BU’s Mask Policy is Inadequate

This is a guest post by Professor Nathan Phillips, Department of Earth and Environment, Boston University.

In light of national and Massachusetts trends in COVID cases, the wisdom of re-opening BU in three weeks is becoming increasingly questionable. But if BU is going to re-open this fall, among all the safety measures it is taking, it needs to address a big safety gap in its present approach: its mask policy.

To cut to the chase, BU should make a bulk purchase of properly-vetted KN95 masks for the university community, as a key part of a prudent strategy to reduce risk of airborne transmission. Institutionally-vetted KN95 masks are preferable to N95 masks for BU because of a shortage of N95 masks that is due to the need to prioritize the requirements of front-line healthcare workers and first responders.

Our current policy is inadequate because it takes a collective action problem, and views it simply as an individual matter. Choices regarding masks matter for indoor airborne transmission, and leaving this type of decision to tens of thousands of individuals will lead to highly uneven individual choices that will have bad effects on the whole community. Currently, for example, the use of bandanas would be allowed. Bandanas are effective at preventing ballistic transmission, but poor at blocking viral aerosols. Even those who might choose a KN95 mask could easily buy a faulty one by mistake, as this recent report makes clear. BU needs a community-level solution to a community-level problem. Masks must be considered not just PPE, but Community Protective Equipment, and part and parcel of the university’s ventilation strategy.

I appreciate that BU has begun to address concerns about building ventilation in light of mounting evidence of the potential for airborne COVID transmission. While this is laudable, these steps, which include increasing air exchange rates and installing HVAC filters, are missing both the very first and the last lines of ventilation defense: masks. Properly fitted and filtered masks inhibit aerosol transmission both at the source, and at the end point of potential infection. If we are investing time and expense in retrofitting rooms with improved HVAC filters, we should also be considering the quality of facial filters.

A recent Harvard-Illinois IT study of COVID transmission on the Diamond Princess Cruise Ship found that, despite good ventilation on this ship, airborne transmission was a likely major route of transmission. A NY Times review of this study states:

But good ventilation is not enough; the Diamond Princess was well ventilated and the air did not recirculate, the researchers noted. So wearing good-quality masks — standard surgical masks, or cloth masks with multiple layers rather than just one — will most likely be needed as well, even in well-ventilated spaces where people are keeping their distance.”

To be sure, the science is not settled and the cited study, a preprint, is one study, but the physical mechanisms posited as being involved make for a highly plausible causal account, and with the health and welfare of tens of thousands of people at BU on the line, as well as the lives of hundreds of thousands of people across greater Boston at risk, use of the precautionary principle is strongly warranted. If a bulk order can procure vetted KN95 at $2/mask, this is well worth an $80,000 university investment in community safety (supposing we need masks for 40,000 people). While there are risks with extended use of respirators like N95, they have been recommended for re-use under conditions of scarcity.  Compliance and enforcement is an important related issue, but due diligence would mean providing at least one properly-vetted KN95 mask to every member of the university community.  

The mask I wear affects you; the mask you wear affects me; the masks we all wear potentially affect everyone in the BU community. We need a community-level solution to this problem.

BU Today and BU Tomorrow

This is a guest post by Jonathan R. Zatlin, Associate Professor of History at Boston University.

A few weeks ago, in the midst of thinking about our future at BU, I invited BU Today to report on a letter to university leaders by the History Department, which you can find here. The letter asked the university president and provost, as well as the dean of CAS to rethink their approach to reopening the campus, and allow instructors at BU the same freedom as our students: the freedom to choose to teach in person or remotely based on each instructor’s own personal situation. To our surprise, we received answers from all three administrators, first from Dean Sclaroff, and then from President Brown and Provost Morrison. As far as I know, these two letters from the upper administration are unique; they have not responded to other letters or petitions from faculty or graduate students. I suspect there are several reasons that we received responses, all of which have to do with aspects of our letter.

