Fresh Air
The disease is respiratory and airborne. Thousands are ill and dying. How to limit its spread and treat it are unknowns. COVID-19? No, tuberculosis. Called “The White Plague” for the associated pallor in its victims, it devastated populations around the world for millennia. In its complex history one can see the reflection of the pandemic we are living through today. And in that history are some genuine findings that can assist us in 2020 as this new pandemic is fought.
The control of tuberculosis was well underway prior to the discovery of streptomycin, the first antibiotic with activity against Mycobacterium tuberculosis. The onset of the Industrial Age brought people in England and then in many other countries into crowded conditions which were often unsanitary and poorly ventilated. The air in industrial cities was foul with smoke and particulate matter now recognized as harmful to the lungs. Once TB entered a living space and was coughed out by the index case, the bacteria were held suspended as particles (droplet nuclei) in the air and breathed in by everyone in the household. The result was inevitable with tuberculous infection in almost everyone and tuberculous disease is a high proportion of those infected. For those who became not only infected but diseased, TB was a death sentence.
The search for a treatment by those with active tuberculosis led them to places with what they called a salubrious climate: deserts, mountains, and other places that had one common element. Fresh air. Dr. Edward L. Trudeau pioneered the concepts of non-crowding and fresh air at Saranac Lake in New York. He founded the sanitarium movement. One result, coupled with a rising standard of living, was a replication of this approach in industrialized nations in people’s homes.
How to apply this knowledge now in the midst of a different airborne pathogen? Think of social distancing today as a lack of crowding. Think of the open air as excellent ventilation. Katherine Baicker and her colleagues from the University of Chicago provide a rationale for opening up the economy, slowly and safely. Not all venues are equally safe and, in their op-ed in the New York Times they provide two interesting graphics to show why some venues are more dangerous than others. The lesson could have been lifted from the historical parallels with TB in the 19th and early 20th centuries. The risk for infection with COVID-19 and TB depends is the product of exposure to the organism multiplied by the time of that exposure. Indoor areas with a small volume of air are riskier than outdoor venues. The time spent in any indoor area, as the figures in Baicker’s article show, help explain the relative risk of a nail salon versus a store. There are links in the article to thoughtful papers being produced by researchers on how such data can be applied to public policy.
There remains much to be learned about COVID-19 but we all should recognize that we have already learned a lot about this pathogen. Reexamining the past history of other diseases such as TB will help bolster mechanisms that reduce the risk for disease transmission and thereby accelerate a safer and more rapid return to something that is better than the lockdown we currently have. We may even have to rethink the architecture of our buildings. Science must be the foundation on which we bring this pandemic to a close.
Here is a link to a great PBS documentary on tuberculosis. And this is a link to a serene flower photo -- close your eyes and relax for 30 seconds after you view.
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