Astrophysicist Screw-Up on Coronavirus Transmission Reaches Astronomical Proportions

Image created by combining Comets Kick up Dust in Helix Nebula (NASA/JPL-Caltech/Univ.of Ariz.) with Novel Coronavirus SARS-CoV-2 (NIAID-RML).

An astrophysicist popular on social media recently wrote an article in Time Magazine arguing for keeping colleges and universities closed. Without clear restrictions in place to reduce disease transmissions, it is almost certainly a bad idea to open schools.

Unfortunately, the astrophysicist misunderstood basic biology of infectious diseases and misrepresented almost all studies that they cited in support of their claim.

Trump and the republicans have certainly completely failed on handling the new coronavirus pandemic and want to open schools and go “back to normal” without much care. They do not care if people die as long as Trump gets reelected.

However, arguing for a worthy goal using bad arguments and misrepresentations of the scientific literature is not acceptable. Scientists on social media should strive to take intellectual responsibility and not pretend to be experts in fields outside their own where they make claims that are easily disproved.

What is wrong with the Time magazine article by the astrophysicist?

The Time magazine article makes multiple scientific errors that will be covered in great detail below. However, many tactics in the article can be clustered into three major categories that will be briefly discussed.

Misunderstands basic infectious disease epidemiology

The new coronavirus primarily spreads within households rather than outside households. This is typical for an infection that is spread via droplets. In contrast, infectious diseases were aerosol transmission can be important (such as measles or influenza) spreads much more outside households. Thus, by simply looking at the disease transmission dynamics of the disease, we know that spread via droplets dominates.

To be sure, aerosol transmission can occur intensive care treatment where there is high air pressure in respirators. This is why those health professionals use visors when performing these tasks. However, it is rare and does not in any way dominant the situation. Being overly fearful of aerosol transmission in households or the community outside these rare exceptions is like worrying about leaving a candle alight when the house is on fire.

For maximum clarity, the phrase “out in the community” is often used in different contexts. It can mean “outside the household”, “outside hospitals”, “outside the group of people coming back from holiday in Europe” or “outside the group of people who were initially exposed”. Care is needed to understand the context in which the phrase “community spread” is used and what it refers to in that particular context.

Relies on preprints, blog posts and Twitter

Second, it relies for many of its arguments on preprints that have not been subjected to peer-review, newspaper articles and even social media content such as blogs and tweets. This is not a scientific approach, but an approach that is based on looking for sources that supporting their position and ignoring those that do not. Preprints are just documents that have been uploaded to a website. There is no assessment being done by editors and the document has not undergone peer-review. It is thus impossible for a layperson (such as Mack) to evaluate the quality and relevance of the findings reported.

In fact, two of the largest preprint servers for biomedicine (bioRxiv and medRxiv) explicitly warns about treating those preprints as verified science:

The warming reads:

Caution: Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Because of the fact that the mass media systematically relied on unverified preprints when writing misleading news stories, some of the preprint servers in question had to put up a large warning message above every single article on the website instructing journalists that the reports on the preprint server has not been checked by experts and that journalists should not treat it as fact.

Did Mack understand this? Probably not, as the text contain no information whatsoever that tells the user that certain claims are based on reports that have not undergone peer-review. But, since the Time magazine article also relies on newspaper articles and social media posts on Twitter as source, perhaps that was too much to hope for.

Information found on social media, even by scientists, is even less credible since they have not even written up their findings and made them available to the public. Rather, social media posts should be viewed on as opinion. Never take medical advice from social media.

Finally, it is important to understand that journalists are not trained scientific experts and they have made too many scientific errors during the pandemic to be recounted here.

Frequently misrepresents the references cited

This is a massive red flag for pseudoscience where this is a chronic behavioral trait and happens all the time.

A paper that argued that infections via droplets was the most likely explanation for the observed disease transmission in a restaurant setting became for the author evidence of powerful aerosol transmission.

A paper that generated aerosolized particles with a machine set-up (“three-jet Collison nebulizer and fed into a Goldberg drum”) became evidence that virus particles from humans can stay in the air for three hours.

