Sadly, poor quality and misleading communication from health professionals concerning COVID is far too common. A recent iteration of this trend has been the habit of downgrading the risks of COVID while simultaneously promoting the threat from influenza, as if this provides some kind of reassurance that COVID isn’t so bad.

Recently a popular UK daytime show – ITV’s ‘This Morning’ – hosted an NHS GP who did exactly this. She stated that COVID “is somewhere between a cold and ‘flu” on the basis of initial symptoms, only mentioning ‘Long Covid’ in passing, and failing to provide any context about the broader potential health impacts of COVID infections.

It is now well established that COVID is a multi-system illness with the potential to affect a broader range of organs compared to ‘flu, with greater risks of long term and chronic complications and mortality.

Quite why so many health professionals choose to misrepresent the balance between COVID and ‘flu is beyond my understanding, but this has real world consequences; fewer people will take reasonable precautions, more will become infected, and there will be more ill health as a result of this guidance.

I have taken the trouble to draft a formal complaint to the broadcasters ITV, and have reproduced the full complaint here.

***********************************************************************************************************

“Dear Sir/Madam,

I want to raise a formal complaint regarding misleading information presented by Dr. Nighat on This Morning, 19th October 2026, covering the issue of the relative severity of COVID and influenza infections in the segment on winter bugs.

Dr. Nighat made two specific false statements which were not corrected, while also downplaying the general risks of COVID infection. Firstly, she stated that a cold can turn into influenza. This is untrue. It is possible that you can have co-infections, with colds and influenza simultaneously, but colds and influenza are different viruses and one cannot morph into the other.

Secondly, she said that COVID lies somewhere between colds and influenza in terms of severity. This is again untrue. While the impacts and severity of the acute phase may vary between individuals, COVID continues to have significantly greater impacts than influenza in the initial stages. Beyond the acute phase, COVID is also now understood to have far greater health impacts than influenza, with even apparently mild infections being linked to subsequent cardiovascular issues, inflammatory conditions and neurological symptoms. For example, this recent study found that while both infections damaged lung tissue, COVID uniquely impairs the bodies natural repair mechanism - https://news.tulane.edu/pr/tulane-study-reveals-key-differences-long-term-impacts-covid-19-and-flu

“In the lungs, both viruses left behind a similar picture: immune cells that failed to fully stand down and increased buildup of collagen, a protein associated with scarring. Those changes can stiffen lung tissue and make breathing feel more labored — a possible biological explanation for why some people report lingering shortness of breath after respiratory infections. But when the researchers looked more closely, they found a key difference. After the flu, the lungs appeared to switch into repair mode, sending specialized cells into damaged areas to help rebuild the lining of the airways. That repair response was largely missing after COVID-19 infection, suggesting the virus may interfere with the lung’s natural healing process.”

Finally, it is well established that inflammatory neurological symptoms remain a unique aspect of COVID infections compared to influenza. While it was correctly stated by Dr. Nighat that the symptom of anosmia (loss of taste or smell) is more unique to COVID, it has been known for some time that extended anosmia following COVID infection is a potential symptom of neurodegeneration. This is one of many research papers on this topic - https://pmc.ncbi.nlm.nih.gov/articles/PMC9377782/ which states - “COVID-19-related long-term olfactory dysfunction and early damage to olfactory and limbic brain regions suggest a pattern of degeneration similar to that seen in early stages of Alzheimer’s disease, Parkinson’s disease, and Lewy body dementia. Thus, long-term olfactory dysfunction coupled with cognitive and emotional disturbance from COVID-19 may be the first signs of delayed onset dementia from neurodegeneration.”

Therefore a loss of taste or smell associated specifically with COVID infection is strongly linked to the development of future neurological problems, a fact that was completely overlooked by Dr. Nighat.

While Dr. Nighat did very briefly mention infection avoidance strategies (masking, ventilation) these were given very low prominence, and placing COVID as a less serious disease than influenza is misleading and potentially dangerous for millions of This Morning viewers.

I appreciate the fact that GPs are very busy (especially since the COVID pandemic began) but not keeping up with the current scientific data on COVID is a serious oversight. I would ask that you ensure your contributors refrain from making such false statements concerning COVID in the future, and ideally that the factually incorrect statements aired in yesterday’s episode are corrected.

Yours faithfully,

Dr Nicola Jane Boyd”

_{1. This article has been written without the use of AI}

I recall last spring a neighbour telling me he couldn’t remember a year when his children were as sick as they were last winter, yet here we are again. Frustratingly, we already have air cleaning technologies that could substantially alleviate many of these illnesses, yet we remain curiously reluctant to deploy them at scale. We are proceeding in a piecemeal fashion, testing mitigations in small trial areas, looking for impacts in specific locations, rather than standing back and looking at these interventions from the perspective of the overall population scale. I believe this is holding us back.

Since 2020 there has been a great deal of discussion of air cleaning technologies. By definition these create spatial differentiation. When we install Far-UVC or HEPA filters we are cleaning the air in a space, while other spaces remain untreated and unclean. How the clinical impact of such interventions is measured has been the subject of furious debate. Traditionally, medical interventions have adopted RCTs as the favoured mechanism to gauge efficacy, with medical researchers arguing this same approach should be applied to air cleaning technologies.

On the other hand, engineers and others have argued that using RCTs to measure spatially based interventions, like Far-UVC, is illogical, as trial participants move in and out of the space, so we cannot logically understand how effective the intervention has been at reducing infections within that space if participants can become infected elsewhere. The concept of a ‘control’ has effectively been lost. They argue that a better approach would be to measure the efficacy of the intervention at reducing pathogen levels within that space, while seeking to understand how pathogen concentrations relate to clinical outcomes, as a means to develop targets and standards.

I am very much in the second group here. I have been told by some clinical doctors that all that matters is how many symptomatic infections there are (the issue of asymptomatic infections is often not even considered) but I am more interested in knowing whether dangerous pathogens are present or absent. If an air cleaning technology can significantly reduce pathogen levels within a given area, the number of infections seeded in that space, symptomatic or asymptomatic, will likely be reduced as a result.

However, there is a problem here, for both sides, if we focus too much on the individual spaces being treated – a particular building or cluster of buildings – and this brings us right back to the exponentials.

In public health there is frequently a mass effect, where the aggregate of individual interventions creates a population scale change greater than the sum of its parts. This is at the heart of the original concept of vaccine induced ‘herd immunity’. Where we have highly effective vaccines, such as for measles, what we see is that above a certain level of vaccination coverage, the disease is effectively eliminated, even if some remain unvaccinated. Coverage is the key word here. If there is a low uptake of the vaccine, some will benefit, although they may still suffer breakthrough infections, and the population level impact will be more limited. However, beyond a certain threshold of coverage, circulation of the pathogen becomes increasingly unviable and everyone becomes protected.

While this concept is readily applied to successful vaccines by the medical community, there are often blank faces when the same approach is argued for effective air cleaning technologies. Instead, the debate tends to focus on the clinical impact of such interventions in limited spaces, rather than zooming out to conceptualise the idea of the mass effect that would result from widespread adoption. Complex RCTs are trialled for small clusters of care homes, for example, often producing indeterminate results, because trial participants can be readily infected elsewhere. Yet those infections are included in the study results with no indication of where they actually originated. Even if the intervention is highly effective in terms of preventing infection within the trial premises, the impacts will be diluted by any off site originated infections which effectively contaminate the results. As with the cumulative protection that comes from extensive coverage with an effective vaccine, we need to apply the same principle to air cleaning devices – widespread adoption.

The critical point here is that exponential growth can function in reverse. In the case of an infectious wave, growth is defined by the ‘R’ number, the proportion of susceptible individuals, contact rates etc. Negative exponential growth provides the mirror image (flipped horizontally) of the typical COVID wave, with a slow decline which gradually deepens over time. In the case of negative exponential growth potentially created by air cleaning technologies, the concept is one of mass and scale. As more devices are deployed into more public spaces, the ability of pathogens to spread and infect shrinks, meaning fewer infected individuals. This in turn starts to protect everyone, even in those spaces without such air cleaning systems, because – just like the measles vaccination – you become less likely to encounter an infected individual. There is a compounding, or exponential effect, based on the mass of interventions – the level of coverage.

Recently, an article in the American Journal of Infection Control has stated that

“Far UV-C light (200-230 nm) likely has the greatest promise as a continuous room decontamination device of the technologies currently available.”

The Miami Dolphins are an example of a commercial organisation that have grasped this, having just extended a trial installation of Far-UVC in parts of their training facilities to cover more high use environments, as the initial results were so promising (based on the measurement of pathogen levels). They understand the risk of exposure to bacteria, viruses and other microorganisms in shared indoor spaces and so are protecting their athletes and staff on site. They cannot, however, guarantee their protection elsewhere, so while their athletes are likely to now have fewer infections than previously, they won’t be completely protected.

We have become somewhat obsessed with identifying what percentage of infections might be avoided by the use of Far-UVC or HEPA filters in a small number of selected settings, such as a sample of care homes, but what if the greater effect comes from deploying mitigations at scale into those environments where most infections are seeded – schools, universities, nightclubs, gyms etc? Because of negative exponential growth and population scale effects, it is possible, theoretically at least, that installing Far-UVC/HEPA into these spaces might, over time, be more effective at protecting residents of care homes than putting them only in the care homes themselves.

As with so much within public health, the emphasis has to be on the ‘public’ element – it really is a collective endeavour. In many ways we are either protected everywhere or protected nowhere. We have understood and applied this concept to effective vaccines, but we are struggling to apply the same conceptual framework to air cleaning technologies.

I believe we now have available tools that could potentially bring us close to the effective elimination of diseases such as COVID, but only if we focus more on the population level benefits rather than over focusing on finding the ‘perfect’ solution for individual spaces. Do this, and perhaps my neighbour’s children can enjoy their school days in a healthier and happier environment.

_{1. This article has been written without the use of AI}

_{2. As ever, I make no commercial endorsements and I have no connections, beneficial or otherwise, with any Far-UVC or clean air technology companies or organisations.}

One of the factors that has been delaying wider adoption of Far-UVC within public health is cost, with the technology currently relying on expensive and relatively bulky lamps and filters. The remarkable aspect of Uviquity’s new platform is that they believe they have identified a means to adapt an existing, low cost, commercially available technology – blue laser diodes – that are already mass produced and used in a range of medical diagnostics, 3D printing and other industrial applications.

Using blue laser diodes that emit at ~ 445nm as the starting point, they have been able to use second harmonic generation to convert the blue light into pure, human safe Far-UVC light (222nm – 229nm) through doubling the frequencies and hence halving the wavelengths. While conceptually this is a simple idea, leaning into straightforward concepts within physics, in practical terms this could represent an astonishing leap forward. It potentially allows Far-UVC manufacturers to tap into an existing, mature technology, that is low cost and readily commercially available. If you are producing a new car model, it’s far easier to adapt an established engine design rather than build a brand new motor from scratch. That’s the genius of Uviquity’s thinking here.

This approach potentially creates three key advantages.

Firstly, by tapping into an existing technology, the manufacturing process itself becomes much simpler.

Secondly, this should open the door to mass production at far lower costs. As the prototype device is also extremely compact, using standard industry components, Uviquity believe their devices will be both scaleable while also being suitable for integration into existing lighting devices. If their claims are verified, it raises the possibility that standard GU10 LED lamps, among others, could be readily adapted to include a Far-UVC element – no need for new dedicated fittings, no rewiring, no specialist installation requirements.

Thirdly, because the light is generated from wavelength specific blue laser diodes, the resulting Far-UVC light is spectrally pure, and hence obviates the need to filter out undesirable wavelengths. This both aides in miniaturising the devices, reduces costs and also benefits operational safety and potentially public acceptance.

Uviquity are expecting to have their first products available later this year for testing by industry partners and independent researchers, with a current target for full commercial production in 2028.

While this is incredibly exciting news, as ever, I would caution that this is a commercial announcement that has not, to my knowledge, been independently verified. It is also the subject of multiple patents, and it is not yet clear how these may help or hinder wider deployment. However, they have presented a conference paper at the recent ICFUST 2026 conference detailing the key aspects of their innovation, and it appears scientifically sound.

Whether this particular technological breakthrough lives up to it’s early promise we cannot yet say, but it is another sign of the fast pace of development within the clean air space. So amongst all the doom and gloom, there are signs of hope for the future.

_{1. This article has been written without the use of AI}

_{2. As ever, I make no commercial endorsements and I have no connections, beneficial or otherwise, with any Far-UVC or clean air technology companies or organisations.}

Blueprint Biosecurity , a non-profit organisation promoting pandemic preparedness, are doing some great work promoting Far-UVC as an air cleaning technology. They are pushing research, funding and public understanding into this new technology, and helping to bring it into the mainstream as a critical public health intervention. This is excellent.

To reiterate, many medical interventions involve processes within the human body that we cannot watch or measure, so RCTs are essential to understand clinical outcomes. This is perfectly valid and logical. But medical ‘dogma creep’ is seeking to extend this methodology into areas where it becomes inappropriate and ineffective, such as testing the efficacy of air cleaning devices. Unfortunately, Blueprint Biosecurity appear to have accepted this dogma within their FIR-Program, which is seeking to design more robust RCT trial protocols to test the efficacy of Far-UVC. As RCTs are fundamentally flawed for this purpose, I believe we are risking delaying Far-UVC deployment and obscuring the real benefits of this technology.

