosol on why this is important?

So basically droplets and aerosols are  the same at some level. They are both balls

of saliva or respiratory fluid that are in  the air, right? If we are infected with Covid

the virus can be in our saliva, or it can be in a  respiratory fluid which is the liquid that wets

the inside of our nose, our trachea, or bronchi,  right? And if the virus is there and we expel

a little ball of this fluid, the saliva, or the  respiratory fluid, it can have some virus and if

that virus gets to someone that's how you can  get infected right the difference is the size

and the behavior in the real world I mean  in a way you can say we could call them the

big ones and the small ones and then maybe that  would be easier to understand but in this field

the big ones are traditionally called droplets and  the small ones are called aerosols right and they

behave differently a droplet like I was saying  earlier, is two people are talking and then one

of them coughs or talks very excitedly, or yells  and there are these projectiles that you can see

actually with the red light that  fly through the air very quickly

and then they cut they land somewhere right and  those are the droplets that's the droplet behavior

now the aerosol is different. The aerosols are  much much smaller and they behave differently and

the typical aerosol that we we used to explain is  cigarette smoke and then you know someone exhales

cigarette smoke and it doesn't fall to the ground  and it's not a projectile right at the beginning.

You exhale it with a certain force but then it  stops the friction of the air stops it and it's

kind of there in front of the smoker right and  then it may it may go up it may go to the side

it may stay there it depends what the air is doing  it follows the air right and again the droplets

infect by impacting the aerosols by inhaling right  now so there is the I'm telling you there is the

big and the small but can we put numbers into  this how big is big, how small is small? So in this

domain, we're talking microns. A micron is a  millionth of a meter you know the virus is

a tenth of a micron, a bacteria is a micron, a  human hair is 100 microns that gives you some

the diameter of a human hair is about 100 microns,  right? So 100 microns you can see already but you

can see the thickness of a hair. A micron is too  small to see right so now the question is when do

you know these these things that these balls of  saliva and respect their fluid when do they behave

like projectiles and when do they behave like  smoke right? Where is that dividing line?

So there has been a long standing error and WHO are still their latest scientific brief still

contains this long-standing error, which says that  basically is five microns that's the difference

between which would be the size of a big bacteria  that's the difference between a projectile

and smoke right now that is absurd we have  known you know really for a hundred years

that is a hundred microns twenty times larger  and eight thousand times in mass this is not

a small error. This is an enormous error and why  do we know? For example because of rain, you know.

We have the weather predictions and  the meteorologists know very well that

the droplets in the atmosphere if there's if they  are 100 microns or larger they they rain basically

if they are 10 or 20 microns they don't you know  and for example one of the categories of pollution

that that is regulated by the for example by  the uscpa in the u.s or by other environmental

agencies in other countries is what we call pm10  which are particles with a diameter of 10 microns

and those float in the air you know and that's a  pollution if they fell to the ground you wouldn't

need to measure them or regulate them because  they will fall to the ground wherever they they

get lifted in the air right so that has been a  long standing error and where the error comes from

you know I don't know maybe we'll should  they go into that now or that because that

that joins with the history yeah,, I mean I  think I'm going to ask you a bit later but

I'm happy for you to go into it now if you want  okay so then this this thing of the five microns

is an error that dates from the 1960s and  we were very puzzled by it and it was really

during the pandemic working with Katie Randall  and Lindsay Mar and Lydia Buriba, as a

couple of historians and couple are so scientists  that we we just were so curious that we started

investigating why do they say five microns where  does this come from, right, and it turns out that

during most of the 20th century it was just denied  that any disease went through the earth that was

something you know someone very influential in  1910 said this is almost impossible you know and

that was accepted so then in the 1962 actually  there is a demonstration that tuberculosis is

airborne you know they put some guinea pigs  so they take the air from a hospital where

there's tuberculosis patients humans that have  tuberculosis and they take the air out of there

and they direct it to some cages with guinea  pigs and they see that they get infected with

tuberculosis but they had another set of guinea  pigs and the air was disinfected with UV light

and those don't get infected. So that was so clear  after many years of trying that nobody could argue

with that the only way those guinea pigs are  infected is because the tuberculosis bacillum

was in the air, so then it was accepted and then  there was a period of time about about 20 years

until the 1980s that really tuberculosis was the  only important disease that was thought to be

airborne, right? And people knew that to get infected  by tuberculosis these aerosols that you need to

inhale need to be smaller than five microns that  is for a specific reason for Tuberculosis because

the Tuberculosis bacterium needs to infect  a cell. It's called the Alveolar Macrophage.

It's something that's on your alveoli and you're  very deep lung. So this needs to be you know,

if you breathe it in and it sticks to your  nose, you don't get infected. It really needs

to get to the deepest part of the lung and for  that it needs to be smaller than five microns,

because bigger you know, the bigger the these  balls are, the clumsier they are and as they

start to go through your nose whatever they  end up sticking somewhere and they cannot

take the turns basically but the small ones  can. They follow. They are better and that's

you know, so then it seems that in the CDC someone  in the 1960s got confused and confused you know,

the droplets that fell to the ground in one to two  meters with with the aerosols that have to go deep

in the lung which are the five microns versus the  100 microns right now this is an enormous error

and it had been pointed out by aerosol scientists  multiple times yet infectious disease doctors had

not listened and the committee that put together  this scientific brief for who which is the

infection provision and control committee you know  was established by who because there was a new

disease COVID 19 so they established a committee  to see how it was transmitted and how we could

protect ourselves right now that committee had six  experts on hand washing but it had zero experts on

aerosols or airborne transmission, which is  shocking, but it still reflects that bias that

it was believed by that community  that airborne transition was almost impossible

and that you know COVID was definitely not  airborne, therefore you didn't need to have anyone

so they didn't have anyone in the committee that  could remind them that this was a known error.

I see, so I think from from what you're  saying someone made an error back in

the 1960's, or before that. It's been incorporated  into textbooks probably of learning and become a

medical dogma something that people believe  is correct when it isn't as you're saying

and then that's led on to you know an erroneous  belief? So what is the size of a SARS-CoV-2 virus

so the virus itself is very small so it's 0.1  microns and on the typical aerosol we think maybe

a micron or two microns and remember that the  volume of a sphere goes with the cube of the

diameter right so if you have a one micron  one micro neurosome and you have one virus

in there the virus is point one percent of the  volume right so which is what we think is going

on that mostly you know we don't expel naked  virus into the air as some some people imagine

what we expel is little balls of saliva and  then there may be a few viruses sprinkled in

there but most of the bowl the aerosol droplet  is saliva or respiratory fluid which is you know

mucin, mucus, sodium chloride and water, you know  things like that, and then there is a few viruses

sprinkled in there. And that's important when you  think about masks something like that. Some people

say things like oh the holes in the mask are  bigger than the virus is like yeah, but that

doesn't mean anything right because you are not  trying to stop the virus we are trying to stop

much bigger balls of saliva respiratory fluid  so why is it important that an aerosol is

considered to be up to a hundred micrometers  rather than less than that, less than five.