This is of course not true at all, since this would make it more potent aerosol transmitter than measles (that can last up to “only” two hours). But the disease transmission of the new coronavirus does not look at all like measles. The new coronavirus spreads primarily within households, which is difficult to explain if infected people are producing aerosols all around them out in the public.

Had that been the case, the non-household path would dominate over spread within households. Just by looking at the way that the new coronavirus spreads allows us to exclude the notion that aerosols are the dominant mode of transmission. No need for fancy, aerosol-producing nebulizers.

Now, let us go over the Time magazine article in some greater detail.

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Localized outbreaks versus massive community spread

Right now, the United States is one of the most severely hit countries in the world by the new coronavirus. The number of reported cases are about 4 million and over 140 000 people with the new coronavirus have died. In contrast, the Vietnam war saw about 60 000 US deaths and World War I had about 120 000 deaths. In essence, it is the worst crisis in the United States since World War II. At its peak, the United States reported 77 000 cases during a single day. Now, the actual figure is much larger as there are many more cases that go unreported.

Mack seems highly concerned about localized outbreaks:

Since the start of July there have been at least two outbreaks among student athletes, coaches, and staff—with 37 infected at the University of North Carolina (UNC) Chapel Hill and 22 at Boise State. Clusters of infection have been traced to college town bars popular with students.

It is good if localized outbreaks were identified and contained, but in a geographical region that have massive spread in the community outside hospitals, it is literally a drop in the bucket. Many college students who have remote education are not constantly sitting inside free from the risk of becoming infected. Mack thus makes a faulty comparison between a small number of localized outbreaks and an imaginary state of zero risk. This is a common fallacy in risk analysis and highlights that just because someone is an expert astrophysicist does not mean they have any relevant level of expertise in any other area. Instead, the comparison should be against the current rates of infection in the college age group and to what degree in-person school attendance changes that risk. This analysis was not done by Mack.

Another useful comparison is that many European countries now have over one hundred outbreak clusters after emerging out of lockdown. Do schools stand out? No. In fact, a study that was done by the Public Health Authorities in Sweden and Finland titled Covid-19 in schoolchildren – A comparison between Finland and Sweden indicates that keeping schools closed (Finland) and keeping schools open (Sweden) during the pandemic made very little difference for cases among children. A systematic review published in Lancet Child & Adolescent Health titled School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review suggested that school closures have a very small impact. That being said, it is important to remember that behavior and susceptibility differs between children of different ages.

Did Mack cite or even read any of these studies? No, of course not. This is because, as an astrophysicist, Mack is not familiar with the research literature on the topic of infectious diseases and epidemiology. This really highlights the incredible arrogance that many physicists have in their thinking that their degree in physics automatically makes them an expert on any other topic outside their narrow field of expertise. In fact, this behavior is so common that it even has its own xkcd comic:

COVID-19 mortality among young people

Mack writes:

A common misconception is that young people with COVID-19 don’t die and therefore college re-openings pose little risk. Sadly, this isn’t the case. COVID-19 deaths in the young are rare, but they happen

There is no such misconception. It is well-established that the mortality rates among very young people are exceedingly low. According to the technical report The infection fatality rate of COVID-19 in Stockholm – Technical report, the infection fatality rate in Stockholm was 0.6% (95% CI: 0.4%-1.1%). For those above the age of 70, this figure was 4.3% (95% CI: 2.7%-7.7%). For those under the age of 70, this figure was 0.1% (95% CI: 0.1%-0.2%). For children, the figures are even lower and the bulk of research indicates that they are both less likely to get sick from the infection and to spread it to others. Again, it is worth to emphasize that children represents a large age group and there are differences within it.

Mack does not present the relative mortality rates for different ages in her text. Instead, she highlights three individual cases (probably for their emotional impact on the reader). Tragic as they are, they do not paint the full statistical picture that is needed to make evidence-based decisions.