Whatever those reasons, we were encouraged that our concerns were officially acknowledged. Given the administration’s reticence to discuss LfA and its perceived shortcomings, I thought it would be useful for the larger BU community to read our letter and the responses to it. To help apprise our colleagues and students, I invited BU Today to report on the letters and what they mean for BU tomorrow. I turned to BU Today because, according to their website, they are a source for “university news” and include “safety” as one of their reporting areas. I recognize, of course, that BU Today is more newsletter than news organization. Any news that conflicts with its mission to enhance BU’s reputation will present a serious challenge to its reporters. That said, I hoped that BU Today’s willingness to print an op-ed by graduate student Emily Chua represented a readiness to report on the actual news: what reopening BU’s campus will actually mean for teachers, students, and staff. One part of that story that needed reporting, I thought, was that History faculty wanted the same choice as is being granted students and the reasons that administrators continue to choose to deny us that choice. 

What I didn’t expect was BU Today’s response. The editor, John O’Rourke, rejected my suggestion that BU Today report on the letters. Worse, he responded by offering a non-solution that is at once telling as it is insulting: “If you wanted to post the letter with a short intro as a comment to the POV that we ran written by Emily Chua, we’d be happy to post the letter in the Comments section of the story.” The story by Emily Chua was published on July 9, and this suggestion was provided on July 20. I wrote, in response, “Placing our letter in the comments section… strikes me as problematic. I’m sure you didn’t intend to suggest it, but your offer … makes me worry that our concerns will simply be swept under the rug, tucked away in comments well after the publication of a different piece. I’d prefer that BU Today report directly on them.” Needless to say, O’Rourke did not take me up on this suggestion. I guess the helpful thing about O’Rourke’s response is that it clarifies BU Today’s institutional position for us: despite sometimes trying to present itself as a journalistic venture, BU Today is not a newspaper, newsletter, or even a newsfeed, for it doesn’t deal in news. Instead, it’s a public relations enterprise, and, as such, it uncritically reflects the views of the BU administration. 

See also these earlier posts on BU Today: On the Response to my Open Letter, An Open Letter to the Editor of BU Today, and Where are you BU Today?

Ventilation Issues and BU Classrooms

This is a guest post by Dr Sarabeth Buckley, a postdoctoral research fellow at Cambridge University. She recently received a PhD from BU’s Earth and Environment Department, where her research focused on ventilation and rooftop gardens.

Towards the beginning of the whole pandemic in early February, there was a story that came out of Hong Kong that was particularly frightening. In a large apartment building, one person on one floor initially tested positive for Covid-19. The virus was still primarily circulating in China at the time. What was scary was that someone ten floors away also then tested positive and that although they did not know each other and had not had any contact, their apartments did share some pipes and there was a leak in the second apartment. This was a very early indication that Covid-19 might be airborne.

WHO denied this, saying that the evidence overall suggested Covid-19 was not airborne. It took five whole months for this article, citing this paper to come out. The article says coronavirus is, in fact, airborne. We all need to take this fact seriously. When anyone coughs they release water droplets of different sizes. Some of these are large and they will fall right to the ground. Others are very tiny, around five μm, which is too tiny to see. Droplets of this size can travel tens of meters away from the person who exhaled them, which is a much longer distance than the length of a normal room, and definitely longer than the length of many of our small BU classrooms. Scientists had hoped that Covid-19 viral particles would not be able to survive in these tiny droplets and might only survive in the bigger droplets that people expel directly, next to themselves. If this had turned out to be the case, it would be enough to just stay out of spitting range of people while sitting inside.

The article states that Covid-19 can survive in these tiny droplets for three hours, which is longer than any of the classes I ever took at BU. This means that if you are in a room where someone who is infected with Covid-19 has been, even if you are on the other side of a large room, you could still catch the virus by breathing in air that someone, perhaps in an earlier class, breathed out a good couple of hours ago. I think about all the classes I took at BU and the little rows of desks a foot or two away. Even if half or more of those desks are removed and the ten people left coming to in-person classes all sit awkwardly, far apart, one person being infected means some portion of the air in the class is going to contain viral particles.

Before the July 4 article, the WHO’s official statement was still that the virus was only airborne in hospitals after medical procedures. It took 239 scientists in 32 countries writing an open letter, explaining the way in which Covid-19 is airborne, for this discovery to be taken seriously. 

