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An Official Smoking Gun on #CovidIsAirborne Denial by Hospitals Because They Didn’t Want to Spend Money Changing Their Physical Plant

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By Lambert Strether of Corrente.

“Something is rotten in the state of Denmark.” –William Shakespear, Hamlet, Act I, Scene 4.

So far, in the United States, we have been limited to teasing out the motivations for official denial or resistance to the aerosol/airborne transmission paradigm in hospital infection control from vague hints in published documents; in fact, from footnotes in official documents. To the best of my knowledge — and I do try to keep track — we’ve never had an official come right out and say “We’re not dealing with airborne transmission in hospitals because that would cost too much money.” Well, now one has. Granted, the smoking gun is in Denmark. In this short and sweet post, I’ll contextualize and present a Twitter thread where the smoking gun official appears.

To be fair, Eric Feigl-Ding amplified the thread, although I had flagged it previously in my meanderings through the aerosol community:

However, I am not the sort of person to be satisfied with context-free images of tweets, especially where I don’t know the players. So herewith the context.

Here are the protagonists in the thread amplified by Feigl-Ding (as I have excerpted and translated it)[1]. There are four laypeople:

1) Fritze Heisterberg @fcandersen (joined 2011);

2) Marianne Ernø @ErnoeMarianne (2011);

3) Christina Brøndsholm Andersen @CBroendsholmA (2017), a choregrapher;

4) Peter Favrholdt @pfavr (2009), a cookware entrepreneur.

(I give the dates they joined to show we’re not dealing with trolls. Also, my Danish search skills are bad, so I can’t dope out anything about Heisterberg and Ernø beyond their Twitter profiles.

Finally, there is:

5) Stinus Lindgreen @stinuslindgreen (2009), a Danish scientist and politician, and a member of the Folketing [Parliament] for the Social Liberal Party. More importantly for our purposes, Lindgreen is chair of Denmark’s Epidemic Committee[2], hence an elected, hence also a reasonably high official in a position to speak with authority about the inner workings of government decision-making in the pandemic.

The thread takes place during and/or in response to a one-day workshop on aerosols at Denmark’s Statens Serum Institut on October 4, 2020. Lindgreen attended, and in his first tweet below supplies a shot of the schedule (aerosol smitte/aerosol infection”) and a shot of a presenter and venue:

And now to the interesting part: The transcript. What we have here, it feels like to me, is a ordinary citizens badgering one of their electeds about aerosols, and cornering him into some interesting admissions. (The population of Denmark is a bit under six million, a scale which permits such a thing.[3]) The original Tweets, in Danish, are italic. Google translations follow in Roman. Lindgreen’s name is bold. His two smoking guns are underlined.

Fritze Heisterberg / @fcandersen Oct 4

Øj jeg gad godt være en flue på væggen og høre @AKiversen fortælle om aerosolsmitte og den uenighed @stinuslindgreen mener der var om det emne…det er alligevel imponerende den uenighed fortsætter!

Oh, I’d love to be a fly on the wall and hear @AKiversen talk about aerosol contamination and the disagreement @stinuslindgreen thinks there was on that topic…it’s still impressive that the disagreement continues!

Stinus Lindgreen / @stinuslindgreen Oct 4

Efter den officielle åbning af Folketinget sidder jeg nu på @SSI_dk til en hel dags workshop om bekæmpelse af aerosolsmitte. Indtil videre rigtig spændende indlæg om udluftning, filtrering og smitterisiko. #dkpol #sundpol

After the official opening of the Folketinget, I am now sitting at @SSI_dk for a full-day workshop on combating aerosol infection. So far, really interesting posts about ventilation, filtration and risk of infection. #dkpol #sundpol

Stinus Lindgreen / @stinuslindgreen Oct 4

Jeg sagde ikke, der var uenighed om, hvorvidt smitten er luftbåren eller ej. Det handlede mere om balancer i håndteringen.

I didn’t say there was disagreement about whether the infection is airborne or not. It was more about balance in handling.

Fritze Heisterberg / @fcandersen Oct 4

Hvilken smitte præcist mener du for pt omtales Covid-19 ikke som luftbåren smitte i dansk regi/udadtil til danskerne!

Og tak for præcisering…ville godt have været der alligevel…

Which infection exactly do you mean because currently Covid-19 is not referred to as an airborne infection under Danish auspices/externally to the Danes!