It is also worth pointing out that very young people who die from COVID-19 almost always (with very rare) exceptions have underlying health conditions. By adding special protection to individuals with such underlying health conditions (perhaps they could continue remote education), the mortality can be substantially reduced even further. Again, it is worth highlighting that this is not a scenario where you move children and other young people from a situation of zero risk to the risks available in schools. Instead, they are shifted from the risks present outside schools in their communities to the risks present in their schools.

School closure has both public health benefits and risks

Mack also appears painfully unaware that school closures have both public health benefits and risks when she insists that:

The rush to re-open is driven by the very reasonable conviction that universities and colleges ought to provide their students face-to-face classroom teaching and a residential “campus experience.”

The CDC has put together a detailed overview of the risks and benefits from a public health perspective for school closures in the document Considerations for School Closure well before the current pandemic. It lists the public health downsides for different kinds of school closures spanning less than 1 week to more than 8 weeks. Thus it is completely wrong to claim that the arguments for having schools open rests on completely subjective and arbitrary things like “face-to-face classroom teaching” or “residential campus experience”.

But, the arguments against school closure by the CDC goes further than that. Here is their entire list of downsides with school closures (this document covers all schools and not merely colleges, hopefully few college students need childcare from their grandparents!):

Less than 1 week closure:

Impact on disease:
– Social mixing may still occur outside of school with less ability to monitor, especially among older students.

2 weeks closure:

Impact on disease:
– Modeling data for other respiratory infections where children have higher disease impacts, suggests that early short-term closures are not impactful in terms of overall transmission.
– Social mixing may still occur outside of school with less ability to monitor, especially among older students.
– Will increase risk to older adults or those with co-morbidities, as almost 40% of US grandparents provide childcare for grandchildren. School closures will likely increase this percentage.

Impact on families
– Key services are interrupted for students (e.g., meals, other social physical health, and mental health services, after school programs).
– Economic impact for families because of the costs of childcare and lost wages. There may be a loss of productivity even for parents who are able to telework.
– Some families may not have capacity for students to participate in distance learning (e.g., no computers, internet access issues) even if provided by school.

4 week closure

Impact on disease
– Longer closures may result in more students congregating outside of school (e.g., other students’ homes, shopping malls).
– Will increase risk to older adults or those with co-morbidities, as almost 40% of US grandparents provide childcare for grandchildren. School closures will likely increase this percentage.

Impact on families
– Students who rely on key services (e.g., meals, other social, physical health, and mental health services, after school programs) are put at greater risk.
– Economic impact grows with length of closure; furthermore, this may exacerbate disparities among families at different SES levels (e.g., parents with lower wage jobs may lose jobs).
– High school seniors likely to lose ability to participate in their prom, graduation etc.
– Some families may not have capacity for students to participate in distance learning (e.g., no computers, internet access issues) even if provided by school.

Impact on schools
– Significant impact on academic outcomes may occur. Losing one month of learning may prevent students from meeting grade level knowledge and skill expectations and may jeopardize schools’ ability to meet standardized testing requirements.
– School staff may be differentially impacted (e.g., hourly workers may be less able to sustain longer closures).

Impact on health care
– Available health care workforce is decreased as HCW stay home with children

8 week closure

Impact on disease
– Longer closures may result in more students congregating outside of school (e.g., other students’ homes, shopping malls.
– Will increase risk to older adults or those with co-morbidities, as almost 40% of US grandparents provide childcare for grandchildren. School closures will likely increase this percentage.

Impact on families
– Students who rely on key services (e.g., meals, other social, physical health, and mental health services, after school programs) are put at substantial risk.
– Economic impact grows with length of closure; furthermore, this may exacerbate disparities among families at different SES levels (e.g., parents with lower wage jobs may lose jobs).
– Student engagement with schools and peers diminishes, which could increase anxiety and other mental health and emotional problems.
– High school seniors likely to lose ability to participate in their prom, graduation etc.