It is it that we're producing lots of different  sizes up to 100 micrometers that act differently

and then we're getting infected and that's  not properly considered is that is that what's

happening well the I would say that these are this  is an an important error but it's not the more

the most important I would say but they and the  significance is that and Dr. Anthony Fauci here in

the US acknowledged that this was an error. I think  it was in September of 2020. he was basically some

arrows of scientists some of my colleagues like  kim pray verdon milton lin simar reached out to

him and they talked to him and they explained to  him that this was an error and he acknowledged

that he gave a lecture at Harvard and he said you  know they explained to me and I believe them it's

an error. We thought for all these years that it  was five microns. It is not and then he said there

are many more aerosols than we thought because  nowadays all these things that we expel that we

thought they would be they were projectiles and  they are not projectiles, so there are many more

aerosols than they thought and that also means  whatever they thought was a droplet is no longer

a problem there are many fewer droplets than  they thought right so you shift you know the

weight and now we know that basically for  every one droplet we may expel we expel a

thousand aerosols and that one that one droplet  has one chance, either it hits you

in these relatively small objectives. It has to  hit you inside the eye, when you're not blinking.

Inside the nostril there, but even the droplet is  coming down and the nostrils point down probably

for evolutionary reasons your stuff doesn't  follow yourself it's very difficult or in the

mouth when it's open right, so this droplet has one  chance at hitting something very small at you know

half a meter to a meter distance is typically what  people talk about and then the aerosol is like the

smoke you accelerate and it's floating there, and  it's floating there, and it's floating there and

you're constantly breathing, and breathing,  and breathing and you're gonna have really

thousands of times more chance to breathe a virus  that's in an aerosol than a virus that happens to be

in that one projectile right yeah, that makes  it really clear now so of course because we

didn't consider on or properly understand that  there were so many aerosols being produced.

We didn't implement the proper protections that  we should have to prevent people from getting

infected with the virus with the coronavirus. So  am I correct in that? Yeah, I mean there is one

one nuance here let me let me try to explain  so I would say when I was saying that

there are two errors and one are wrong I  would say there's one that's more important

in the big picture and one that's less  important the more important one is is what

we call the droplet dogma which which really is  the belief that a disease that's transmitted most

when people are close and then people keep  more distance there's less transmission that

that's a droplet disease and it's transmitted  by these projectiles right and the reason why

transmission decreases with distance is  because the droplets fall to the ground that's

that's the droplet dogma then exactly what size  droplets I would say that's a secondary thing

it is I mean it's important for the reasons we  have discussed it's also important because it

reveals the deep ignorance in this field about  aerosols, right? It was something they thought

doesn't infect, so therefore they didn't study and  you assemble a committee of top scientists by the

WHO, who are experts on disease transmission. Nobody  in that committee understands the physics, right?

So that is useful and nobody at WHO either you  know, none of the who personnel who oversaw that

committee who work on that report saw that error. The second I heard that I was like

what? What are they saying, you know, immediately for  me if I had been in the committee I was like you

cannot publish. This is an error, right? But there  was nobody you know so I think that's the that's

some of the significance of the five micron order  but the other error is more significant because

because basically it was so it was Charles Chapin  was this epidemiologist in 1910 who who said that

you know that we we have empirical evidence by  then you know from the times of the plague or

or other diseases that that basically distance  helped, or the Crimean war, the distance helped if

you have more distance respiratory diseases are  transmitted less and you know it was there was

a possibility it was because of the error because  of these droppers that fell to the ground and this

person said it is because of the droplets that  fall to the ground and this really became a dogma

and it's something people learn in text books,  you know, in the medical field in the infection

prevention field and they never questioned it  and they never studied the details of the physics

of whatever because because they knew right  and they have many important things to study

they they were gonna study something that that  everybody knows is that way right so now the

problem is that that's an error that you know if  if something is transmitted less with distance you

know the fact that something that that's gravity  basically that something is functional is one

hypothesis is possible if these things exist and  they fall to the ground you would see that this is

decreases with distance but there is another  possibility if you if you take more distance

let's say from a smoker you know you breathe less  and less smoke right because the smoke is more

concentrated in front of the person as you keep  more distance you breathe less right and that's

also a plausible hypothesis right so airborne  transmission can also explain the decrease of

transmission with distance but then if if it is  droplets that fall to the ground if you are beyond

2 meters whatever you are completely safe right  the projectiles are not going to make it but now

if it goes in the air then in a poorly ventilated  location you could have a super spreading event

like we've seen in choirs and restaurants, or  whatever is less likely than getting infected when

you are closed because when you are close, you  are inhaling the most smoke, right? But if you're

in a room which is a box that traps the smoke, or  in a car, or whatever and you are not ventilating,

the smoke accumulates. This invisible smoke that  has a virus, that's a respiratory air resource

and you can get infected and that's what we see. So basically the for 110 years the medical field

confused gravity with the real explanation which  is dilution, right? So they so it's an error in the

physics. They misunderstood the physical mechanism,  but these are people who are not physicists don't

study physics that's not what they do and in fact  the methods of physics are very foreign to them

you know they think in terms of clinical trials  and different things and that's not how you know

that's a very rudimentary approach compared  to what we can use in physics because because

physics is less complex than biology you know so  that is the really the really major error that

there was and there was I mean I don't see other  way to say that there was this fundamentalism

about droplets. I mean, it was a dogma and there  is people and some of the most fundamentalist

people were people like Bonnie Henry in British  Columbia where I think you are or, you know, in

some places in Canada. I would say it's the hotbed  of droplet fundamentalism and is like you know

the and also it's associated with one other thing  that is you know they keep asserting that they are

right and they're droplets or whatever in the face  of evidence of overwhelming scientific evidence

but of course if you say we are the authority you  are not so you set up a what what I call medical

supremacy, you know, it's like you know we're  doctors because these are diseases we are above

you physicists there are societies and we get to  to say what the truth is and you don't have a seat

at the table and we get to say what's acceptable  evidence, and your evidence is not acceptable, right?

And you know if you set it up like that and those  are the people that control Public Health agencies,

you know, I can give all the interviews I  want, I can write all the papers in science or

the answer that I want, but if they say this is  not valid this is invalid evidence Jose doesn't

have the qualifications to have an opinion on  this then there you are, right? And that's

but I would say that's not science, that's  sociology of science, you know, at that point

well on this program we this is evidence-based. We believe that you, we know that you have

the evidence and that's why this series  has been created to give a voice to the

people like yourselves to tell the truth about  what's happening. I think it's astonishing that

environmental scientists people that were experts  on aerosol transmission were not included on the

World Health body I think it's astonishing that  in the face of all of the evidence that's been

released that's there as plain as your face and  mine that there's this this intransigent dogma

held about droplet theory and the non-acceptance  of SARS-CoV-2 being airborne. So the whole point

of our episode today is to explore your papers  and show the world. Because you know the general

public the evidence that's out there really and  they will hopefully demand for change because

because this hasn't been adopted. We're not getting  the protections that we need. We're not getting

our air filtered . We're not being, you  know, the air isn't properly ventilated and we're

continuing to get infected with SARS-CoV- 2 which  is dangerous as you know. But I'll move on now,

so thank you for those excellent explanations  which transgressed several questions that I

was going to ask. So just to sort of. There is  sorry, there is there is one thing that could

naturally come now maybe it's coming later, which  is try to explain: Why are the protections not

being implemented? But maybe I could explain that  now I can explain later whenever you want yeah,

I think I'll come back to that because I suspect  it's going to be a political answer. Am I correct?

