Dominic Cummings: How the UK Ignored Evidence That the Virus is Airborne

By Trish Greenhalgh, Professor of Primary Care Health Sciences, University of Oxford. Originally published at The Conversation.

“I think we are absolutely fucked. I think this country is heading for disaster. I think we’re going to kill thousands of people.” According to Dominic Cummings, those were the words spoken by the then deputy cabinet secretary Helen MacNamara on March 13 2020 when she realised that the UK had no plan for dealing with the unfolding COVID crisis.

And it’s not over yet. The UK’s tally of COVID-19 cases – undoubtedly an underestimate – is now 4.5 million, with over 127,000 COVID deaths. Between half and 1 million people, including 122,000 healthcare workers and 114,000 teachers – give or take a few tens of thousands – remain too sick to work full time. Highly contagious mutant variants, which entered the country recently through ineffective border controls, are spreading exponentially, causing new local outbreaks. Effective prevention measures, such as mask mandates in secondary schools, are being prematurely rolled back. The UK’s third wave is predicted to be small but could yet dwarf the previous two waves.

Boris Johnson’s former chief adviser’s warts-and-all account of political backstage events during February and March 2020, raises political questions, such as what the prime minister knew and when, as well as scientific ones, such as how the UK government’s Infection Prevention and Control team could have denied for so long that SARS-CoV-2 is airborne, thereby delaying the introduction of effective measures to contain its spread.

At what point, for example, would it have been reasonable to conclude, as Cummings did this week, that hand-washing and surface cleansing would be ineffective unless accompanied by additional measures to control airborne virus?

The day before the alleged quote from a senior UK government official, the World Health Organization declared COVID-19 a pandemic. What scientific evidence was there at that time that the virus spreads through the air?

Two days earlier, on March 9 2020, the Japanese government had introduced its “3Cs policy”: avoid closed spaces, crowded places and close contact, especially when talking or singing. These three measures were based on detailed analysis of outbreaks using not just prospective contact tracing (to identify people who may have caught the disease from an infected individual) but retrospective tracing (to find how that individual became infected).

This allowed public health experts to hypothesise about a possible airborne route of transmission. The Japanese government was honest with the public, explicitly invoking the precautionary principle:

We do not have enough scientific evidence yet on how significantly such actions can reduce the risk of spreading infection. However, since places with poor ventilation and crowded places are increasing infections, we ask that you take precautions even before scientific evidence for clear standards is found.

This prompt and cautious policy, based on preliminary but rigorous science, helped ensure that Japan’s first wave was tiny. Its death toll is orders of magnitude less than the UK’s. The tone of the Japanese government’s public health messaging in the early weeks of the pandemic contrasts markedly with Cummings’ description of Boris Johnson who, he alleges, behaved “like a shopping trolley smashing from one side of the aisle to the other”.

It’s Not Too Late

Putting aside the important question of how far Cummings’ account of chaos at the heart of government was inflated by the desire to settle scores with his former colleagues, the prime minister now needs to get a firm grip on this deadly virus. Fourteen months after Japan first introduced its 3Cs policy, it’s high time the UK introduced measures that did more to acknowledge the evidence on the airborne nature of this virus and that will help prevent a catastrophic third wave.

First, effective ventilation of indoor spaces should be prioritised and resourced. The level of carbon dioxide (CO₂) in room air is a good proxy for how much the air is being shared because we breathe it out. All businesses, schools and other public buildings should obtain and use CO₂ monitors and ensure that levels remain in the healthy range (400-700 parts per million). In the longer term, building design regulations need to reflect the risks of airborne infections.

Second, physical distancing should continue to be enforced. Maintaining two metres distance protects against both droplet and airborne modes of transmission, since most airborne spread occurs via close contact – think of someone exhaling smoke. Note, however, that the longer people remain in an unventilated room, the more concentrated any airborne virus will become and the farther it will spread.

Finally, masking in indoor spaces, which works moderately well against both droplet and airborne transmission, should continue. To reduce airborne transmission, the mask must fit snugly with no gaps around the sides for air to escape. For full protection against airborne virus, a high-grade mask, such as an FFP3 or N95 respirator, must be worn. Indeed, Boris Johnson might like to reconsider the open letter I and my colleagues sent him in February this year requesting such protection for healthcare workers.

In sum, the emerging consensus on the importance of airborne spread requires coordinated measures at individual, organisational and national policy levels to make spaces safe. It is a better-late-than-never opportunity for the prime minister to demonstrate leadership.

