Re: Fw: COVID - Aerosol transmission and the 3 "C"s

Colonel Rexford

Great advice, thanks for sharing. I have an outside table and fridge if anyone wants to brave the heat some evening in Tucson!

On Thu, Jul 9, 2020, 2:41 PM John C via <> wrote:

I am forwarding this email I sent a few days ago to the boardgaming group I game with because some of them had resumed fact-to-face gaming (there has been some pull back since AZ went bad COVID-wise)
I know the two miniature gaming groups I attend are also playing face-to-face games at times.

I want to make sure that my gaming friends are as fully informed as they can be, with the proviso that what is set out below is my understanding and opinion based on my reading of the literature and opinions from colleagues.
There is a selfish motive - if one of you gets hit badly by COVID, I don't want to feel that I could have done more by sharing information / understanding of the situation - so here it is, for what its worth.

The safest option is not to face-to-face game.  I understand that this deprivation is hard, and that we all have to make a personal judgement as to the level of risk we are willing to accept.   So I give you my understanding of how to minimize the risks if you decide to do face-to-face gaming.  Obviously do not just take my word for it, do your own reading and research.  Bear in mind most of the stuff on TwittyFace or InstaTube is rubbish, not all.
As I say below, if you have questions about your personal situation, consult your health care provider or primary care physician.

Also bear in mind that the death rate is small under 60 and starts to climb over that.   Estimate from a study on death rates in Europe was 15% if you are over 90.


----- Forwarded Message -----
From: John G Curran <curranjohng@...>
To: Valley of the Sun Gamers Group <azboardgamers@...>
Sent: Sunday, July 5, 2020, 02:57:56 PM MST
Subject: COVID - Aerosol transmission and the 3 "C"s


Sending this because I know some people are getting together for face-to-face gaming.
This is my personal understanding and opinion of where we are.  Research things for yourselves.  Don't just take my word for it.

When you do game face to face, please consider wearing a face mask.  Many experts are convinced that these flare ups are related to exposure to aerosol transmission rather than droplet transmission.
Droplet is when some sneezes on you and you feel a drop or two hit your arm or whatever.  
Aerosol you normally don't see from human sources - we all can send out aerosol as well as droplet. Aerosol is in the sub 5 micron range.  Droplets are larger.
Aerosol is like fly spray.  Outdoors it disperses pretty quickly, but if you spray in a room, you can still smell the fly spray a considerable time later.   There is usually relatively little air motion in a room (and even if there is, most of the air circulated by air conditioners is recirculated air) so aerosols last longer.

I just got a cloth mask with a filter for trips to the shops, etc. The filter claims to remove anything 2.5 microns or more.  So not a complete filter against COVID.   In March or so, 4 aerobiological laboratories (U. Penn, U. Texas, US Military and I forget the fourth) reported on aerosolizing virus in biological chambers (not exactly sure what an aerobiological lab is, but I assume it normally focuses on bio-weapon defense).  They found Corona viral particles existed in the 1-5 micron range, i.e. my mask is only effective against 50% or so of viral particles.   Not surprising.  Only the N-95 masks are fully effective. 

The WHO is still obsessed by surface transmission and close range droplet infection.  But there are several events which point to significant aerosol transmission (the Washington choir event, the Guangzhou restaurant event, etc.).
WHO plays it very conservatively because they advise the whole world.   They worry if they endorse something not totally proven that countries with poor health care and limited resources, will divert those resources into a probable rather than a proven path.  Unfortunately that conservatism is not serving us particularly well in this pandemic.  I have attached a piece from Yahoo news about a letter from a group of epidemiologists chiding WHO for not paying enough attention to aerosol transmission.

The Japanese (and other East Asian countries) have had a relatively mild course with COVID-19.   This is puzzling as Japan has the highest proportion of elderly in its population compared to the rest of the world.
The Japanese death rate (in a closely packed population of 60+ million) is about 0.8 per 100,000.
The US death rate is 38 per 100,000.  While there are many theories (early universal masking, Japanese antibody response, history of BCG vaccination, better civic discipline, etc. etc.) one program most people have followed in Japan is to avoid the 3 "C"s - Crowded events, Closed spaces, Close quarter conversation.  Avoiding the 3 "C"s seems to have been a significant contributor to the relatively mild course of COVID in Japan.

So I would suggest......
1. Limit gaming to 1-on-1 when face-to-face.  
Avoiding in person gaming would be safest, but I know people are stressing out from lack of social interaction.

2. Wash your hands regularly.  
While surface transmission is clearly not as important as once thought, it still does occur.

3. Wear a face mask.  
Estimates of asymptomatic infections are very varied but seem to be in the 45% to 60% range.  Asymptomatic means just that - you don't know that you are sick, you feel fine. BUT you are still putting out virus.  Estimates vary, but one estimate is that you put out virus for 2-4 days before the virus becomes active,  and then for the next 7-11 days.  Obviously if you are an asymptomatic carrier the rule of thumb of 14 days quarantine after exposure makes sense, given the range of potential days of viral output.
When you get together with a buddy, you may both feel fine, but there is no way of knowing, unless you get a test a day or two before the session, whether either of you are an asymptomatic spreader.

4. Avoid the 3 "C"s.   
Avoid Closed Spaces - That really means bars and restaurants, but game rooms are also closed spaces.  I know it is too hot to game outside, but game in as big a room as you can, with good air circulation if possible.   Try to position the game table so that it is at right angle to the air vent, i.e. the air is blowing across you, not from one person to the other.    Run one of those air filters if you have one - although they may not be effective against aerosol particles - but it can't hurt.
Avoid Crowds - so avoid multi player games if possible.
Avoid Close Conversations - I know you cannot avoid being close over a game table, but consider pulling back a little while your opponent takes their turn, and WEAR A FACE MASK.   Yes, only an N-95 mask or similar totally protects you, but wearing a mask cuts down the virus you are sending to your opponent (if you are an asymptomatic carrier - if you are symptomatic it is obviously reckless to be playing at all!) and his/her mask similarly protects you.   A significant benefit to you of wearing a mask is that it cuts down the number of times you touch your face! (face touching is thought to be a major source of surface transmission).

All this is based on my current personal understanding as a medical professional of where we are with this pandemic.  Information changes daily, so do not take my word for it, do your own reading.  Please do not use TwittyFace or InstaTube as reliable sources of information - there is loads of junk out there.  If you have questions or doubts or concerns, reach out to your personal medical care giver or primary care provider for information.

Stay safe and good gaming....

John Curran

"Sophisticated, charming and humble" - all down to his club shirt!

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