Early on in the COVID-19 pandemic, many leading scientists in aerosol physics and infectious diseases quickly understood that the primary mode of transmission of the SARS-CoV-2 virus, which causes the disease, was through airborne mechanisms. Despite these admonitions and decades of evidence supporting their concerns, the World Health Organization (WHO) and national health agencies disregarded these concerns. The failure to address the route of transmission and coordinate a global response has seen the pandemic extend into every corner of the planet infecting much of the global population. Although official COVID-19 deaths are approaching 7 million, global excess deaths are now at 25 million and the prospect of repeat infections with new variants of SARS-CoV-2 has created a pandemic within a pandemic, with Long COVID characterized appropriately as a mass disabling event.

Dr. Alexander van Assendelft, a retired pulmonologist from Finland, recently contacted the World Socialist Web Site to speak on his early efforts to bring attention to the world that SARS-CoV-2 was transmitted through aerosols, and it was necessary to take appropriate measures to address this mechanism to bring a swift end to the pandemic. He called for better source control, through the limitation of speech in indoor spaces, as part of a comprehensive response that included masking and ventilation.

However, despite his attempts to raise concerns with local, national and international officials, including the editors of high-impact medical journals like The Lancet, Dr. van Assendelft and his colleagues were repeatedly rebuffed. It took the WHO nearly two years to say that COVID-19 is airborne, by which time the Omicron variant had already emerged and the crisis posed by the pandemic had deepened. The following interview is part of the International Committee of the Fourth International’s inquest into the COVID pandemic.

Benjamin Mateus (BM): What do you remember or when did you first hear about the pandemic? What was your first understanding of what was happening when COVID-19 began to appear? 

Alexander van Assendelft (AA): I naturally heard about it already in January 2020 and got worried, even more worried because I was in Spain, and I heard about how it was developing in Finland and at that time also, especially in Italy, where it was awful.

I didn’t understand more of it than anybody else at that time until the 28th of March 2020 when I received a link to an evening news piece from our son. There was Professor Ville Vuorinen [Professor of Energy Technology at Aalto University, Finland], who was speaking about the work he had been conducting for not more than about two weeks at that time.

Dr. Alexander van Assendelft [Photo by Dr. Alexander van Assendelft ]

He said he had preliminary results and concluded that people exhale aerosols when they speak. Being a pulmonary physician, I was struck by a bolt of lightning at that moment when I suddenly understood that the transmission of the SARS-CoV-2 virus must be by aerosol, which explained its rapid transmission all over the world.

I was quite shocked also because I had never heard about such things relating to transmitting infections through talking and breathing. The only aerosol sources I knew were the ones we use to give medicines to asthmatics in aerosol devices. 

BM: If I may pause for a moment, you are a retired pulmonologist, correct? 

AA: Yes.

BM: Can you speak more about your profession and what you did after you retired? Maybe just so that people can understand who you are. 

AA: I studied in Switzerland, in Basel, and became a physician in 1970. And then I went on to specialize and became a pulmonologist in 1976. Since then, I was working in two different hospitals until I was elected chief physician for the Central Hospital in North Karelia, Finland.

In 1986 I was elected medical director of the Central Hospital in Kotka in southern Finland. I was director there until 1992. From then on, I was assistant chief physician, until my retirement in 2015. After that I thought I would have a peaceful life.

But then the Corona came, and it didn’t become at all peaceful because I happened to acquire a new specialty. I have tried to really catch up with the Corona in all the ways I have been able to.

BM: As a pulmonologist, I’m assuming much of your work is done in the critical care setting. And does part of that also include respiratory infections?

AA: In my case, very little in critical care, but all sorts of infections naturally. 

BM: At the time, one of the issues that a lot of the physicists raised is that there’s a very strong divide between medicine, meaning you receive people who are already infected and you treat them, and the aerosol physicist, who is more interested in the mode of transmission. Medical schools and training don’t really address the physics behind how infections are acquired.

AA: Yes, that’s true. And that’s probably also why I didn’t know much about the ways they are transmitted. Naturally. I knew, for instance, that tuberculosis was very easily transmitted through the air, and measles too. But we were only concerned about the people who got ill, and the mechanism behind it was not such an important factor. We just tried to give medicines and make them better through the right treatment.