And thanks for the clarification…would have been there anyway…

Stinus Lindgreen / @stinuslindgreen Oct 4

Det er en strid om ord – også i denne forsamling. Men enighed om at smitten sker via den luft, vi deler.

It is a dispute about words – also in this assembly. But agreement that the infection occurs via the air we share.

Fritze Heisterberg / @fcandersen Oct 4

Overfor befolkningen er det ærligtalt ikke ok!

Og det er jo ikke bare en strid på ord det handler jo også om hvordan der handles i hverdagen.

For man kan ikke undgå luftbåren smitte med håndvask eller?

In front of the population, it is honestly not ok!

And it’s not just a dispute about words, it’s also about how you act in everyday life.

Because you can’t avoid airborne infection with hand washing, can you?

Stinus Lindgreen / @stinuslindgreen Oct 4

Det handler mere om, hvad det betyder for praktikken på hospitaler.

It is more about what it means for practice in hospitals.

Above is Smoking Gun #1. Apparently, there’s some “practice” more important than protecting patients from a highly infectious airborne disease. (I’d speculate this is Hospital Infection Control, in hospitals and at WHO, but I can’t back that up yet.)

Fritze Heisterberg / @fcandersen Oct 4

Men som sagt det handler ikke bare om 🏥. Men om smitteforbyggelse generelt hele vejen rundt i samfundet og eks offtenlig transport.

En del af smitteforbyggelsen er i [Denmark flag] også man for fortalt hvordan covid-19 og influenza smitter. For pt bliver der råbt håndvask før udluftning!

But as I said, it’s not just about 🏥. But about infection prevention in general throughout society and e.g. public transport.

Part of infection prevention is in [Denmark flag] also telling how covid-19 and influenza are contagious. For now, hand washing before venting is being shouted at!

Stinus Lindgreen / @stinuslindgreen Oct 4

Betegnelsen “luftbåren” betyder i dansk kontekst noget for, hvilke krav det stilles til indretning af isolationsstuer osv. Det var pointen. Konsekvensen af de mudrede udmeldinger kender vi.

In the Danish context, the term “airborne” means something for the requirements for the design of isolation rooms, etc. That was the point. We know the consequences of the muddy announcements.

Peter Favrholdt / @pfavr Oct 5

Det betyder også meget for hvordan vi indretter os udenfor hospitalerne. Udluftning, HEPA, eller man kan gå udendørs. Hvad med skoler?

It also means a lot to how we arrange ourselves outside the hospitals. Ventilation, HEPA, or you can go outdoors. What about schools?

Fritze Heisterberg / @fcandersen Oct 5

Præcis!

Exactly!

Stinus Lindgreen / @stinuslindgreen Oct 4

Men derudover er jeg ikke uenig med dig. Jeg har rejst spørgsmålet utallige gange, og det tog som bekendt lang tid, før udluftning blev en del af de officielle anbefalinger.

But other than that, I don’t disagree with you. I have raised the issue countless times and as you know it took a long time for venting to become part of the official recommendations.

Seems familiar!

Christina Brøndsholm Andersen / @CBroendsholmA Oct 4

Det er ikke godt nok næsten 3 år inde i pandemien. De danske sundhedsmyndigheder må kommunikere klart ud at den primære smittevej er luftbåren og at den bedste beskyttelse er ventilation, HEPA luftrensere og FFP2/3 masker. Danskerne spritter fortsat hænder mod en luftbåren virus

It is not good enough almost 3 years into the pandemic. The Danish health authorities must communicate clearly that the primary route of infection is airborne and that the best protection is ventilation, HEPA air purifiers and FFP2/3 masks. The Danes continue to spread their hands against an airborne virus

Marianne Ernø / @ErnoeMarianne Oct 4

Sgu da ikke bare på hospitaler!! Har du ingenting forstået?

Don’t just go to hospitals!! Didn’t you understand anything?

Stinus Lindgreen / @stinuslindgreen Oct 4

Jeg prøver bare at forklare, hvorfor man ikke brugte denne betegnelse i Danmark – fordi det ville have konsekvenser for indretningen af hospitaler.

I’m just trying to explain why this designation was not used in Denmark – because it would have consequences for the layout of hospitals.

Above is Smoking Gun #2. Health of patients not the first concern of hospitals, apparently.

Fritze Heisterberg / @fcandersen Oct 5

Og @stinuslindgreen der fik vi sat 2 stregner under politik vandt over ordenlig information om smitteveje til borgerne hvilket en som @AKiversen prøver så godt hun kan. Kedeligt du ikke fik hørt hende for hun er en vigtig stemme i formidlingen. Håber, at du læser hendes tweets.

