Why a Biologist's COVID-19 Blogs Went Viral

An Interview With Erin Bromage

Laura A. Stokowski, RN, MS

June 02, 2020

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Erin Bromage, PhD

When biologist Erin Bromage posted a blog about reducing personal risk for contracting COVID-19, little did he realize that he was about to become very well known. His ability to turn complex scientific principles into clear guidance for action has clicked with millions of people. Medscape spoke with Bromage about the COVID-19 blogs read round the world, and what he foresees for the country moving forward. This interview has been edited for length and clarity.

Which of your posts got the most attention, and why do you think that happened?

I wrote a post called The Risks – Know Them – Avoid Them. I was writing it for my friends and family in Australia and here in the United States. Both countries were about to reopen, but no one had any idea of where to put our energy with respect to risk mitigation or hazard reduction behavior.

So I put together a story: this is what we know, this is what it means, and this is what we can do. It seemed to gel. I think it's because I could simplify the information that was out there. It's helped a lot of people visualize the risks.

I work in infectious diseases, but mainly with animals. I had been keeping a close eye on the virus since early January. Come February, I started seeing things that made me realize that this is going to change our lives. So I started putting little snippets out to friends on Facebook. After eight or 10 of those posts, one of my friends asked me to put them on a website so everyone could read them.

When I wrote about things like grocery shopping or whether pets can transmit the virus, I'd get a couple of thousand people reading my posts. Then about a month ago I wrote the post about risks, looking at all the data and what it would mean for summer going forward.

I posted it on a Wednesday night, and when I woke up in the morning, it had about 8000 views. By the end of Thursday night it was closer to 200,000. I reached out to my university and said, "Help — I don't know if I've done something wrong." They gave me the help I needed, sort of a buffer around me because I was getting a lot of requests.

Over that first weekend it ended up getting seen by 6 million people. The mention in the New York Times made it explode. It's now had about 18 million views on my site and another 5 to 7 million on hosting sites in different languages.

Your blogs have been praised by neuroscientists, physicians, business owners, teachers, and many others. Yet, you say that you aren't an expert in these topics. Where do you get your information, and how do you decide what to write about?

No one could possibly claim to be an expert in all the disciplines contributing to the knowledge on SARS-CoV-2. My training in infectious diseases and immunology helped me understand the science outside of my specialty, but one of the most revealing mediums I found was #epitwitter — a group of epidemiologists on Twitter discussing in real time their findings, the findings of others, ideas, and where the science was going.

They would say, "Hey this paper came out today and this is significant." You could see from the minds of about 80 people where the most important papers were in the field and what the collective mind was thinking. It's an incredible opportunity to watch some of these amazing virologists, epidemiologists, and public health experts all coalesce on a single problem and then take that information and put it into something that's relevant.

In your blogs, you use math to illustrate what happens in different social situations, adding the variable of time. How does time influence risk?

I was more attuned to this is because I do infectious dose work quite regularly in my lab. When we do experiments with animals, there is a really strong factor with dose and time. You can give high dose over a short period and the result is severe disease. You can give a low dose over an extended period and end up in the same situation, and then there's everything in between.

So exposure is not this one-off circumstance. Exposure can come in many different ways, and there are even more nuances. There are different infectious doses that happen between your eyes, your nose, and your lungs that affect things differently. We do the same thing with animals. If you give a dose intranasally, it's very different from just putting it into the air for an extended period of time.

I was very interested in dose-time, and I didn't think most of the general public was aware that that was an important factor. People were having a hard time trying to understand contact tracing situations. You might be contacted if you had been in contact with an infectious person and speaking with them for 10 or 15 minutes, but they didn't know why. Why not 5 minutes? Why did it matter if you were in the same environment as them for a half hour or an hour, but not 15 minutes?

When I was able to put all that together — that it's exposure to virus and time, you get to the same results by different pathways — I think the light went on for a lot of people. This is why splashguards went up in grocery stores. This is why the bus drivers are getting sick in NYC, because they are getting a low dose over an extended period of time.

So it started to make sense to everyone about why we are being told to do things or not do things and how it related to the biology.

What does that mean for reopening businesses? For example, restaurants or movie theatres may try to make the environment safer by having fewer tables or selling fewer seats. Will that work, if people are still spending
2 hours together?

For every extra body you take out of a room, you are lowering the risk that somebody infected is in there to start off with. Then assuming that someone in that environment is infected, there is a gradient of respiratory droplets from that person that radiates out. So, certainly, having people spread out more in enclosed environments is an important way to reduce infection, but it's not the solution to controlling all infections. Having a restaurant at half capacity that is still enclosed and has no or very little air exchange is going to be just as risky, but to fewer people.

