Covid-19 How Can the WHO continue to be so wrong

One of the worst things about this pandemic is the lack of facts leading to conflicting and flat out wrong advice being give to people all across North America at least and probably much of the world.

I, for one implicitly trusted the WHO. When we were watching events unfold in China early on there was no sense of anxiety. The WHO advised countries that closing borders was ineffective and unnecessary. This may be the biggest mistake they made - who knows how early containment could have affected where we are now.

Trump has focused on the influence that China had on the WHO as his excuse to defund them. Certainly Chinese deception and influence does seem to have affected the whole trajectory of this pandemic and needs to be addressed but this is not the extent of the WHO's failure.

In some ways, their ongoing mistakes could be causing even more harm.

Blindness to Past and Blatantly Weak (and bad) Advice

Perhaps their most egregious error is that bad early advice regarding masks. Although there has been plenty of evidence that masks help contain the spread of viruses that are spread through the air by small water droplets and it was early known that this was a primary cause of transmission of Covid-19, the WHO advised that masks were ineffective.

I'm left shaking my head. In every pandemic threat we seem to have to relearn the basic fact that masks help limit the spread of an airborne contagion. Most significantly, cautionary advice following the SARS epidemic concluded that masks were effective for a very similar virus and should recommended as part of any response plan.

The 6' social distancing rule was derived from the knowledge of how far water droplets can typically travel before falling to the ground. This almost universal social distancing rule is the biggest endorsement that there could possibly be for masks. It tells us that our health leaders were confident that spread was by droplets.

With masks that distance is much shorter. Much less restrictive lock downs could have been achieved simply by using masks. It is tragic to think how much less we would have had to affect our economies if masks had been advocated early on.

A related misunderstanding was the relative safety of outdoor activity. This is also patently obvious when considering spread by droplets. The infinite air volume outside and the omnipresence of some level of breeze means that virus will very quickly dissipate outdoors. We never needed to close ski hills, hiking trails, golf courses etc. Social distancing is still advisable but the low density of people in most outdoor activities makes it trivial to achieve safe outdoor activity. Venues with denser population like beaches and popular parks are problematic but with reasonable levels of social distancing are still relatively very safe.

We could have kept more of the economy open - restaurant patios for instance. Instead, we are faced with a very grim future for the restaurant business. Many restaurants have already closed their doors permanently with more to follow.

Now that we are reopening, we are leveraging the effectiveness of masks and the relative safety of outdoor activity. Consider that this level of lock down is probably all that was ever needed.

I am happy that Canada erred on the side of our safety. I think that was more important than the economy. However, imagine how much better things could have been with better advice coming out of the WHO to guide our world leaders.

Reopening Indoor Activity

Now we are mostly faced with problems reopening indoor activity and recent information about the role of aerosol born virus is potentially very important to proper assessment of the kinds of activities that are safe indoors. Aerosol refers to much smaller airborne particles that can remain aloft for much longer periods of time.

At first the WHO said aerosol transmission was insignificant prompting a large ad hoc group of doctors to write an open letter to the WHO pleading with them to acknowledge the role of aerosol transmission. While it seems true that aerosol transmission has been very low it also seems that it will become more of a threat as we reopen more indoor activities and once again it seems that the WHO is again going to be sadly, blindly wrong.

Aerosols seem to be produced when there is more aggressive breathing or activity in the throat and mouth - intubation for ventilators, dental procedures were early situation where aerosol transmission was suspected. However more recently, there is growing anecdotal evidence that loud talking, singing and, likely, exercise also can produce aerosols.

That should tell us that some businesses, e.g. gyms with agressive breating are very problematic , churches with loud group singing are worrisome and that any environment with numbers of people in a contained air volume is also problematic. I, for one, do not feel comfortable at this point getting on a plane.

In areas like most of Canada where we have successfully contained the virus, there is not very much virus in circulation so nearly any activity is relatively safe. However, that is not true in other parts of North America. There are blooms of virus in many southern states. The role of aerosolized virus could be very important in how we deal with indoor activity.

Abandoning the Elderly

The saddest thing in Ontario is that while we locked down the general population way more than necessary we ignored the health of our most vulnerable elderly population in long term care homes. The government new that elderly were most at risk and that indoor settings were problematic but no one thought to evaluate the safety of these homes and protect these people.

While that should perhaps have been obvious it also falls on the WHO  and health leaders to give more clear practical advice to help world governments make good policy.

How Can We Expect People to Trust Science

Mistrust of science is quite widespread and its not that hard to understand why when the people that we trust to give us good advice are so consistently, irresponsibly wrong.

When faced with unknowns they should have been more prudent. 

• The WHO knew early on that this had the hallmarks of a pandemic. It would have been prudent to advise limiting travel.
• They knew that a primary means of transmission was breath. It would have been prudent to recommend the use of masks.
• There is a growing body of evidence that aerosol transmission is happening. It would be prudent to identify indoor activities that are prone to risk of aerosol virus.

I think in each case, the WHO has eventually retracted their bad advice and support the facts. They are not evil. They are smply not up to the task.

Flip flopping is devastating to trust. How many people are still rebelling against the use of masks. They cite lack of agreement and conflicting advice from our leaders.

A pandemic happens fast. Much can't be known 100% at the beginning. I think it is far better to advise prudence than to wait for certainty.

I don't know the answer but at present I do not trust the WHO, at all.

This isn't over yet though. We need leadership. We need them to be better.

What's Next - Prevention, Treatment, Vaccine

The WHO could still have a helpful role. A lot of hope is on a vaccine but despite many efforts there has never been a successful coronavirus type vaccine so a banking everything on a vaccine is naive at best.

In the interim we need to do all that we can to help prevent people from contracting the virus and improving the recovery of peope that do.

One promising area of prevention is the weird anti-correlation with smoking observed in European countries that still have prevalent numbers of smokers. The belief is that the responsible agent is nicotine. This deserves to be talked about more openly with more dedicated study.

In severe cases the immune system overreacts with devastating effect. The virus may not be solely a direct killer. but it is responsible for a cascade of events that overwhelms our system. A promising area of treatment is to stabilize the rest of the body's systems until the virus can be fought off.

Consider a future without a vaccine. In that world, we would all eventually be exposed to the virus. A preventative agent that blocks infection or a treatment that improves our survival rate is the next best thing.

There is still a need for strong leadership.