And @stinuslindgreen there we put 2 lines under politics won over proper information about routes of infection to the citizens, which someone like @AKiversen tries her best. Too bad you didn’t get to hear her because she is an important voice in the media. Hope you read her tweets.

Fritze Heisterberg / @fcandersen Oct 5

Det kan jo virkelig bide sig i måsen når man ikke informere ORDENTLIGT om smitte til borgerne hvilket kan have konsekvenser på kort og langsigt!

Oven i vil man ikke tilbyde vaccine til alle og derfor klinger #sundhedforalle meget hult!

It can really backfire when you don’t PROPERLY inform citizens about infection, which can have consequences in the short and long term!

On top of that, they don’t want to offer a vaccine to everyone, and therefore #healthforall sounds very hollow

Christina Brøndsholm Andersen / @CBroendsholmA Oct 4

Og det er heller ikke godt nok næsten 3 år inde i en pandemi med en luftbåren virus at det ikke er obligatorisk at bære masker på hospitaler og andre sundhedssteder som fx læger og vaccinations steder

And it is also not good enough, almost 3 years into a pandemic with an airborne virus, that it is not mandatory to wear masks in hospitals and other healthcare facilities such as doctors and vaccination sites

Christina Brøndsholm Andersen / @CBroendsholmA Oct 5

Dette viser jo med al tydelighed, at @SSTSundhed ikke er i stand til at stå i spidsen for pandemirespons. Det er uetisk og sundhedsmæssigt uforsvarligt af forholde den danske befolkning at #covid19 er luftbåren bare fordi det så blir besværligt på hospitalerne.

This clearly shows that @SSTSundhed is not able to lead the pandemic response. It is unethical and health-wise indefensible from the point of view of the Danish population that #covid19 is airborne just because it will be difficult in the hospitals.

Indeed!

* * *

Of course, “layouts” differ by hospital, and I am sure by country and jurisdiction too, depending on regulations, medical practice, culture, etc. However, I think we can make a reasonable speculation about what’s going on. Cook Children’s Checkup Newsroom quotes a few of “the rare remaining physicians who have treated measles.” They descibe the “layouts” of the past and how they changed:

Measles is one of the most contagious diseases known to exist. According to the Centers for Disease Control and Prevention (CDC), the virus can live for up to two hours in the air where an infected person coughed or sneezed. If other people breathe the contaminated air or touch a surface that’s been infected, they risk infection. For this reason, Dr. Hucaby says a doorbell was installed outside of the pediatric clinic where she worked during the outbreak.

“Parents were asked to ring the bell if their child had a fever, with or without other symptoms,” she said. “A nurse would go out into the hallway to look at the patient. If they appeared to have a risk factor for measles, we would take them straight into an exam room. We didn’t sit them in the waiting room.”

Another Cook Children’s physician, Britt Nelson, M.D., remembers a time when seemingly every hospital had an area dedicated to infectious diseases. Dr. Nelson is the medical director of the Physician Network at Cook Children’s, but in the early 1980s he was just starting his career.

“Every place I worked before Cook Children’s had an infectious disease ward where patients could be isolated,” said Dr. Nelson. “But as infectious diseases became better controlled, particularly the ones that are so contagious like chicken pox and measles, we didn’t need to have a special ward anymore.”

The reason for the decline in such quarantined areas is simply vaccines.

As is well known, Covid vaccinations don’t prevent transmission. Hence the hospital layouts of today, optimized for the beforetimes, when vaccines were sterilizing and coughing people didn’t infect each other in waiting rooms and hallways, or need to go directly to exam rooms, would need to be changed to prevent airborne transmission (see studies here and here on preventing transmission in anterooms and waiting rooms). I don’t know why Denmark’s hospitals (successfully) fought to keep the airborne paradigm from coming before the public. In this country, I would speculate that private equity — or competion by putative non-profits with private equity-backed competitors — was an important factor. From the Journal of the American College of Radiology, “Private Equity–Backed Hospital Investments and the Impact of the Coronavirus Disease 2019 (COVID-19) Epidemic‘”:

[T]he restrictive nature of the PE business model demands an abundance of short-term profits for success. That, in turn, makes it unlikely that an investment firm in this class would consider the use of alternate longer-term strategies—including solutions that would avoid hurting physicians and other employees, particularly in the middle of a crisis. If a firm is not going to be involved in the investment after 10 years, then it is unlikely that the PE investor will be interested in whether the physician culture at a hospital is destroyed. It is also unlikely that much thought would be given to what happens to patients if a hospital goes bankrupt or is turned into commercial real estate for condominium development. These events during the COVID-19 crisis highlight the limits and risks associated with third-party financial investment in health care. In good times, investors and their portfolio companies can do quite well, but in a stress test like this pandemic, key stakeholders, including patients, physicians, other providers, and their communities, can be significant losers.

