Uncontrolled Spread: Why COVID-19 Crushed Us and How We Can Defeat the Next Pandemic

by Scott Gottlieb

The CDC’s preoccupation with fomites probably contributed to the agency misjudging the contribution of aerosol transmission and discounting the use of masks early in the pandemic. It became increasingly clear that a lot of spread wasn’t merely through droplets but also through aerosol transmission.29 Droplets are larger particles we secrete when we talk, cough, or sneeze.30 They are heavier and can’t travel long distances. Aerosols are smaller particles that emerge after droplets start to evaporate. They can spread through the air over longer distances and stay suspended for prolonged periods of time. This becomes especially true when the aerosols get into sealed, indoor spaces. If the right patient was in the right confined space at the right time in their illness, typically a day or two before symptoms set in and when they were maximally contagious, then the pattern of spread they could spark could look more like measles (which spreads through aerosols) than flu (which spreads primarily through droplets). Yet, in considering COVID, the CDC had flu in mind.