Mix of answers,

So talking, shouting, laughing, singing, our basic  activities we perform every day. Can you please

explain to the audience how these activities  cause the formation of aerosols and by what degree?

Yeah so that's very important what you just said  we we produce aerosols, or many of us produce

episodes used when breathing. But we really produce  many more when we talk, when we shout, when we sing.

Also when we cough, or when we sneeze and what is  an aerosol? So we said it's a little bowl of the

saliva or respiratory fluids so we are you know  our cavities are wet with these fluids and they

have to come out. So it's is when the air comes out  when there are jets over for example in the mouth.

I say p, p and you can already see that if you have  any saliva on your lips, that jet of air going

over your lip may take some of it and make little  balls of virus. Right, so it's basically that

shear force we call that you have a surface that's  wet and there is the air is going by very quickly

and it can pick up a little bit of of that, of that  liquid and then it can exit in into the air. Now we

we do know there is very strong evidence  in the pandemic that vocalizations or talking or

shouting whatever is strongly associated  with transmission. Right, I mean, there are

many outbreaks in choirs. There are dozens and we  wrote a paper on one, but there is used many, many

outbreaks. But to my knowledge there is  no outbreak that I know of in a library,

or in a movie theater, where people are quiet.  Right so it is very clear and there is also many

outbreaks in bars where people are are shouting  because the music is loud. So it is it's very

clear. I think anyone disputes that vocalization  increases transmission and now vocalization

results in producing many more aerosols through  these mechanisms right sometimes is your vocal

folds you know how we how we generate the noises  basically so the air is rushing out of us and it

goes through the surfaces that that that move and  that's how we how we make some of the sounds right

and those surfaces the vocal folds are wet  basically in this saliva and it can some of these

can be picked up and come out of an aerosol, there  is also other processes in our lungs basically we

have something that is like like bubble formation,  you know, so we have like a bronchial which is like

a tube and you can think the tube collapses  when we exhale and then both sides are wet so

now when it opens up you have a formation like a  bubble like one of the kids bubbles used to film

and then as you open up that film breaks like  the bubble and you know the material it was in

that that bubble surface now it's an aerosol and  it can come out right and that fluid could have

the virus right so there are different ways in  which in which we produce our results now at the

beginning of the pandemic, WHO and other public  health agencies said oh that's not really a

concern what's self-concern is aerosol generating  procedures in the hospital which is like when

when do intubation, or different procedures in  which basically they put oxygen, or they that are

pretty aggressive with the respiratory system. Say  in those cases we can produce aerosols that comes

from the first SARS there were some cases it  wasn't very clear, but it's something that again

became a little bit of a dogma they were they were  sure that you could make aerosols in those cases

right now during this pandemic that hasn't been  investigated in a lot more detail and actually

what we see is that those procedures actually  don't make aerosols it's not intubation that

make aerosols. For example they when you extubate,  so someone who has been intubated and you remove

that system then we tend to cough and  it's the coughing that makes aerosols,

right, so that was also wrong, but  it's something, and it was, you know,

once all those scientists started doing  the measurements, it was obvious, but again

this was something that the doctors had concluded  based on patterns of transmission with SARS and

it hadn't really been investigated properly I  should say. Right, okay, and so from what i've

gathered from what you said today and also your  papers is that breathing produces a certain amount

of aerosols talking even more and shouting and  laughing even more again is that correct? Yeah

and by a lot I mean and there are different  numbers in the literature but some typical

numbers will be like maybe breathing you produce  a certain amount and talking maybe 10 times less

and the louder the talk the more the more you  produce and if you are shouting or singing maybe

it's 50 times more. Right, so this you know  so you can see how in a choir where you have

you know lots of people singing. You really  have 50 times the chance of having an outbreak

than in the library you know and on top of that  in the library normally you have less density of

people and people are breathing less air so yeah,  so the difference is is very large and as I said

that's really not not disputed, that the louder we we produce sounds, the more aerosols

we produce and the more outbreaks we see and  obviously that's critical for the public to know.

So that they can protect themselves. So that they  know if they're talking in an enclosed environment

and there's many of them talking then if they knew  that then they'd be aware that they should limit

themselves to those environments so that they  limit the amount of time that they're infected

I completely agree I mean I think it's  very important to to explain and there

are different ways people can adapt right  there is some people would like to use the

brute force force approach I have a colleague  from finland I think he and he said you know

we should tell everybody not to talk for  a month and then the virus would go no

and I told him I agree that would work now does  this that has no chance I mean it will work for

the virus but there's no chance I mean we will  have a revolution if you tell people not to talk

but there are other smarter things that we can  do and there is for example in the subway in

Mexico City or in Barcelona in some places  they have signs that say ‘please don't talk

in public transportation to reduce transmission  please type on your phone’ you know do SMS,

whatever, don't talk on the phone and people have  been following that and that that's something very

helpful in that moment that you're in a box you  can also explain to people it's like for example

you're working in an office and some of the time  you're quiet working in your computer and some

of the time you have to talk to other people, so  when you have to talk to other people, go outdoors

if you can. Right, and then you're making the  unsafe part you are doing it outdoors which is

a much safer location and then the part that's  safer something else is like you know because

we exhale many more viruses when we're talking if  we're gonna talk if we're in a situation or in a

like like now maybe where you are not wearing a  mask all the time when you should put it on is

when you talk right or when you're gonna sing  whatever which is the opposite that a lot of

politicians and people have been doing during the  pandemic you know we see people on TV constantly

they have the mask and then they're gonna talk and  they remove the mask, giving the completely wrong

example. You know, that's when they should  put it on you know, there is actually the

Public Health Department. I believe in Santa  Clara County in California and they always do

the briefings with the mask and I like all  this, these people really understand what's

what's going on. They're giving the right  example. But the other, so there are many

of these things that are not they don't cost any  money, or they are you know, and they are not that

difficult and they would reduce transmission  a lot but they haven't been explained because

for the reasons we already discussed. Well that's  why this program's here and you know, thank you

for that fantastic answer. Knowledge is power is  what I say. So aerosol production is affected by

other different factors such as different phases  of infection different sizes of human for example

a child versus an adult larger body mass index to  name a few. Can you please explain the different

variations in aerosol production and what this  means in terms of transmission? So that is

not very well known. I mean the parameters  that you have mentioned have been observed

to change also production, so it's clear that kids  in average children produce less aerosols, but

they still produce some. There was a paper out of  MIT where they saw obese people, or people who had

lung disease seem to produce more aerosols, but  the overarching factors there is huge variability

you take 10 people my age and gender and whatever  or you take 10 of these people or you take 10

children and they vary factors of a thousand in  how many aerosols they produce for reasons we don't

fully understand and we also know in the course  of the disease, because at the end the disease

is changing the properties of your respiratory  fluid and there are mechanical properties like

the viscosity that are very important or if it's  more dry or less drier or you produce more mucus

so that's changing how many aerosols we produce. So this is something where there is

a lot of research and a lot of results, but is  not well understood. I mean at the end I think

they we have to use the precautionary principle  I cannot you know if if I could tell you well is

is people from Spain between 45 and 55 year old  that are the highest or producers then you could

you know keep you know, but there is nothing,  there is no recipe. I can tell you it's people who

for blonde or whatever that that are the hierarchy  producers, it can be anybody, right? Based on what

we know and also anybody can be infected and be  contagious during this pre-symptomatic phase.