Obviously, ownership that wants short-term profits won’t be investing in revising hospital layouts to include special infection wards (not rooms, but wards), new anterooms, or even doorbells. Nor will they encourage any practice that would encourage a demand for such facilities investments. Hence, no masking, since masking provides the strongest possible signal that #CovidIsAirborne.

Returning to the transcript for one moment: It’s really remarkable for an official to let the cat ouf of the bag as Lindgreen did. Somebody from our famously free press should interview him and get more detail. It would be nice of some officials in our country were as forthright as Lindgreen, too.

UPDATE Adding if anybody on this side of the Pond wants to throw the internal deliberations of some Hospital Infection Control Commmittee over the transom, I’d be very interested.

NOTES

[1] I would have used @threadunrollapp, but Twitter isn’t famous for the coherence of its threading, especially when the conversation has a lot of byways, and I couldn’t get it to unroll all the tweets I wanted in sequence. So I created this thread manually.

[2] Apparently, there is an Epidemic Commission (epidemikommissionen), and an Epidemic Committee (epidemiudvalget). The Commission “advises the government on management of the Covid-19 pandemic,” and was also part of a Danish government reorg when Covid broke out:

Responses to contagious disease outbreaks are governed by the Danish Epidemics Act. (Lov om foranstaltninger mod smitsomme sygdomme og andre overførbare sygdomme (Epidemiloven) (LBK 2019-10-01 no. 1026).) On February 27, 2020, Sundheds- og aeldreministern (Danish Minister of Health) added COVID-19 to the list of contagious diseases covered by the law. (LBK 2020-02-27 no. 157.)

On March 12, 2020, the Danish Parliament (Folketinget) passed legislation amending the Epidemics Act using expedited procedures (hastelov). The main change in the law was that it gave the Danish Minister of Health most of the powers that were formerly prescribed to the Epidimikommission (Epidemic Commission), in order to provide for a speedy response [hmm] to COVID-19. Normally, an Epidemic Commission is made up of representatives from the Danish Health Authority, the police, a doctor, a veterinarian, a customs and tax authority representative, a regional hospital representative, a representative from the Danish Emergency Management Agency, and three members from the regional council. (§ 3 LBK 2019-10-01 no. 126.)

What the difference between the Commission and the Committee is I cannot say, my Danish search skills again being insufficient.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.

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59 comments

  1. ambrit

    “Truth is the first casualty in war,” applies here.
    Donning my tastefully designed Tinfoil Hat, (whence comes “Mad as a hatter?”) I can see Truth as being an early casualty of the Eugenicists’ Crusade presently ramping up.
    How long ago did Gibson come up with the meme of “The Jackpot?”
    See: https://www.wired.co.uk/article/william-gibson-agency#:~:text=Gibson's%20last%20book%2C%20The%20Peripheral,including%20telepresence%20%E2%80%93%20across%20alternate%20timelines.

    3. French75

      > whence comes “Mad as a hatter?”

      At the risk of telling you what you already know — this phrase originates from the hat-making industry, where hatmakers (“hatters”) used mercuric nitrate to make hat brims more stiff. Being in contact with a soluble mercury compound led to hatmakers developing heavy metal poisoning, leading to nerve damage, motor control problems, memory loss, and other complications.

      1. ambrit

        Zounds! Just like your ‘namesake’ “handle,” the ubiquitous French 75mm field gun of WW-1 fame, you have blown my conceit off of the face of the map. (Oh well. I had forgotten the ‘real’ source of that phrase. Alas.)
        All’s fair in web and war???
        Stay safe!

      2. Thistlebreath

        Shot of cognac with a champagne chaser. The drink was aptly named after the French artillery piece.

    4. ArvidMartensen

      I started thinking it was a war against people. But now think it isn’t.
      It’s just a sign that the people who devote their lives to making more money, think money is hugely more important than people. And of course they control the government.
      So they don’t even notice ordinary people, like I don’t see bugs on the road. They Just Don’t Care About Us.

