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cover of episode From Hippocrates to COVID-19: the scientific fight to prove diseases can be airborne

From Hippocrates to COVID-19: the scientific fight to prove diseases can be airborne

2025/4/7
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Shop now in stores and at Nordstrom.com. Hi, Benjamin here. Welcome to episode 11 of Nature Hits the Books. In this episode, I'm joined by science writer and New York Times columnist Carl Zimmer. Carl's latest book, Airborne, The Hidden History of the Life We Breathe, was published in February.

This book dives into the invisible maelstrom of microbial life swirling in the air around us, examining how it helped shape our world and the implications that breathing it can have on human health.

Carl and I focused on this latter topic, looking at efforts to show that diseases could spread large distances through the air, the staunch resistance to this idea, and what the rivalry between these two groups meant for public health.

Carl Zimmer, thank you so much for joining me. Thank you for having me. So your book then, Airborne, it starts pretty much with a personal experience of what it's like to be in an enclosed space. Specifically, it's about a trip you made to see a choral group back in 2023. My wife and I, we went to a concert in

To go to this concert, we actually flew across the country and went to Washington State to a town called Mount Vernon. We wanted to see a singing group there called the Skagit Valley Chorale. And it was a lovely local concert. You know, lots of their friends were in the audience and local people who just love the music. But this was very special because...

Unfortunately, the Skagit Valley Chorale had been one of the first group of people to experience the explosive, deadly contagiousness of COVID. In March 2020, they got together for a rehearsal and they were following CDC guidelines. They knew that COVID was sort of around somewhere, but they were given guidelines. It seemed fine for them to get together if no one felt sick.

By the end of that night, over 50 people in this group got sick. They all got sick from one person. Three of these singers had to be hospitalized and two of them died. And so, you know, coming back to see them was really a powerful thing because they had gone through a tremendous trauma, a long, difficult road to feel comfortable to get together and sing together again.

And I was sitting there thinking about the fact that they didn't realize back in 2020, none of us did, that COVID is airborne. And so sitting there in that huge auditorium, I thought,

Thought a lot about the air around us and what is it that we contribute to that air as we exhale? What do we inhale? What is the ventilation? What's the connection with the great atmosphere outside? I even brought a carbon dioxide meter with me just to sort of keep an eye on things. And I could see the carbon dioxide in the room getting higher and higher and higher. That's because more and more of that air had passed through people's lungs. And who knows, perhaps other stuff came out too.

So it really felt like a good place to start this exploration of life in the air. Right, because you reported extensively on the, has to be said, ongoing COVID pandemic. And I'm sure you could have written the whole book just about that. But COVID begins and ends this book, right? It kind of comes full circle. And maybe we should do that today. And this field then of working out what

comes out of our lungs, what we breathe out, is called aerobiology. It has a kind of a specific definition. It's not coughs and sneezes spread diseases. It's so much more than that, right? Traditionally, public health experts really saw

the main threat of respiratory diseases of being essentially someone just coughs in your face, or maybe they cough on their hand and then they touch their hand to a doorknob or something like that. So there was this idea that, yeah, you can cough up viruses or bacteria, but it's only a threat in short range. Aerobiology is about life in the air all around us, including the life that we release into the air. And even when we're breathing,

we are releasing tiny droplets and some of those droplets will carry with them bacteria, viruses, fungi, you know, whatever happens to be in our airway. There are lots of things living in our airway, beneficial things, harmless things, sometimes harmful things. And when you are a germ that's floating inside a tiny, tiny droplet, you might just float and float and float. You're not going to just fall to the floor. So in other words, to an aerobiologist,

Diseases, they're not like cannonballs. They're more like smoke. You wouldn't be surprised to smell smoke across a room if someone had a cigarette out on the other side, especially if the doors and windows are closed. You should think about diseases the same way. Listeners to The Nature Podcast know that my background was in microbiology. And so the fact that airborne diseases exist today

kind of wasn't remarkable to me. But what struck me reading your book is this really hasn't been the case for modern medical science for a very long time. Yeah, that's true. And that was part of the puzzle that I was trying to solve in working on this book, because during the COVID pandemic, you know, scientists were having lots of debates about lots of different things. And that's understandable. I mean, this was a new disease. They were trying to make sense of stuff.