Masks certainly help, but they can’t prevent you from breathing in particles. They’re not sealed. When you breathe in while wearing a mask, you can feel the slightly cooler air rushing in through the little areas on the sides of your nose where the mask isn’t quite flush with your skin, and this air hasn’t gone through the cloth. What masks do help with is preventing your own water droplets from being sent off to mingle in the air. Therefore, if everyone wears a mask the entire time they are around other people, then, hypothetically, all of the viral particles infected people breathe out should be caught on the inside of the mask fabric and stop their journey there.

There are a few other things that can be done. Classrooms can be cleaned very frequently with cleaning implements like ultraviolet lights, for example. But one of the most important things that can be done is ensuring that rooms have good ventilation. If potentially contaminated air is being continuously pulled out, recycled air is heavily filtered, and new fresh air without Covid-19 is pushed in at a fast enough rate, this should help get rid of the viral particles twirling about above our heads, threatening to infect us.

This is basically about trying to create a situation reminiscent of an outdoor environment, where the air is moving around so much that it fairly quickly whisks away any viral particles just hanging about (unless you are within direct firing range). This is where some of my work comes in. The recommended ventilation level for removing Covid-19 particles is thirty cubic feet per minute per person (Allen and Macomber, 2020), but how do you know what the current ventilation rate is?

A primary method for testing what ventilation rates actually are is measuring CO2 concentrations in rooms with multiple people in them. This is because, as everyone knows, people are constantly breathing out large amounts of CO2 that build up in confined spaces like classrooms; the more people, the more CO2 builds up. If CO2 concentrations get too high, this indicates that ventilation is not sufficient. Governing bodies set limits for CO2 concentrations in rooms. Generally these are:

5000 ppm – Upper limit of what should ever be found (ACGIH, 1999; OSHA, 1997)

1000 ppm – Suggested limit for classrooms, in particular (ASHRAE, 1989)

800 ppm – Suggested limit in Massachusetts (MADPH, 2020)

As part of my PhD research, I took CO2 measurements in BU classrooms to understand how well ventilation there is working. You can see for yourself how well some of the rooms in the College of Arts and Sciences building did on this test.

Macintosh HD:Users:Sarabeth:Desktop:MY DOCUMENTS:Personal:Activism:Covid19:BU:CAS Classroom CO2.png


Each color is CO2 measurements taken in a different classroom over the course of a week. They obviously go far above the 800 and 1000 ppm limits.

From one perspective, CO2 can affect how well you perform mentally, meaning high concentrations can make you a bit slow and sleepy, and you have probably experienced this first hand. High concentrations are also known to be associated with other pollutants, such as particulate matter, sulfur dioxide, or, as is critical in this case, biological contaminants. This is usually referred to as Sick Building Syndrome, but in the present context, you might as well just call it Covid-19.

What I found was a sign that current ventilation, at least in CAS classrooms, is far from efficient enough to deal with even normal contaminants, let alone something as contagious and virulent as Covid-19. This is good and bad. It means BU is not ready for normal classes at this point, but it highlights a clear step BU must take in order to make the campus safe in the fall. At this point, BU has said they will be doing “a comprehensive review of all HVAC systems, upgrading filters as needed.” This must include increasing ventilation rates and actively monitoring CO2 concentrations in these rooms, in order to keep tabs on whether or not ventilation is actually functioning at a high enough level. There are even third parties who BU could hire to help them test building ventilation and set up a system that will keep everyone safe. They just need to make this a priority and let us know what their plan is.

– ACGIH (American Conference of Governmental Industrial Hygienists). (2011). TLVs and BEIs. Cincinnati, OH: American Conference of Governmental Industrial Hygienists.
– Allen J. and J. Macomber. Healthy Building: How Indoor Spaces Drive Performance and Productivity. Cambridge, Massachusetts: Harvard University Press, 2020.
– ASHRAE. 1989. Ventilation for Acceptable Indoor Air Quality. American Society of Heating, Refrigeration and Air Conditioning Engineers. ANSI/ASHRAE 62-1989.
– MA EOHHS (Massachusetts Executive Office of Health and Human Services). (May 8th 2020). Massachusetts Environmental Public Health Tracking: Ventilation. https://matracking.ehs.state.ma.us/Environmental-Data/indoor-air-quality/ventilation.html
– OSHA. 1997. Limits for Air Contaminants. Occupational Safety and Health Administration. Code of Federal Regulations. 29 C.F.R 1910.1000 Table Z-1-A.