  2. Ignacio

    So, it is all about hospital layouts what prevents saying the truth? Oh dear… Ukraine war idiocy does not come as a surprise then. We are all submerged in PMC inability to admit truths so they take idiotic measures in accordance. The West is rotten. Isn’t it? (Not just Denmark). Criminals many of these are.

    Thanks a lot for you enlightening research.

      1. Ignacio

        IMO, the personnel working in hospitals (schools etc.) should be the ones questioning the policies the hardest. Another group of lambs in front of the abattoir are they.

          1. Ignacio

            At least they ask for best masks as PPE for them as well as for patients. Pity they don’t get the headlines.

    2. BeliTsari

      Remembering when two PA Amazon completion centers had death rates >Philly? Lpine cooks, auto, slaughterhouse, field workers were only reported by WSWS; while unions & our duopoly fought uppity 1099’d essentials: uninsured, paid sick-leave, PPE, Worker’s Comp, NPI, test/ tracing or care for VULNERABLE loved-ones they’d been forced to infect (TERRIFIED to call 911, intubated & cursorily, die horribly all alone). All they’ve bothered themselves to learn, is how to hide the poor’s corpses, by misclassifying PASC deaths of re-re-reinfected gig-serfs as stroke, MI, renal failure or “natural causes” as “upticks” of hundreds-of-thousands are simply ignored by press & tech billionaires’ Internet LIE machine, dispelling every single fact, excess mortality jump, astute clinician, consistently accurate epidemiologist and non-G7 nation (not controlled by GBD/ CDC, Brownstone Institute Libertarian DEATH Panel) harvesting indentured precariate’s homes, labor, equity & kids’ futures, as we’re being repeatedly fed to private equity & NFP slaughterhouses (where we’re intentionally infected WHILE Moderna & Pfizer sets off our hijacked, burnt out immune systems?)

  3. Alex V

    A clarification regarding the meaning “indretningen”. In this context it likely means “equipment” or “furnishing” rather than “layout”. Still highly relevant to the discussion.

      2. vao

        Relying upon the analogy with German terms, I would say that the difference is as follows:

        epidemiudvalget – epidemy committee: In German this would be “Epidemieausschuss”, and the term indicates that a group is formed with members of and within one existing institution (e.g. the Parliament), whereas

        epidemikommissionen – epidemy commission / Epidemiekommission indicates that a group is formed besides other institutions by gathering people from various institutions.

        I.e. two different schemes with effects on who sets up and dissolves the group, who reports to whom, how are members selected, what are their confidentiality duties, etc.

  5. Angie Neer

    “However, I am not the sort of person to be satisfied with context-free images of tweets, especially where I don’t know the players.”
    For which I’m extremely grateful. Thanks, Lambert.

    Yesterday’s Doonesbury (Yes, I’m so old I remember when it was edgy) is framed as a retirement party, where the original Covid virus addresses a family of variants. It says “I’ll rest easier knowing my descendants will never stop taking the fight to the unvaccinated!” Good grief.

  6. Brian Beijer

    “I don’t know why Denmark’s hospitals (successfully) fought to keep the airborne paradigm from coming before the public.”

    I’ll take a stab at that. I believe the answer is New Public Management. This neo-liberal approach to public services began infecting all Swedish public agencies in the late 1980s, from schools to healthcare. It was the beginning of hollowing out the public sector by changing the idea that public agencies are for the public. Instead, “citizens are viewed as “customers” and public servants are viewed as public managers”. From Wikipedia: New Public Management is an “effort to make the public service more “businesslike” and to improve its efficiency by using private sector management models”.

    I think New Public Management goes a long way to explaining why Denmark’s hospitals fought to withold the information from the public…or should I say their “customers”.

    https://en.wikipedia.org/wiki/New_Public_Management

    2. The Rev Kev

      Been noticing for decades on the insistence under Neoliberalism of converting any societal relationship as a commercial-type one with the appearance of contracts everywhere. You see this with health, employment, mental health – everywhere people now have to sign contracts. And of course to carry this out you need a professional managerial class – so employment guaranteed. And it infects politics. One of the major parties in NSW back in the 90s went into a major election with the campaign slogan ‘Managing populations better’ I kid you not. So here they decided on an acceptable annual death toll that would not disrupt the general economy and would not require the total revamp of building regulations and design which would be actually required.