The key here is that while drug and vaccine treatments are internal and travel with the trial participant, air cleaning technologies treat a specific space, through which people move. Unless all the participants within an RCT remain static within the intervention and control arms for the duration of the study, the results become largely meaningless and can be statistically chaotic. This is a fundamental flaw that cannot be overcome within an ethical trial framework.

Where we are testing the public health efficacy of devices, we measure outcomes, we don’t use RCTs. We don’t conduct RCTs on the benefits of refrigerating food. Instead we’ve measured pathogen levels before and after refrigeration and developed food safety standards from there.

The extent of the RCT dogma is also illustrated by the response to RCTs into hand washing. We know good hand hygiene is an essential part of infection control, but as I previously said here multiple RCTs into hand hygiene have failed to produce consistent results proving its efficacy. In fact, one comprehensive, large 2020 RCT study (66 care home units, 640,486 resident days) actually showed more hand washing increases some infections! . The response within the medical community is to either glide over these inconvenient results or to conclude that the RCT designs were not good enough. However, when an RCT finds HEPA filters are ineffective at reducing infections, the RCT construct in this context is deemed to be ‘robust’ and the results reliable. These contradictions demonstrate the levels of prejudice within public health, both in favour of RCTs to assess clean air technologies and against clean air measures in general.

The experience of the RCTs into hand hygiene should serve as a red flag warning to Blueprint Biosecurity and everyone else in the clean air space. In seeking to placate the medical establishment dogma that only RCTs can provide proof of efficacy, we risk obscuring the real benefits of clean air technologies. We will be handing those already sceptical of the need for clean air further ammunition in the form of a poorly applied research framework, which they will wrongly take as evidence that clean air technologies don’t work.

Blueprint Biosecurity really are doing some excellent work in the Far-UVC space, but I have written to them about my concerns and have urged them to avoid the pitfalls of the RCT dogma for assessing this air cleaning technology. My full letter to them is reproduced below.

Dear Sir/Madam,

I welcome your focus on Far-UVC as an air cleaning technology and your wider research and engagement activities. These are much needed. However, I am deeply concerned about your promotion of RCT’s as being required to demonstrate efficacy. I note your efforts under the FIR-Protocol to design sufficiently robust RCTs, which implicitly acknowledges some of the practical shortcomings of RCTs in this context, but there is a fundamental flaw in the RCT methodology for the assessment of physical devices which cannot be overcome, and adherence to this approach risks delaying deployment, and consequently unnecessary illness and deaths.

RCTs are not the ‘gold standard’ for outcomes that are clearly physically measurable. Contrary to medical dogma, they are subservient protocols when compared to physical measurement, with RCTs widely adopted in medical treatment assessment only because it is impossible to measure what is going on in the human body. Vaccine and drug interventions are internal and travel with the patient, and therefore RCTs are logically valid in this context. For physical devices delivering public health via spatial treatments, we have to measure the physical impacts within that space, and using RCTs to measure clinical outcomes within individuals moving in and out of that space is illogical.

For example, pharmaceutical companies do use RCTs to assess the efficacy of drug treatments. They do not use RCTs to assess the efficacy of Far-UVC systems in drug production clean rooms – they simply measure the pathogen load. Likewise there has never been an RCT conducted on the public health benefits of refrigeration; we simply measure bacterial growth rates under different temperature regimes and extrapolate a safe food storage temperature from laboratory studies.

To get an understanding of the potentially catastrophic scale of the impact of employing RCTs to guide policy in the wrong context, we can look no further than the issue of hand hygiene. There is absolutely no doubt that hand washing and sanitising are critical elements of public health. There are multiple studies demonstrating the pathogen reduction impacts of hand hygiene. The evidence for it’s effectiveness, as measured by RCTs, is however, extremely weak. See here - https://pmc.ncbi.nlm.nih.gov/articles/PMC8138990/

Multiple well designed, high powered RCTs have failed to find consistent benefits from hand washing, in many cases finding statistically significant correlations suggesting better hand hygiene leads to more infections! This is clearly an incorrect conclusion, but it points to the fundamental flaws in RCT methodology for such studies, rather than any real effect of hand hygiene.

For an RCT of any scale or statistical power to be valid for Far-UVC assessment, we would need to maintain a study population, within both the intervention and control arms, that is completely immobile within the study areas; no study participants could be allowed to leave throughout the entire study period, because infection outside the study area would negate any results. This is clearly impractical and is a primary reason why many RCTs for such public health interventions produce chaotic, meaningless results. The RCT method is simply not appropriate for these interventions.

An alternative, straightforward approach, avoiding time delay, expense and invalid results, would be to establish a clear and consistent testing protocol that can compare pathogen load, in air and on surfaces, under conditions where Far-UVC is on and off. This would enable us to optimise the best configuration of Far-UVC deployment for any given space. As with food hygiene, we can then make reasoned assessments of the required target levels for pathogen concentration, reducing these as far as practicable below the assumed infectious dose, using these as the target for Far-UVC installation design.

Occam’s Razor tells us that the enemy of good science is often over complication. That is precisely what we are dealing with here. To this I would add the issue of dogma; clinical science is predicated on RCTs because it has to be; you cannot measure internal drug effects. But this has now become a dogma that has been illogically enforced onto research areas where it is a totally inappropriate methodology. Once we can demonstrate that Far-UVC substantially reduces pathogen load in occupied spaces, all we then need to do is increase the number of spaces where Far-UVC is installed. We will then see population scale falls in infections, just as we do with better hand hygiene and food refrigeration. Researchers will continue to puzzle over why RCTs don’t show a clear association between Far-UVC and infection control, but one day they will realise that this is because the RCT methodology is at fault, not washing our hands, using fridges or installing Far-UVC lamps.

There is an urgent and critical need for those active within the Far-UVC space to confront the ‘dogma creep’ that is leading to the inappropriate application of RCTs and we desperately need proponents of better public health to start thinking outside the box and to challenge the cosy consensus that has become entrenched around the RCT methodology. Alongside your extremely valuable and worthy contributions to the Far-UVC debate I would urge you to avoid making the potentially catastrophic mistake of relying on inappropriate RCT methodologies to advance Far-UVC deployment.

Yours,

Dr Nicola Jane Boyd

Principle Researcher, TEC Ltd

Previously PhD Computational Chemistry, University of Durham, UK

_{1. This article has been written without the use of AI}

While these are valid criticisms of the study, and do largely render the results meaningless, a more fundamental critique of the study design is that RCTs are the wrong method for assessing a physical intervention such as HEPA filtration.

RCTs have to be used where outcomes are not directly measurable, like vaccine or drug trials, and where the intervention is predetermined and constant (eg a patient receives a vaccine, and that vaccine stays with the patient throughout the study). Where RCTs fail for measures like filtration is that even if all the technical questions are adequately addressed, because we are looking at treatment of a physical space, rather than an individual, unless the study participants stay within their respective control/intervention locations for the entirety of the study period, the results become largely meaningless. For example, in the JAMA study, we have no idea if residents left the care homes, staff could have become sick at home, and there was no way of understanding what the impact of the HEPA filters was on pathogen concentrations where they were used.

The alternative approach, and much better option, is to simply measure how effective the intervention has been. In the case of HEPA filters, this would involve measuring the pathogen load with and without HEPA filters running.

Tackling the RCT obsession is a long haul, but I submitted the following comment to JAMA, which has now been printed alongside the original article.

Dear Editor,

It is deeply disappointing to see another major study on air cleaning technologies succumb to the inappropriate application of the randomised control methodology.

Far from the ‘gold standard’ that some assume, RCTs are an unfortunate necessity for situations where we cannot directly measure physical or biological outcomes, such as drug effects inside the human body. Where we have physical phenomena that can be directly measured, such as viral persistence in air, RCTs are unnecessary and can be misleading. We don’t rely on RCTs to justify whether we need to purify drinking water; we measure pathogen and pollutant loads to check whether the purification process is functioning correctly.

We have solid evidence that HEPA filters can effectively capture viral particles. In laboratory studies HEPA filtration at an effective rate of 2 air changes per hour (ACH) reduced measured SARS-CoV-2 load by 96.03% (1). The question is whether we can replicate this ACH rate effectively in a real world situation. This should be assessed via physical measurement, not RCTs.

In the current study, if staff and residents were free to move in and out of the study areas, the entire RCT methodology breaks down. Unless the participants were restricted throughout the full duration of the study to the intervention and control settings, it becomes impossible to identify where infections actually occurred, and the results therefore become effectively meaningless. You could, in theory, construct a logically valid RCT design. This would require strictly restricting participants movements exclusively to intervention/control areas, within functionally identical buildings, and then physically introducing equivalent concentrations of pathogens into the study areas, in order to derive any indications of the efficacy of the HEPA filters. However, such an RCT approach becomes an impractical and unethical construction.

It remains potentially the case that it may prove impossible to replicate the laboratory efficacy of HEPA filters in real world situations such as care homes, due to practical issues such as noise, ACH rates, and human control, but that cannot be assessed via RCTs. We can, however, measure pathogen load under HEPA/no HEPA conditions, and that’s the data that needs to be gathered.

Beyond HEPA we are witnessing remarkable technical advances in the arena of air cleaning technologies (2). RCTs will never be an appropriate protocol to measure the efficacy of such physical devices, given the restrictions required to make such studies logically valid. The alternative is the simple approach; install these devices, switch them on, and then measure the pathogen concentrations. As we do with water.

1) https://journals.asm.org/doi/10.1128/msphere.00086-22
2) https://www.spiedigitallibrary.org/conference-proceedings-of-spie/13890/3080065/Aluminum-nitride-integrated-photonics-for-far-UVC-second-harmonic-generation/10.1117/12.3080065.full

_{1. This article has been written without the use of AI}

I would like to clearly state that all my writing, here and elsewhere, has never included any input from AI beyond basic internet search tools. There are three fundamental reasons why I refuse to use AI in the writing process.

Firstly, the sense of achievement that arises from conceptualising, planning, researching and drafting an article, entirely through my own thoughts and efforts, is of the utmost importance to me. When I write, it is my voice that is speaking. What is the point of writing an article based on what a computer program is guiding me to write?

Secondly, I want to be free to think independently, untrammelled by the intrusion of AI algorithms that crawl over all existing writings to regurgitate the most common and accepted views. I want to be free to ask questions and think of alternative perspectives, that may be new or even unpopular. Charles Darwin devoted his life to one all-encompassing, brilliant theory that upended centuries of assumptions, challenging the very soul of what it meant to be a human, causing social uproar in the process. Would an AI reflecting the Victorian norms of the day have helped guide him towards such a stunningly unique conclusion?

Thirdly, I feel there is an insidious element to AI assisted writing, in that it’s ease of use and speed encourages writers to churn out content on a regular timetable – the weekly newsletter, the annual book – regardless of the inspiration or quality. Emily Brönte and Harper Lee are each immortalised for one single book that reflects their unique experience, knowledge and creativity, arguably the best books in their respective fields. Had they been driven to regular publications by machine assisted technologies would we would now be recognising their unique brilliance?

This also feeds into that corrupting loop of dopamine fixes, through ‘likes’, ‘restacks’, ‘reposts’ etc, which encourages and perpetuates prolific output at the expense of quality and content. This in turn serves to bury the human generated content, which takes time and effort. There is a consequent risk that original thinking will be squeezed out, to the detriment of the wider human experience. While I’m no Brönte, Darwin or Lee, I only write when I am inspired, and if I feel I may have something worthwhile to say. There is no ‘schedule’. I am not pursuing commercial endeavours or endorsements here, and as a result there are long gaps between my posts. That’s the antithesis of a good social media strategy and is a severe handicap to those of us relying solely on our own brains in a world swamped with AI generated content.

Finally, on a more general concern I have regarding AI, the algorithms are constructed to identify and reflect the broad consensus views of the day. They serve to validate and promote majority view points. But what happens when the majority is wrong? Progressive change frequently comes via radical, maverick thinkers, often excluded from the mainstream until emerging evidence for their opinions becomes unchallengeable. In an AI dominated world such views risk being buried ever deeper, and despite the advances claimed for AI we may find real change becomes even slower. Had AI been dominant in the 1980s I wonder whether those few maverick scientists warning of catastrophic man made climate change would have had an even tougher time trying to make their voices heard?

In a current issue close to my heart, is AI helping or hindering the public health response to COVID? In my opinion, the conventional view is wrong. We already have the technical ability to effectively eliminate a whole swathe of airborne diseases, including COVID. Yet AI will continue to select the consensus views suggesting limited and transient hybrid immunity, sub-standard COVID vaccines and a bit of protection for the vulnerable is sufficient. The key developing safe air technologies are largely absent from the search results, and AI does not routinely promote an aggressive elimination strategy. It lags well behind the radical new breakthroughs within the last few years as these are not yet mainstream.