Right, so you kind of have to assume during  periods that there is a lot of people infected.

That anyone you're with could be infected,  right? Even if they're vaccinated. Even if

they already have COVID. We are seeing people who  had Omicron and they are getting infected again

pretty quickly. So you know, so you just assume  that that the people you are with indoors could

be infected and then you protect yourself. You  ventilate. You wear a mask or whatever, depending

on you know, the how many cases there  are, the level of precaution that you,

or the level of risk you're willing to  accept and yeah, there's no, there is no

Rule. We can give you know, with  this type of people is always safe,

or these type of people are very dangerous.  Okay. When reading your research, I found

the variables that affect aerosols particularly  interesting on the one hand the size physical

and chemical properties of an aerosol influence  where the virus can go and what it can do yet

another factor that adds additional variability  is the external temperature and weather condition

specific to the aerosols location in other words a  cold hot or humid external environment also has an

impact can you please explain these variable  effects and why they are important so again

this is an area of research and there are some  there is something that's known and some stuff

that's contradictory between different researchers  but it's clear that you know temperature like

like without food that's why we put food in the  fridge you know cold keeps preserves biological

things like viruses and that's what they do in a  biology lab they have freezers and that's how they

preserve the virus and heat destroys it faster.  Right now this is not a very big effect. Right,

I mean in it may have played a role for example  there were these meat packing plant outbreaks and

those those places are really are really cold  they're often at 10 degree c or 50 degree f

just so that you preserve the  meat and then the virus may be

being preserved in the air and be infected  for longer and that may play a role but

otherwise I tell people you know, don't don't  increase your thermostat by a few degrees thinking

that you're safe. That's not the thing to do you  know, humidity, we think it plays a role because

you know so you exhale this aerosols which as we  said is this bowl of saliva and respiratory fluid

that has sodium chloride mucin or other components  and a few viruses and they are you know floating

in the air around there and now if you expose this  to a high humidity environment it's going to swell

and pick up water in a dry environment it's  going to lose the water and become this clump

of dried stuff right kind of like like  the mucus on your nose right that type of

phenomenology but in a much smaller. Now the virus  is relatively delicate these these viruses are not

hardy like some bacteria you know and  they can be destroyed relatively easily,

so for example, if this aerosol is drying and  during the drying you're forming some crystals

that may break the virus, or on the other hand  that may protect the virus, you know, so now

that's kind of the general, or it may you  know, some chemical reactions that destroy

the virus may be faster in one situation than  the other. So that's kind of the general reason

why we think humidity plays a role. Now exactly  how you know, there is some results that say

low humidity is bad for the virus. I and there are  others that say low humidity is good for the virus

and I'm on the second camp. I mean we we published  a study with some colleagues from Argentina

and what we found is that when you had a dry spell  in Buenos Aires, nine days later like clockwork

you had more cases. I mean you had a humid period.  Nine days later you had less cases I mean it was

going up and down and up and down the humidity  and the cases were just following you know so

to me it seems to declare in the real world being  in a very dry environment is a problem you know

now some people hear this and say “oh should I  buy a humidifier?’ And I tell them, “no don't

buy a humidifier,’ if you buy a humidifier what  you're saying I'm gonna leave the virus in the

air if it's there and I'm gonna try to kill it  faster to deactivate it faster. Say if you're

gonna buy at the end, a machine that costs money  that you plug in the world, they have to maintain,

buy a filter that just removes the virus  from the air you know rather than leave it

there floating and trying to deactivate. Okay  thank you. Yes, very sort of complex things

to consider. So our environment clearly  plays a major role in aerosol transmission.

Can you please explain the behavior of the aerosol  when it's indoors, versus the aerosols behavior in

an outdoor environment? Yeah, so that's a great  question and we know one of the clearest things

of the pandemic is that there is much more  transmission indoors than outdoors about 20 times

more is the estimate right from from different  studies and we know this from very early in

the pandemic there was a study in Japan very  early on and they they saw this they follow

people who had met with people indoors and  outdoors and it was 20 times more likely

to infect someone indoors right now people talk  at the same distance in order another even they

talk a little closer outdoors because they you  don't have the ceiling so people feel a little

you know more comfortable getting closer,  so it's not that they are you know and these

droplets these projectiles are gonna come  in come out indoor and outdoor or whatever

just the same in fact those people may have to  talk louder because there may be cars. So maybe

more droplets. Right, so if it was these droplets  or the surfaces you know, you would expect that

transmission would be the same indoor and outdoors, but we see that this is 20 times less

this is an indoor pandemic and this can only be  explained by the aerosols, right, because indoors

you know the air moves about 10 times more slowly  even though you know many of us outdoors you don't

feel the motion of the air is still moving faster.  And you can experiment with smoke for example

and indoors on top of that is you know the  air may you know the smoke maybe you know at

the beginning dissipated, but then if you are  in this box which is the room which is fully

ventilated it will accumulate just like if  you're in the room with a smoker if you are

closed you are smelling the smoke immediately if  you are on the other side of a large room at the

beginning you see the smoke but you don't smell  it but after 10-20 minutes you smell it right

and you know because they are also strapped but if  you are at the same distance of someone outdoors

you know unless you are really unlucky with the  wind direction you know you see the smoke and

you smoke and it never gets to you because the  outdoors is used so much larger you have I mean

we said the cure of the pandemic of this droplet  dogma is confusing gravity with illusion right

and this is and really dilution is what explains  the indoor /outdoor, and not gravity, right? So then

sorry I forgot what was you were going somewhere  else with this question. Well I think I just wanted

