Tuesday, June 30, 2020

The Safety of Outdoor Air for Coronavirus Is Now Obvious

There is now powerful observational evidence that outdoor air is extraordinary safe regarding COVID-19, and the recent protests have helped provide it.   The protests/riots began in Seattle and other cities on May 26th.  Thousands gathered without social distancing and a good 10% had no masks.  They participated in chanting, singing, screaming and other activities that ensured plenty of droplets were injected in the air, and that unhealthful environment was "enhanced" by coughing from tear gas and other agents.

Did this huge exposure result in increased spread of COVID-19?  The answer is clearly no.

Consider Washington's King County, a hotbed of protests starting 26 May (see below).  Both hospitalizations and deaths showed no  upward spike after the protests (the blue line shows May 26th).  We should have seen a signal by now, since the average time to symptoms is approximately five days.



It is important to note that the number of COVID-19 cases is going up modestly in King County, but that is being driven by a near doubling of tests (note that the bottom graph starts earlier).  Much of the media neglects to note the importance of increased testing in finding more cases.


This lack of a coronavirus spike has been noted in every major city in the U.S., something discussed in the Seattle Times today and in many media outlets.




These are huge number of independent experiments in varying environments and climates.  A very good sample. And the obvious conclusion is that COVID-19 has a very difficult time spreading in outdoor air.  There is no other explanation.

Some of you might argue that many of the protestors were young and so would not get very ill.  True enough.  But young people can get sick from it and they could certainly give it to their parents, neighbors, and folks in food stores and restaurants.  There were plenty of teenagers and folks in their early 20s still living at home who were at the protests.

You want more evidence?  No problem. About a month ago, there was a huge media commotion about "irresponsible" outdoor parties at Missouri's Lake of the Ozarks (see picture below from the famous "party cove".  Several media outlets promised a huge uptick in COVID-19 cases.


What actually happened?  Nothing.  No spike of COVID-19 cases in the neighboring counties.  Outdoor air is safe.


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The lack of outdoor transmission is consistent with the scientific literature.  There is in fact no documentation of effective outdoor transmission of coronavirus (see my earlier blog for documentation).    Some examples of scientific papers discussing the issue, include:

Qian et al., 2020:   Examined 1245 confirmed cases in 120 cities in China and identified only a single outbreak in an outdoor environment, which involved two cases. 

Nishiura et al., 2020:  Transmission of COVID-19 in a closed environment was 18.7 times greater compared to an open-air environment (95% confidence interval).

The reasons for a lack of outdoor transmission are clear:

  • Virus concentration are low outdoors because of the tremendous dispersion of the virus in the outside environment.  This results in low viral concentration.  
  • Solar radiation rapidly kills the virus.
  • Higher humidity in the outside air is bad for transmission.
  • Social distancing is much easier outside.

We have folks going outside with great fear, even wearing masks when they are alone or distant from others.

The other day I was biking down the Burke Gilman trail and an older women saw me coming and fled off the trail, pushing her mask tight around her mouth as she turned to face away from me.  There was profound fear in her eyes and it was completely unnecessary.  Really bothered me.

And such fear is being stoked by local politicians and governments.  The City of Seattle parks STILL has many of the parking lots closed and threatening signs everything.

Completely inconsistent with scientific evidence and even the Mayor's Office's own statement on the lack of transmission during the protests.  Talk about being anti-science and irrational.

Take a look at the welcome provide by Seattle Parks and Recreation for Magnuson Park, one of the city's jewels.  Why does the Mayor allow this situation to continue?  City parks should be completely opened.



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Additional Material

One commenter noted that percentage of positive test are increasing recently, indicating viral spread.  This is true.  But as shown by the plots of positive percentiles for Washington State (and daily tests), the rate of positives fell for WEEKS after the protests (which started at the time of the blue line).  The minimum was in mid-June.  The positive percentage is a very fast reacting measure of increase of COVID-19 transmission and there is NO hint of a surge with the advent of the protests.  More recent rises, in WA and for most of the country, are associated with lessening of restrictions and lockdowns.


PS:  Wearing masks is a very, very good thing if you are indoors.   More than a good thing-- necessary in all public indoor spaces.