While AI has tremendous potential in data based scientific research, I remain nervous about farming out the writing and conceptualising processes to algorithms. On a personal level I don’t want to lose the satisfaction I derive from creating something myself, from my own choices, while I retain concerns about the loss of originality that potentially arises when we drift away from human originated thinking.

One of the BREATHE initiatives has developed a pathogen detection system that is scheduled for testing in two San Francisco schools later this year. Biosensors will detect the presence of pathogens, and in this case trigger the HVAC system to increase ventilation rates, although in principle these could also link to Far-UVC installations. Over the next year the study aims to understand the pathogen detection process, before an anticipated roll out to potentially 60 schools in year two, when the effectiveness of the detection and control system will be tested.

I can’t stress how significant I think this is. The old ‘3 Ms’ adage comes to mind – ‘Measure, Monitor, Manage’. If we can’t measure something, we can’t monitor it. If we can’t monitor it, we can’t manage it. In terms of public health, this is why we have failed to control COVID and many other infectious diseases; when we enter an indoor space, we don’t know if pathogens are present, which ones they are, we can’t quantify them, we don’t know how long they persist.

Despite making remarkable advances in air cleaning technologies like Far-UVC, alongside traditional technologies such as HEPA and ventilation, the critical missing link has always been the ability to measure how air cleaning systems are working in real time. Biosensors effectively close this loop, providing certainty and enabling air cleaning to be managed as effectively as a thermostat manages a central heating system. In turn, the ability to ‘see’ that the air is clean will engender greater public confidence that such measures work and help boost calls for widespread deployment.

For decades we have relied on testing water to ensure it is clean and safe to drink. The methods we have developed to clean water have been measured and monitored for a very long time, and we now have such confidence in the cleaning systems that the measurements are now simply routine checks to ensure everything is working as expected.

Without such sampling systems for airborne pathogens, researchers cannot say with certainty how effective air cleaning systems are in practice, and so have been leaning towards randomised control trials (RCTs) to test efficacy. This approach is somewhat irrational in this context, largely because people are not static and inevitably move between treated and untreated areas. There is a tendency to only identify symptomatic infections, and there is no way of identifying where an individual actually picked up an infection.

We’ve never used RCTs to justify cleaning water. An analogy would be employing an RCT study in buildings with clean water systems, but where the occupants can leave and drink dirty water elsewhere. Apart from being ethically questionable, the results would convey little meaning. However, if we can test the cleaned water, we can say with certainty that it is disease free and be confident that the water cleaning technology works. That’s the promise of biosensors when it comes to clean air.

In the words of Elizabeth Caley, the co-CEO of Poppy Health who are behind this trial “we’re trying to build an immune system for buildings…..Your immune system needs to actually identify what’s attacking it in order to take the right response. That’s what we’re trying to do for what’s in the air in a building ... that ranges from bacteria, viruses, pollen, molds — basically a universal approach so that the right actions can be taken automatically in the building.”

I think the ‘immune system for buildings’ is a brilliant concept, and that this whole approach to detecting and managing pathogens should be at the forefront of a modern public health policy, in a truly preventative strategy. For many years I’ve viewed Far-UVC as a critical development in this sphere, but in many ways, effective and efficient biosensors are just as significant.

My only regret is that this is taking place in San Francisco and not yet in Scotland!

_{1. This article has been written without the use of AI}

I was concerned when I saw the article ‘What to Know About Cicada’ published recently in JAMA. As with many similar articles, it focused entirely on variant tracking experts discussing the evolutionary journey of SARS-CoV-2, even quoting T. Ryan Gregory - former stern critic of COVID-19 ‘calm mongering’ - as saying “Cicada is not a cause for alarm”.

While understanding the finer technical details of this virus is still important, and surveillance remains vital, I find it frustrating that these discussions tend to be divorced from the fact that we are the sole source of these new variants. There is a tendency to avoid human responsibility, hiding instead behind catchy pet names and discussions of how scary or benign each new variant might be. Such articles are near meaningless unless placed within a wider public health framework, where transmission control is at the forefront.

As long as we turn our backs on the control of transmission, we will be forever trapped on this ominous, unpredictable and bumpy evolutionary ride alongside Delta, Omicron, Nimbus, Cicada, Sooty, Tigger, Max, Buster, Whatever.

So I submitted a comment which has now been published, which I have reproduced in full below:

Over focusing on COVID-19 variants risks complacency

Nicola Boyd, PhD Comp. Chemistry | Principle Researcher, TEC Ltd, formerly University of Durham

COVID-19 continues to have severe impacts on society. A recent OECD report on Long Covid found 1 in 20 are actively suffering symptoms, resulting in “lasting structural change to labour markets and economic productivity” [1]. In Scotland, the number of GP appointments has risen by a staggering 42% since 2019 [2]. Data from the ONS show the UK has suffered a 3 year fall in healthy life expectancy since the start of the pandemic [3].

While discussion of the latest COVID-19 variants, complete with pet names, fills social media channels and has some marginal benefits to wider public health understanding, it is largely a side show. We do need to understand new variants/strains for academic reasons, but the key public health focus should always be on control and elimination, which in turn will significantly limit the opportunities for such new variants to arise. Cholera variants are not given catchy names, or the focus of endless discussions; instead here in the UK we get on with the business of investing £15.4bn a year in cleaning water to make cholera variants largely irrelevant. This is the approach we should be taking with COVID-19.

Any discussion of COVID-19 that fails to include the rapidly developing options for rigorous transmission prevention protocols is incomplete and fails to grasp the true gravity of the situation we are facing. The contributing experts may not be aware, but in addition to the traditional ventilation and filtration technologies, the last six years have witnessed revolutionary advances in transmission reduction technologies such as Far-UVC air and surface disinfection innovations [4], as well air sampling biosensors employing electrical circuits capable of detecting multiple pathogens in real time [5]. Recent modelling of current Far-UVC technologies deployed in public settings, translated into healthcare, economic and QALY benefits, found exceptional cost-benefit ratios of between 1 to 10 – 110 in normal periods, rising to 1 to 9,000 in a new pandemic situation [6].

Furthermore, recent developments in solid-state Far-UVC semiconductors, utilising existing blue light diodes, potentially offer cheaper, scalable Far-UVC solutions that can integrate into a wide variety of disinfection applications [7].

We increasingly have access to the tools required to target control and elimination of COVID-19. I believe that a lack of awareness of this potential, even among many COVID-19 researchers, is why we have largely walked back from any ambition for community-wide transmission reduction. While technical analyses of the nature of the virus are important, these should take place within an appropriate cognitive framework ‒ seeing the wood as well as the trees. In the context of COVID-19 this means framing discussions around the facts that infections are far from benign, nor are they inevitable.
Dr Nicola J Boyd

[1] https://www.oecd.org/en/publications/addressing-the-costs-and-care-for-long-covid_87a0c171-en/full-report.html
[2] https://www.gov.scot/news/increase-in-access-to-gp-care/
[3] https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/between2011to2013and2022to2024
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC7314750/
[5] https://www.sciencedirect.com/science/article/pii/S0039914025006824
[6] https://api-journal.accscience.com/journal/article/preview?id=6779
[7]https://cdn.prod.website-files.com/67e52ee2c28f42b5e236d38c/69dcf9ddca7c028feaf8ac4f_Uviquity_SPIE_Proceedings_13890_Manuscript_2026.pdf

_{1. This article has been written without the use of AI}

In public health policy, details matter. Recently two papers published in the John Hopkins University Journal Health Security, concluded that Far-UVC cannot currently be recommended for widespread adoption, in large part due to a need for more data concerning the risks of Far-UVC and ozone. Both papers focused solely on laboratory studies and models, omitting to cite important real world data demonstrating that Far-UVC operating at the correct dose and under basic ventilation levels does not result in any significant increase in ozone and associated secondary chemistry considered hazardous to human health.

The two papers recommended that Far-UVC is restricted to ‘high risk’ areas or emergency situations, suggesting it could be deployed in epidemic or pandemic scenarios. I view this as somewhat irrational. We are still facing repeated Covid-19 epidemics, and the threat of new emerging pandemics, which SARs-CoV-2 demonstrated could spread round the globe within days. The notion of responding to these with the wholesale installation of Far-UVC, a process that would take months or years, is not a credible strategy. There is no justifiable reason why we are not deploying Far-UVC now.

I believe that if you are presenting a scientific review, it is of fundamental importance to be accurate and comprehensive. This is particularly significant if the intention is to shape and inform public policy. In this case, the partial data coverage led to what I believe are distorted conclusions.

Make no mistake; if this advice is followed, people will suffer and die needlessly as a consequence. I have therefore submitted a formal complaint, with some suggested amendments. This has been acknowledged by the publishers and is now going through the formal complaints process. I will provide an update once the response is provided, but in the meantime I have copied the complaint below.

AS FOLLOWS:

Dear Editor,

I am writing to you to express my concern and to raise formal complaints about two recently published papers in the Health Security Journal. In both cases my complaint relates specifically to the sections on the impact of Far-UVC on indoor air quality. Both papers fail to discuss or include relevant references of published empirical data obtained from realistic real-world scenarios under the operation of Far-UVC devices. These are serious omissions, which in my opinion, create a distorted perspective and lead to misleading conclusions and recommendations that may have significant negative impacts on public health policy. Such shortcomings should, in my view, have been addressed at the peer review stage, if not by the original authors, and they are so serious that corrections or retractions should be urgently considered.

The papers of concern are;

Paper 1. Far UVC Technology and Germicidal Ultraviolet Energy: Policy and ResearchReview for Indoor Air Quality and Disease Transmission Control Linder AG, Zhu AW, Bruns R, Olsiewski P, Gronvall GK. Health Security. 2026;0(0). doi:10.1177/23265094261421824

Paper 2. Breaking Down Silos: A Multidisciplinary Approach to Mitigate Indoor Airborne Pathogen Transmission Zhu A, Bahnfleth WP, Bruns R, et al. Health Security. 2026;0(0). doi:10.1177/23265094261418814

Paper 1. Far UVC Technology and Germicidal Ultraviolet Energy: Policy and Research Review for Indoor Air Quality and Disease Transmission Control, finds that Far-UVC is highly efficient and effective at eliminating bacteria and viruses from indoor air, while being safe for skin and eye exposure.

However, in the section ‘Environmental Impacts of Far UVC and Interactions With Indoor Chemistry’ the authors discuss the issue of ozone, secondary organic aerosol (SOA) and Far-UVC at some length, citing in support of these concerns a number of studies deploying teflon chambers/oxidation flow reactors (OFRs) and computer simulations. (References 35, 37, 43, 45, 48). Furthermore, for unexplained reasons, a study of a high powered 254 nm sterilising device designed only for unoccupied spaces (ref.36) was also cited, despite not being relevant to the issue of 222 nm Far-UVC and indoor air quality. This should not have been included in this section and is misleading.

Only one real world Far-UVC 222nm study was cited (ref. 42 ‘Influence of germicidal UV (222 nm) lamps on ozone, ultrafine particles, and volatile organic compounds in indoor office spaces’). However, this study focused solely on how Far-UVC affects ozone/SOA levels in a series of office buildings when the HVAC systems were shut down, leaving the buildings running at unfeasibly low (and illegal) ventilation rates of 0.2 ach.

Even with virtually no ventilation, they found only modest increases in ozone with Far-UVC, at values still well below the equivalent rates found in teflon chamber experiments, and the results were inconclusive regarding the formation of secondary pollutants. Indeed, the referenced study authors state: “These discrepancies [lower ozone levels than teflon chamber studies] are attributed to the small volume of the test chambers, the higher O3 production rates caused by the increased reflectivity of the chamber materials compared to building materials, and the lower O3 decay rates caused by both limited surface deposition and gas-phase reactions”. In other words, they are saying that teflon chamber experiments are not representative of real-world scenarios when examining the potential impacts of Far-UVC on indoor air chemistry.

The authors of paper 1 then proceed to recommend that widespread adoption of Far-UVC should be delayed due to the concerns over indoor air chemistry. These conclusions are not supported by current real world empirical data which have consistently shown that Far- UVC devices operating at the minimum intensities required for disinfection, combined with basic ventilation rates, do not result in any significant increase in ozone and associated secondary chemistry considered hazardous to human health. [A number of these references that needed to be included are provided at the end of this letter].

At no point do the authors discuss the potential shortcomings of chamber/OFR/simulation studies. While such studies can provide useful insights, they are heavily dependent on methodology, the assumptions made and the quality of the input data, and we should always default to real world empirical observations whenever available. Critically, such real world observational data that is available was not cited or referenced in the commentary, and this is a significant oversight.

Paper 2. Breaking Down Silos: A Multidisciplinary Approach to Mitigate Indoor Airborne Pathogen Transmission, provides a broader overview on the different strategies available to mitigate pathogen transmission, but unfortunately falls into the same trap as Paper 1 when discussing the issue of Far-UVC and indoor air chemistry. Paper 2 references three of the same Far-UVC chamber/OFR/simulation models cited in Paper 1 (refs 85, 87 and 88) while also mistakenly including the same study of a high powered 254nm UVC disinfection device as referenced in Paper 1 (ref. 86 in this Paper), which is once again irrelevant to a discussion of Far-UVC. Yet again, there was no discussion of the limitations of chamber/OFR/simulation models studies, or of the tendency for these to overstate ozone production from Far-UVC, and no real world studies were included to portray more likely and realistic effects. Furthermore Paper 2 references Paper 1 (ref. 89) when stating that further study is required before Far-UVC can be safely deployed, despite ignoring existing research that contradicts this assertion.