I think where I'm going with that question  is that, when we're outdoors you've you've

you've correctly said that transmission  is 20 times higher indoors than outdoors

and you said because of the way the aerosols  behave that we don't have as much air movement

indoors and so they're suspended in the air as  we're producing them and then whoever's infected

and contagious it is allowing the uninfected and  non-contagious to to breathe in that contagious

virus and become infected in an indoor environment  when we're outside the air blows the virus away

and I guess the ultraviolet violet light from the  sun kills it so am I correct in in saying that

not quite I would say we said when we are  outdoors is mostly dilution so basically

there is more horizontal wind that's going to  take the virus away and dilute it and also you

don't have a ceiling right many times what we  exhale you know in places like like where you

live in canada or here most of the time we  are exhaling air at you know 37 degrees c

something like that and the air around you is  at 10 or 20 or zero so the this air that we're

exhaling is warmer and it rises but if you are in  a room it hits the ceiling and then it comes back

if you are outdoors it keeps going basically  and it gets very diluted so it's mostly dilution

now the UV light of the sun it can deactivate  the virus it can kill the virus but

it's not fast enough in general because  even under full sun it takes a few minutes

and under most conditions you know in the like  now the evening or the morning or a cloudy day

it really takes half an hour in many places  you know so then you know if you are with

some smoker and then they exhale some smoke a  few minutes later or half an hour later where

is that smoke it's just not not that relevant  because after you know it's really it will have

to be a much more intense UV light that to kill  the virus in seconds but that's not that's not

that would be very harmful for us you know so do  we need to wear masks outside when we're outside

in in periods of high transmission or for people  who want to protect themselves because they're at

risk or they want to be cautious we need to wear  masks outside in one situation which is when we

are close talking to someone right because that's  the situation in which you can imagine your tummy

to smoke and you can still you're crosstalking  to someone for a while you can still inhale

quite a bit of smoke depending the way the air is  moving right now if you're at a distance if you

are hiking if you are skiing you know I mean not  except maybe your skin let's say when you go in

the chair or when you're going there I mean I have  a cousin who got infected in one of these cabins

you know was that was close going skiing right  so there are the periods when you are sharing

the air when you're close to others that's when  we need to wear the mask now when when many times

in many many governments have had rules to say you  have to wear masks everywhere indoors and outdoors

and you know we are so scientists understanding  well it's more nuanced, like I just explained, but

when we talk to Public Health people, what they  tell us is well yeah, you are technically correct

but you know you in Public Health for the overall  public, you cannot give them complex instructions

about many things, for masks, all these things  for ventilation, all these things for washing

your hands, all these things because it's too much  and then people don't do it, or don't do it well

so they said you know so what we tell them is that  I need and if you tell people okay you have to put

the mask on when you when you you're walking on  the street now you meet someone up with your mask

on then take it off the people don't remember  to do that so you just tell them to wear it

at all times and then if they encounter someone  that's a token they're wearing the mask. Right,

very good point. Thank you for that due to  the difficulty in capturing tiny aerosols that

contain viable virus the scientific community does  not have consensus that SARS-CoV-2 is airborne

could you please explain why it is challenging  to capture and measure aerosols containing the

coronavirus because basically a very small amount  of virus in an invisible aerosol is enough to

infect basically I mean we said the virus is  tiny and you need a relatively small amount I

mean it's debate exactly how many copies of the  virus but maybe 10 maybe 100 that you need to

inhale which is a minute amount of material that  you need to inhale and that can get you infected

it's hard to detect that in the air you know  it's like so there can be a very small amount

that's difficult to detect by scientific  techniques and it can still be infected

you know and especially because as we know there  is another aspect which is that the disease is

very variable not everybody who has COVID is  infected. We know many people you know they get

infected the husband gets infected and they're at  home and the wife doesn't get infected or whatever.

You know it's like and there are many studies  that show many people don't exhale any virus

you know they measure the air that  they're exhaling and they don't detect

any virus but other people exhale very large  amounts of virus, hundreds of thousands of

viruses copies per hour, right? So then when you  do experiments, you have to be lucky that you catch

someone who is a high emitter and also people only  exhale a lot of the virus during a short period of

time before they have symptoms when you don't  know who they are, you know, so that when you go

to a hospital to measure the virus is not the best  place to do it but that said there have been there

have been already many publications where people  have found the virus in the air an infective virus

in their base there is virus that that then they  put in some cells and the virus is able to infect

the cells you know one other thing I guess I  should say in terms of this this later part of

the infectivity is that when you sample the virus  you know so you have to you have these balls that

float in the air and you have to take it out of  the air and often this is done by shooting a jet

of air against the surface. That's what we call  an impactor because then basically these these

balls cannot make the bend and then they impact  the surface but that process is very violent

for the virus right and it may it may destroy  it right so and basically all the all methods

use that type of technique and so we have now  pathogens like tuberculosis and measles that

everybody agrees they go through the air never in  the history of medicine has anyone succeeded at

you know sampling rumor where Tuberculosis  patients were and put that on cells and

managed to infect cells or with missiles is  the same thing right while we know that when

that that same air was was piped to guinea pigs it  was able to get them infected so if there is this

you know the air is big and the variability is  large and it's just a difficult problem now there

are there are some more recent developments  during the pandemic people have developed

now some other instruments that are much much  more gentle and they preserve the virus and

that's really how we have people have achieved  those demonstrations but it is a difficult problem

and reading your papers there's  been virus found in in hospital

vents and air ducts that could only have got  there if if through aerosols and there's been the

kind of guinea pig experiment done with  SARS-CoV-2 and another animal I believe

where one one set of animals was contagious  and infected the other set of animals wasn't

and they used a tube so that they breathed the  same air and the second cage became infected

proving that it was aerosol am I correct in that? You are correct it's been done with ferrets and it

has been done with hamsters and I believe also  with certain types of monkeys, so it has been

demonstrated in that way. yeah, I mean and  those are all I think, I mean, that's all

it took for tuberculosis to be accepted.  Right. It was an experiment with animals,

however you know during the pandemic we've  been told you know by by a lot of these

public health people that animal experiments  are not relevant because they are not human,

yet they were relevant on how fortify pluses  that was accepted based on animal experiments and

I mean in that paper in the Landsat that you  mentioned it was just not you know if you only

had the evidence of the Lancet you say 'oh maybe'  but we have the animals we have the indoor outdoor

difference we have super spreading events we  have you know so many like the fact that we have

captured viable virus from the air you know the  fact that there are really no arguments against it

against urban transmission the fact that we have  transmission with people without symptoms that are

not coughing and are not producing many droplets  we have transmission at a long distance you know

people for example who are in a quarantine hotel  in new zealand and they are in different rooms

and they basically never have any contact but the  air of one room goes under the door and then goes

under the door of the other room and gets three  people infected that has been published in a cdc

journal right is and then once you start  looking at everything all the evidence and

you see that it's coherent and the only way  you can explain all the observations together

is that transmission through the air is what's  important. So I think that really you've set the

stage for answering the question that you wanted  to kind of answer earlier in the program I mean

for me and lots of other medics, you know. The  evidence base for SARS-CoV being airborne is

categorically correct and there for all to see. So  why isn't this scientific evidence being accepted?

so that's that's a million dollar  question but I would say and I can

give you my approximation. I have thought a lot  about that question because I've been puzzled

by the resistance. Certainly in the  pandemic I thought once we explain to people

on Twitter, on papers, or whatever what's  going on then they will understand.