54 comments:

  1. Thankyou Cliff Excellent post! My sentiments exactly!

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  2. There is so much we don’t know right now. Everyone is different. I’d rather deal with a paranoid mask wearer than someone who is calling COVID-19 a “hoax” with no mask on. Reality is somewhere in the middle.

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  3. Thank you. I agree parks need to be open. Our greenspaces are more important than ever for many.

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  4. The consensus of epidemiologists is that in fact the spike in cases nationwide is NOT solely attributable to increased testing. The infection rate is going up, not just the number of infections. So pointing to testing alone is a meme that is simply not true. See, e.g., https://www.cnbc.com/2020/06/22/who-says-record-coronavirus-numbers-is-not-just-because-of-more-testing.html

    What is true, though, is that outdoor transmission is less likely than indoor transmission, by a good margin. Still, I personally would not want to hang around with a hundred others on blankets in a park, not moving much for hours, as some pictures/videos show some people are doing. Keep moving, especially if there no wind, and try to keep some distance.

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  5. Sound information based in observable data, often called science. Refreshing all around. What's notable to me is that airplanes use near medical-grade HEPA filtration technology. Since they have to recycle air it makes sense for them, the local grocery store hasn't, until now, had a reason to manage indoor air quality in the same manner. It makes me think our indoor air was always much dirtier than I'd have imagined. Perhaps the next real step is a much closer look at indoor air quality, air circulation, purification, and HVAC design at large. Thanks for sharing a calm and simple recap of what the science shows. Irrational fears don't make it easy for any person or group to plan in a logical manner - rational thought is our best bet. For those who've lost loved ones, I'm very sorry. My heart goes out to you, even though we've never met, there's no fairness in such a loss, and no one deserves such pain. Let's keep leaning into the science, and keep our wits about us, and in time, we'll be alright.

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    1. https://www.newsweek.com/500-delta-airline-staff-test-positive-coronavirus-10-dead-1513016

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  6. Be careful Cliff. Despite speaking the truth, you're exposing cracks in the prevailing narrative and the wrath inflicted on those who dare to do so is well documented.

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  7. Cliff, a legitimate point, but again, you fail to take into account the risk associated with the throngs of people who collect at or en route to these much less risky outdoor venues, namely stores, restaurants, etc. Case in point, Ocean Shores. To be certain, the beach is safer, but the large collections of people indoors is a risk factor which simply can't be ignored - particularly if people cannot be counted on to be sensible and wear a mask or maintain social distancing. Obviously, if we could depend on people to do the sensible thing, we'd be having a different conversation, right?

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    1. People don't have to go to the store or restaurant to visit a Seattle park. People living in Ocean Shores don't have to do so before visiting a beach. Inside people should wear masks and follow social distancing

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    2. You're quite correct that you can't depend on everyone to do the sensible thing. I also, however, know a lot of people (myself included) who ARE doing the sensible thing: physical distancing when practical, wearing face coverings when distancing is not practical (or when the space-invading yahoo factor is high).

      There are a variety of tools at our disposal (carrots as well as sticks) to deal with these reality refuseniks. But I can assure you that one option is off the table: asking me to put myself back into a box and participate in another generalized shutdown.

      So let's be sure to focus our efforts where they will make a difference (e.g indemnify businesses that kick the knuckleheads to the curb when they produce phony "medical excuse" cards). Believe me, an invitation to relive the spring of 2020 all over again won't do anything but infuriate millions of registered voters at a time when we need people to make rational choices at the ballot box -- and not feel compelled to strike back at tone-deaf incumbents by "teaching them a lesson." We know where that left us in 2016, right?

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  8. Thank you, Cliff. It's obvious enough when you consider the evidence. Sorry that it's not commonly reported. It is a lesson though about the credibility of the media.

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  9. Another great post Cliff. Is there enough data to make a good hypothesis on the percent of the population that has been exposed to Covid 19? The political scientist out there throw many differ numbers out, I would be interested in a educated estimate.

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    1. Yes, please publish such a hypothesis.
      Another review of the data that I am interested in would be the death data. Has the morbidity trend of COVID-19 declined over the weeks?
      Are the generally "healthy" population groups "safe" from COVID-19 death? (For example as compared to the other ways that people die.) Would our society and economic health be better served by isolating unhealthy people from risk of COVID-19?