In summary, the authors of both Paper 1 and Paper 2 failed to reference any of the several published papers based on realistic real-world scenario measurements of indoor ozone/SOA in the presence of Far-UVC devices. I believe that these glaring omissions materially alter the understanding and interpretation of the benefits and risks of Far-UVC as a critical public health tool, and could be construed as misinformation, although I am sure the authors did not intend this. However, in my view, these errors are serious, and if they serve to potentially slow down the wide-spread adoption of such an effective, life-saving technology, lives will be lost needlessly. The researchers, reviewers and publishers all have a responsibility to correct such errors. I would therefore politely request that corrections are made to both papers, to include;

i) Suitable references to real world scenario studies on indoor air quality relating to the operation of Far-UVC devices, to be included along with the results from computer simulations based on chamber/OFR experiments as already cited (see below for suggested references for additional inclusion).

ii) Substantive changes to the commentaries to discuss the shortcomings of teflon chamber/OFR/computer simulations studies in the context of Far-UVC and indoor air chemistry.

iii) Amendments to the conclusions to reflect current science and empirical real world data on the issue of Far-UVC and ozone/SOA, to state that there are no justifiable reasons to restrict the use of Far-UVC at the correct disinfection rates and under adequate ventilation rates to emergency situations only.

Whether we like it or not we remain in a health crisis. Recent data from the ONS and Eurostat confirm that healthy life expectancy across Europe and the UK has fallen sharply after 2020, and in many countries is still falling, demonstrating that something remains seriously wrong with public health management. Along with repeated epidemic waves of new Covid-19 variants, we also face the growing issue of multi-drug resistant microbes and the looming threat of further dramatic zoonotic spillover events such as H5N1. SARS-CoV-2 demonstrated that when faced with a newly emerging, highly transmissible pathogen we might have as little as 48hrs to prevent rapid global spread. Deploying Far-UVC across the public estate will take months, more likely years. The notion that we should only deploy Far-UVC widely if some new health emergency arises is irrational and not a credible strategy. It is vital that esteemed journals such as Health Security ensure that published work and policy guidance is comprehensive, up to date and understands the big picture context.

I would be grateful if you could consider this complaint and take the appropriate action.

Yours faithfully,

Dr N. J. Boyd

Additional references for inclusion

1. Narouei FH, Tang Z, Wang SI, Hashmi RH, Welch D, Sethuraman S, et al. (2025) Effects of germicidal far-UVC on ozone and particulate matter in a conference room. PLoS One 20(8): e0328224. https://doi.org/10.1371/journal.pone.0328224

2. Memic S, Kaple CE, Cadnum JL, Donskey CJ. Do far ultraviolet-C light technologies increase ozone concentrations in healthcare facility patient rooms? Infection Control & Hospital Epidemiology. 2025;46(8):858-860. doi:10.1017/ice.2025.10207

3. Petri Kalliomäki, Hamed Sobhani, Phillip Stratton, Kristen K. Coleman, AdityaSrikakulapu, Ross Salawitch, Russell R. Dickerson, Shengwei Zhu, Jelena Srebric, Donald K. Milton Ozone and ultra-fine particle concentrations in a hotel quarantine facility during 222 nm far-UVC air disinfection doi: https://doi.org/10.1101/2023.09.29.23296366

4. Buonanno, M., Kleiman, N.J., Welch, D. et al. 222 nm far-UVC light markedly reduces the level of infectious airborne virus in an occupied room. Sci Rep 14, 6722 (2024). https://doi.org/10.1038/s41598-024-57441-z

5. Brenner, D. J., The public-health significance of far-UVC-induced indoor ozone and its associated secondary chemistry, Photochemistry and Photobiology, 100, (2023) https://doi.org/10.1111/php.13892

END

_{1. This article has been written without the use of AI}

The widespread adoption of Far-UVC is contingent on a comprehensive appreciation of risks, benefits and context: incomplete or misleading information must be challenged. Two papers recently published in the John Hopkins University Journal Health Security could potentially distort perceptions of the risks of ozone from Far-UVC. Both papers conclude that risks from ozone are such that Far-UVC cannot currently be recommended for widespread adoption. Make no mistake; if this advice is followed, people will suffer and die needlessly as a consequence.

I believe the data does not support these conclusions, and I am so concerned that I am submitting a formal complaint to the publishers regarding these papers, requesting critical amendments that fundamentally alter the conclusions. This isn’t something I particularly enjoy doing, but this post explains why I believe it is necessary.

The coincidence of the Covid-19 pandemic with the explosion of open access scientific publishing has led to a huge interest in the science within the online Covid Cautious community. Unfortunately, I have seen many cases where published articles lack sufficient scientific rigour, and where the peer review process has, in my view, failed. This has often resulted in low quality papers being promoted online by an uncritical community, which can have damaging long term consequences.

Two papers caught my eye last month, specifically the discussions on the issue of Far-UVC and the risks of ozone and resulting pollutants, such as secondary organic aerosols (SOA)

Paper 1) Far UVC Technology and Germicidal Ultraviolet Energy: Policy and Research Review for Indoor Air Quality and Disease Transmission Control

and

Paper 2) Breaking Down Silos: A Multidisciplinary Approach to Mitigate Indoor Airborne Pathogen Transmission

What struck me most forcibly was that neither group of authors chose to reference any of the several published papers based on realistic real-world scenario measurements of indoor ozone/SOA produced by Far-UVC, which have consistently shown that the use of Far-UVC at the minimum intensities required for disinfection, combined with basic ventilation rates, do not result in any significant increase in ozone levels that could be considered hazardous to human health. [For readers interest, I have provided some of these references below]. Instead, both papers 1 and 2 chose to focus their commentaries and references on sealed teflon chamber experiments and mathematical models derived from these, without discussing the limitations of such studies.

Teflon chamber experiments are conducted in a controlled, isolated and inert environment that is not representative of real-world conditions. They will inherently find elevated ozone levels caused by Far-UVC compared with those found in real world situations. Mathematical models derived from these can provide useful insight, but are highly dependent on the quality of the input data and the assumptions built into the construction of the models.

Both papers 1 and 2 extensively cited published research based on teflon chamber experiments and associated models. Only one real world study was cited in either case (paper 1): Influence of Germicidal UV (222 nm) Lamps on Ozone, Ultrafine Particles, and Volatile Organic Compounds in Indoor Office Spaces. However, this study inexplicably focused solely on how Far-UVC affects ozone/SOA levels in a series of office buildings when the HVAC systems were shut down, leaving the buildings running at unfeasibly low (and illegal) ventilation rates of 0.2 ach.

This is the equivalent of researching winter temperatures in a building when you turn off the heating. It gets cold! In the study scenario, the answer is to simply switch the HVAC system back on. Problem solved!

Even with virtually no ventilation, they found only modest increases in ozone with Far-UVC, still well below the equivalent rates found in teflon chamber experiments, and inconclusive results regarding the formation of secondary pollutants. Indeed, the referenced study authors state: “These discrepancies [lower ozone levels than teflon chamber studies] are attributed to the small volume of the test chambers, the higher O₃ production rates caused by the increased reflectivity of the chamber materials compared to building materials, and the lower O₃ decay rates caused by both limited surface deposition and gas-phase reactions”. In other words, they are saying that teflon chamber experiments are unrealistic.

With these caveats, this study further undermines the conclusions derived solely from teflon chamber studies, although the authors of paper 1 failed to highlight or discuss such a perplexing methodology within the referenced study, or to contextualise the findings of this and other teflon chamber studies as non-realistic under real world operational conditions.

The failure in papers 1 and 2 to cite several published papers showing no adverse ozone effects from Far-UVC under realistic real-world conditions in the references and associated commentaries are serious over-sights which should, in my opinion, have been picked up by the peer review process. I view these as glaring omissions which completely distort the conclusions of the papers. I believe the papers need to be substantially amended to include the full range of references on the subject of Far-UVC and ozone, with further substantive alterations to the text to correctly state current knowledge on this issue. I will also be questioning why the publishers peer review process failed so spectacularly on this point.

In public health policy, details matter. Such a distorted review of current science on the issue of Far-UVC and ozone could be construed as misinformation, although I’m sure the authors did not intend this. However, in my view these errors are serious, and if they serve to potentially slow down the wide-spread adoption of such an effective, life-saving technology, lives will be lost needlessly. The researchers, reviewers and publishers all have a responsibility to correct such errors.

Real world studies into Far-UVC and ozone:

Effects of germicidal far-UVC on ozone and particulate matter in a conference room

Do far ultraviolet-C light technologies increase ozone concentrations in healthcare facility patient rooms?

Ozone and ultra-fine particle concentrations in a hotel quarantine facility during 222 nm far-UVC air disinfection

222 nm far-UVC light markedly reduces the level of infectious airborne virus in an occupied room

The public-health significance of far-UVC-induced indoor ozone and its associated secondary chemistry

_{1. This article has been written without the use of AI}

There are many ways to define great science and great scientists, but in my opinion the most important attributes are;

- meaningful research, with a definitive purpose, to solve significant societal challenges

- scientific inquiries that focus on long-term visions rather than short-term gains towards perceived fast track glory

- science that is detailed and meticulous yet which retains a ‘big picture’ perspective

- science that opens up new avenues to explore and hence new ways of doing things

- science that is reproducible, conducted with integrity, honesty and independent of egos.

Whether we like it or not, we are facing a series of linked public health crises; the development of drug resistant superbugs, the deepening impacts of airborne infections, and the looming threat of new zoonotic pandemics such as H5N1 avian ‘flu. Now, more than ever, we need aggressive public health measures, using new innovative tools, to add to our arsenal. Critically, we need scientists whose thinking goes beyond the existing status quo, and whose insights and research can help shape emerging paradigm shifts.

At a recent meeting of the General Hospital and Personal Use Devices Panel (GHPUDP), the FDA announced it’s intention to prioritise the development of standardised certification and assessment protocols for germicidal UV-devices – welcome news indeed. Within this, Far-UVC is one recent innovation which is showing tremendous promise. At the meeting David J. Brenner, Higgens Professor of Radiological Research at Columbia University Medical Centre, gave a presentation on the safety and efficacy of Far-UVC. David Brenner was the first to identify the huge potential of Far-UVC through his assiduous scientific insights and investigations. I believe that he is a scientist who encapsulates the attributes that I describe above, representing the best that science can offer.

David Brenner has devoted his entire career to researching and understanding the effects of radiation on people.

“Radiation is very much a two-edged sword ‒ used in the right way it has revolutionized modern medicine ‒ such as through CT scans and as a cure for many cancers. But radiation used in the wrong way can be harmful. To maximize the benefits of the many different applications of radiation, we need to understand exactly how they affect us ‒ from our DNA to the whole person.”

This is a scientist who raised concerns about the developing tendency for over prescribing the use of diagnostic CT scans in US hospitals, through formally quantifying the potential risks. He also developed safer alternative protocols for radiation treatment for cancers. For example, he proposed that a small number of larger radiotherapy doses (with a reduced total dose) rather than frequent smaller doses was a safer and more effective treatment for slow growing tumours such as prostrate cancer, and this is now standard practise in clinical settings.

David Brenner’s expertise once again came to the fore following the “underwear bomber” incident in 2009. As a result of this incident, the US government proposed that every airport passenger should be screened with full-body X-ray back scatterers, rather than a few selected individuals as was done previously. In a detailed letter to the US government, David Brenner outlined his concerns from a public health perspective about the population risks of developing cancer due to increased X-ray exposure for billions of airport passengers. He proposed a safer alternative full-body screening method - millimetre (radio) wave scanners, which do not emit X-rays. As a result these are now standard at most airports across the world. Ensuring that radiation is used responsibly by society, through carefully balancing the risks and benefits, has always been at the forefront of his work.

David J. Brenner, Higgens Professor of Radiological Research at Columbia University Medical Centre

It was just over a decade ago that David Brenner lost a close friend to a multi-drug resistant super-bug after a routine hospital procedure. Paul Rice was a Labour politician in their home town of Liverpool, with whom David Brenner shared a passion for Liverpool Football Club. Losing a close friend is always painful. I lost a very close friend of over twenty-five years who meant a great deal to me, suddenly and unexpectedly in December 2018, and life has never been quite the same since. The similarities end there, because unlike me, David Brenner used the tragic loss of his friend as the inspiration to explore alternative strategies in the war against super-bugs.

In a 2017 TED talk about Far-UVC, David Brenner talked frankly about his friend ‒ “I was truly shocked… He was a healthy guy in the prime of life.” He also explained that each new antibiotic we develop creates a future antibiotic resistant super-bug, and that we are trapped in a perpetual arms race which we are now losing. He was also aware that the number of people killed by super-bugs each year was rapidly growing and that on current trends, the worldwide number of deaths from these microbes every year could exceed 10 million by 2050. New ways to tackle the impending super-bugs disaster had to be developed. (This 10 million figure is now likely to be an underestimation. The introduction of the highly infectious SARS-CoV-2 virus into the mix in 2020, a virus known to cause incremental damage to the human immune system, is likely to amplify this statistic).