Impact on schools
– Significant impact on academic outcomes will likely occur; losing 2 months of learning is likely to prevent many students from meeting grade level knowledge and skill expectations and will jeopardize schools’ ability to meet standardized testing requirements
– Loss of educational progress, even having to add an extra semester or year to graduate or move up a grade.
– Staff within the schools may be differentially impacted (e.g., hourly workers may be less able to sustain longer closures).
– Maintaining communication with school staff, families, and students becomes substantially more difficult as the school closure lengthens.

Impact on health care
– Available health care workforce is decreased as HCW stay home with children.

Mack is welcome to disagree with any or all of these points, but they clearly demonstrate that the case for opening schools or keeping schools open does not reduce down to “face-to-face classroom teaching and a residential campus experience”. How could Mack get this so wrong? The answer, like before, is that an astrophysicist does not have detailed expert knowledge of public health or epidemiology.

Actually, the CDC has a robust set of infection control measures

Safety measures proposed so far revolve around sanitation, masks, and physical distancing. These might be sufficient for a trip to the supermarket; for several reasons, they are likely to fail in the context of daily life at a university.

This is, again, completely wrong. The CDC has a long list of safety measures and mitigation strategies for schools in their article Considerations for Schools that go beyond “sanitation, masks, and physical distancing”.

This includes, but is not limited to:

  • Signs, messages and broadcasts
  • Ventilation
  • Modified layouts
  • Physical Barriers and guides
  • Student cohorts
  • Staggered scheduling
  • Staff training
  • etc.

The entire guide is just one example of robust measures that have been proposed that do not simply reduce to “sanitation, masks, and physical distancing”. Why did Mack not mention such guidance documents such as this one? The answer is, again, that Mack does not have the required expertise required to be aware of these documents.

Mack also provides no reason or evidence whatsoever why basic hygiene, masks and physical distancing “are likely to fail in the context of daily life at a university”.

The US and mandates

There is also a clear American ideological bias in the way Mack views public health:

First, some colleges are only “encouraging” (not mandating) mask wearing this fall, drastically reducing effectiveness. When a strict rule is in place, classroom enforcement will likely be up to individual instructors, and proper mask use (e.g., a snug fit that keeps all noses covered) cannot be guaranteed.

As we have seen from large-scale protests against masks, forcing people or mandating something is not at all a way to drastically boost effectiveness. Quite the opposite. To take one example to illustrate this phenomena, the childhood vaccination programs in Sweden with its completely voluntary system is ~97%, while the corresponding figure is in the low 90s in the United States. Even Mexico has higher coverage for measles vaccination than the U.S.

Mack seems to be laboring under the mistaken belief that unless you force people to do something, they will not do it. This is not correct. In reality, forcing them to do something can very well backfire spectacularly as we have seen with anti-mask protests in the United States.

Physical distancing is the best protection against becoming infected

Perhaps the most deeply pseudoscientific claim in the entire article is this:

Second, physical distancing is a moving target. Some states have argued that 4 feet of distancing is enough in the classroom, on the assumption that everyone will only cough (or breathe) straight ahead. UNC Chapel Hill even suggested that 3 feet would do, until an outcry caused them to reverse course.

Not at all. It has been known for many, many decades that a distance of approximately 6 feet (about 2 meters) is sufficient to drastically reduce the spread of respiratory droplets and thus the spread of the disease. This CDC recommendation even includes some extra distance compared with the WHO recommendation of 3 feet (~1 meter) that was based on cold viruses and bacterial meningitis. This is not “a moving target”. The bulk of published experimental studies indicate that 3 feet is sufficient and the 6 feet principle is based on lower-quality studies. Since the spread falls with distance rapidly, the precise metric between 3 and 6 feet is not important compared with it being at least 3 feet.

This is not a moving target. It does not matter one bit what various state officials claim. They can argue for whatever they want, but the science of physical distancing is clear. It works. In fact, physical distancing is the best supported intervention we know. The way that Mack casually dismisses is a sign incredibly dangerous and rampant pseudoscience.

In addition to physical distancing, other public health mitigation strategies such as barriers and cohort teaching further improve the impact of physical distancing. These were the mitigation strategies that Mack failed to mention earlier in the Time magazine article.