And yet the fiercest debate, it seemed to me, was how does it spread? So you would have World Health Organization and other public health organizations saying, oh, like, you know, keep three feet. If you're three feet away, you'll be OK. Wash your hands, wash your groceries, so on.

because that's how this spreads. Whereas there was a small but very forceful group of scientists who had been studying airborne infection for years who said, you need to take seriously the possibility that this is airborne. And by airborne, they meant spreading like smoke. And I thought,

why are they fighting? Like, this seems like it should be easy. This is one of the easy ones. Why is there so much fighting? I mean, it wasn't for two years that the World Health Organization finally explicitly put into print, yes, okay, COVID is airborne. And that took me back into this history. I think the reason for that strange situation that you observe is just that history really kind of like established a consensus that then people assumed was...

all very well established when it really wasn't. And in fact, all these ideas I was just telling you about, about diseases spreading like smoke, the foundation for it was all worked out in the 1930s. So it's a really remarkable case of the way that science unfolds

Not how we assume it does. And that unfolding, I mean, you take it back to antiquity, really, and the start of this kind of miasma, this bad air as what people understood at the time to be a source of disease spreading. And then that going out the window with germ theory and Louis Pasteur, and then a modified version of miasma coming back and this kind of interplay between the two. Yeah.

Yeah, it's a fascinating way in which these ideas kind of bounce off each other, come into conflicts. Sometimes people try to merge them, and this is happening over centuries. So Hippocrates and his followers would say what we consider infectious diseases would be spread by these people.

corrupt movements of air, miasmas. This is actually borrowing from more of a religious idea in ancient Greece of like a curse that could be visited, say on a city, and you needed to purify yourself to get rid of it. So Hippocrates creates a kind of natural version of that. Somehow the air gets corrupted, and then if you inhale that, then you get sick. And it had a lot of explanatory power

because a village of people might all suddenly start to develop the same symptoms all at once and they might be young and old. And so, hey, it must be because the air came along and we all have to breathe and there was something wrong in the air.

So in one form or another, this lasts for a very, very long time, you know, past the scientific revolution, past the Enlightenment. I mean, even in the 1880s and 1890s, you have plenty of people, prominent people saying that the air is responsible for things like cholera, typhoid. I could go on and on and on. Even though in the 1600s, you know, people invented microscopes and started to see little squiggly things.

And by the dawn of the 18th century, you had these people who were called contagionists who would say, we think that these invisible creatures are responsible for plague and all sorts of other diseases. And they were roundly mocked and laughed off the stage because they

They didn't have any good clear-cut links saying, okay, here I'm showing you that this microbe causes this disease in people. What would later be known as Koch's postulates, rubber Koch, was associated with finally demonstrating this in the late 1800s.

But the problem is that the germ theory of disease, like it showed, okay, cholera, not in the air. It's caused by bacteria in water. Yellow fever, not miasmas. It's a virus in mosquitoes. You know, syphilis is bacteria spread in sex and on and on and on. And so one disease after another was getting essentially sort of pulled out of the air so that by the early 1900s,

You can just see it just written out explicitly, like leading public health figures saying, we don't have to worry about the air anymore. And that's really weird because people like Louis Pasteur, before he became famous for all his germ theory of disease stuff, he was an aerobiologist. He found germs floating in the air. He demonstrated that as part of his own quest to understand how life arises and

And he actually thought that diseases could spread through the air. He was wrong in the sense that he thought like cholera could spread through the air. That's wrong. But, you know, he had this idea like these germs are floating, like why can't they make us sick? But that got wiped out by the germ theory of disease. And yet there were still this kind of small resolute group, I suppose, I don't know quite how you describe them, who want to show that the air isn't a desert. What were some of the early experiments that started to...

to regain favor, I suppose. Plant biology and plant diseases seems to play quite a big role. Yes, that's right. Because in addition to understanding how we get sick, we want to understand how our livestock and crops get sick because, you know, when they get sick, we have nothing to eat.

