Belgium has long targeted measures to reduce airborne infections. The country’s epidemiologist is encouraging Norway to do the same.
During large parts of the pandemic, Belgium has had a much more targeted approach to airborne infections than Norway.
For several months, cafes, restaurants, bars, nightclubs and gyms in Belgium have been asked to measure air quality. Now the same goes for all classes.
It has become clear last year that handwriting and hand washing have little to say in the fight against the coronavirus, Espen Rostrop Nakstad, assistant director of health for VG, said Thursday.
– Nakstad told VG on Thursday that the ventilation in the room you’re in and the distance with others are most important, not the hand alcohol.
However, we do not have national measures to reduce airborne infections in Norway.
How did Belgian public health authorities realize the importance of airborne infections so early?
a little research
The truth is that we know very little about how the lung virus is transmitted. But we should be more aware of this at the beginning of the epidemic. At first, we were very confident in our assumptions and were quick to take on the assumptions of the World Health Organization and ECDC, which believed that the virus was transmitted primarily by hands and due to close contact, explains the government epidemiologist at the Belgian Institute for the Public. Health Stephen Van Gucht to VG.
When you stand near someone and talk to them, you can drop large drops towards the person you are talking to and thus injure them, van Guchte points out.
– We thought that airborne infections, aerosols, were something very rare that almost only happens in hospitals, for example in respiratory patients. Beyond that, it must be very rare, he says and continues:
The problems are that there is very little good research on this topic.
Van Gucht believes that one must realize that a lack of quality research has been the reason why many countries and health authorities, such as Norway, have been reluctant to take measures against airborne infections.
We did the same thing in the beginning, and I got a lot of criticism. But I will never forget the journalist who asked, “Even if there is no evidence, isn’t there evidence that there isn’t?” ‘I think that’s very true,’ he says.
Do you have any advice for the Norwegian health authorities?
You should take airborne infections seriously. He says ensuring good ventilation is critical in rooms where members of several families meet.
Obvious signs of airborne infection
As early as May 2020, the Belgian Institute of Public Health wrote a report on the importance of airborne infections.
In a pandemic situation, one must sometimes introduce measures based on insufficient evidence, but common sense and good assumptions. That’s why we used face masks for the residents and focused more and more on the importance of good ventilation and aerosols, says Van Gucht.
As an expert in virology, he was also not surprised that there were no good studies on airborne infections.
Such research is difficult and expensive, he says.
Despite the lack of good research, Van Gucht points to several examples that the importance of airborne infections is probably far more important than the research communities initially thought:
- A study on rodents: Using a specially designed device, the researchers were able to show that the virus spread through aerosols in rodents that had not been in close contact. (external link)
- Outbreaks in mink farms in the Netherlands: The virus spread like wildfire in dry grass without close contact of mink. (external link)
- A laboratory study was able to detect the virus in air samples from the room of a Covid patient. (external link)
- And perhaps most importantly: reports of outbreaks among people in real life. For example, a blast in a choir in the USA where the choir kept a good distance and followed recommendations for hand alcohol and distance. (external link)
The eruption of Halden’s Eshal volcano in February, in which more than 100 people were infected, is an example that airborne infections have played an important role.
Measures the percentage of oxygen in the room
Van Gucht points out two critical measures to reduce air pollution:
- Make sure there is good ventilation to reduce air tightness
- wear a face mask
In Belgium, cafes, restaurants, bars, nightclubs and gyms are required to install CO2 meters.
When the application was also made in all classes on Thursday a week ago, Belgian Health Minister Frank Vandenbroek said the following:
Let me emphasize again the importance of ventilation. We underestimated it for a long time.
Vandenbroek warned that if an infected person enters a closed room, the virus will remain in the air even if they leave the room.
It is preferable to place the small box in the middle of the room. If the carbon dioxide meter indicates that at least one percent of the air in the room has already been inhaled by a person, companies should implement immediate measures such as ventilation.
If CO₂ shares increase more, companies must close.
Read more about Belgium’s air quality requirements in the fact box:
Random inspections are conducted and companies can be fined if they do not comply with the requirements.
The advice was vague
Van Gucht points out that many countries, including Norway, already early in the pandemic believed that the risk of infection was lower outdoors than indoors.
– The advice was vague. What you’re actually suggesting is that aerosols matter, because if an aerosol isn’t important at all, it doesn’t matter if you meet indoors or outdoors, he says.
He compares it to someone who smokes indoors: smoke visibly hangs in the air indoors and people in the same room become passive smokers. In the open air, the cloud of smoke will disappear even with a light breeze.
There is a big difference inside and out. So if you say that the risk of infection outdoors is lower than indoors, you are actually implicitly saying that you think aerosols are important. So there was ambiguity from the start, I think, in many of those recommendations, he says.
Van Gucht acknowledges that there are challenges in ensuring good ventilation, especially in Scandinavian buildings.
Designed to maintain the indoor climate inside and the outdoor climate outside. It’s good for the environment, but not for spreading infection, he says.
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