There is a growing consensus that in places with an uncontrolled COVID-19 epidemic, being inside a building where people are talking—such as in a bar, restaurant, office, or classroom—puts you at risk of infection. We now know that SARS-Cov-2, the virus that causes COVID-19, can linger in the air in the form of tiny droplets (aerosols) and can infect people as they breathe in.

You are always at the risk of infection. What matters is not if the risk exists, but how large it is. Furthermore, there are probably no country that has a completely uncontrolled COVID-19 epidemic. Most countries do not have an epidemiological curve that has always been in an exponential phase. Had that been the case, there would have been many more cases than there because an exponential function grows quickly after it takes off from very small values. Secondly, all outbreaks are moderated over time as the population of people who are currently infected or immune rises. The virus can find fewer and fewer new people to infect and the spread decreases. The hyperbolic language is probable due to the fact that the situation in the United States is very grim.

In the quoted passage above, there are three references cited for the idea that aerosols represents an important mechanisms of spread.

First is an article called Clusters of Coronavirus Disease in Communities, Japan, January–April 2020 published in the journal Emerging Infectious Diseases. However, it makes no mention at all of the word “aerosol”. How odd of Mack to cite a paper in favor of the idea that aerosols represents an important mechanism of spread and the article does not even mention the term! So what does the paper conclude?

We noted many COVID-19 clusters were associated with heavy breathing in close proximity, such as singing at karaoke parties, cheering at clubs, having conversations in bars, and exercising in gymnasiums.

Yes, if you are in close proximity to other people, such as singing together at a karaoke party, you are at high risk of becoming infected. However, this paper does not lend any support at all to the idea that aerosol transmission is an important driver for spreading the new coronavirus. In bars and clubs, customers and staff should practice physical distancing. If they do not, it can be a place where the infection can spread. Attending parties is probably something that should not be done at all. Almost all of them can be postponed to after the pandemic with hardly any downside. If Mack meant that there is a growing consensus that you can get infected by being close to infected people in bars, this is also an incorrect assessment as this is trivial and has been known for a very long time. At any rate, the reference cited here does not support the idea that aerosol transmission is common or important as a general mechanism. But what about the other two citations?

The second reference is to a popular science summary in Nature called Mounting evidence suggests coronavirus is airborne — but health advice has not caught up. Yet this news feature presents no original research whatsoever. Instead, it describes how some scientists published a commentary (the scientific equivalent of an opinion piece) and how the WHO responded. An in-depth document called Transmission of SARS-CoV-2: implications for infection prevention precautions prepared by the WHO and released on July 9 had this to say:

Outside of medical facilities, some outbreak reports related to indoor crowded spaces (40) have suggested the possibility of aerosol transmission, combined with droplet transmission, for example, during choir practice (7), in restaurants (41) or in fitness classes.(42) In these events, short-range aerosol transmission, particularly in specific indoor locations, such as crowded and inadequately ventilated spaces over a prolonged period of time with infected persons cannot be ruled out. However, the detailed investigations of these clusters suggest that droplet and fomite transmission could also explain human-to-human transmission within these clusters. Further, the close contact environments of these clusters may have facilitated transmission from a small number of cases to many other people (e.g., superspreading event), especially if hand hygiene was not performed and masks were not used when physical distancing was not maintained.(43)

Thus, the WHO concluded that the alleged studies that claim that aerosol transmission is an important mechanism for the spread of the new coronavirus can be explained by non-aerosol transmission. Thus, Mack has yet again misrepresented a reference. The WHO has not at all concluded that aerosol transmission is an important mechanism for the spread of the new coronavirus. But what about the last reference?

The third and final reference in this section is just a New York Times article titled “The Coronavirus Can Be Airborne Indoors, W.H.O. Says” that cover similar materials to the second reference. As we saw, the WHO said no such thing. They highlighted that it was possible, but that the findings could be accounted for by non-aerosol transmission.