Healthy people as young as 45 at greater risk from Covid-19 than people deemed “at increased risk” by the CDC

This is a guest post by Michael Otsuka, Professor of Philosophy at the London School of Economics

A study just published in Nature reveals the following: even for someone with no underlying health conditions, the increased risk associated with being 45 years of age, rather than 30, is greater than the increased risk associated with various health conditions the CDC deems sufficient to render a person “of any age” at “increased risk of severe illness from COVID-19”.

I. Quantifying the risks the CDC recognises

According to the CDC:

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

The aforementioned study in Nature — which is entitled “OpenSAFELY: factors associated with COVID-19 death in 17 million patients” — quantifies the risks associated with the above health conditions. It indicates that, when one adjusts to control for age, gender, level of income deprivation, and other health conditions, the CDC-listed conditions are associated with increases in one’s risk of death from Covid-19 by the following factors (see righthand column of Table 2 on p. 10):

  • Those who have kidney disease (GFR <30) are at 2.52 times greater risk of death than those without kidney disease
  • Those who have COPD are at 1.63 times greater risk of death than those without respiratory diseases
  • Those who have an organ transplant are at 3.55 times the risk of those without a transplant
  • Those who are obese (BMI of 30 or above) are at 1.05-1.92 times greater risk of death than those who are not obese
  • Those who have chronic heart disease are at 1.17 times greater risk of death than those without heart disease
  • Those who have Asplenia, including sickle cell disease, are at 1.34 times greater risk of death than those without this condition
  • Those who have uncontrolled diabetes are at 1.95 times greater risk of death than those without diabetes

Whatever one’s age — and therefore even if one is as young as 30 years old — having any of the above conditions is sufficient for classification as “at increased risk of severe illness from COVID-19”. The increased risks associated with these conditions range from 1.05 to 3.55 times the risks to those who lack these, as well as any other, health conditions.

Table 2 also indicates the following strikingly dramatically increasing risks associated with advancing age, even among those who are “healthy” insofar as they lack all of the above, as well as any other, health conditions. Compared with a healthy 30 year old:

  • a healthy 45 year old is at 5.00 times greater risk of death
  • a healthy 55 year old is at 16.67 times greater risk of death
  • a healthy 65 year old is at 40.00 times greater risk of death
  • a healthy 75 year old is at 101.33 times greater risk of death

II. Why are those who are older at such increasing risk?

The “OpenSAFELY” study does not address this question. Elsewhere, the hypothesis that Covid-19 involves impairment of the immune system has been offered as an explanation for why increasing age appears to be such a great risk factor:

Many T cells apparently die, and so the body’s reserves are depleted — particularly in those over age 40, in whom the thymus gland, the organ that generates new T cells, has become less efficient.

…The new research may help answer another pressing question: Why is it so rare for a child to get sick from the coronavirus?

Children have highly active thymus glands, the source of new T cells. That may allow them to stay ahead of the virus, making new T cells faster than the virus can destroy them. In older adults, [as mentioned above] the thymus does not function as well.

III. CDC has removed its age 65 threshold for increased Covid risk

In light of findings such as those reported in Nature, it is unsurprising that the CDC has recently “removed the specific age threshold” of 65 which it once affirmed. “CDC now warns that among adults, risk increases steadily as you age, and it’s not just those over the age of 65 who are at increased risk for severe illness” from Covid-19 infection. The CDC also maintains that “Age is an independent risk factor for severe illness, but risk in older adults is also in part related to the increased likelihood that older adults also have underlying medical conditions” (my emphasis added). Sensibly, and in line with the findings of the “OpenSAFELY” study, the CDC now says the following about “Older Adults” under the general heading of “People Who Are at Increased Risk for Severe Illness”:

https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html

The data simply does not support an age threshold of 65. As I have shown in Section I above, even those who are 45 years old and healthy are at greater risk than 30 year olds whom the CDC classifies as “at increased risk of severe illness from COVID-19” because of underlying health conditions. If any employer attempts to adhere to the now-discarded age threshold of 65, there will be a glaring lack of consistency and parity in the protections it extends to their workers who are at higher risk.