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  10. As an epidemiologist, I agree that the evidence supporting the lack of transmission from King County protests is great. But I respectfully disagree that it can be unequivocally attributed to being outside. As you say, 10% did not wear masks. Therefore, 90% did. What you did not mention is that people who felt sick were asked to stay home from protests. Both of these are important prevention measures that cannot be discounted. Being outside does reduce transmission, but we cannot say that being outside is the only reason that the protests did not increase COVID-19 cases. Note that the 2 papers cited about outside transmission are pre-prints and have not been peer-reviewed or published.

    In addition, the recent rise in cases in King county may be due to the increase in testing. It may also be a small but true increase in spread. What is not mentioned in this post is that the % of positive cases has ticked up in King County recently. You can see that in the first graph here: https://www.kingcounty.gov/depts/health/covid-19/data/key-indicators.aspx The rate is not driven by an increase in testing. It may also be related to an increase in activity either from phase 2 or protests or other indoor & outdoor activity.

    Bottom line is that being outside is safer (but not 100% guaranteed), and it's still important to wear a mask, practice social distancing, and stay home if you don't feel well.

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    1. THANK YOU. High mask compliance and extensive use of respirators and KN95 and N95 masks cannot be discounted.

      Hannity, Doucey, and McConnell are all telling POTUS to wear a mask, and advocate wearing a mask.

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    2. Thank you! You said everything I was trying to formulate succinctly and clearly.

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    3. My only thought about using Seattle protests as an example. You are saying 90% usage. I attended two big protests, the 60k and 20k. I never saw one person without a mask. My sister said she saw one person and they ask a medic for a mask. I stood and watched all 60k people walk by I saw 100% mask usage, obviously 100% is impossible, but I would say 99% Def outside air helps. Im curious about these numbers for other big cities that had big protests with less mask usage.

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    4. I'll back up Mr. Unknown -- I watched the first half of the silent march (the "60K" event) pass before joining, and my quick-and-dirty estimate was 95%-98% wearing masks. Of the rest, there must have been some with legitimate medical/behavioral barriers to mask use, and in any case those without masks definitely tended to move more along the edges of the route -- presumably to distance themselves as much as they could while still participating.

      Bottom line: common sense and common courtesy are powerful tools for moving us back to a sane and sustainable approach to living our lives.

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    5. I viewed several dozen pictures.... 90% is about right I think.Example:
      https://apnews.com/56bce7fd6a210ff1c9c66f6f8a5b1ba6

      https://magicvalley.com/news/state-and-regional/inslee-slams-trump-seattle-george-floyd-protests-continue/article_6bbe2430-8a23-5026-869c-b935f4d20c7b.html

      Can easily provide a dozen more...

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  11. Glad to have an epidemiologist commenting! It was good that many used masks, but there were large numbers that did not (10% of thousands is still a lot of folks) and no one was wearing masks at Lake of the Ozarks. True...sick folks were told to stay home, but as has become obvious, substantial transmission occurs mBEFORE individuals become apparently ill. This is particularly true of young people, who dominated the protests.

    Those papers have not been published yet. But do you know of ANY publication in the peer-reviewed literature that demonstrates outside transmission of coronavirus? Or any major viral disease? There is a huge literature on healthful nature of outside air regarding flu. It is true that positive percentages are slowly rising, but there was no surge in such positives directly connected with the protests...cliff

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    1. The unsheltered homeless ought to be a good found experiment on this subject. Probably most of us are spending less time inside than we used to; I'm spending far less. However, I don't know how tents affect matters. So are we prone to viruses? (Um, duh, hepatitis.) Respiratory viruses? Coronaviruses?
      There have been reports of hot spots in shelters, but nobody known to me has tried to check what unsheltered people's COVID-19 record is. Someone who agrees with your position ought to try.

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  12. 90% WORE masks. I think that is a critical point. 90% wore masks and from 5/30 to 6/8 a good 10% to 20% wore full respirators, and 20% to 30% work KN95 or N95 due to concern/risk of teargas and pepper spray exposure.