The new coronavirus is not primarily spread via aerosols

Mack repeats the same error of misrepresenting the references cited in the next paragraph as well (the last claim about masks are discussed in the next section):

Research has shown that air flow can transmit aerosolized SARS-Cov-2 much further than 6 feet. In the absence of constant and efficient ventilation, viral particles can remain airborne for at least 3 hours. In most universities, opening all the windows and doors would be impractical or impossible, and air conditioning systems can waft recycled air over occupants for hours.

The above part contains three references. Let us again go over them in some detail.

The first reference is to another article in Emerging Infectious Diseases called COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. They looked at disease transmission inside a restaurant with substantial use of air conditioning. Basically, the air condition appears to have moved droplets from a person who was infected to a healthy person sitting over 2 meters away. This is obvious as an air current can make droplets move further than if no such air current is available. However, the study concluded that:

From our examination of the potential routes of transmission, we concluded that the most likely cause of this outbreak was droplet transmission.

Indeed, this is the same conclusion reached by the WHO. The reference “41” in the above quote from WHO leads to the same paper. Thus, this paper does not demonstrate that aerosol transmission is an important mechanism for the spread of the new coronavirus. But what about the two other references?

The second citation does not go to a scientific paper at all. It goes to a blog post. This is not a peer-reviewed published scientific paper and can probably be ignored right away. However, it only mentions aerosols in two places. The first mention revolves around toilet flushing.

We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk.

Yes, you should not inhale the aerosol from another person’s toilet after they have pooped in it and have begun flushing. This is true in general and has nothing to do with the new coronavirus. No argument there. But it does not show in any way that public toilet aerosol inhalation is an important mechanism for the spread of the new coronavirus.

The second mention of “aerosol” in the blog post involves a cluster outbreak from a choir (linked to an article in the LA Times). Singing probably expels more droplets than merely breathing and there is no information about the degree to which they fully practiced physical distancing. This may be the same case as the reference “7” in the WHO technical report that has already been covered.

Thus, this second reference does not demonstrate that aerosol transmission is an important mechanism either. But what about the third reference?

It turns out that the third reference is the paper where they used a machine set-up to generate aerosols that purportedly lasted three hours in the air. The study is called Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. As explain earlier, they used “three-jet Collison nebulizer and fed into a Goldberg drum” to create artificial aerosols and then measured how long they were airborne. Needless to say, this is not at all what happens for humans. It also provides zero evidence that aerosol transmission is an important mechanism for spreading the new coronavirus.

But perhaps the best evidence for why we know that the main transmission method is through respiratory droplets is the way the disease spreads. Diseases that are mostly spread via aerosols spread over the entire community, whereas those that are spread primarily via droplets spread from longer close-constant with other people (more common within a household). A study called Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020 from South Korea published in the journal Emerging Infectious Diseases looked at household versus non-household transmission. The abstract is worth quoting in full:

We analyzed reports for 59,073 contacts of 5,706 coronavirus disease (COVID-19) index patients reported in South Korea during January 20–March 27, 2020. Of 10,592 household contacts, 11.8% had COVID-19. Of 48,481 nonhousehold contacts, 1.9% had COVID-19. Use of personal protective measures and social distancing reduces the likelihood of transmission.

So after studying close to 60 000 contacts for almost 6 000 index patients, they found that there was an order of magnitude higher household contacts who had COVID-19 compared with non-household contacts. This is exactly what we would see if the dominant mechanism of spread of the new coronavirus was from respiratory droplets and not aerosols. This is not the only study and the bulk of the published research and observation of the spread of COVID-19 together indicate that the spread is primarily driven by respiratory droplets that are not aerosols.

Does this mean that aerosol spread somehow cannot occur? Of course not! We know that aerosol transmission can occur in certain specific situations. Perhaps the most well-known such situation is when health care personnel is working with respirators and other machines with higher air pressure in association with the respiratory tract of patients. These procedures absolutely generate aerosols and that is why many health care professions are using visors in those situations, in addition to other personal protective equipment.

But when it comes down to it, aerosol transmission is rare and it cannot account for the observed spread of COVID-19.