And crop failure due to diseases was something that was tormenting farmers basically since the start of the agricultural revolution. And so in the Bible, when God is threatening his people, he is threatening with diseases of crops, like for example, stem rust, which can knock out a wheat field and then just destroy farms all over the place. It's a fungus and it spreads through the air. And

And so in the 19th century, a lot of the debate about the germ theory of disease was actually really about agriculture. So for example, the Great Hunger, the Irish famine caused by potato blight,

There was a huge debate. Some people thought, well, the air is bad and it's making these potatoes rot. And then when they rot, then they spontaneously generate what we would call a blight, this microorganism. But other people said, no, no, no, no, that microorganism, that is the cause of the blight.

You know, that's germ theory of disease, like taking place on your farm. And so, you know, plant pathologists were kind of ahead of the game, I would say, compared to the infectious disease people, because certainly by the early 1900s, like everybody understood that potatoes could get blight from spores going through the air and

Wheat could get stem rust from the air. You know, there was this stuff around. I write about these just amazing adventurous aerobiologists who would hop into planes or go up to the stratosphere in balloons to catch stuff. And it was dazzling. There were headlines in the 1930s about finding these plant diseases 13 miles in the sky. Like, how is this happening? How high can life go?

And those people, actually one of those people named Fred Meyer, in 1937, he actually coined the term aerobiology. And he actually convinced the U.S. government to open up a whole research center for aerobiology. It would have been like the National Weather Service here in the U.S. It would have been a real revolution. But unfortunately, he died in a plane crash and the whole thing fell apart.

But in terms of human diseases, there were very few people who were thinking along these lines. And really, the two key people were this husband and wife team, William and Mildred Wells. Yes, actually, in my notes about William Wells, I've got difficult to love. Tenacious, I would say both of them tenacious. Yeah. I mean, you tell me about them. What was interesting is that during the pandemic, as I was scratching my head and saying, well,

why is this whole airborne thing so difficult and contentious? And I would talk to scientists and more than once people would say, well, you need to go back in history to understand this. And in particular, you need to get to know about William Wells and his wife, Mildred. And I was like, I have no idea who you're talking about.

There have been no biographies written of the Welles's, none. They're just a few little scraps published in medical journals, honestly. William Welles wrote one book, which is kind of unreadable, and they published a series of papers, but

again, like who they were and how they developed this idea and how does a husband and wife team work in the 1930s? Like, I didn't know any of that. And I noticed that someone who was writing their dissertation on sort of aerobiology in general did a little research on the Wellses and mentioned that there were some papers available. And I was like, oh, I got to check this out. And

I don't know what to expect, but I didn't expect like 30 document boxes packed with letters and unpublished memos and reports and so on. And what was really surprising was that a lot of it was actually written by their colleagues themselves.

complaining about how hard it was to work with them. I just like on and on and on. And suddenly I was like, oh, wow, I am dealing with two really complicated, interesting, and I have to say now, ultimately tragic figures. There's a couple of reasons that we don't know about William and Mildred Welles.

One is that they were ahead of the time, and another reason is that they just could not get along with anybody. They just kept destroying alliances and friendships all the time. One close colleague said they are their own worst enemies, and that was really remarkable. I think what stood out to me, Carl, is the efforts that they went to. They fully believed...

that diseases, human diseases, could be spread through the air and set up some extraordinary experiments. And yet it seemed like it was a swing and a miss every time. They were so close and it wasn't until everything was put together. Things like trying to bathe whole towns in UV light because there was this thought that maybe UV could kill things in the air. And these experiments maybe weren't quite as well controlled as they should have been, but...

When you piece them all together, they kind of showed more of a whole. Is that fair, do you think? Yeah, I mean, they were incredibly ambitious. But at the same time, like, you know, you mentioned that townwide experiments. Mildred Wells herself in 1947 did go to this New York town and

basically install as many UV lamps as she could. And, you know, the results were mixed. I mean, people should have looked at that and said like, oh, there's something here and maybe we can build on this. But there was this feeling like, ah, we're skeptical already of airborne disease. So this isn't going to persuade us. That was part of the problem.

But, you know, they had done other experiments which were much more compelling and airtight, forgive the pun. But in 1940, a big measles epidemic sweeps through Philadelphia way before there's a vaccine. And they put UV lamps in a school. And it's quite clear that, you know, if you were in class under a UV lamp, your chances of getting measles as a six-year-old was 10 times less than if you were unprotected.