And that hasn't happened. The resistance continues  in many places. Right we've convinced some people,

or some people have accepted it, but many have not  even though it's now on the WHO webpage they say

it's airborne. But still many other public  health agencies don't accept it. And many,

many maybe will accept it and we'll  put it on webpage but then they won't

promote the measures, the masks, the ventilation,  whatever that go along with that acceptance. Right

so they take an intermediate position so why  is that? I think there is there are two reasons

or two families of reasons right one is scientific  or scientific, sociology and history and the other

one is political and these two reasons  are kind of reinforcing each other right

so the scientific reason has to do with  what I've mentioned earlier in the program

so there was an error and people you know  good faith scientists really believe this

was a droplet disease because it behaved like the  flu which they thought was a droplet disease and

it's true that early on you behave like the flu  the problem is that the flu is also airborne and

that's also something that they had rejected for  the same reasons right so then so there was this

this error that as I mentioned comes from 1910 and  this error is worth reviewing the history briefly

why could it that ever get so ingrained and  it really has to we have to go back to 2500

years ago hippocrates in ancient Greece I mean  basically they he came up with the theory of

miasmas they said when a lot of people are getting  infected at the same time with the same disease

it must really be the error because he's what we  have most in common right and so he put forward

that hypothesis and so then basically for two  cent two millennia basically humankind thought

we were getting infected through the air that was  the dominant there were other theories but that

was the dominant theory right and we get to 1850  not that long ago less than two centuries ago and

still that was the dominant theory was the  miasmas right and that was very scary you

know you could get tuberculosis or something just  by breathing it in there was little you could do

to defend yourself it was also kind of  phantasmagorical they didn't understand

dilution, right? It's not it's not that you're  breathing the air coming out of another person

but the disease may come from from putrid  matter miles away and then you get infected and

you know, so Chapin in 1910 thinks is more  contact transmission, it's when we are close to

someone and when we touch and that's when we get  infected and he comes at the right time because I

was saying until 98 until the 1850s it was really  the miasmas world dominant but then in the 1850s

Jon Snow shows that Cholera which was thought  to transmit through the earth really transmits

through water right and then Ignaz Semmelweis  in Vienna shows that the Purpura Fever that was

thought to transmit through the air, is emitted through hands and if you wash your hands, the cases go

down and then later in the 1890s there's other  scientists that showed that malaria and malaria,

‘mala area’ is ‘bad air’ in Italian it has always  been thought to be bad air and then they show no

no it's not the air, it's mosquitoes right? So now,  so we had thought for millennia that it was it

was the air and then suddenly all these big  diseases that that are you know kill a lot of

people are shown well so then there is the you  know people wonder well is was this was the era

superstition all along and really is not important  right and there was a fluid period but chapin who

was someone very respected says the air doesn't  happen that was that was a superstition we should

accept progress and germ theory and really his  contact is when we touch other people or this

spray droplets that fall to the ground  whatever and he is too successful you know

people you know he's he's taken he's taken  as progress you know people are tired of the

air that you cannot defend yourself and he's  successful because distance reduces disease

transmission and so does washing our hands for  some diseases whatever so that becomes a dogma

right and now you know during the 20th century  basically there is a resistance and even since

the 30s William Wells and other researchers were  trying to show that diseases like tuberculosis

and measles were airborne but they were  considered droplet diseases right and for

decades and decades you know measles which  now is used as a prototypical urban disease

it was accepted in 1985 after seven decades of  telling us it was a droplet this is so this wasn't

this wasn't easy to demonstrate and they were not  eager to accept it and there is even a paper on

smallpox there was a there was a clear airborne  outbreak where basically someone in a hospital

infected all these other people that were in  other rooms and when you put the smoke in the room

of the infected person it went to the rooms  of the people who got infected it was clear

it was to the air and there is a report from that  basically done in collaboration with WHO that says

you know, we look at the other possibilities  whether it was surfaces or droplets and it was

impossible so then we got to airborne transmission  with the inhalation of aerosols which it was a

possibility against which all the investigators  were prejudiced so they admitted that was that was

the move throughout the 20th century that urban  is something very unlikely you know and coming and

that propagates all the way to 2020. you know when  the pandemic starts and the who starts a committee

and in that committee there are zero experts on  airborne transmission but six separate hand washing

that comes that's the history right now those  people who were very prominent and you know

made an enormous error you know they said in in  march of 2010 that saying that the disease was

airborne was misinformation now they said that what  was misinformation is actually the main mode of

transmission and the things that work for that  main mode of transmission which are masks and

ventilation whatever we were not told they were  important until much much later for example by who

right so that error that certain people made in  public health and infectious diseases has led to a

lot of deaths and economic losses and whatever now  some of those people have accepted it some some

do not want to and i've been told by one of them  in private that we need to find a way that we can

accept this and we can save face so it's not  like he doesn't disagree that we're right it's

just he wants to save face, right and W choice is  a little bit on that department, you know, they

will put it on the web page because it will be  scientifically embarrassing not to accept it, but

then they don't say it if you search the Twitter  feed of WHO for the word 'airborne' is not there

basically in the last two years, so that's one  reason I think is there was this enormous error

that was a good faith error at the beginning but  then it has it has turned into into really res not

wanting to admit that you were wrong and that and  that your error caused a lot of a lot of death and

economic damage and this is the other reason  I think is political right because that alone

wouldn't be enough right if if for example  we were saying well it's transmitted through

through water or something that was easier  to control let's use filter the water you

the governments will have jumped at that and  will say oh this is so much easier to do than

than all these other things we're doing right but  what we're telling Governments is more difficult

to do Governments love the droplets and the  surfaces. Why? Because you know if you're getting

infected, because you're basically not washing  your hands enough and you're touching your face,

or because you're not keeping your distance right  that kind of thing if you get infected it's your

fault. You didn't wash your hands, you didn't  keep your distance, it's all your individual

responsibilities. So the governments  can tell people what to do, but they,

the governments don't have to do so much right on  the other hand. If you get infected by breathing air

that has a virus in a school, in a government  building, in a company now you as a student or as a

teacher in the school, you don't have the power to  clean that air and remove the virus from the air.

That's a responsibility of the school of the  government of the company and that's something

that that I mean cost some money and then you  have to take the responsibility if you don't

do it then you are liable for example in the us  for not having done it you know people can sue

you and things like that so I think that's that's  something that's a very important reason why they

they keep us as we yeah, I mean they don't want  to admit it clearly and that they want to keep

keep saying even though when it has  been so clear and with omicron and

it's just so transmissible you know how  could you how could anyone believe that

that's still the surfaces and the droplets  especially when everyone is so paranoid about

you know hydro alcoholic gel and all that you know  I think what you said is so critical and I think

two things have been brought to mind I think the  way we're taught science needs to be reformed

yes I had to do Physics and Math to get into  medical school in the UK. Well I chose to do

Physics and Maths and Chemistry and then and  did a GCSE in Biology to get into medical school

and so when I read your papers, I mean,  I accepted that SARS-CoV- 2 was airborne

around about sometime in 2020 anyway because I was  reading research about it and I could understand

and conceptualize the physics that you're talking  about because I've had that education in school.

I think at the moment the sciences are too siloed  it's a infectious disease specialists should know

about Physics since we're producing aerosols  which behave and obey the laws of physics

and then the World Health Organization wouldn't  have had a committee that was complete that had

not a single aerosol scientist sitting on it and  that's how the major form of trans transmission

the second thing with regards to the political  perspective I think they I think a lot of people

in politics expected the pandemic to be over  within a year or two or less and now this virus

is here to stay and really we need to adopt the  discoveries that people like yourselves have made

because millions are dying I think we've had  a hundred million I i can't remember my own

figures but 100 million people infected with the  omicron variant and there's more variants to come

because nearly 50% of the World's population is  unvaccinated, so we now have a degree of urgency

in accepting the scientific evidence, so that we  can all protect ourselves against ever getting

infected and if you listen to our episode on long  COVID even Professor Banerjee showed in one of his

research papers that even one infection from CoV-2  can lead to one or multiple organs being damaged.

