December 1,2020: This post was based on the best available evidence at the beginning of the pandemic (March-April 2020). The information contained is still very relevant, but there is also now an updated/companion review specifically looking at the transmission of COVID-19 (and concluding aerosols play a very important role in it’s transmission), that can be found here.
The rapid emergence of COVID-19 has created tremendous uncertainty in medicine. We don’t know where this pandemic is headed. We don’t know the ideal management strategy. Every day brings conflicting information. Emergency medicine is a field that embraces (or at least tolerates) uncertainty, but knowledge is an important pillar of our sense of control in medicine, and COVID-19 is doing a good job highlighting massive gaps in our knowledge. One of those gaps is the precise mechanisms through which infectious diseases spread and how best to protect ourselves. We hear terms like “aerosol generating” and “droplets”, but their precise meaning can be unclear, and so it is hard to know how to adjust our practice. In this post, I will review everything I have been able to learn about aerosols and droplets, how they spread, and how they should impact our practice.
I will start with a major caveat: despite reading hundreds of papers on this topic, I still have a lot of uncertainty. I think that uncertainty is born from uncertainty in the literature. There was debate and conflicting information with every new paper I found. However, it is also important to recognize that I am an emergency physician attempting to distill in a few weeks topics that people have dedicated entire careers to. If you think I missed something, or want to add to the discussion, please do so below.I also want to acknowledge that these are incredibly trying times. We are all anxious, and that anxiety is made worse by the conflicting information that we are receiving. There is a risk that by adding even more potentially conflicting information I might add to that anxiety. I think science is fundamentally important. I think this information is important. How we act on this information is equally important. Remember that nothing here is definitive. In already trying times, we don’t want to create conflict with our colleagues.
Try to use any information available to work collaboratively, focusing not on the negatives of uncertainty and disagreement, but on the positives of growth and a common goal of safety for all healthcare workers and our patients. For the most part, I am reassured by what I read, and will continue to work hard to use this information to keep my entire team safe….read more.