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  1. John A

    And guess what. Topic A in mainstream media not Cummings anymore but that Johnson has just married his long-term mistress, (creating a vacancy as J Goldsmith put it). So many angles to cover, the bride’s dress, the fact that ceremony for the now thrice married Johnson and on the record as persuading another mistress to have an abortion, was in the Catholic cathedral in central London. As more than one meme put it, one wedding and 150,000 funerals.

    1. Colonel Smithers

      Thank you, John.

      Just one abortion for the daughter of the News of the Screws’ “voice of reason” and chairman of the Tote..?

      Further to the vacancy, that was a quote from Jimmy Goldsmith, father of Zac. The mistress went out with Zac when she joined the Tory party machine after university.

      Papists like me are still celebrating after Johnson returned to THE faith and made an honest woman of that nice Catholic girl.

      1. H. Alexander Ivey

        Colonel, you made my day, well played comment!

        Steve, you are a troll. Thank you for your interest in national security. Please sit down.

    2. Steve

      “Mistress” is very outdated and sexist. There’s no equivalent term for a male in the same situation.

      Ever wondered why that is?

      Perhaps refrain from using such language in future.

      1. bassmule

        Gigolo: noun, plural gig·o·los.
        a man living off the earnings or gifts of a woman, especially a younger man supported by an older woman in return for his sexual attentions and companionship.
        a male professional dancing partner or escort.

          1. CanCyn

            Nope. Boy toy refers specifically to younger men/older women. Regardless, the point should not be to find a male equivalent for the word mistress. The point is that, once again, the press have jumped on the distraction band wagon thus helping the government remove focus from the important problems of the day. I. Don’t. Give. A. Damn. about BoJo’s marital status or shenanigans. When we will we ever learn?

        1. Yves Smith

          Correct, because mistresses are well-established roles going back to the days of aristocracy when marriage was about property and progeny and mistresses were for enjoyment. No male equivalent because property usually passed on the male line.

          In case you missed it, there’s still a wage gap and men on the high end status and money-wise are particularly advantaged in this game.

          Language policing does not change economic relations.

      2. Michael

        ‘Paramour’ is the male equivalent I know of though I just looked it up and it seems to be gender neutral..

        1. Basil Pesto

          I think ‘lover’ works as well, though it’s not a perfect substitute for ‘mistress’. It’s not too late to devise a male equivalent. Master? The problem, of course, is making it stick.

        2. PlutoniumKun

          In mandarin, its ‘chickens’ for female mistresses/prostitutes, ‘ducks’ for male equivalents. I’ve no idea why, but I quite like it. I even described someone as a duck once, luckily nobody knew what I was talking about.

      3. Lambert Strether

        > Ever wondered why that is?

        Because existing social relations skew that way. I am sure that in the fullness of time, when there are male mistresses, a term will be evolved for them. I found “manstress.” Perhaps that will catch on.

        > Perhaps refrain from using such language in future.

        The idea is, in Orwellian fashion, to make it impossible to have the thought by removing the word for it. Social relations cannot be made to evolve that way (although symbol manipulators may think that it does). People would simply come up with new words, that being how language evolves.

        1. ambrit

          I was always partial to the archaic term: leman.
          It signifies a paramour, lover, etc. It is a gender neutral term.

          I heartily agree with your invocation of Orwell. (A name to conjure with.) [Many wrestle with the original of the Saint of Airstrip One.]

        2. Fearn K

          Are you sure it’s not just that it’s still seen as socially acceptable to pour scorn on women for the moral ‘crime’ of entering into a perfectly legitimate relationship between two adults?

          Is this commendable or to be encouraged?

          If we stopped using denigrating language such as “mistress”, would we understand the relationship of these two adults any less? No, of course not.

          So you’re invoking Orwell to put up a ‘thought crime’ strawman?

          Interesting debating position.

          People ask others to refrain from using offensive language all the time. That isn’t of itself Orwellian in the slightest.

    3. Jon Cloke

      I can’t understand the continuous obloquy directed at PM Borisconi’s partnerships; the moral comings and goings (as it were) of the elites are surely what we buy our newspapers for?

      I’ve always enjoyed hearing about Borisconi’s weddings, including the current one, and I shall be looking forward to the next…

  2. GlassHammer

    You know I keep hearing that mitigating airborne spread would be too expensive for schools and businesses to implement but makeshift air filters are fairly effective and really inexpensive to build. (Heck most schools and businesses in my area already have box fans for summer heat and that’s half of what you need for a makeshift air filter.)

