A new study suggests that COVID-19 may be spreading from person to person in tiny droplets or aerosols. This has huge implications for the hospitality and tourism sector. Mallika Naguran discusses the study and suggests ten health and safety measures to take on board to tackle the spread of the coronavirus.
Dodges Ferry, Tasmania, 10 July 2020. As cafes, restaurants, bars, resorts, hotels and tourist attractions open for business once again even as coronavirus pandemic rages worldwide, it pays to be more careful. COVID-19 has proven to be not just very infectious, but also very tricky to contain.
Second waves of infection from the nasty coronavirus that first began in Wuhan, China (reportedly) as early as December last year are now sweeping through cities and regions in many countries. The State of Victoria in Australia is reeling from rising numbers of infected cases, again. Businesses in hospitality, tourism and travel are once again severely impacted by the forced restrictions imposed by the government. The six weeks lockdown of Metropolitan Melbourne and Mitchell Shire from 9 July 2020 is estimated to cost the Victorian hospitality industry about $1billion, according to the Restaurant and Catering Industry Association.
Question is, do the preventative measures and advice such as maintaining 1.5m distances between one another and washing hands often still work? Or should more be done to ensure that the virus does not spread any further?
How does the virus spread – large or small droplets?
There is growing evidence that small droplet (airborne) transmission is a significant route of infection indoors. (Supplied: Airborne Transmission Of SARS-CoV-2 By Lidia Morawska)
The top brains in medicine and engineering now think that the initial measures in virus prevention are not good enough. Take for instance how the virus spreads.
They cited evidences that SARS-CoV-2, the coronavirus responsible for the COVID-19 pandemic, can in fact pass from person to person in tiny droplets called aerosols. Aerosols are tiny droplets that pass through the air and accumulate in air over time. So just coughs are not what to watch out for. Instead, it’s the air that is exhaled from infected individuals (especially those who speak loudly or sing!). Lack of ventilation adds to the danger of virus transmission.
Such new viewpoints are offered by an international group of 239 clinicians, infectious-disease physicians, epidemiologists, engineers and aerosol scientists. They published a commentary in the journal Clinical Infectious Diseases that urges the medical community and public health authorities to acknowledge the potential for airborne transmission. They also call for preventive measures to reduce this type of risk.
The World Health Organization (WHO), which initially ignored their call to review how the virus is being dealt with, is now paying attention. In fact, the WHO has been slow to handle the spread of the virus effectively; for instance, it only offered recommendation for the use of mask in June, six months after the infection had spread worldwide. In contrast, China, Taiwan, South Korea and Singapore enforced the wearing of masks in public based on their own judgement and previous handling of SARS-associated coronavirus (SARS-CoV) in 2003.
At a press conference on 7 July 2020, the WHO said that it would issue new guidelines about transmission in settings with close contact and poor ventilation. “We have to be open to this evidence and understand its implications regarding the modes of transmission, and also regarding the precautions that need to be taken,” said Benedetta Allegranzi, technical leader of the WHO task force on infection control. It later issued a scientific brief in response (see next section).
WHO has stubbornly downplayed the significant threat of the coronavirus being transmitted by aerosols, which easily accumulate in poorly ventilated venues. These aerosols—droplets less than 5 micrometres in diameter—can be carried by air currents. Which means that what we had been told before, that only virus-laden droplets bigger than aerosols and contaminated surfaces are to be avoided, might not have been out rightly correct.
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Implications of COVID-19 aerosol transmission for hospitality
It would be foolhardy to ignore this new piece of information. Café, restaurant and pubs should consider broadening the physical distance requirement between one patron and another, beyond the currently advocated 1.5m. This would be in advance of what most governments recommend, and stricter. Incidentally, WHO still maintains the recommendation of at least 1m (3 feet) distancing, even after 11, 874, 226 reported positive cases in 216 countries or territories, and over half a million deaths as of today.
It is important to understand that the virus can be transmitted as aerosol even as government-mandated lockdowns ease and businesses reopen. “To control [the pandemic], we need to control all the means of infection,” says Morawska Buonanno, who first contacted the WHO with her concerns and published a summary of the evidence in early April.