    There is a single super spreader event from protesters in South Carolina - outdoors.

    I agree with most of Mass's blog, but outdoors + wear a mask + keep moving = probably pretty damn safe.

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  13. Very disappointed in this and it's clear you have no epidemiology training (which is expected since you're not an epidemiologist, but it's interesting you have such apparent confidence in your ability to interpret epidemiological data). It's not about the total number of positive tests- that alone would be explained by an increase in testing. It's about the positivity rate, or what ratio of people are testing positive. We were down to almost 1% at our best in King County, now we're up to almost 5%. That is not explained by an increase in testing but an increase in the spread of the virus. If it wasn't spreading, the positivity rate would remain at 1% and as testing capacity increased, the total number of positive cases would also increase but not the positivity rate. Hospitalizations and deaths lag several weeks behind the positivity rate, so we will likely see those metrics increasing soon. Reading this post makes me embarrassed on your behalf; the equivalent of an epidemiologist writing about the intricacies of climate science and missing very basic concepts.

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    1. Please don't be embarrassed for me. You are incorrectly interpreting the positive rates. It DROPPED after the protests and bottomed out in mid-June after which it has risen has restrictions were lifted or reduced. Tell me where I get the fact wrong.

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    2. where did you pull the data for the positivity rate graph? I used the data from https://www.kingcounty.gov/depts/health/covid-19/data/daily-summary.aspx and did a 7 day moving average of positivity rate -- I see a bottom of 1.61% 7 day moving avg on May 29, a rise up to 2.1% on 6/4, a drop to 1.5% on 6/12, and then a steady climb back up from there. a big chunk of that may be the UW frat row cases rather than protests...but the shape of my data is different than yours so wondering your source.

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  14. "The other day I was biking down the Burke Gilman trail and an older women saw me coming and fled off the trail, pushing her mask tight around her mouth as she turned to face away from me. There was profound fear in her eyes and it was completely unnecessary. Really bothered me."

    I'm going to assume that this was because you weren't wearing a mask. Even though there's less possibility of transmission outdoors, why not just take the extra precaution? It's so easy. I wear one most of the time when I bike, especially in a high traffic area like the Burke. Why put others at an (albeit minimal) risk, just to prove a point?

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    1. I and most other people on the B-G trail are not trying to "prove a point" by not wearing masks. They are simply unnecessary and using them in such an environment is simply provoking fear. Even the CDC does not recommend them outside when there is reasonable distancing.

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    2. I don't wear a mask when I am climbing up a mountain trail. The mountain air is thinner and climbing a steep a hill is hard work, a mask would leave me too out of breath. I don't worry about not wearing a mask because for most of the hike I am alone and there is little chance of me spreading the virus when I quickly walk by one or two people. If I encounter a big group I step off the trail until they have passed. When I was training for high school cross country races there were a few times where I tried to run with a mild cold, I hardly noticed the cold before the run but within minutes it became obvious I was not well and by the end of the run I was miserable. I came to the conclusion that I couldn't do a really effective workout when I had a cold and it was best to pause my training until the cold passed. The point I am trying to make is if you have the energy for a cardiovascular work out you are not sick. Even if people with mild cases of COVID would notice when they exerted themselves.

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    3. Two reasons why I don't wear a mask when exercising: 1) Those of us like me who need glasses have to put up with fogging up especially when breathing hard reducing vision; and 2) those of us like me who like to push ourselves need more oxygen than you can suck though any mask except a forced-air mechanical breathing system. Wearing a mask slightly increases your "dead volume", that is, the air in your windpipe that is not refreshed at every breath. The air behind the mask is not refreshed effectively at the exhale. I notice the difference even climbing stairs- and I'm in pretty good aerobic shape. This effect is even worse if it is raining and the fabric is wet: Remember waterboarding?

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  15. Big fan of this article and the sentiments and analysis behind it. I also find myself strangely bothered and almost insulted when people freak out when I'm outside without a mask. (Although I agree indoor masks make sense.)

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    1. You're bothered because those people want you to embrace and validate their own ignorance. Just keep in mind it has nothing to do with you, really -- it's their problem, not yours.