Following the loss of his friend, David Brenner applied his rigorous understanding of quantum biophysics and how light (radiation) interacts with biological matter, to the pressing issue of multi-drug resistant microbes, asking questions that no-one else was asking. He knew that wavelengths around 200 nm (informally called Far-UVC) are strongly absorbed by proteins in mammalian cells (specifically through the bonds linking proteins together called peptide bonds). Key to understanding this ‒ and the following is a very crude description of quantum biophysics ‒ is that each wavelength has a particular energy associated with it. The shorter the wavelength the greater the energy (see below).

Comparison of wavelength, frequency and energy for the electromagnetic spectrum. (Credit: NASA’s Imagine the Universe)

Critically, the atoms and bonds which make up molecules absorb this energy discretely and differentially. In other words, molecules have their own characteristic ‘fingerprint’ or absorption spectrum. So we perceive grass to be green, rather than blue or red, because the chlorophyll molecules that carry out photosynthesis strongly absorb blue and red wavelengths and their associated energies, while poorly absorbing green light. The ‘left over’ green light is diffusely scattered from the cell walls, causing our eyes to perceive grass as green.

David Brenner proposed that the preferential absorption of Far-UVC wavelengths, particularly by protein peptide bonds, would ensure that these wavelengths were absorbed by the outer dead layers of our skin and eyes, thus acting as a brake on further penetration. The outer protective layers would effectively soak up this energy. This may seem counter intuitive, as shorter UVC wavelengths carry greater energy and hence greater destructive power, but it is a simple quirk of nature that these shorter Far-UVC wavelengths are preferentially absorbed by protein peptide bonds. Conversely, while longer UVC wavelengths carry with them less energy, they are not as strongly absorbed by proteins so can bypass the outer layers and penetrate further into skin tissue, causing potential damage to sensitive dividing cells (see below).

Slide from David J. Brenner presentation, GHPUDP meeting December 2025

David Brenner also postulated that as bacteria are single-cell microbes, and significantly smaller than human cells, it was probable that Far-UVC wavelengths would still be capable of causing lethal damage to these microbes without harming humans. As with all science, without evidence these would have remained as theoretical postulations, with limited practical potential ‒ to make progress they needed to be tested and demonstrated. At the time there was little funding or interest in this area of research, but in 2013 David Brenner and his team were in a position to publish their seminal paper, dedicated to the memory of his friend Paul Rice ‒ “207-nm UV Light - A Promising Tool for Safe Low-Cost Reduction of Surgical Site Infections. I:In Vitro Studies”

This ground breaking paper provided the first evidence that David Brenner’s postulations were correct: Far-UVC did indeed appear to be safe for humans while remaining highly effective against bacteria, paving the way for a new solution to infectious and drug-resistant microbes. It is entirely conceivable that in the decades to come, this paper will come to be seen as the greatest turning point in public health since the discovery of penicillin.

David Brenner’s team then went on to demonstrate that Far-UVC was not only effective against superbugs, but exceptionally effective against airborne viruses like influenza H1N1 and other human coronaviruses. Multiple studies from across the globe have since confirmed that Far-UVC is a potent tool against both surface and airborne pathogens, while also being safe for use in the human environment. One of the key advantages of Far-UVC is it’s ability to attack many different types of microbes outside the human host, thus helping to address the growing concern of multi-drug resistant bacteria and vaccine resistant viruses that rapidly evolve to outwit the immune response.

There is no doubt that David Brenner’s scientific insights and research have the potential to reshape public health, opening up new avenues in the control of disease and pandemic preparedness. They promise nothing short of a revolution in disease control akin to the advent of clean water or the development of antibiotics and vaccines. But his discovery goes way beyond public health. From food security to environmental remediation, Far-UVC is paving the way for environmentally friendly and energy efficient solutions to other critical issues across multiple sectors (see below).

The wide ranging applications for Far-UVC technology across multiple sectors

It is often stated that the key to success in science is asking the right questions. But as the renowned Canadian environmentalist and lichenologist Trevor Goward aptly remarked “….what people often neglect to say is finding the right perspective from which to conceive them.”

The tragic loss of his friend gave David Brenner a compassionate perspective from which to strive for solutions to significant public health challenges facing humanity. His meticulous attention to detail did not hamper his ability to see the ‘big picture,’ and his discovery progressed to unlock new areas of research with the potential to solve critical issues beyond the realm of public health.

I don’t know and have never met David Brenner, but I don’t get the impression he is driven by an ambition for personal fame and a desire to bask in the limelight, nor does he appear to be a scientist clamouring for social media attention, despite his remarkable scientific breakthroughs. But one thing I am pretty confident about is that his legacy will have a substantial effect on your life, my life, and the lives of future generations to come. I don’t know about you, but that’s what I call a great bit of science, and a great scientist.

_{1. This article has been written without the use of AI}

_{2. As ever, I make no commercial endorsements and I have no connections, beneficial or otherwise, with any Far-UVC or clean air technology companies or organisations.}

A recent Feature Article by Katherine Lang in the BMJ Why covid-19 is “a vascular disease masquerading as a respiratory one” has attracted a good deal of attention on social media from within the covid aware community, as it provides welcome confirmation of long held view that covid should be seen as more of a vascular disease.

I was concerned however, that some of the statements in the article served to reinforce the general acceptance that constant reinfections are inevitable, an approach I have termed the ‘surrender narrative’.

I am very pleased to be able to report that the BMJ has accepted my Rapid Response comment on this article, which I have reproduced below.

**********************************

Dear Editor

While it is encouraging to see recognition that covid-19 is a vascular disease as much as a respiratory condition, there are two fundamental misconceptions presented in this article.

Firstly, the article states that “the best preventive measure is vaccination”. This is fundamentally incorrect. The best preventative measure is to avoid infection, and vaccination alone cannot achieve this. Indeed, so poor are the vaccines against infection that far from the heady early days of 94% efficacy (1), we have now completely given up reporting on infection prevention, choosing only to focus on the limited and short term efficacy against severe outcomes.

Over reliance on sub-optimal vaccines will not provide a secure long term strategy; in animal husbandry, there are many examples of non-sterilizing vaccines being restricted or withdrawn due to fears they will drive pathogens down new, more dangerous evolutionary pathways (2), but this is precisely the sole strategy now being adopted for covid-19.

The second fundamental misconception in the article is the unspoken assumption that infection is inevitable. With a few notable exceptions, since perhaps 2022 ‒ 2023, the medical profession’s response to covid-19 has been in effect to walk away from the established public health principles of ‘control, eliminate, eradicate’, adopting instead what I have termed the ‘surrender narrative’ ‒ that infection is inevitable, and the medical response is merely to mop up the consequences, rather than tackle the disease at source.

We now have abundant evidence of persistent, long term, population level harm arising from repeat covid-19 infections, of which cardiovascular complications are just one part. Total GP consultations in NHS Scotland have rocketed by 42% from 2019 to 2025 (3), with if anything, the rate of rise increasing. At the same time we have acquired far greater knowledge about transmission mechanisms, with the growing appreciation that airborne infection is a far more prevalent vector than surface contamination (4). But we are also concurrently witnessing the development of revolutionary new technologies that offer the chance to control such infections.

Over the last six years there have been significant developments in the understanding of traditional ventilation and filtration technologies, and CO2 monitoring innovations for indoor spaces. Most markedly we have seen revolutionary advances in Far-UVC air and surface disinfection technologies (5), along with air sampling biosensors to detect multiple pathogens in real time (6). This is not a question of going back to 2019; we have an unprecedented opportunity to move forward into a new era of public health protection.

It is time that the medical profession recognised this emerging paradigm shift and moved on from the surrender narrative to a broader perspective that includes the control of such airborne diseases. A developing target of elimination of diseases such as covid-19 and influenza would be ambitious, but with the new and emerging technologies now available, alongside existing medical knowledge, it is not unreasonable to view this as a feasible possibility.

(1) Wise J. Covid-19: Pfizer BioNTech vaccine reduced cases by 94% in Israel, shows peer reviewed study. BMJ 2021;372:n567. https://www.bmj.com/content/372/bmj.n567
(2) Read AF, Baigent S, Powers C, et al. Imperfect Vaccination Can Enhance the Transmission of Highly Virulent Pathogens. PLOS Biology 2015 https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.10...
(3) Scottish Government. News. Increase in access to GP care. 4 November 2025. https://www.gov.scot/news/increase-in-access-to-gp-care/
(4) Fan Y, Nishimura H, Katsumi M, et al. Minimal Influenza Virus Transmission From Touching Contaminated Floors and Metal Door Levers: Laboratory Study II. Microbiol Immunol. 2025 Jul;69(7):397-406. doi: 10.1111/1348-0421.13226. Epub 2025 May 19. https://pubmed.ncbi.nlm.nih.gov/40390178/
(5) Buonanno M, Welch D, Shuryak I, Brenner DJ. Far-UVC light (222 nm) efficiently and safely inactivates airborne human coronaviruses. Sci Rep. 2020 Jun 24;10:10285. doi: 10.1038/s41598-020-67211-2 https://pmc.ncbi.nlm.nih.gov/articles/PMC7314750/
(6) Sinha S, Upadhyay LSB. Biosensing technology for detection and assessment of pathogenic microorganisms. Future Microbiol. 2024 Oct 29;20(1):57–72. doi: 10.1080/17460913.2024.2417621 https://pmc.ncbi.nlm.nih.gov/articles/PMC11731313/

_{1. This article has been written without the use of AI}

The ongoing COVID-19 pandemic¹ is both bringing home how dangerous shared indoor air can be, while simultaneously showcasing multiple ways to control and eliminate these dangers. It has also demonstrated societies striking inertia to adopt proven technologies that carry clear societal benefits. Each year, airborne viruses such as SARS-CoV-2, other coronaviruses, influenza, RSV and rhinovirus cause billions of instances of illness, and lead to severe infection or death for tens of millions. Tuberculosis, a disease which is solely transmitted through the air still continues to kill 1 million people a year. Yet when you present solutions – clean air technologies – a common rebuttal is ‘it’s too expensive.’ This is an odd response because when applied to water, the financial outlay required to provide safe, disease free water is never questioned, and is accepted as the status quo.

Others have asked why we don’t clean air like we clean water. This short essay invites you to flip this question on it’s head and ask why don’t we manage waterborne threats like we currently manage airborne diseases?

This year Britain invested £15.4 billion in cleaning water, equating to £226 per person. Every day 16 billion litres of water – six and a half thousand Olympic-sized swimming pools – is collected, stored, treated and then transported through 810,000 km of pipes and sewers – a distance sufficient to reach the moon and back.

Water is cleansed of pesticides, pharmaceuticals, nitrates, phosphorous, bacteria, viruses, protoctists and Uncle Tom Cobley and all. This is performed through numerous treatments including filtration, activated carbon treatment, reverse osmosis, oxidation, UV disinfection and chlorination. Water quality is monitored through regular sampling. Collecting, treating and moving water is a complex and costly business.

Sampling water quality in a UK treatment plant

But what if we started to think that, like with air, the £15.4bn was ‘too expensive’ and looked for an alternative strategy? How would that work? We wouldn’t want to regress back to pre-industrial times, so we could make the collection and storage of water an individual responsibility, while tapping into the resources the pharmaceutical industry and modern medicine can provide to tackle the various consequences of untreated water. We could;

– vaccinate everyone periodically for typhoid/cholera (c 60% efficacy – slightly better than the current influenza and COVID-19 vaccines – but still leaving many people unprotected).

– vaccinate against hepatitis A, a virus associated with a lack of safe water and poor sanitation

– massively boost production of antibiotics for parasitic protoctist infections such as giardiasis, cryptosporidium, cyclosporiasis and for bacterial infections such as leptospirosis, campylobacteriosis, legionellosis and dysentery that we don’t have vaccines for.

– increase production of oral hydration treatments for e-coli and salmonella among others

– medication to treat toxic algae bloom poisoning

Parasitic protoctist – giardiasis

We would also need extra NHS resources: more doctors and nurses to cope with increased GP visits; more hospital beds: and additional resources for treating the high-risk groups disproportionately affected by waterborne diseases. We would also need to plan for permanent increases in sick leave, loss of economic productivity and disruption of children’s education.

The impacts would stretch further. Many researchers now believe that cleaning polluted water historically led to a decrease in non-water transmitted contagious diseases such as TB and pneumonia.

“The leading explanation seems to be that contaminated water weakens the immune system, making one susceptible to other contagious diseases, not just typhoid “(Harvard economist David Cutler)

Therefore, if we stopped treating water we should also expect to see a more general rise in sickness and mortality from these secondary undesirable effects.

For those who have the resources, investment in domestic scale water treatment systems would be feasible, but once outside the home, safe water would not be guaranteed in workplaces, public buildings and leisure facilities.