The authors of the paper drew findings from documented outbreaks such as a choir rehearsal in Mount Vernon, USA and a restaurant in Guangzhou, China. At the restaurant, 10 people from three different families became infected but none of the waiters or 68 other customers did. The authors observed no evidence of direct or indirect contact between people, but showed how the transmission occurred through the air in a crowded and poorly ventilated space.
According to the study, there was no outdoor air supply in that restaurant apart from the brief and infrequent opening of a fire door. Hence a "recirculation envelope" was formed over the three families' tables, which were in the direct line of one air conditioning unit. In the same restaurant, all other tables had four other air conditioning units to service them.
The authors showed that, in both cases, the high attack rate values could be justified only assuming the airborne transmission as the main route of contagion. They added “such outbreaks are not caused by the rare presence of a superspreader, but can be likely explained by the co-existence of conditions”. This co-existence includes emission and exposure parameters, leading to a highly probable event, which can be defined as a superspreading event.
On 9 July 2020, WHO issued a scientific brief in response to the paper about the transmission of SARS-CoV-2. Referring to the cases mentioned, WHO said that “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.”
Let’s not allow another superspreader to occur. Let’s take science seriously and get smart. Do the right thing. Here are a few measures that help prevent virus transmission within hospitality and tourism settings:
1. Wear a mask – always have staff and attendants put on a well-fitting mask. Tight masks have better prevention than loosely worn ones. Even if your country’s government doesn’t have this requirement, make it your own policy, for the safety of your staff and customers. “Fabric masks, if made and worn properly, can serve as a barrier to droplets expelled from the wearer into the air and environment,” WHO said.
2. Wear gloves when touching products that are handed to customers. This prevents infection from being transmitted through surfaces. Personal protective equipment or PPE is recommended when administering to guests staying in quarantine hotels.
3. Place tables further away than 1.5 metres from one another, say 2 metres or more if there’s space. If the virus still lurks in your precinct or city, switch to offering takeaways and delivery services. It is going to be hard to generate revenues, but it has to be done for the sake of the community’s health.
4. Have as much air come through to allow ventilation in an enclosed space. Restaurants that rely on air conditioning or heating should have doors and windows slightly open to allow fresh air to circulate within the area.
5. Avoid having large groups of people converging in one area. This is to prevent the possible airborne transmission of the virus.
6. Advocate good hygiene habits such as the frequent washing of hands, avoid touching the face (especially eyes, nose and mouth), cough or sneeze into a handkerchief or elbow. Carry a sanitiser with you. Wipe down surfaces with alcohol solutions that are recommended as effective disinfectants. “At all times, practice frequent hand hygiene, physical distancing from others when possible, and respiratory etiquette; avoid crowded places, close-contact settings and confined and enclosed spaces with poor ventilation; wear fabric masks when in closed, overcrowded spaces to protect others; and ensure good environmental ventilation in all closed settings and appropriate environmental cleaning and disinfection,” WHO said.
7. Watch out for symptoms of COVID-19 infection. Even a mild headache can be a sign that one has caught the bug, and one can be highly infectious to others on close contact and in places they’ve been. Remember also that since the bug can be spread as aerosols, the virus lingers in the air for hours. So encourage staff, family or friends to stay home when symptoms such as headaches, sore throat, fever, coughs or running nose are being reported.
8. Be open to being tested for COVID-19. It might save the lives of family, friends and colleagues.
9. Keep up to date with virus prevention measures.
10. Stay healthy, advocate exercise especially outdoors and close to nature. Nature heals the mind, if not the spirit!
We are into the seventh month since COVID-19 was first reported, and globally, we are far from arresting its spread. Let wisdom prevail. Save lives. Save the hospitality and tourism industry by taking on stricter measures while being innovative in keeping the business going.
References:
WHO on Coronavirus
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Download the paper “Quantitative assessment of the risk of airborne transmission of SARS-CoV-2 infection: prospective and retrospective applications” here:
https://www.medrxiv.org/content/10.1101/2020.06.01.20118984v1.full.pdf
Evidence for probable aerosol transmission of SARS-CoV-2 in a poorly ventilated restaurant
https://www.medrxiv.org/content/10.1101/2020.04.16.20067728v1