      Outdoors | physical distancing | face covering = choose any two!

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  16. First comment on this blog. I work at a large Windpower project in the Pacific Northwest and have considered this site a public service for a while. This specific blog-post is no different; well stated and well reasoned. Thank you.

    And this really does sum it up - "Talk about being anti-science and irrational."

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  17. The good news is that the virus seems to be attenuating globally and locally:
    Global COVID-19 CFR Graph

    Here's some fascinating research on Theory and Empiricism in Virulence Evolution.

    Usually the death rate continues to decline with novel species. It's just basic ecology.

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  18. Another data point is Washington D.C. Lots of protest activity there last month and I noticed in the New York Times today that it is one of the few states/districts where the new case trend is downward right now. See https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

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  19. In all fairness, a mask outdoors is absolutely NOT needed if you bike on a road. I’m not so sure about a fairly narrow and popular trail like the Burke Gilman.

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  20. My first comment!

    Glad to see the note about solar radiation. Direct sunlight kills. UV disinfects in seconds. Time to open parks and playgrounds.

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  21. Thank you for getting into the science behind why its safe to go outside. I find it interesting that many European countries are doing so much better than us and they did not close down all their parks. I saw a video of a crowded German farmers market where everyone was wearing masks. The protests and the German market show it is safe to be in a crowd of people outside if you are wearing a mask and you don't need a mask if you can maintain social distance. The number of cases is going up alittle bit but I suspect its due to the easing of the lockdown not the protests. Its true that it takes 3 weeks for the full effects of the protest to be known but if the protests were spreading the virus the number of cases would have started to rise within 1 week of the first protest. The number of cases did start to rise about 1 week after King County went into phase 2 so loosening restrictions are likely to blame. Even with this increase we are doing alot better than most states and we are one of the few states that is doing as well as the European Union, I don't think we should panick yet.

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  22. The BOW WA Weather reporting rock-on-a-string has been wet and dribbled on all day today, Apriuly 1. It was supposed to be less than .1 inch instead of the .45 or so. Even weather experts are not right all the time - just sayin'

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  23. Thanks Cliff. I know there are many difference between how WA has handled reopening vs. the South and Southwest, but I have wondered if part of it (a large part) is that air conditioning is so prevalent in those areas. Might explain why CA is having problems too. Of course the NE and Midwest use air conditioning too, but these areas have a lot more humidity.

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  24. Unfortunately our government officials are control freaks. They are more interested in controlling people than in applying good science.

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  25. It was explained by one of the of experts as to why the protests probably wouldn't make a big impact.

    90% wear masks, of the 10% that don't only 5% of them are potentially infected (number that test positive in society).

    This 5% needs to come in contact with the 10% that aren't wearing masks and aren't infected.

    Add in the outdoor effect of poorer transmission and you end up with almost nothing.

    What results is such a small number of new infections from the actual protest it wouldn't show up in the count.

    60-70% is where the herd immunity starts to take effect. So with 90% wearing masks, and being outside, it plays out to be a non event.

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    1. It is important to keep in mind that masks are NOT 100% effective. One study (https://www.npr.org/sections/goatsandsoda/2020/07/01/880621610/a-users-guide-to-masks-what-s-best-at-protecting-others-and-yourself) suggests they are closer 30%. So just because folks wear masks does NOT mean there is no exposure. Masks are certainly useful in REDUCING but not eliminating emission of COVID or breathing it in...

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  26. We've had an extended period of strong coastal westerly winds. Will this "turn over," the eastern Pacific, bringing colder deep water to the surface?

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  27. I've worked in an industry that required me to wear a mask or full cartridge respirator for about 50 years, plus sold them for about 25 years. So I know they aren't 100%, nothing is 100% effective in life.

    We can take the worst case scenario in the testing you linked and say it's 30% effective.

    Add the small number of people without the 30% protection, but still all of them being outdoors. This makes a 30% factor still significant.

    That's why it was predicted in advance to not be an event that would spike the numbers.

    I just happened to have some N95 masks around before all this happened, so thats all I use.