  7. David Anthony

    Well, this also fits in quite nicely with the Asian response. They were hit hard by SARS and after, prepared for the next contagion by changing their hospitals and preparing for a very contagious virus. So, they mask and have in place a healthcare system that does not need to be changed.

    Everything starting to make sense now.

  8. CanCyn

    You’d think that, in general, hospital HVAC systems would be designed to combat airborne infectious disease, no pandemic investment required. Is that really such a crazy expectation? If be prepared and err on the side of caution were ever good policies, hospital HVAC would be a place for them. Instead, hospitals can be nasty, dirty places. When my mother-in-law was in her last years (she died in 2016), suffering from COPD, her doctor tried really hard to keep her out of the hospital as she said it is no place for a sick person. Hospital acquired infections and disease are actually a thing, with their own acronym HAI. https://inivos.com/blog/5-most-common-hospital-acquired-infections-hais/.
    That the bean counters have had such control during the pandemic is no surprise. But to see it laid out like this is still somewhat shocking and truly sickening. And no doubt this cost avoidance didn’t happen solely in Denmark.
    Too bad the HVAC industry isn’t big like Ag and Pharma, maybe we’d be so air filtered we’d be going to hospitals just to get some fresh air. Ha, ha. A girl can dream can’t she?
    Otherwise I have to go with the bean counters are criminals and “They’ll be the first ones with their backs to the wall when the revolution comes” (someone said this elsewhere on NC recently, sorry for the lack of hat tip)

    1. Yves Smith

      It varies by hospital. I was just at the New York’s Hospital for Special Surgery, which is relentless about infection control. I was in a small office building near the hospital where MDs affiliated with the hospital see patients. In the exam room, my trusty Aranet4 gave readings of low to mid 600s.

      1. Lambert Strether Post author

        > high ceilings and open windows

        One of the reasons I hate being in modern hospitals is low ceilings and closed windows (along with flourescent light). The atmosphere is very oppressive.

        I believe the HIC paradigm is fundamentally spatial in nature: Divide the facility up into zones, and then control the zone according to use (i.e., so-called “Aerosol Generating Procedures”* in operating theatres). I don’t think that paradigm works with Covid because shared air builds up in hallways, waiting rooms, offices, everywhere.

        This is my speculation. I would need to do more research to see if this is correct.

        NOTE * This was the sole concession from the HIC community on aerosols. Otherwise, it was droplets all the way. If I understand correctly, the HIC community had a ton of influence at WHO and I would imagine at CDC as well, and they used their power to dismiss airborne transmission for way too long, and then their concession was grudging. (There was a Canadian IC dude who resisted universal masking for HCWs because the benefits of masking has to be weighed against the harms. When asked what the harm was, he answered “acne.” He’s still being sought out for quotes by the press….)

        1. PlutoniumKun

          Something happened in the mid 20th century (probably related to the development of antibiotics and the loss of the traditional ward matron) where the basics of hospital design was thrown out the door and replaced with glorified big plate office buildings. Even things like the use of brass/copper handles was seen as old-fashioned. Hospital design became a battle between surgeons wanting to prioritise active interventions with a variety of other professionals looking after their own needs and/or pet design obsessions. Ergonomics seems to have become the buzzword for a lot of designers. In all this, ventilation and airiness became a secondary or tertiary consideration, one for the engineers to figure out once the basic building was designed. The contrast between the 19th century hospitals and the 1970’/80’s buildings I’m familiar with is striking (and does not reflect well on the more modern hospital designers).

          I have noticed (just making casual observations of hospitals built and designed in the last 20 years), that high ceilings have made a comeback, although i suspect this is more to do with trying to make wards seem less oppressive and to provide more room for ever more elaborate equipment set-ups.

            1. PlutoniumKun

              Yes, I think the perception developed within the medical/public health profession in the mid 20th Century that the problem of infectious diseases was ‘solved’, so only basic precautions were required. A number of my now deceased aunts were nurses of the old school (trained in the 1940’s to 1960’s), and they never stopped complaining about how sloppy modern nurses and doctors were.

              The demise of TB might also have played a part. My mother’s final hospice was a 19th Century former TB sanctuary. The main ward was high ceilinged, with tall French windows onto a sunny south facing veranda. It was a far nicer environment than many of the very modern new units constructed in the same facility. It was so open that deer from the nearby park would poke their heads in for handfeeding snacks by the patients (yes, this is potentially unhygienic, but the staff took the sensible view that the joy these deer provided the terminally ill outweighed other considerations).