BM: And do you think there’s a need to somewhat amalgamate the public health in relation to infectious diseases and physics? Also, in the facilities where people are treated, meaning that we can’t be so specialized that we don’t understand one person’s role versus another person’s role.

It’s important for the specialties to exist, but we must be talking to the aerosol physicist. We must be speaking to the public health people who establish policy. We must be speaking to the hospital system and explaining the engineering behind filtration and the technology. These different areas seem to be very separated, and there’s no communication between them.

AA: Yes, I agree, absolutely. That is probably the greatest problem and has been the reason why at the beginning and not even now, it’s realized how important the physics are, which the aerosol engineers already had been working on by the end of the 1990s and beginning of the 2000s because of the SARS-CoV-1.

That’s one point also for me which has been very important. I have a great admiration for the engineers, who really from the beginning understood what it was about. They have been as frustrated as I, that the message just doesn’t go through to those who should take care of what to do about it.

BM: Because of what you had told me about Professor Vuorinen, I looked up and found his article on modeling aerosol transport and SARS-CoV-2 virus exposure by indoor inhalation, which was finally published in October 2020. Did you happen to communicate or speak with him on these issues when you saw his report on the news? 

AA: Well, I have become almost friends with Ville since then. At the beginning I was very annoyed with him because I tried to get him to be more active in Finland to inform the authorities from his point of view, as he is the foremost aerosol expert in Finland.

I think the engineer’s way of thinking about their duty is to inform us physicians and the authorities about what is happening and why it’s happening, but it’s not really their duty to inform the public in the way we would like to. The first time I called him we had almost a dispute, which I was quite unhappy about.

Since then, we have been in contact, and a very nice thing was that he recently received a prize from the Finnish Academy for applying computational flow dynamics to the study of the spread of COVID through aerosols. It is one of the most important prizes for researchers in Finland. He invited me to the celebration of this prize for his work with COVID-19.

He’s an aerosol researcher, for meteorology and other kinds of aerosols, but not for COVID or viral transmission. However, he changed his whole scientific approach when he realized that he understood more than anybody else in Finland about it. 

BM: I want to also interject, that at the time in Sweden, Catalina Neeson had published in November 2020 their experiences with identifying SARS-CoV-2 genetic material in hospital ventilation systems a long distance from where the COVID patients were being kept.

They say in their conclusion that airborne transmission of SARS-CoV-2 must be taken into consideration for preventive measures. Their report is based on data from April and May of 2020. I think you also referenced in your letter from October 2022, “Overcoming failures of imagination, rethinking of the US Covid-19 pandemic response.” You wrote that there was a reference to an ABC News article in Chinese, from February of 2020, where it said that the Chinese authorities had recognized that transmission of COVID was happening through aerosol or airborne pathways.

They actually go a long way to say things like, if you’re in a closed space, try not to talk, try not to be in close contact, open your windows and take basic airborne precautions … and this is in February 2020… 

Placing these in context, on March 28, 2020, you get this link to a news piece where Vuorinen says the virus is transmitting through aerosol, which has significant implications. What did you try to do? This is a huge paradigm shift in recognizing that the pandemic is airborne. What were the implications of this in your mind, and what were you trying to do to let people know about it? 

Censorship of the science on aerosol transmission

AA: I really acted, I would say very fast because already on March the 29th, I wrote a letter to be published in the big newspaper in the capital city, the Helsinki Helsingin Sanomat.

As I realized that it wouldn’t be published, I wrote to the THL (the Finnish Institute for Health and Welfare). At the same time, I wrote to our government and all the ministries in charge and warned them also and asked them to inform the public and to contact Professor Vuorinen to get some more information. There were still no reactions.

Then I tried to get this knowledge out internationally. On the 7th of April, I wrote a short article in the European Respiratory Society’s new COVID-19 forum, where I recommended that we should speak as little as possible indoors, that the ventilation and air filtration all over in the buildings should be looked after, and that the people, at least in the shops, should have masks on.

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