So you know we need to adopt the science and thank  you so much for persevering coming on this program

and many others and continuing to educate  us of this yeah, and if I may comment

on those two issues, I mean you were talking  about the education of the doctors and

I mean I think this is one way I mean at the end  as I said, this was an error in physics confusing

the dilution with gravity made by people who  don't study physics very much and had a hard

time understanding but I think the other thing so  you could say well they should study some physics

and that would be one way to do it the other  way is through collaboration which is a way

the way a lot of people do you know doctors have  to study so many things that now you have physics

and it's something so foreign and whatever is  is that the best way another way is just to to

collaborate with people who know that stuff and  have an interest like you know people like like

myself and many others are so scientists or with  whoever relevant physical scientists building

scientists ventilation experts engineers you know  there is different type of people and we are more

than happy to help but as I said I mean it's been  very unfortunate that for example in I mean we

faced a lot of resistance early on trying to get  the message out and the journalists wouldn't talk

to us because they thought we were like the 5g  people it's like oh these urban people are some

conspiracy theorists and then we finally  had that that letter to who in july 6th

and then we got finally a lot of press coverage  and suddenly it seems that a lot of journalists

were like 'oh these guys are for real' and they  started doing interviews and WHO was very upset

about that and there is one of WHO scientists  in this panel, who basically said I think

like the quote was like these people are chemist  engineers, owners of ventilation companies

and they don't really understand infectious  disease and I mean despite the fact that they

were like 40 or 60 signatories to the leather  who were infectious disease people but also

but kind of saying establishing again these  dichotomies like we are the doctors we know

you guys are inferior and you don't know and  that's that's really the drama that there wasn't

a possibility for both fields of knowledge to to  contribute right I mean there is a diagram that

sometimes I use in the presentation and say  anything that's happening inside of the body

whether it be you know antibodies vaccines  organ damage whatever I mean I don't I don't

go there that's something for doctors or you know  people who study biology or biology to intervene

but once things go out in the physical world and  they're flying around and you need to breathe them

or they need to interact physically then physics  is part of the equation and that's not something

that should be medical supremacy that the doctors  basically what do they do they they look at

empirical patterns of transmission things like  with distance or we put this mask and there is

more less transmission but those things are very  crude and they don't look at the mechanism of

what's going on and they don't make use of a  huge amount of knowledge that we have about

how air moves how the viruses behave how they are  resource behavior all of these things so that's

that's really the sad thing and that hasn't really  changed significantly to this day you know who

that committee continues to not have anyone who's  never a scientist to my knowledge when you know

for a disease that's airborne. Half the committee  should be people with airborne expertise you know

and the same is true you know, and I think in the  CDC, or in the British Columbia, or in many places

we are in the same situation that we're still  in this medical supremacy and they're still

telling us that that we are just unqualified.  It's not like we it's not like you know,

we're having a debate of equals and they have more  argument no no we are unqualified to participate

and the things we say are not acceptable evidence  that's that's kind of what's what's bad now

on the second thing where you say we we need to  to do it and we need to accept it I mean I I'm not

you know it's I mean early on I was thinking you  know we there is a landslide and the evidence is

accumulating and so much that WHO is gonna fault and it's gonna say it's airborne and

but to this day, they haven't. I mean they  they have put in the webpage quietly and

the same for a lot of other Public Health  Authorities the majority of them worldwide

haven't accepted it clearly and haven't  haven't acted on it. Right and when is there

more interest and when there's more pressure  for change. When there is a wave you know,

so at some point, we thought the pandemic was  over and then there was the Alpha variant,

oh and then there was more pressure and we made  some progress, but then it went down and then

and we were told for example from a regional  government in Spain that they were waiting

for the pandemic to be the op to be over because  they didn't want to do anything about ventilation

they told us privately just you know and then the  Delta wave came and there was more attention and

we made some more progress and then it waned or it  was kind of waning and then Omicron came and then

we that's when who finally accepted it and put  in the webpage because you know Omicron was so

contagious that it was just so embarrassing to  keep denying it you know, but still now we're

going down and in these periods you know there  are many fewer articles interviews now we have a

war in Ukraine and other things that you know are  important and people are worried about and these

details of the transmission recede into the  background and we still have this power structure

of the medical people, you know, infectious diseases people. This is the Public Health people being

in absolute control and systematically  excluding people from other disciplines

so that that that problem persists to different  degrees in different places but that's that will

continue to be a problem now I we will see I  mean it varies depending on on the location and

but I you know I mean what I at the beginning I  thought we were running a sprint you know that

that it was working like crazy on this topic and  we were going to publish some early papers and

we were going to really convince people because  the evidence was so clear and the evidence was

so clear and we published the papers but now  I realize that's not enough because if you

you feel qualified to ignore the papers the fact  that the papers are there doesn't mean anything

right so I think now we are in a marathon we have  to keep working both scientifically and through

communication as you are doing and try to reach  out to more people we have really reached out to a

lot of people and my impression is in the medical  profession in general more people are in agreement

that this is airborne but the key disciplines  that have the decision power infection control

and public health those are where the core of the  resistance is so kind of we need to keep working

and at some point we were being asked to make  suggestions for the white house about what what

do we recommend you know whether it's this issue  you know so recommended all they use ventilation

filtration better mask whatever but one thing  I wrote in that in that report as a suggestion

was like we really need interdisciplinary research  where there is basically research funding that you

can only get if you have doctors and infectious diseases people and public health and engineers and other

scientists whatever and they have to do joint  projects because these people need to know each

other basically this these silos were really you  know nobody knew who each other was you know and

you know so when people like me went into the New  York times and said that these infectious people,

the infections, these doctors are like who's this  guy he has no credibility. He's you know and there

was no one I could reach out personally you know  that was sitting in the who committee who knew

me from working together for ten years you know  I reached out to people but there was some you

know some scientists in Colorado who doesn't seem  to have work in disease transmission, or whatever.

So powerful Jose. So powerful what you've just  said and again I'm repeating myself you know

it's such a shame that there is this hierarchy  that you're talking about of of one element and

unfortunately in the medical profession who are  looking down on the likes of you who are highly

respected in your field and have part of the  solution of us getting out of this pandemic.