              Much of it is internal politics. I was peripherally involved in the initial site selection of two hospitals. It was interesting to see how the initial contract design sequence was a battle between senior doctors, government officials, specialist architects, administrators and a variety of other players. Patients didn’t get a look in. It did occur to me at the time that technical input (i.e. the ventilation engineers) were an afterthought.

              1. Ignacio

                When physicians think of nosocomial or clinic/hospital infectious diseases they mostly focus on operation and post-operation diseases so it is mostly all about fomites plus droplets and antibiotic resistance. They focused so much on it and forgot about the most frequent events: airborne transmission.

              2. Ignacio

                Ventilation engineers are told to bring solutions on the exchange of pathogens between the hospital and the outer environment mainly in the form of filters but mostly or only in the entry/exit of the ventilation systems. Norms deal with the quality and maintenance of those filter systems.

        2. CanCyn

          John Conly is the guy, he won a Governor General’s award just before Covid broke loose ffs – https://www.gg.ca/en/honours/recipients/146-10361
          On a (somewhat) brighter note, the CBC did publish a slightly questioning article about his anti-N95 stance.
          He in no longer the head of the research (into HAI) ‘business’ he more or less founded,, but hasn’t had the thorough drumming out he deserves, at least not that I can find in the press, more praise than panning here: https://www.w21c.org/2022/07/15/w21c-announces-our-new-academic-director/

  9. Jason Boxman

    Is it still eugenics if that’s merely a side effect of because markets? In a country as large as the US, perhaps it is both.

    1. Lambert Strether Post author

      > Is it still eugenics if that’s merely a side effect of because markets?

      Side effects are effects. I am amazed to find a copy of Marge Piercy’s wonderful Woman on the Edge of Time, which everybody should read, online:

      In your time I think people talked about effects and side effects, but that’s nonsense.”

      “How? Like when I take Thorazine, the effects are controlling me, making me half dead, but I get lots of side effects, believe me, like sore throat and … constipation, dizziness, funny speech.”

      “But, Connie blossom, all are effects! Your drug companies labeled things side effects they didn’t want as selling points. It’s a funny way to look at things, like a horse in blinkers.”

      She thrust out her chin. “But there’s a difference. The main effect is the thing you do something for.”

      “But Connie! The world doesn’t know that. Don’t you see?

      Awhile back, I introduced (or picked up from somewhere) “stochatstic eugenics.” Unlike the Nazis, we don’t have an officer pointing people this way or that way when they get off the train at the camp (this way to the overs, that way to the barracks). We have systems for that, the more complex the better. (The dark side of the PMC love of complexity. Our political economy[1] makes it very easy for people not to have intent, and yet for the eugenics to take place.

      [1] “The Association Between Income and Life Expectancy in the United States, 2001–2014” JAMA

      Life expectancy increases continuously with income. At the age of 40 years, the gap in life expectancy between individuals in the top and bottom 1% of the income distribution in the United States is 15 years for men and 10 years for women.

      No one individual intended that…

  10. Sub-Boreal

    Data point:

    Yesterday a health adventure required a visit to the ER at my local hospital in interior British Columbia. In the entire 4 hours that I was there, I saw no other N95s other than the one that I came in with. Although mask-wearing was being enforced, the ones that were being handed out and worn by staff were the loose, floppy procedure masks.

    We’re [family-blogged].

      1. CanCyn

        Our own Hilary in that the PMC women fall all over themselves about her, they love her. She is the queen of hand washing! Even wrote a book called Wash Your Hands. Definitely deserves a Sociopath of the day award.

  11. Anthony G Stegman

    In capitalist societies every life is assigned a value. In the legal system a poor, uneducated person is valued less than a wealthy educated person. Insurance companies assign values to the lives they insure. Automobile companies and aircraft manufacturers (think Boeing) will forego some added safety features because their cost- benefit analyses show the costs exceeds the dollarized value of the benefits (saving lives and preventing injuries). So no one should be surprised that hospitals make the same calculations. We tell ourselves that every life is precious. In reality, some lives are more precious than others. This is the reality. No amount of hand wringing will change that.

    1. Jason Boxman

      But the elite expose themselves to the same range of negative outcomes, including long-COVID. And they do so enthusiastically. So they don’t believe it might happen to them? Or they don’t believe it’s real? Or they don’t know that long-COVID exists? Or they’re fatalistic and don’t care.

      None of these possibilities excite me.