In Britain, if we did apply the same strategy we are using to manage airborne infections to water, abandoning that £15.4 billion annual investment in favour of downstream mitigations, would this be cost effective? I think we can all agree that we would be hard pressed to find any health agency, commercial enterprise, government or voter that would support such an approach. It would be far more costly, socially devastating and economically damaging for any country to switch to such a reactive system. Instead, we all accept a state mandated system, with legal obligations to pay for and provide safe water, within well defined statutory requirements, because we’ve learned from a long history that this is by far the most efficient way to manage water.

Even with clean water, the previously mentioned medical interventions can be vital for civil emergencies (such as floods) rare system failures and for some participating in recreational outdoor water activities, but they are not used on a routine basis. Outside the UK they remain essential for the one billion of people who still lack access to safe piped water, but here the WHO continues to advocate for ‘point-of-use’ strategies for clean water supply, rather than mopping up the mess caused by dirty water.

It’s not as though we don’t have comparable technologies to clean indoor air as well – we do. And, unlike the bulky nature of water that requires huge infrastructure to store and transport from one location to another, indoor air can be treated in-situ. We have companies specialising in particle monitoring systems for real time detection of airborne pathogens. The highly effective UVC/Far-UVC disinfection solutions are available and continuously developing. We have the well established filtration technologies, and the relatively recent CO₂ monitoring innovations are now being applied to public indoor spaces.

Far-UVC at work in an office space

Governments have yet to appreciate the false economy of their failure to address the issue of shared indoor air, but where clean air technologies in the business world have been fully embraced, we are starting to see some remarkable results. In the US, Sunrise Senior Living care facilities installed comprehensive Far UVC systems across three of their largest facilities. Compared with the previous year they achieved

– 92% reduction in respiratory illnesses – effective elimination

– 78% decrease in antibiotic prescriptions for respiratory conditions – vitally important considering the WHO’ s warning: “Antimicrobial resistance is outpacing advances in modern medicine, threatening the health of families worldwide”

– 65% reduction in resident hospitalisations due to infections

– 43% decrease in staff sick days related to respiratory illnesses

Equally staggering were the economic benefits, with the return on investment achieved in just 9 months. As a result Sunrise Senior Living has approved the rollout of Far UVC systems to all of their facilities over the next 18 months.

Elderly care home residents enjoying breakfast

Also in the US, Pig Hill Farms are now addressing livestock and human health concerns through installation of Far-UVC systems as a critical biosecurity solution, especially in the light of the recent surge in highly pathogenic avian influenza cases. EuroShop, the world’s no.1 retail fair is increasingly seeing businesses investing in modern hygiene technologies to protect both customers and staff from the threat of both airborne and surface pathogens.

“Investments in modern hygiene technology pay off twice over: They not only increase objective cleanliness but can also strengthen the brand image and promote customer loyalty.” Sven Reck (EuroShop)

UVC air disinfection in retail setting, from https://www.lighting.philips.co.il/support/cases/food-and-large-retailers/dm-shops

The thread that links all of these disparate businesses is – money. Happy and still alive elderly care home residents bring in more income, gym owners don’t want their customers to be ill in bed with ‘flu or COVID, missing sessions, and healthy pigs are highly profitable. Through investing in clean air technologies they believe they have a competitive advantage – it’s that simple.

I find it strangely perverse, that my prior belief that leftist collective political sentiments and strong societal leadership have not been successful drivers of a compassionate health policy: rather, it increasingly appears that it is the business world that is driving clean air initiatives, precisely because the ‘do nothing’ status quo is the less cost effective option. But compassion is also cost effective – they are not mutually exclusive.

UK government policies around the dangers of shared indoor air are riddled with distorted perspectives. When in opposition, Labour spoke harshly about illegal sewage dumping, which led to 3,286 hospital admissions in 2022-23 from waterborne infections, an increase of 60% since 2010. They said this was “unacceptable”, “sickening”, and placed additional pressure on the NHS, promising they would take tough action. Yet, over the last twelve months, admissions to hospital from a single contagious airborne disease – COVID-19 are approaching 60,000. Despite being 20 times greater than all waterborne admissions combined, Labour is silent.

UKHSA COVID-19 Hospital admissions data year to December 2025

North of the border, the Scottish government has announced that there has been a 2.4 million increase in GP consultations over the last 12 months. I’d bet my mortgage that many of the extra 2.4 million visits are a consequence of the pandemic and are preventable. The solution – an extra 171 doctors, and an additional investment of £531 million – is presented as positive news, but is in fact a clear sign of failure. We should be asking – why are we all becoming sicker?

Excluding all other airborne diseases, studies show that COVID alone costs Britain annually £4.2bn in additional NHS care and £10.5bn in lost work capacity/informal care costs. That’s almost the entire annual investment in water treatment frittered away on the impacts of a single airborne disease.

I believe that the key problem is that, unlike water – a commodity supplied by a corporation, company or public authority, acting under state regulation – the shared air we breath is free. No one pays for it, so no one takes responsibility. There is no question that this attitude is costing far more than it would to tackle the issue – just as we all accept with water. I suspect that at some point in the future, state mandated strategies to provide safe indoor air for all, will be seen as the most compassionate and the least expensive option. But only when the penny drops that we are all drinking cost effective investments while breathing false economies.

1Defined as showing periodic exponential growth cutting across international borders.

_{This article has been written without the use of AI}

Emerging new technologies can offer exciting new opportunities, yet also present us with a dilemma; how do we balance the promised benefits against the potential risks? A caution led approach may eliminate risk in the short term, but endanger human well-being in the long term, through delays and barriers to adoption. On the other hand, rushing to embrace innovative technologies may lead to unintended adverse consequences.

Often described as the ‘precautionary’ and the ‘innovation’ principles, these differing approaches are tricky to reconcile, with no definitive “correct” point of balance. Numerous factors can shift the balance one way or another. The EU is renowned for a cautious approach, whereas the US promotes innovation through light touch regulation. China has it own distinctive approach, reflecting their political and cultural make-up.

The purpose for which the novel technology is designed can also shift the balance. Regulation of medical biotechnology generally favours the innovation principle, whereas regulation of biotechnology for agriculture, public health and environmental protection more often applies the precautionary principle. For the latter, endless new studies are required to ‘prove’ absence of any potential harm, rather than demonstrate clear benefits. Public perception - scepticism or enthusiasm - can also tip this balance, as can the social context; the application of new innovations in times of crisis are more likely to be supported than in situations that lack such a sense of urgency.

In response to the ongoing COVID-19 pandemic, two very different technologies emerged, each with huge potential to protect human health - mRNA vaccines and Far-UVC light. mRNA vaccines were adopted with great eagerness, with regulators applying the innovation principle, thus saving millions of lives. The “willingness to take acceptable risk based on the value of the opportunity” was crucial. In contrast, the bar was set considerably higher for Far-UVC, with ongoing precautionary evaluation hindering progress and widespread adoption. The back stories to these two novel technologies could not be more different.

mRNA biotechnology

The origin of mRNA biotechnology lies in life’s magical biochemistry and a molecule found in all living cells – natural ‘messenger’ RNA, or mRNA. These ubiquitous molecules act like instruction leaflets, carrying vital information for building and assembling the thousands of molecules necessary for life to function - hormones like insulin, digestive enzymes such as pepsin, and antibodies, vital components of the immune system.

For decades, the concept of synthetic mRNA had teased scientists with the promise of revolutionising medicine, from treating cancer to developing vaccines. In principle, any disease fighting molecule could be built within living human cells, once those cells had received the necessary mRNA instructions. Living cells could then become the factories, bypassing many of the costly and time consuming synthetic fabrication steps required to make pharmaceuticals.

Unfortunately, for a long time the intrinsically unstable and potentially toxic nature of synthetic mRNA, combined with the potential for serious adverse immune responses, kept mRNA technology firmly off-limits. These obstacles did not deter Dr Katalina Kariko, whose perseverance and key insights enabled synthetic mRNA to be tamed yet remain robust enough to be considered sufficiently safe and effective for use in human medicine. For her ground breaking work Katalina was awarded the Nobel prize.

Applying this technology to vaccines seemed an attractive opportunity. All that is required is to deliver into our cells pathogen specific mRNA instructions for building tiny but crucial parts of those pathogens, called antigens (In the case of SARS-CoV-2, the mRNA vaccine instructions are translated into the spike protein). These artificially induced invaders then stimulate our immune systems to produce antibodies, amongst other immune molecules, thus preparing a defence from future attacks.

Source: https://www.researchgate.net/publication/356474248_Messenger_RNA_mRNA_Vaccine_Large_Scale_Manufacturing

Despite the fact that this technology unlocked an entirely new way of making vaccines that was rapid and relatively straightforward, no mRNA vaccine had ever been licensed until the impending crisis of a pandemic came knocking on our doors. The unfolding, awful human toll pushed authorities to accelerate COVID-19 vaccine development. This involved “an unprecedented flow of cash” along with flexible decision making, leading to “some of the fastest vaccine development and testing in modern history”. Emergency authorisations were issued even before completion of phase 4 clinical trials, a stage ideally required to monitor real world effectiveness, safety concerns and resolve outstanding questions. In the words of Dr Thana Cristina de Campos-Rudinsky, from the Princeton Institute for International and Regional Studies -

“These unknowns include…..whether or not the vaccine prevents viral transmission, how the vaccine affects different groups, as well as the vaccine’s long-term safety profile...The UK’s and many other countries’ decision in approving a COVID-9 vaccine without complete certainty illustrates the complexities of public health decisions…..Health policies always involve some level of risks, many layers of complexity and difficult trade-offs among competing policy goals, relative utilities, objective values and principled reasons.”

These judgements were reasonable, given the circumstances. Had we waited until we had full certainty on all these questions, many millions more people would not be alive today. The urgency of the situation required us to apply the innovation principle, focusing more on the potential benefits rather than the unintended risks. But did we apply the same level of urgency to another powerful tool for combating disease, Far-UVC technology?

Far-UVC technology

Unlike the biological origins of mRNA vaccines, the genesis of far-UVC emerged from a physical phenomenon - light waves, or more precisely, electromagnetic radiation. Just as ocean waves vary considerably when measuring from crest to crest, light waves also assume different wavelengths as they travel through space. Measured in nanometers - that’s a billionth of a meter - light waves range from the longer wavelengths of radio waves to the billionth of times shorter gamma rays. This continuum of wavelengths is described by the electromagnetic spectrum.

source https://www.canada.ca/en/health-canada/services/sun-safety/what-is-ultraviolet-radiation.htm

Sandwiched between visible light waves and X-rays are the Ultra Violet (UV) light waves, which are classified into three bands – UVA (315-400 nm), UVB (280-315 nm) and UVC (100-280 nm). Most of us are familiar with the longer UVA and UVB wavelengths in sunlight that provide us with vitamin D and make us feel good, but too much exposure can lead to skin cancer and cataracts, hence the need for sunscreens and protective clothing.

The shorter UVC wavelengths are highly efficient and potent light disinfectants. Effective against all known microbial pathogens - whether on surfaces or airborne - UVC 254 nm light disinfection is an established 80 yr old technology that has been widely used in water disinfection, food decontamination and the control of TB in hospitals and homeless shelters. In fact for decades it has been known that established UVC is “effective in reducing disease transmission, even for highly contagious airborne diseases such as measles, influenza and the common cold”. However, in western societies, with the arrival of vaccines and antibiotics, the control of infectious diseases using UVC light largely fell out of fashion. [For those interested, an excellent in depth article on the history of UVC light disinfection and the key pioneers of this technology can be found in: Ultraviolet light and indoor air disinfection to fight pandemics: A technology long overdue. ]

Established UVC technology can potentially cause skin and eye irritation, “although the long-term health risks are considered to be negligible compared with common solar UV exposures”. Nevertheless, to completely avoid any adverse effects, conventional UVC has been limited to upper room applications only, when used in occupied settings. Encouragingly, more recent research has found that by shifting to slightly shorter UVC wavelengths, notably 222 -230 nm, informally known as Far-UVC, not only is the effectiveness against pathogens maintained, but numerous published peer reviewed studies show no measurable negative impacts to skin and eyes under direct exposure, despite including much larger doses that would be allowed in real world settings.

Unlike conventional 254 nm UVC, the shorter wavelengths of Far-UVC cannot penetrate further than the outermost layers of human skin (which is composed of dead epithelium cells), nor cause any detectable eye irritation, making it suitable for all occupied spaces. In fact, Far-UVC expert Dr Ewan Eadie, Head of Scientific Services for Photobiology and Optical Radiation at Ninewells Hospital in Dundee states that “Far-UV exposure of 30,000 hours or 3.5 years is equivalent to 10 minutes in the sun.” So long as the source of Far-UVC is from filtered lamps that screen out any other potentially hazardous wavelengths, it is completely safe.

Far UVC is particularly effective for pathogen reduction, as it is able to quickly treat large volumes of air, and thus achieves far higher equivalent air changes per hour than is practically feasible with ventilation or filtration alone. Studies have shown well over 90% pathogen deactivation within minutes. This rapid rate of removal is vitally important for highly infectious diseases such as COVID-19. With Far UVC we can forget ‘equivalent air changes per hour’ – we are talking about air changes per minute.