For the medical community, fall is the start of the medical conference season. People who plan to attend these conferences are thinking about flying. You wrote a blog recently on Flying in the Age of COVID-19. We've heard stories of people taking off their masks once they are on board. Is flying too risky?

The cabin of a plane is almost as good as you can get for an indoor environment. Your biggest risk on the flight is not the person in front or behind you, it's the person beside you that you strike up a conversation with. That's a face-to-face conversation from very close, so in a very short period of time, infection can occur. Just understanding where the risks are and behaving appropriately is important if you are going to fly. Your risks are those people immediately around you and surfaces you touch, going to bathrooms, things like that.

With regard to masks on flights, the longer the mask can stay on the lower the respiratory emissions from that person. Taking a mask off for short periods of time to eat or drink does increase the risk, but if the mask is worn the rest of the time, this balances out.

What frustrates me is that the mask is not really for you, it's for everyone who is around you. They're protecting you and you're protecting them — it's a bit of a social contract that you have when you are flying. If airlines are requiring you to wear masks, they shouldn't be removed. People should understand that if you are going to fly — to get into these close-quartered spaces, we need to reduce harm as much as we can, and do our part.

If you are flying from places that have a high prevalence of infection and going to a place where hundreds of people will be gathering in the same space, you may just be tempting fate. Not only do you run the risk of becoming infected from the flight itself and all the associated activities — departure, arrival, baggage claim, transportation, etc —  but you are going to be sitting in an environment with colleagues for hours on end.

And if you are infected 1 to 3 days after your flight, then we have a much larger problem. It's no longer just you. It's everyone you are there with. So these things need a lot of thought before we embark on this type of event again.

In one of your blogs you advocate dropping the term "social distancing." Why is that?

Along with many epidemiologists, I've been trying to change the term from social distancing to physical distancing. It's a small change but it makes a big difference. It's not about being disconnected socially from the people around you — it's creating a physical space between people that is almost too far for the virus to be transmitted. That's the basis of the 6 feet. The vast majority of respiratory emissions will drop and land at the feet of someone 6 feet away, whereas many will hit their face and chest of a person only 3 feet away.

Creating physical distance — not becoming socially isolated — is the goal of these mitigation strategies. If I'm standing 10 feet from somebody across my lawn, I'm having social interaction but I still have the physical distance I need to be safe. The closer you are, the more dangerous it is.

What are the biggest misunderstandings right now driving people's behavior when outside of the home?

Masks are a big misunderstanding at the moment. Because we have this idea that masks were made to protect the wearer, people have had a hard time adopting the idea that masks are an important part of the control of infection when you can't physically distance. And the narrative that got mixed up from the CDC in the effort to try to protect PPE for healthcare workers only added to the confusion that we have now in society. When you add politics on top of that, it's become a silly debate when we know it has an effect. That's disappointing to me.

The CDC has done it again with changing fomites from being a risk to not being a risk in a period of a week and a half. Data doesn't change that quickly, but we were all scratching our heads about why they lowered the risk of fomite transmission. We knew it wasn't the primary driver but it was there. They put it in the same category as cats and dogs, and that just confused everyone in public health. Where's the data that helped make that decision?

Now they've moved it back, saying they didn't mean to add to the confusion. But now we've had a week of dialogue where surfaces aren't as important.

Because this is so new [to the USA] and we don't have a history of widespread epidemics of infectious diseases in recent memory, we don't really know how to react and behave correctly as a society yet. Other countries that are scarred by their history, like Hong Kong and Taiwan, were able to jump straight into it and get control very quickly because the general population already knew the behaviors they needed to do in order to limit the spread of the virus.

We are the infants in all this. We are still learning and that's been hard. People need to understand that masks have a role, and surfaces have a role, and that all the things that we've been discussing — enclosed spaces, long time, etc, all have their part in controlling the trajectory of what happens over the next few weeks, months, or year — whatever we are dealing with now.

What mistakes are we making in our early efforts to open up?

My biggest fear is opening without a plan. If you read my blogs, it's all about planning. Give people the tools they need to make the best decisions/choices for themselves and their families in the risks they face and the ways they can reduce them.

I'm finding that a certain group of people are rushing to open and maybe haven't thought it through enough. I'm fortunate to work with people who are really thinking about how to reopen and do it as safely as they possible can. Even though they were given the green light to open last week, they chose not to until they had systems in place to protect not only their workers but their guests.

Erin S. Bromage, PhD, is an associate professor of biology at the University of Massachusetts Dartmouth, where he teaches courses in immunology and infectious disease. Dr Bromage's research focuses on the evolution of the immune system, the immunological mechanisms responsible for protection from infectious disease, and the design and use of vaccines to control infectious disease in animals. He also focuses on designing diagnostic tools to detect biological and chemical threats in the environment in real-time.

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