      1. Lambert Strether Post author

        > So they don’t believe it might happen to them? Or they don’t believe it’s real? Or they don’t know that long-COVID exists?

        They believe, I think, that they are more fit (as their position in society shows). Hence “vaxed and done.” If they get Covid, it will be “mild” (they always say mild). And they can always take Paxlovid, or the latest nostrum. Also, doing risk calculations (like Wachtel’s absurd formula) is homework. They like homework. Homework has been a key factor in all their advances through life, so perhaps they believe it will protect them from Covid.

        Perhaps they believe in airborne transmission but only if they associate with the unfit (i.e., those with co-mordidities, i.e. proles, essential workers, etc.) Since they don’t associate with the unfit (i.e., people not like themselves) there’s no problem.

        Those are my guesses. It’s an extremely interesting social phenomenon. Remember, though, that these “adults in the room,” the “smartest” are colossal fuck-ups when it comes to anything other than feathering their own nests. Weird ideologies, magical thinking, intellectual fads, fantasies in the forms of diagrams and tables, defunct economics, sheer ignorance, arrogance — these all dominate the thinking of our governing classes.

  12. Senator-Elect

    They should have called the virus Electronic Health Records 2.0. The administrators would have secured a massive budget, spent millions on consultants and put out reams of documentation. The results might not have been any better, but at least people would know how to protect themselves.

    1. Verifyfirst

      If only Trump had gone all the way and proclaimed it an actual biological warfare attack from China. The US would likely have dealt with that much more effectively, “on a war footing” etc etc. .

  13. JBird4049

    Sometimes my mind gets weird(er) and I get… visions? Sometimes it is my mind trying to tell me something and sometimes it is just wackiness. Maybe something I ate? What it is can be hard to discern.

    I am trying to find a good dvd of Waiting for Godot for some inexplicable reason and for a break I am reading today’s NC’s delivery of Gloom, Doom, and Despair including this bit of murder for profit. A vision of Emperor Palpatine stepping past a curtain and telling a line of applicants for apprentice ‘Give into your hate. Let the Darkside flow through you. Yesss…’ just appears in my head and it’s wtf?!

    I guess Luke failed his audition? And people are seeing a fabulous new job opportunity? Or is the Emperor just trying to expand his search? Maybe last night’s mustard hotdog was too spicy?

    Also, while I am raving, can anyone recommend a good version of Waiting for Godot?

    2. Lambert Strether Post author

      > Sometimes my mind gets weird(er) and I get… visions?

      ““Sometimes I wonder if I’m in my right mind. Then it passes off and I’m as intelligent as ever.” –Samuel Beckett

  14. aletheia33

    RE: lambert’s UPDATE re internal deliberations of an infection control committee, at a nonprofit hospital–could these be obtained via FOIA? just asking.

    and, in general, can a city’s hospital really keep these secret? might a hospital’s “customers”, that is, citizens in the area served, have some right to see these, in some communities?
    or could such citizens get hold of them via some kind of lawsuit?

    just asking.

  15. eg

    And not just the hospitals. Precisely zero rentier building owners (nor governments nor private organizations) want to spend any money improving air quality analogous to the public sanitation efforts on water supply to which even our benighted Victorian forebears eventually acquiesced.

  16. hayek's heelbiter

    Yup.. Across the Pond, a HUGE percentage of COVID cases were iatrogenic, caught from people in and visiting NHS hospitals. Authorities continued to insist on handwashing, social distancing, while refusing to install UV-C air purifiers.
    TFL (“Transport for London”), which manages London’s Underground system, installed them in their stations relatively quickly when the nature of the disease became evident.
    The world is upside down when iit is safer to travel on the crowded subway system than go to a hospital because of an airborne virus.

      1. hunkerdown

        Fixed link:

        The Consequences of Neoliberalism in the Current Pandemic
        Vicente Navarro

        Abstract

        This article analyzes how the neoliberal policies, such as the politics of austerity (with considerable cuts to social policy expenditures including medical care and public health services) and the privatization of health services, imposed by many governments on both sides of the North Atlantic, considerably weakened the capacity of the response to the coronavirus pandemic in Italy, Spain, and the United States.

        Keywords: neoliberalism, pandemic, coronavirus, public policy

  18. Dick Swenson

    This topic is dealt with in various places in the book Premonition by Michael Lewis. It is a great book on the topic of the CDC, Public Health, and many other topics that surfaced because of the inept governmental response to the issue of pandemics.

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