The potential for UVC light and specifically Far-UVC in disease control is huge. Edward Nardell, Harvard Medical School Professor of Global Health and Social Medicine, one of the key pioneers of UVC light disinfectant, with decades of experience researching airborne infection prevention, describes Far-UVC as an “untapped potential to mitigate airborne infections”, stating -

“It is not an exaggeration to claim that the most effective, evidence‐based, cost‐effective, safe and available engineering intervention to disinfect air is being largely ignored during a lethal viral pandemic spread predominantly by the airborne route.”

Despite all of this evidence and experience, governments and public health bodies have been strangely reluctant to adopt and promote this promising technology. Unlike mRNA vaccines, where rapid deployment under the innovation principle was seen as essential, Far-UVC lags behind, beset with obstacles, with requests for more data and a focus on arbitrarily looking for potential harms, rather than accepting the clear benefits. This has led to a seemingly endless barrage of sometimes spurious questions over safety and efficacy, which has had the effect of slowing public acceptance and official adoption of a lifesaving technology.

What about ozone & VOCs?

Ozone is a well known air pollutant. Indoor background ozone levels in the absence of Far-UVC typically range from 4-6 ppb (parts per billion). The current FDA guidelines stipulate that indoor concentrations from medical devices should not exceed 50 ppb. Two “real-world” studies (one in a hotel room and the other in an office), showed an increase of approximately 5 ppb with Far-UVC lamps switched on. Both studies employed higher Far-UVC doses than the recommended limit and the rooms were comparatively well sealed, suggesting that additional Far-UVC ozone generation is unlikely to be a significant issue. This has been further corroborated by Dr Ewan Eadie (Head of Scientific Services for Photobiology and Optical Radiation at Ninewells Hospital, Dundee), who showed that Far-UVC lamps running at 10% of maximum output did not generate additional ozone, yet were still extremely effective at inactivating pathogens. Another study in an animal care facility, conducted by Dr David Brenner (Professor of Radiation Biophysics, Columbia University), found no enhanced Far-UVC ozone generation.

Some studies conducted in sealed laboratory aerosol chambers have found that Far-UVC can lead to elevated ozone levels, and unfortunately these data have been reported out of context, leading to unwarranted concerns. We don’t live in sealed aerosol chambers, and the basic ventilation rates and natural ozone decay in real world settings effectively eliminates this as a problem.

Ozone can also react with ‘Volatile Organic Compounds’ (VOCs) in indoor air, to create secondary pollutants harmful to human health. One ubiquitous VOC found in cleaning and personal hygiene products is limonene, which is particularly reactive with ozone. This has been raised as a potential concern for Far-UVC, but without adequate ventilation is already a potential indoor air quality issue, irrespective of Far-UVC use. In reality, the previous studies showing little or no Far-UVC ozone effect in real world scenarios also did not demonstrate Far-UVC enhancement of secondary pollutants. If limonene were to be an issue for air quality, the answer is better control of ventilation and a more frugal use of scented products and cleaning materials.

What about the skin microbiome?

Bizarrely, concerns have been raised about Far-UVC disrupting the skin’s natural microbiome. Handwashing, alcohol sanitizers, bathing and showering are all known to disrupt the natural balance of the skin microbiome, but notably, this was not an issue raised by public health agencies regarding the constant exhortations to sanitize our hands. In any event, these surface effects are known to be transient, whether Far-UVC or washing induced.

What about cost?

The widespread deployment of Far-UVC will undoubtedly be cost effective. The costs to society of the failure to control the transmission of SAR-CoV-2 are unfathomable. Welfare benefits, strained healthcare systems, high costs of treatments and lost productivity are escalating as a result of this one virus alone. In 2023, the German economy was estimated to have lost 0.8% of GDP due to workplace absences from Covid-19, and McKinseys have calculated that the days lost to ‘mild’ Covid infections will reduce US workforce availability by up to 2.5%. Investment in Far-UVC will carry a price tag, but as Dr Ewan Eadie remarks -

“The cost of Far-UVC is unlikely to be borne directly by the individual, and in any case is in flux due to market competition and manufacturing advancements. Products tend to be more expensive during the ‘innovators’ and ‘early adopters’ phase of the adoption curve , which is arguably where Far-UVC stands at the time of writing. Following successful early adoption of and confidence in the technology it is projected that the cost of Far-UVC installations would decrease.”

The financial benefits of Far-UVC would also be greatly enhanced as unlike disease specific vaccines, it is effective against multiple pathogens.

Will the public accept Far-UVC?

In contrast to mRNA vaccines, where the messaging was very clear on the benefits and safety of a ground breaking technology, a lack of public awareness of Far-UVC as a safe and effective tool for killing airborne viruses and bacteria has hindered progress. However, Dr Ewan Eadie has demonstrated that that when the basic concepts of Far-UVC are clearly communicated, public opinion improves. To accelerate progress he strongly recommends clear public health messaging and states

“Such channels utilised for current health protection measures could be leveraged to provide informative and reputable information on Far-UVC, as presently there is a lack of such information. A centralised, freely accessible resource would be key in appropriately conveying information on Far-UVC to the wider public.”

Diverging approaches

Trapped within the precautionary principle, Far-UVC has struggled to make significant headway. Despite a proven track record and an excellent safety profile, it’s use to date has been limited. While the UK Ministry of Defence is understood to have installed Far-UVC units and the technology has been regularly seen in the White House, there is an eery silence around Far-UVC within wider public health circles.

In contrast, under the innovation approach, mRNA vaccines were placed firmly in the limelight, with rapid deployment, even before all the questions concerning safety aspects and efficacy could be fully resolved. The outstanding questions of durability, side effects and transmission prevention have now been answered. Current research aims to address these shortcomings, with fine tuning of the mRNA vaccines to reduce reactogenicity and ongoing research to develop better, more durable COVID-19 vaccines. As with all emerging technologies, post deployment monitoring, research and refinement are crucial. For Far-UVC however, it appears that every last detail and scrap of uncertainty needs to be addressed before we consider it as a viable technology.

In Conclusion

It is a sobering thought that had we waited for phase 4 trials to be completed for the mRNA vaccines, millions more people would have died from Covid-19. A focus on the potential benefits through the adoption of the innovation principle was essential. It is an equally sobering thought that had society similarly fast tracked Far-UVC technology, with it’s own ‘Operation Warp Speed’ of huge investment, rapid research and full government support and promotion, countless more lives would have been saved, and millions spared the ravages of Long Covid. And if we had applied Far-UVC alongside the mRNA vaccines, we might now genuinely be here in 2024 contemplating the effective elimination of Covid-19.

This is not even about going back to pre-pandemic 2019. We now have better tools and greater knowledge to engender a twenty first century revolution in public health, and a huge leap forward to a future where infectious diseases are no longer viewed as an inevitable fact of life we must endure.

The tale of Far-UVC is one full of regrets, but it is not too late. In this Tale of Two Technologies, were we to fully embrace Far-UVC as a vital tool for combating disease, to paraphrase the great storyteller Charles Dickens, ‘it will be a far, far better thing we do, than we have ever done; it will be a far, far better future we go to than we have ever known’.

_{1. This article has been written without the use of AI}

_{2. As ever, I make no commercial endorsements and I have no connections, beneficial or otherwise, with any Far-UVC or clean air technology companies or organisations.}

Control, Eliminate, Eradicate are the three pillars of global disease reduction. These three powerful words are written through public health officials like a stick of rock. Under the auspices of public health, they have distinct meanings.

• ‘Control’ is defined as the deliberate action to reduce infection rates and hence the burden of disease.

• ‘Eliminate’ means reducing disease incidence to zero in a particular geographical area, but not necessarily worldwide.

• ‘Eradicate,’ the holy grail of disease management, is defined by WHO as the “permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts.”

Control, eliminate and eradicate are synonymous with what ‘living with disease’ has always meant. If eradicate is not possible then control and eliminate are applied relentlessly through testing, monitoring, education, pharmaceutical interventions, and a huge range of social and environmental preventive measures. Sanitation, clean water and pasteurization are examples of control and elimination measures that enable many of us to live safely amongst hazardous pathogens we cannot eradicate from our environments.

None of these measures can be implemented effectively without global coordination, global health campaigns, political and economic support, and crucially, the setting of time defined targets. For example, the WHO is aiming to eliminate HIV/AIDS by 2030 - “...we now have the tools and knowledge to end the HIV/AIDS pandemic as a threat to public health — and to do so by 2030.”

With SARS-CoV-2 we have introduced a serious new global health threat to the world, paying little attention to control, eliminate and eradicate, and instead relying solely on vaccines for protection.

Successful vaccines

There is no doubt that the development of successful vaccines in modern medicine has made a significant contribution to keeping these three pillars standing tall and strong, saving countless lives. However, to be considered successful, a vaccine needs to be safe, highly effective, and in possession of the following three attributes:

• complete protection against infection for 90% or more of the population

• long-term protective immunity against infection (ranging from years to life-long)

• protection against severe disease if rare breakthrough infections occur.

A helpful feature when developing a vaccine is that the pathogen is antigenically stable, acquiring mutations very slowly. Boosters are then rarely required, if at all, after completing the initial primary vaccination series.

Successful vaccines include those developed for Smallpox, Hepatitis A, Tetanus and Diptheria, Measles, Mumps, Rubella (MMR) and the Human Papilloma Virus. When it comes to reducing disease burden, successful vaccines can do most of the heavy lifting for control, eliminate and eradicate. Measles was briefly eliminated from the UK in 2016 for example. Smallpox has been completely eradicated worldwide.

Partially effective vaccines

However, not all vaccines are born equal. ‘Partially effective’ or ‘imperfect’ vaccines - do not score so highly on these three attributes. ‘Partially effective’ is usually defined as providing less that 50% protection against infection, and/or protective immunity is relatively short-term. Their fragile nature means that they need to be used with care, and with a clear view of potential long-term consequences. Partially effective vaccines include those previously developed for HIV, malaria and dengue, although encouragingly, and after decades of hard work, there have been some welcome advances in the effectiveness of the malaria and dengue vaccines.

The development of a successful, durable HIV vaccine has proved particularly challenging. Some hope was provided with the RV144 vaccine and more recently the combination vaccine approach, but efficacy and durability for both approaches has now been deemed insufficient and these vaccines are no longer recommended for use in the wider community.

With SARS-CoV-2, the initial results of the vaccine trials gave rise to optimism that we had the makings of a successful vaccine delivered in record time. They were highly successful in that they offered good protection against severe disease, saving many lives, but it quickly became apparent that in terms of durable protection against infection, the vaccines underperformed. The presentation of the vaccines as offering ‘complete protection’ was a fatal sleight of hand that has hamstrung the entire pandemic response ever since. Poor protection against infection was not an unexpected possibility. As early as June 2020, prior to vaccine deployment, Dr Anthony Fauci claimed durability of protection was likely to be an issue:

“When you look at the history of coronaviruses…….., the reports in the literature are that the durability of immunity that’s protective ranges from three to six months to almost always less than a year. That’s not a lot of durability and protection.”

With little attempt to control transmission, these comments prove prescient, and over time, durability of protection has steadily declined. This has allowed rapid viral evolution and more transmissible novel immune-evading variants. The current crop of SARS-CoV-2 vaccines now provide negligible or no protection against infection and only modest protection against severe disease.

This disease continues to inflict social, economic and physiological havoc across the world. Increasing numbers of people are suffering with the devastating impacts of Long Covid, currently estimated to affect at least 65 million people globally. In the words of world-renowned COVID-19 researcher Dr. Zizad Al-Aly,

“The best way to prevent Long COVID is to prevent COVID in the first place. There is no Long Covid without COVID.”

But herein lies the problem.

With the current collective behaviour making it increasingly difficult to avoid infection, and most governments ignoring transmission control measures, the question arises: Could more regular boosters of these partially effective vaccines lead to better control of SARS-CoV2?

The logistics of boosters

Let’s imagine that a well meaning UK government decides to offer three vaccines every year to as many people as possible, in the hope that this will significantly suppress SARS-CoV-2 transmission and push the virus into an evolutionary cul-de-sac. With a total UK population of 67.33 million, a high uptake of 80% of the population would need 54 million people to accept a vaccine every four months. That’s 162 million jabs annually. With ~ 252 working days in a year, this would mean providing 643,000 jabs on each of these days, on a constant, ongoing basis. That’s the equivalent of vaccinating 1% of the population every single working day. Logistically, this would be a colossal challenge.

The UK’s record vaccination rate, set early in the pandemic, was 830,000 jabs in a single day. The daily average was well below this. Achieving this record necessitated 3,000 dedicated vaccination centres, mobilising 750 army personnel and recruiting tens of thousands of volunteers. It was a truly exceptional national effort. It is inconceivable that the perpetual logistical challenge of 643,000 daily jabs could be maintained, in purely practical terms. Even if this were possible, vaccine fatigue would quickly set in, with falling compliance rates quickly disrupting this strategy,

Dr Arijit Chakravarty’s group, whose previous modelling has been eerily accurate in forecasting the ongoing SARS-CoV-2 transmission dynamics, now predict that without serious efforts to quench transmission, even vaccinating the entire population multiple times a year will not be sufficient to prevent the emergence of novel, immune-evading variants. This is deeply concerning. Policy makers in most countries are fixated on controlling the virus through vaccination alone. More disturbingly, some countries have promoted infection as a benefit – an irresponsible, illogical and perverted interpretation of a ‘control’ measure, and an approach completely unprecedented for any other global health threat.