And that is actually considered still actually one of the best demonstrations that a measles is an airborne disease and B you can control it in the air. And this wasn't a secret. They published the results. It was covered in the news.

But, you know, it got forgotten because sort of the public health consensus never really wanted to absorb this. And the Welles' just couldn't make the case. Was it that they were pushing against this established dogma then and being who they were made it difficult for their voice to get heard? What's interesting is that William Wells in particular, like his voice was definitely heard. The problem is that people would describe being in committee meetings with him in the mid 1940s where he would say,

go on and on and on for hours just getting more and more agitated and yelling and they would try to sort of interject and say like but wait tell us about your evidence but hold on like how do you know that and he would just dismiss them and they would say like we just came away just not believing a word he said which is kind of crazy because he and his wife did the work they had the results and

And if people had followed up on them, I think a lot of lives would have been saved, honestly, and not just in the COVID pandemic, just overall. And certainly things like TB as well. I did a lot of work in TB hospitals. Yeah, a lot of work in TB hospitals. And if UV lights had been installed in every room in TB wards, like doctors and nurses who are attending these patients would have been protected, like

A few did, but it wasn't really until the 1990s and the 2000s that UV light started to become more common, even in tuberculosis wards.

even after we've long known that tuberculosis is completely airborne. I mean, there's one place, though, that their message was taken on board and was researched at length for many, many decades, and that is in the development of bioweapons. That's right. Yeah. And when I was starting to work on this book, I talked to a scientist named Donald Milton at the University of Maryland, and

And I just said, like, well, what is the historical evidence that was built up about airborne diseases and about aerobiology? And he said, well, you know, there's William Wells, there's other people and so on.

But honestly, a lot of this stuff is classified because it was done to build biological weapons. And I said, wait, what? And he's like, well, think about it. These were airborne weapons. Thanks to him, I thought to kind of look more closely at this. And it's quite shocking, actually, how much the aerobiology of the 1930s

gave rise to biological weapons. I mean, literally the people in World War II who were going to build these weapons in the United States, they looked at the work of William and Mildred Wells and said, okay, great. We're going to take their technology. We're going to take their methods and we are going to replicate them here on a military base. And we are secretly going to

figure out like what's the dose you need to expose animals to kill them. Wells had been doing this in order to figure out how to protect people from disease. And now the U.S. military was doing this to figure out what's the best spore of anthrax to put in a bomb, for example.

Or if you want to blast a hose of deadly microbes onto a city, what's the right mix? And so a lot of this work, even some aerobiologists themselves actually cooperated secretly with the government on this. The connections are way more explicit than I realized at first. And there is, it's hard to avoid a military metaphor, a double-edged sword here then. So we have these public health folk looking for that smoking gun, there's another one, and struggling to find it.

And yet it had been written down and it is in a file somewhere in a government warehouse. And there's this dichotomy of we're trying to use the bad side for these dreadful weapons that could have been used in the good side as well. And did you get a sense that really not having these results public in any way

stymied progress in public health. I do think that happened, actually. And actually, I read about one biological warfare expert named Theodore Roseberry, who, after the war, wanted to publish some of his results because he felt like this would actually be useful for people to understand the danger of airborne disease and just ordinary life.

And he had to go past government censors to get that information into print. It was a very difficult thing. And they would say, no, you can't say this, you can't say that, and so on. And a lot of that other material just remained classified. So not only were those results hidden from the scientific world, but the brains themselves, those aerobiology brains, people who are really good at studying aerobiology, they

They were on the other side of a wall doing classified research. And this lasted for decades. It wasn't just World War II. In the Cold War, the United States and the Soviet Union just built colossal stockpiles of biological weapons. And there were scientists who were doing that work. And I think that was one of the things that...

you know, really kept air biology not really living up to its true scientific potential. And what do you think changed that? What were some of the, I guess, key diseases, I suppose is a weird way of saying it, but what was it that changed researchers' minds in the public health sphere, do you think?

There were a few people who sort of carried the torch after William Wills died in 1963, but just a few. And they were mainly concerned about tuberculosis. But towards the end of the 20th century, there became this sort of emerging concern

about new diseases, about emerging diseases, diseases that could spill over from animals because, you know, HIV had really kind of made people aware like, oh, here's a virus in primates and it can devastate humanity.