So how come Mack drew the wrong conclusions here? It is probably a complex explanation. However, not having expert-level knowledge on the topic means that it is far more difficult to understand, analyze and draw appropriate conclusions from scientific studies. Furthermore, Mack relied far too much on social media posts. Finally, it is typical sign of a pseudoscientific approach to things to cite references that do not support the claim being made.

Let us move on to the issue of masks that are only mention very briefly.

Masks

The final part of the paragraph quoted above involves masks:

Masks help, but they’re not perfect protection.

Of course masks are not a perfect protection. Everyone knows this and it does not matter one bit. The goal is not for masks to be prefect, but to have a beneficial effect and be widely adopted. So even though it only reduces the risk of spread for any given individual by a moderate amount (since cloth masks are not N95 respirators), the collective effect is a large decrease in disease spread. The sheer ignorance in attacking masks by saying that they are not perfect is truly astounding.

The reference cited is a preprint from medRxiv with the title Quantitative Method for Comparative Assessment of Particle Filtration Efficiency of Fabric Masks as Alternatives to Standard Surgical Masks for PPE. There is really nothing to discuss about this paper as we know from published studies that masks are non-perfect. It just does not matter. Again, the goal is not for masks to be perfect, but for them to be wildly used. That is where the big effect of mask usage comes from.

If even an astrophysicist cannot grasp the simple idea behind mask use, it is no wonder there is a large anti-mask movement in the United States.

Universities are not at all like elderly care homes or cruise ships

There’s a real risk that so-called contingent faculty, those in “insecure, unsupported positions with little job security and few protections for academic freedom” will have no choice—they will feel pressured to teach in person or be replaced.

There is absolutely nothing that prevents universities from taking this into account, except perhaps their own greed. Yes, the U.S. system is broken in terms of the huge power imbalance between employer and employee, but there are obvious ways around it.

Mack then tries to insist that universities are like elderly care facilities or cruise ships. I kid you not!

Beyond the classroom, colleges and universities are “congregate settings” that are known to create high risk for viral transmission, akin to nursing homes or cruise ships. The campus experience includes bringing students together in dormitories, dining halls, athletic training, parties, bars and clubs—gatherings that would risk becoming “superspreading events.”

No, universities are nothing like cruise ships or elderly care facilities.

First of all, the reason that cruise ships got hit so badly was that the had the infection spreading before there was sufficient knowledge of the virus or how it behaved. Cruise ships were also in the middle on nowhere on the open ocean and had virtually no access to personal protective equipment or public health practices in place.

Elderly care facilities are also not a comparable situation, since some of the biggest reasons for why they were hit so badly has been due to cutbacks in elderly care for decades, sometimes as many as 40% of staff admitting to ignoring basic hygiene routines and that people who were there are often working hours and thus not covered by government boosts to job security enabling some people to stay at home when sick without losing their income or job. Elderly care facilities are also not homogeneous. There are many elderly care facilities that managed to keep the infection out or managed to stop it after it had gotten in.

Most countries already have bans on larger social events, specific restrictions for bars and restaurants, recommendations against parties and so on. The CDC guidelines recommend a large number of things to reduce the risks.

An unpublished focus group posted on Twitter is not a study

Perhaps the least credible “research” cited by Mack is the following:

But a recent study led by Dr Sherry Pagoto at the University of Connecticut—a survey of 2,698 students who will be returning to campus in a few weeks, and in-depth interviews with a further 35 students—suggests that many obstacles lie ahead, especially if students are not meaningfully engaged in the reopening planning process. (Dr Pagoto has shared the initial findings of the 35 in-depth interviews on social media.)

This sounds interesting! Is there a published paper available? Nope. A preprint? No. Then what is available? A series of tweets recounting a focus group she had. Of course, a series of tweets have no scientific validity whatsoever. We have no way of checking to see if the tweets correctly reflect the result and no way to check the methodology of the study.