    Combine those makeshift air filters with a few standard fans properly placed to move air into and out of a room (place one high and one low at the entrance make them face opposite directions) and you mitigated a great deal of the airborne spread.

    FYI, I base this all on my extensive knowledge of smoking up a kitchen from burning food and being too cheap to buy an expensive air filter to get rid allergens in my home.

    1. Lambert Strether

      > Combine those makeshift air filters with a few standard fans properly placed to move air into and out of a room

      I’ve been regularly linking to sources on this in Links and Water Cooler. Here is Dr. Corsi on ventilation costs for schools, a long thread:

      And here is a link on DIY air filters.

      On an institutional basis, I would bet these costs are not that much greater than hygiene theatre including plexiglass (which also involves a lot of janitorial work).

      So, making ventilation systems Covid-safe doesn’t have to be a budget-buster.

      Also, your comment mocks your own “extensive knowledge of smoking up a kitchen.” I think this is fine. A lot of ventilation stuff comes down to common sense — although administrators don’t like it because it’s hard to formulate detailed rules when so much depends on physically unique spaces). The “Three C’s” is common sense.

      1. ambrit

        As any “proper” Victorian* would enlighten you, “common sense” is either “common” in that classically classist sense, or not “common” at all, as in rare and exclusive.
        *As in “Mr. Lee’s Greater Hong Kong.”

      2. GlassHammer

        In the end all we needed was a MAGA box fan with home air filters slapped onto it to stop the pandemic.

        FYI the next pandemic will be solved with baking soda and vinegar.

  3. The Rev Kev

    Well Boris at the time was faced with two choices. He could pretend that aerosol transmission was not a thing, encourage wipe-down theater and wait until herd immunity was reached or a magic vaccine was developed to save them all – whichever came first. Then it would just be a matter of going back to the economy of 2019.

    On the other hand, he could have said that aerosol transmission was real which would have meant a total revamp of building codes and retrofitting all the older buildings to allow more air flow along with other structural changes to society. But as he figured that the pandemic would only be here two year or so, went with the former approach.

    Of course doing so will be of no absolute help for when the next aerosol-transmitted pandemic comes along but hey, that will be somebody else’s problem he figured. But it will only be a matter of time until somebody works out the consequences of his decisions (or lack thereof) and comes up with a Boris Body Count.

    1. Kurtismayfield

      The problem is that no one is thinking long term. The next pandemic, I will not trust a word out of authorities. They have pretty Ven that they think only about themselves and their short term gain. So now you will have the uninformed AND the informed left with zero reason to trust the government.

    2. Robert Hahl

      Admitting that aerosol transmission is real would have slowed down the process of reaching herd immunity, which Johnson initially believed was the best plan. I recall they actually announced it was the plan; but had to backtrack on that due the shocking number of deaths being predicted.

    3. ChrisPacific

      I don’t think it’s quite that binary. As the Japan example illustrates, a lot of the airborne vs. surface issue is simply identifying which situations are highest risk and tailoring health advice and policy accordingly, and the empirical evidence was clear at a pretty early stage even if the science lagged (I can remember noticing the features all of our clusters had in common, for example). “We don’t know what’s going on yet, but it’s clear that the following situations are high risk, so avoid them” (essentially the Japanese advice) would have gone a long way even without revamping building codes and retrofitting buildings and the like.

      Johnson of course, being Johnson, chose to make up his own story about what was going on and believe that, while ignoring pretty much all scientific or empirical evidence to the contrary. This is exactly what he did with Brexit (aided and abetted by none other than Mr. Cummings, I might add).

    4. Lambert Strether

      > aerosol transmission was real which would have meant a total revamp of building codes and retrofitting all the older buildings to allow more air flow along with other structural changes to society.

      Ultimately, yes (and a good thing, too). But there is a lot that can be done by opening doors and windows, building DIY fans/filters, adjusting existing HVAC etc. The initial response doesn’t have to cost the earth. See my comment above.

  4. Rob Dunford

    1/2 way through 2020 I read about research into specific UV light frequencies that had the unique ability to not only sterilise surfaces out of the direct light path but also be non-harmful to humans. What happened to that?

    1. Equitable > Equal

      I think by then the focus had already turned to preventing transmission by aerosol – Except for trump who famously ruminated on using bleach or a light to kill the virus in the lungs sometime around summer 2020.