Not every medic thinks that way. I'm a medic that  doesn't and the whole point of this program is to

get the information out there and not and as  i've said earlier knowledge is power and if

people understand how this virus is transmitted  understand what we need to do in order to get back

to some form of pre-COVID life which is to adopt  ventilation filtration techniques masking etc what

you're going to talk about then we can live safely  with this coronavirus it isn't going away I think

people are getting that idea now and we have the  propensity of ruining ruining the next generation

several generations to come if we allow people  to get infected because of the risks of chronic

disease to our children to our unborn children and  our young working public never mind everybody else

who's immune suppressed elderly etc so I think  it's critical and urgent that the science that

you've discovered is adopted accepted and things  happen. Thank you so much for that statement. I

know we're coming to near the end of time but this  is such a powerful, powerful episode and I really,

we all really appreciate your contributions  and your participation in this program. So

I'm going to get to the last question, because  frankly speaking, you've answered all the others

at present. Our focus on managing this  pandemic is via vaccination and I agree

vaccination is one of, if not the most  important risk reduction or mitigation strategy

for controlling the spread of the coronavirus. I  believe vaccination, vaccination alone will not

get us out of this pandemic. We need additional  risk reduction strategies working in tandem

creating what I have been calling a  360 degree pandemic management solution

and for the audience please see the website  for a direct for diagram of this solution the

kojalamedical.com/covid19theanswers part of the  website on your twitter feed. You talk of a swiss

cheese approach which I think is similar can  you please explain this to the audience? yeah,

I am I mean I agree with with everything you  said. The Swiss cheese analogy which is not mine,

I mean I learned it from Ian McKay who's an  Australian biologist. I think it existed before

the idea is that the Swiss cheese you know has  holes so you cut the slice and it has some holes

but every slice has different holes right and the  idea is that especially if you go indoors and you

have a bunch of possible things you can do but  none of them is perfect right I mean as you said

the vaccines reduce transmission reduce severity  but they don't eliminate transmission right

and then we have masks and we have good masks  like N95 and they work very well. But they're not

perfect. You can have a leak. It's very difficult  to make sure it's a hundred percent right and the

same is with ventilation or with filtration you  know there is they help a lot but you could be

unlucky and or you could be close to someone who's  very infective and still get infected. Right,

so the idea is that you do multiple things and  then it's like the virus is trying to go through

all these layers of Swiss cheese and maybe  it goes through the whole of your vaccination

but it hits the mask or it hits the filtration or  something like that so the idea is to layer these

mitigations and that's that's the correct approach  and it works very well when you do it right and

which layers and how much of the layers how much  ventilation how much filtration how good of mass

depends on on the risk how many cases are there  where you are at that point in time how severe

is the disease you know as we learn more about  long COVID as you said how much at risk are you

you know are you an elderly person are you immunosuppressed, or are you a single parent with

four kids and you don't want to risk you know not  being in their life, or you know or whatever reason

you have, right? So I think that's that's yeah, very  useful and I don't know your your 360 diagram, but

I can I think I can still picture it I think i've  seen other ways to do it but I mean ideas is this

that we need the vaccines alone are not enough  we need more of this in particular what they call

non-pharmaceutical interventions things like  masks or ventilation something which are not

some drug or vaccines that you put  into your body. It's something we do

in the in the physical world right? Yes, I  mean the 360 degree solution is part of that,

so the way I see it is that we need vaccination,.  We also need regulator public health governmental

financial support ,we need environmental  changes which is what you talk about

ventilation filtration masking education. We need  information technology. Technology so that we can

sort of monitor people when they're contagious,  do good contact tracing. We need testing.

So if you bring all of these in the circle to  varying degrees you know, so for example testing

would be really important to see if it's safe for  you to go to school, as well as being vaccinated,

as well as having a ventilation infiltration. So  you'd have different weighted incidences of all of

those different things but collectively we would  need a bit of them in order to protect ourselves

against the coronavirus so we have to look in it  and more of that whole way and I think that's very

similar to your swiss cheese analogy yeah I mean  this is a different way to to the diagram I mean

you're also talking more broadly I was more  focused on transmissions and thinking of

filters and ventilation and of course things like  you mentioned you know testing and isolation and

all those things and contact racing are really  important right but it's just yeah, so we need

to do all of them because again yeah, the testing  of testing fails some of the time contact tracing

you are not always successful but when you are  successful you prevent some transmission and then

if you are not successful then the mask may save  you or the vaccine or you know it is the sum of

everything that keeps us safe exactly so we're  reaching the end now, so this has been a fantastic

episode Jose and I'm excited to hear next  week's episode with Shannon and Jason. So

the next week's episode is SARS-CoV-2 is  airborne part two. How do we combat it?

things mean that there is less virus in the air  then you know now you go to the earth so they say

okay so if you keep more distance you are going  to inhale less of the virus that's that's living

another person just like with a smoker so that's a  good idea it is not because it falls to the ground

but distance works the fact that distance work is  empirical right now if you say well now the air is

flow of air by your eyes then you know so by then  you have the you still have the virus floating in

the air what can you do so you can do basically  four things one is you do nothing you you breathe

air with a virus that's risky then the second  thing is you take the air that has the floating

virus and you put it outside either through an  open window through a system of twos it goes

outside and then air comes in from outside which  shouldn't have any virus because of dilution and

uv and whatever right so that is ventilation right  sometimes people think I have an air conditioner

in the window is that ventilation and that's not  ventilation that's cool in the air but the air is

still trapped in the room so ventilation means  the air goes out and with it goes the virus so

there is less virus for you who's in the room to  breathe right now sometimes you cannot do that

for whatever reason and then filtration is the  next thing to try right so what what's a filter

it's a piece of cloth that when the air goes by  a lot of the air sources stick to it that's what

masks are and our lungs are the engine are there  from the engine that moves the air through that

through that filter right but you can also have  a filter that you you know you have a fan that

you plug into the wall and it it takes air from  the room and it passes it through a filter right

that works really well I have a colleague that  did this for example in a school and then they

took the filters back to the lab and they do pcr  and they find the SARS-CoV-2 virus in the filter.

How did the virus end up in the filter? The only  way is because it was floating in the air and

the filter removed it. You know, just like mass  work filters work right now there are there are

a couple of types the hyper filters or the corset  rose and tail boxes maybe we can talk more in more

detail next time but you know then the third  thing you can do but basically okay so let

me go back so ventilation is the virus goes out  with the r filtration is like no you keep the air

but you remove the virus you remove the virus  from the air then there is a third thing you can

do which is disinfection which is you keep the  air in the room and you keep the virus floating

but you try to kill the virus to the activator  so you are still going to breathe in those virus

particles but they are no longer infected because  you have killed the virus right you can say now

that starts to be more challenging and there is  it can be done with UV light as I mentioned with

Tuberculosis and that works it's just much more  expensive than filters so for some places for a

emergency room waiting area of the hospital or  a prison or whatever it but it's a good idea but

it's more expensive but then there are others  other techniques where people basically and

they're being selling like hot cakes with ions  plasmas photocatalysis or putting bleach in the

air or hydrogen peroxide or alcohol or whatever  all of these I think they're dangerous because

they may destroy the virus but for the same reason  they're going to hurt us and they're going to

create other pollutants I think they should be  avoided now so that that would be the summary of

Thank you so much Jose fantastic  episode thank you for educating us all

and let's hope this just gets out there  and the public demand what needs to be done

and look forward to interviewing you and  your colleagues next week keep well and safe.

Okay. Thank you very much for  having me and thanks for listening

Thanks for listening to this week's episode of  COVID 19 The Answers. If you enjoyed the episode,

please subscribe, rate and review and do visit  our website kojalamedical.com/COVID19theanswers