Race pseudoscience raises its ugly head

As if Mack could not sink any lower, she brings up discredited race pseudoscience:

While the risk of death from COVID-19 is lower among the young than the old, we’ve seen that young adults can die of the disease and the risk is five to nine times higher among those who are Black, Latinx or Indigenous.

This is absolutely false. There is nothing intrinsic to ethnic minorities that makes them at higher risk of getting infected or dying from the new coronavirus. A thorough CDC analysis of the situation instead identified the following reasons:

  • Living in densely populated area.
  • Racial housing segregation.
  • More multi-generational households
  • Being an essential worker (this probably includes front-facing service personnel as well).
  • Being uninsured.
  • Obesity, high blood pressure, smoking.
  • Systemic racism (an umbrella term for all the different structural ways society has screwed over ethnic minorities).
  • etc.

These are some of the factors that explain why ethnic minorities are overrepresented in the statistics. Most of these factors will not be relevant for university students living on campus. At no point do they discuss the fact that the reasons for the over-representation is almost certainly completely related to modifiable social and economic factors. To their credit, the paragraph after does mention overrepresentation in university service jobs.

There is a badly controlled (but not “uncontrolled”) pandemic in the United States

Mack continues to use emotionally manipulative and misleading language:

Universities that fully re-open in the midst of an uncontrolled epidemic will bear responsibility for the damage they cause to their wider communities.

There is a badly controlled epidemic in the United States, but this is not the same as if it had been uncontrolled. Here is how the current graph looks (from the John Hopkins Dashboard):

…and here is how it looks with a logarithmic y-axis:

As can be seen, the rise currently is not as steep as it was in the early weeks and months. Thus, it is not an uncontrolled epidemic.

Is it a badly controlled outbreak? Yes. Is Donald Trump and many state leaders completely failing to handle the new coronavirus pandemic? Absolutely! Is Donald Trump the worst President that the United States has ever had? Without question.

But, is it an uncontrolled epidemic? No. There is evidence that some of the restrictions put in place are working, especially if you look at the level of states and compare those that have handled it bad against those who have handled it better.

Taiwan is an island and not comparable to the United States

What would it take to re-open safely? We can look to Taiwan as an example.

Taiwan is a terrible example. This is because there are so many differences between Taiwan and the United States that you could realistically never reached the level of management that Taiwan had.

First, Taiwan is a small island. Islands always have an advantage against pandemics. Almost all islands are performing very well in the fight against the new coronavirus.

Second, Taiwan experienced the SARS epidemic up-close and has since developed robust public health infrastructure and protocols for handling similar events. In contrast, the United States scrapped a lot of their pandemic preparedness.

Third, Taiwan actually did have a second spike in April.

Fourth, as even Mack points out, there was very little community transmission in Taiwan, so it is not comparable.

In that context, it’s hard to see how any U.S. university could have a safe on-campus reopening plan comprehensive enough to succeed.

That is because Mack is setting up an impossible standard and then, when the United States for obvious reasons cannot possibly achieve it, just gives up and say that safe reopening is not possible.

Conclusion: The intellectual responsibility of scientists

Mack surely knows that it is very common for arrogant physicists to go into other areas for which they lack expertise and make claims supported by very little evidence. Perhaps that is why a co-author was added that had some ties to public health, but it does not appear to have helped.

Should the US re-open schools? It is an issue that is actually far more complex than either Mack or Trump understands. The problem with a lockdown is that it can only be maintained for a relatively short period of time. So there has to be a robust and long-term post-lockdown strategy. Right now, it is difficult to argue for a non-staggered opening due to many reasons. Because the failed federal response to the pandemic, the vast anti-intellectual culture in the United States and many other factors, the future appears very uncertain.

At the end of the day, it is very important for scientists and public intellectuals like Mack to take some measure of intellectual responsibility, especially on social media. It is important to read up on a new subject thoroughly. One should not misrepresent published scientific papers. Finally, one should understand that being an expert in some area does not make one an expert in another area. It can be very dangerous to make incorrect pronouncements since the status as a scientist and public intellectual are often seen as authoritative in society.

Emil Karlsson

Debunker of pseudoscience.

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