    2. Hayek's Heelbiter

      TFL (Transport for London) actually does use UV-C sanitizers in their underground stations.
      Not so the NHS.
      I asked a friend who works for the NHS why it is safer to travel on the underground than to enter an NHS hospital.
      He explained that TFL is not actually a government agency. Not quite sure how he explained it. The entity s something quite different that can make rapid decisions.
      For the NHS to install UV-C sanitizers:
      A. First it would have to run studies to prove the efficacy of UV-C sanitizers.
      B. Once all the reports were in and it was proven that UV-C sanitizers do provide a measure of protection, the NHC would run studies to see what were the most efficient and cost effective UV-C sanitizers.
      C. Then it would have have to put out the tender to purchase the UV-C sanitizers.
      D. Then it would have to purchase a bunch of UV-C sanitizers.
      D. Then it would have to deploy the UV-C sanitizers to all the hospitals and surgeries [clinics to American readers] under its aegis.
      By the time all the bureaucratic box-ticking had been accomplished, the pandemic will (hopefully) have been long gone.

  5. Mikel

    And the world STILL doesn’t know enough about the aerosol transmission and this virus. Too much time was spent in denial because of – let’s be real – fear of demand for regulations around indoor air filtering.

    Nothing much being done about the spread of the virus – only a way to treat an endemic was figured out.

  6. Kouros

    Epidemiologists do not come across the “Precautionary Principle” in their studies. Also, epidemiologists do not study the physics of very small particulates. But, when measles is airborne and even TB (a bacterium) spreads as airborne particle, one must be cautious.

    My bosses weren’t…

  7. Dick Swenson

    Re Covid planning, mitigation, etc., read Michael Lewis’s new book, The Premonition. Chapter 10 will make your blood boil.

    Lewis is a grat story teller and this is a great story to tell.

  8. Robert Hahl

    Reading about the AIDS pandemic in And The Band Played On by Randy Shilts (1987), and he here are many parallels to what is happening now. The media reported whatever the government said without checking if it was true, and few politicians or government agencies would admit that the agent was a virus or that it was getting into the blood supply and Factor VIii until long after that was obvious to front-line people.

    Nobody in “leadership” has an interest in taking costly preemptive measures because they will be seen as panicky and unreliable. And if the prentice measures worked, people will they were not really necessary and nothing would have happed anyway. Tough job.

    1. The Rev Kev

      Been meaning to read that book. And wouldn’t you know it. Fauci was at the heart of the AIDS epidemic and was a controversial and divisive figure even back then. In fact, he once said “My career and my identity has really been defined by HIV.” To many people that is true – and not in a good way either.

  9. Ignacio

    The washing mania has been one of the stupidities of the pandemic that started with the Chinese showing trucks to clean Wuhan in the early days and there is no end to this in sight. Now it has been partially substituted with a second mania, that of going several meters away from an unmasked runner and other similar attitudes but then forgetting that indoor meetings for hours is where the real risk resides (together with close physical contact). The third mania is novelistic. the lab escape hypothesis, which is clear demonstration that human conduct prefers the fiction of narratives rather than the rule of facts. Even people that should know better are inadvertently misled to this narrative without considering in the simplest way the difficulties of such narratives and the consequences of ignoring the more likely reality that viruses evolve in nature and eventually reach humans when barriers are broken.

    We live in a world in which posturing, marketing and narrating are our strongest drivers. When all fails, we then go and blame the nearest scientist. Stupidity, stupidity, stupidity, increased to the third power.

  10. Hayek's Heelbiter

    Former scientist here.
    We must never forget that the Government’s initial strategy was “Herd Immunity.”
    I got into a riproaring argument with a woman on the Government’s pandemic communication committee.
    Even at that early stage, there was enough information in the scientific literature, particularly using SARS and MERS as templates, that far greater precautions should be taken immediately.
    “The top government scientists are recommending that herd immunity was the way to go,” she insisted.
    “It’s not herd immunity,” I retorted. “It’s herd f*ng insanity.”
    She quoted a few more government advisors, and I decided to let it go.
    You need no clues to guess who was an early victim.
    Fortunately, after three grueling weeks, she made a full recovery.
    And we’re still friends.
    Ps. Will not reiterate my running battle with the London Fire Brigade and their adamantine regulations that keeping doors and windows open was the cheapest way to minimize covid transmission.

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