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  28. Here is one estimate from a scientific paper preprint:
    https://www.medrxiv.org/content/10.1101/2020.02.28.20029272v2
    Closed environments facilitate secondary transmission of coronavirus disease 2019 (COVID-19)

    "The odds that a primary case transmitted COVID-19 in a closed environment was 18.7 times greater compared to an open-air environment (95% confidence interval [CI]: 6.0, 57.9)."

    But also look at this:
    https://www.cebm.net/covid-19/what-is-the-evidence-to-support-the-2-metre-social-distancing-rule-to-reduce-covid-19-transmission/

    "Smaller airborne droplets laden with SARS-CoV-2 may spread up to 8 metres concentrated in exhaled air from infected individuals, even without background ventilation or airflow. Whilst there is limited direct evidence that live SARS-CoV-2 is significantly spread via this route, there is no direct evidence that it is not spread this way.

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  29. The mass media has been ignoring that the number of COVID-19 deaths has remained mostly unchanged despite the increase in infections. A couple of days ago the reported value was zero. Early in April where the number of infections peaked, the number of COVID-19 deaths peaked a few days later. Now it seems that the number of deaths is not following the number of infections. The explanation could be that elderly people have been isolated or self-isolating while now younger people are getting infected but are (fortunately) much less likely to have life threatening consequences from it. This points out how isolating senior homes and recommending elderly people to avoid contact with others indoor may be enough to handle the crisis.

    Concerning masks, there is no evidence that cotton masks and very little evidence that surgical masks prevent spreading the virus. If you are in close contact with elderly people indoor it may make sense to wear a surgical mask especially if they have heart conditions, in all other situations you can leave it in the gloves compartment.

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  30. I notice that a lot of people step off the sidewalk onto a busy street just to avoid being within 6 feet from another person. Is this the interpretation of "stay safe"?

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  31. I agree with most of this...
    but...
    I think the main reason for keeping pouplar state parks clowed is not the state park it self, but rather that people also get into local services like shoppin and restaurants. That's how my county has gotten the first corona cases. People visiting from King county because Seattle restaurants were closed and our could be open. This was in March.
    Another thing with outdoor face coverings is that you can only control your own distance to others, but you cant control how fast others pop up in your proximity when waling on a relatively empty sidewalk "downtown"....

    However corona virus is airborne depends on whether there is carries particles in the air. A dry summer day in AZ is probably less likely to transmit virus than a foggy day in San Francisco or a humid day in Seattle. Smoke from smokers has also been seen carrying virus...

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  32. I am puzzled by some of the comments. Whether people seek to be outdoor by traveling from home or going to a local park the fact is they are outside. The alternative? Well, staying inside. How can that possibly be safer? FYI, my wife and I, both in our 80's, live at the beach. We see the inlanders invade. They are welcome to enjoy themselves. Being in the most at risk category We will avoid the hoards, indoors or out. Life is worth living. For everyone.

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  33. Thank you for your well-thought data-driven scientific commentaries. (Over the years.)

    Another review of the data that I am interested in would be the death data. Has the morbidity trend of COVID-19 declined over the weeks?
    Are the generally "healthy" population groups "safe" from COVID-19 death? (For example as compared to the other ways that people die.)
    Would our society and economic health be better served by isolating unhealthy people from risk of COVID-19?

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  34. Thanks for the post Cliff. You inspired me to do a little google researching to see what other commentators around the world were saying on this. My not cherry picked set of findings is generally supportive. I plan to email my representatives about this.
    https://www.theatlantic.com/health/archive/2020/04/closing-parks-ineffective-pandemic-theater/609580/
    https://www.vox.com/2020/4/30/21232696/reopen-parks-coronavirus-covid-19
    https://www.washingtonpost.com/outlook/2020/04/13/keep-parks-open-benefits-fresh-air-outweigh-risks-infection/

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  35. Cliff,

    I agreed with your blog, but there were few comments upon my initial reading. Now, I am surprised at the comments that are critical. It seems you have made it very clear and that people simply need to follow recommendations and expect people to be frustrated at this point in the pandemic process. Finally, know right, do right and accept it until another strategy is available.

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  36. These are unprecedented times with the coronavirus business safety. People have seen great changes in the way of life with the closing of businesses and stay at home orders.

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