Many public health authorities and policy makers understandably want to focus their vaccination efforts more strongly on high risks groups, but as the proverb goes, ‘you’re only as strong as your weakest link’. High viral transmission in the wider community quickly leads to new immune evading variants, thus eroding the vaccine protection afforded to these vulnerable groups more rapidly. This is the unfortunate scenario we have today.

Protect the vaccine and perceptions of ‘NPIs’

‘Protect the vaccine’ was a concept promoted by Dr Deepti Gurdasani early on in the pandemic..

“Had vaccines been presented as one tool of many, with an additional focus on protecting vaccine efficacy by suppressing transmission to reduce the rate of evolution of variants, we may have done better.”

Dr Deepti Gurdsani

Protecting the vaccine was given little attention by governments, public health authorities or the public. Instead, we proceeded on the basis that we had deployed ‘perfect’ vaccines, a colossal strategic error. Alternatively, perceiving the vaccine as a valuable but fragile tool, in need of additional support, would have – and may yet – help us extract better value from whatever level of population vaccination we can realistically achieve.

A broader ‘vaccine plus’ strategy would include ‘non pharmaceutical interventions’ (NPIs). Unfortunately, this expression is a rather hapless description, as it is defines NPIs negatively – as not being something – thus creating an impression of inferiority.

To aggravate matters further, for many, NPIs have become firmly associated with restrictive social interventions, imposing individual obligations – masking, distancing, staying at home – rather than ‘enabling’ interventions, such as, air filtration, ventilation, far-UV sterilization and real time air sampling biosensors.

To quote Professor Brendan Crab AC, the CEO and director of the Burnet institute

“we need to pay close attention to passive controls, especially strategies to promote clean indoor air, and learn how to better engage at-risk communities, rather than focusing solely on active controls including testing, vaccines and treatments, crucial as they are."

Perhaps there were two principle reasons why, when SARS-CoV-2 engulfed the world, governments, public health officials and policy makers turned to the pharmaceutical industry for a solution. Firstly, the success of numerous existing vaccines gave hope to many. Secondly, the pharmaceutical industry is a well defined industry, with considerable lobbying influence. Trade associations, such as the Association of the British Pharmaceutical Industry and Pharmaceutical Research and Manufacturing of America provide clear lines of communication through industry representatives, thus helping to push the policy agenda.

In contrast, the collective ‘clean air’ design and engineering technologies are a multi-disciplinary, disparate group of professions, associations and institutes, spanning architecture and design, engineering, building trades, ventilation specialisms and more. While they each have their own trade associations, there is no overarching identity or unifying name for this sector to match the eminence of the pharmaceutical industry. Perhaps the ‘Safe Air Sector’ (SAS) could be a contender? [Motto - “Who breathes, wins”?]

Some critics of a ‘safe air’ approach claim that no single technology is 100% effective. While true, let us remember that engineering innovation accelerates at an unrivalled rate. For example, renewable energy technologies represent one of the fastest developing engineering sectors, with efficiency and energy generating capacity dramatically improving over very short time-scales.

This is far from unique in the world of engineering. In May 1961 JFK announced his ambition to put a man on the moon by the end of the decade; the astonishing pace of engineering capability meant that Neil Armstrong fulfilled that ambition just eight years later. That’s how fast technology can move when there is political will.

Safe air technologies will also continue to develop very rapidly. In contrast, vaccine development can be unpredictable, onerous and prolonged, due to the vagaries of pathogens and the complexity and heterogeneity of the human immune system.

This is not to say that an infection blocking, durable SARS-CoV-2 vaccine will not be forthcoming, but just as HIV, malaria and dengue have proved particularly challenging for vaccine developers, a successful and durable SARS-CoV-2 vaccine may also be hard to achieve.

Looking ahead

We currently remain basking in the afterglow of the initial vaccine success, but the sun is setting on the vaccine only strategy. By failing to quench transmission, we are steadily degrading the only tool we are using. Eradication of SARS-CoV-2 may never be possible, but control and elimination are certainly within our capabilities. A paradigm shift is urgently required to place ‘safe air’ technologies alongside pharmaceutical interventions as fundamental control measures. To achieve this, we need to elevate and unite engineered solutions so that they become a clearly identifiable sector to match the eminence and political heft of the pharmaceutical industry. We need to persuade leaders and policy makers that it is in all of our interests to apply such technologies.

Just as the earth’s climate did not pause while humanity dithered over whether global warming was real or not, SARS-CoV-2 will not wait for the WHO, public health officials and governments to vacillate and procrastinate over the current and long-term threat this virus presents. We need to use all the tools in the toolbox and rediscover what control, eliminate, eradicate really mean.

_{1. This article has been written without the use of AI}

Imagine a world where half of all children perished before adulthood, and the despair and suffering this would cause. Until relatively recently this was our world. Irrespective of location, culture or historical era, every second child died. Even as recently as 1950, globally one in four children still died. The chances of reaching adulthood dramatically increased only as a result of public health progress over the last 100 years or so, and controlling infectious disease was the main driver for this progress.

In the UK, the first momentous step taken to reduce child mortality arrived with the Public Health Act of 1848. This reforming Act was a result of a ground breaking report produced by the health reformer Edwin Chadwick. His genius was to combine statistics with the prevailing descriptive narrative of the appalling social conditions that led to frequent outbreaks of disease. The 1848 Act provided for clean water, proper sewers, and weekly refuse collections, but most importantly, it set the precedent that the state was responsible for the management of public health. Chadwick, while a Utilitarian, was motivated by both ethical and economic considerations. Disease created huge costs in poor relief – welfare benefits in modern parlance - and an unhealthy populace was not economically productive.

Ever since Chadwick’s time, the synchrony of moral philosophy and scientific data has been instrumental in guiding public health policy, with the primary focus placed on re-engineering and controlling the environment for the benefit of all. Bolstered by the development of vaccines and other pharmaceutical tools, public health has not only dramatically reduced child mortality but also gave children a greater opportunity for longer and healthier lives. Today the chance of a child surviving and reaching adulthood is 96% globally. Paradoxically, this has now led to a widespread assumption that children are ‘robust’. Looking back, the stark historical record on child mortality suggests otherwise. If we expose unprotected children to disease, a longer, healthy life, filled with opportunities, is not guaranteed.

In 2020, Covid, a complex multi-system disease , which can damage a wide range of organs, invaded their world, challenging their health and disrupting their education. In our attempt to ‘live with Covid’, most adults have the autonomy to make choices. We can ignore, engage with, or reject the available scientific data. We can take precautions or choose to gamble with the repercussions of being infected. Children have no such agency, and therefore have no choice. Without a systematic, critical evaluation of our assumptions, can we be certain we aren’t jeopardising their futures?

Societies through the ages have often followed paths that they believed were justifiable at the time, only to find later, with reflective reasoning, such beliefs were unacceptable. Dangerous futures can also arise when societies choose to reject or ignore knowledge – the “Galileo Effect” inspired by the cardinal in Brecht’s play Galileo Galileo who refused to look through a telescope to avoid the evidence that the planets revolved around the sun. We should not assume we are today immune to the Galileo Effect – think global heating and what climate science was telling us in the 1980s.

From the start of the pandemic many assumptions about Covid and children became entrenched within society. It was claimed that “Children were more likely to be hit by a bus than catch Covid”. Some in the medical and science establishments were too hasty in declaring that children were less susceptible to Covid and subsequent post-Covid health impacts - ‘Long Covid’. Unexpected surges in other illnesses have been blamed on long-past lockdowns – so called “immunity debt”.

We now know that children are both victims and vectors, and that children play a substantial role in disease transmission. Most studies of Long Covid have focused on adults, resulting in an underestimation of the prevalence of pediatric Long Covid syndrome. Current estimates indicate at least 16% of children suffer from Long Covid with each infection, and an analysis of 40 million healthcare records in Germany showed that children are just as susceptible to this condition as adults. The evidence for biological mechanisms leading to Long Covid is now overwhelming, and it is accepted that SARS-CoV-2 can spread to multiple organs and persist for months in children regardless of the severity of the initial infection.

Chronic, persistent symptoms lasting for months, years or even decades following infections are not unique to Covid and have been documented for many other diseases, including Lyme, Dengue, Ebola, Polio and SARS-1. The fact that Covid shares this intrinsic characteristic is highly concerning, as with each sweep of the virus more children will potentially be left with long-term disabilities.

Counter to the initial assumptions, children can also suffer lasting neurological symptoms with the most common being memory and concentration deficits, sleep disturbances, anxiety and depression. Perhaps even more insidious are the biomarkers for persistent lung and heart damage post Covid. One study found that an average six out of ten previously healthy children displayed heart impairment after an asymptomatic or mild Covid infection. When a Senior Consultant Cardiologist at Newcastle’s Freeman Hospital such as Dr Rae Duncan, asks the question “what is Covid doing to our children?” we should sit up and pay attention. Whether or not these abnormalities resolve with time she says is not known, but with the prospect of children being repeatedly infected, she strongly advocates for a very cautious approach to Covid.

So called “immunity debt” is also becoming increasingly difficult to justify as more time elapses since the removal of all protections. Babies born well after the last Covid measures ended are suffering elevated rates of invasive Group A Strep (iGAS), and a strong body of evidence now implicates the role of a prior Covid infection in the recent surge in severe RSV cases in young children.

The belief that ‘immunity debt’ is behind these worrying health impacts is just that – a belief. There is no scientific evidence for the concept. If close social contact and exposure to abundant pathogens strengthened immunity, the children of 1848 would have been very healthy indeed, and there would be no place in history for Chadwick. Assuming that children are largely unscathed by the SARS-CoV-2 virus has not only slowed the pace at which scientific data has been gathered, but is arguably irresponsible and dangerous. The science is now ringing loud alarm bells. In the words of Dr Dick Zoutman, Professor of Infectious Disease at the University of Toronto “The fact that SARS-CoV-2 persists in our children should send shock waves through our society and compel us to do more to protect our children from Covid.”

Sir Edwin Chadwick (Licensed under CC BY 4.0.)

Deterioration in children’s health is having a major impact on their education. It is well established that health and education are inextricably linked. Poor health leads to increased absenteeism, high drop-out rates and squandered futures. In the words of Professor of Health Education, Cynthia Woford Symons, “No curriculum can compensate for deficiencies in student health status.”

The school absenteeism figures are shocking. Government figures show that the biggest single factor is sickness. Over half of persistent absence is also due to illness. Children are becoming sicker. This shocking situation is also reflected among teachers, with record levels of absenteeism due to illness. Along with healthcare, the educational sector now has the highest levels of occupational Long Covid. Teachers are also becoming sicker. Assumptions such as “behavioural changes”, “culture shifts” and “lack of social contact” due to long-past lockdowns are often flaunted as explanations for children’s lost days from school. But these explanations cannot be relevant for teachers. The common denominator that links this dramatic rise in absenteeism in both children and staff is the presence of a novel, highly transmissible pathogen.

Meanwhile, The Department of Education, OFSTED, the Children’s Commissioner, and most headteachers and school governors, remain near silent on the issue of protecting children from this disease. Perhaps for some this is due to a reluctance to engage with the scientific data- the Galileo Effect. For others, it may be a genuine belief in misguided assumptions. Others may simply believe it is too costly to invest in the infrastructure necessary to protect children, and that catching Covid is inevitable. For whatever reason, ignoring such risks to children is unacceptable. To paraphrase Dr James Wilson, Professor of Philosophy at UCL, a neglectful state is a far more worrying prospect than an interventionist government. This is no less true when it comes to children’s futures.

Poor air quality is known to cause reduced academic achievement. Studies are now showing that ventilation and filtration systems in schools can reduce the transmission of Covid by more than 80%. Installing air filters in all English schools would cost less than half the cost of the proposed Royal Yacht. The ‘do nothing’ option is far more expensive, with additional costs for children’s healthcare, academic support for those falling behind, and strained school budgets to cover staff absences. The US Federal government has allocated $123bn for clean air in schools because they see this as a cost saving measure. Without protective measures, it is not hard to imagine many of today’s children growing up facing shattered dreams, opportunities lost and work place discrimination.

Many of our assumptions and beliefs regarding Covid and children are incompatible with the current scientific data, and clinging onto these risks society following paths that place children’s futures in jeopardy. Uncertainties remain regarding the full extent of the long term damage from this virus, but ethics should propel us to act out of sympathy towards children and do our utmost to protect them from further suffering. Under these circumstances the precautionary principle – part of the ethical umbrella we use to protect citizens from future dangers – becomes essential.

Ever since those first momentous strides in public health, ‘living with pathogens’ has always meant suppressing and driving them towards elimination – in other words we ‘throw the kitchen sink’ at them. Never has it meant ignoring or even encouraging infection, as we are doing today with Covid. Looking back, Chadwick’s radical public health proposals met with fierce resistance, but were he alive today, he would be pressing hard for new public health measures – the Control of Airborne Pathogens Act, 2023, perhaps? And if he were successful, we would still be talking about this revolution in another 170 years.

1. This article has been written without the use of AI

Subscribe now