And then SARS came. So this was the first coronavirus that caused a pandemic. And so in 2003, scientists are studying it and some of them are looking at it and looking the way it's spreading in hospital wards or through apartment buildings. And they're saying this doesn't make sense in that paradigm of

just short range, you know, just spitting on you or getting the virus on surfaces. Like this seems like it's spreading long distances through the air. And so researchers would say like, huh, like I wonder how much people have looked at this in the past. And then sooner or later they would find themselves reading something by William and Mildred Wells. And they would say, who are these people? Because they didn't know who they were.

I mean, these are expert scientists who are trying to understand this. They're like, this is the first time I've heard of them. And so they all, one by one, were rediscovering the Wellses, which is kind of crazy that these people were lost for many decades. And then you started to have this small group of people who were studying things like SARS and then influenza after the 2009 pandemic, things like that.

and worrying about not only might some existing diseases be airborne, but the next one, the disease X, that could be airborne. And in fact, if disease X is airborne, that's the worst. That's the worst possibility because then it's just spreading incredibly easily and it's really hard to control. We have to be ready for it. And they were just

They couldn't get any traction, even, you know, right up until COVID. You and I are talking almost on the fifth anniversary of the start of the pandemic. And I can think back to when that started and we didn't know what we didn't know. And really, you do obviously spend a good long amount of time looking at COVID and this phenomenon.

fight to get the evidence in front of the right people to say that this is airborne we need to get on top of this i would say that from january 2020 from the first detailed reports that were starting to come out of china people like donald milton people like lindsey marr at virginia tech uh uh people like like yugo lee and university of hong kong they were all saying like uh

This doesn't look great. And some of them thought this actually already makes me think that this is airborne. And they immediately started to try to get the word out, to get things published in newspapers or in scientific journals.

right away. And they were getting rejected over and over and over again. Nobody wanted to hear it. And then they said, the World Health Organization, you need to think about whether this is airborne. They would go on Twitter and say, COVID is not airborne. In hindsight, you know, we can tell that if those people had been taken seriously, then this probably would have been a different pandemic. And what do you think was one of the key things that happened? Obviously, you have your choir that you visited, for example. I mean, was that

that something that tipped the scales, do you think? Or was it an accumulation of results? Or did one thing make people sit up and take notice? I wouldn't say it was one thing. But certainly there were some key studies that once people really started to look at them and think seriously about them, they said,

You know, it's starting to look like maybe that makes more sense than the way we were thinking about it before. And the Skagit Valley Chorale and their outbreak was one of those key experiences because the news hit that all these people had gotten sick at once. And then some of these people

same scientists I was telling you about, they got in touch with the singers and they said, we've been concerned that COVID is airborne and people haven't been taking us seriously. We

we would like to work with you to study what happened. And so they all agreed to this. And the singers were like, you know, maybe something good can come of this horrible thing that we've been through. So they worked together and the scientists published a paper where they laid out that based on the principles that William and Mildred Wells had laid out,

The best explanation they concluded for how this thing happened was that one person came into that church that night for rehearsal and released these droplets and they traveled many meters away and other people inhaled it and they got COVID. And so, yeah, I would say that was one of the key things. People would talk about it later. It was very strange for this chorale to look around and say like, oh my gosh, we've become like famous in the scientific literature. Like what's going on? And,

I think it's fair to say that this argument that diseases aren't airborne or this dogma that it is close contact...

that has passed now, surely, as a result of the COVID-19 pandemic. And does this mean that more people are now really paying attention to this sort of thing, or more avenues of research are being opened up, looking at this kind of aerobiology, do you think? I do think so. I mean, Nature actually published sort of a consensus report on COVID and some of the main conclusions. And at the top of the list, they said COVID spreads through the air.

There are certainly still some scientists who think, oh, well, you know, maybe there are other routes that it can also use. But I would say that the scientific consensus is clearly that it's airborne. And not only that, but the World Health Organization has actually overhauled

all its language and its conceptual frameworks about how diseases spread. And now they are working on this concept of how pathogens can transmit through the air. And physicists are getting involved in creating exquisitely detailed models of what happens in your lungs and then what happens to the pathogens that you might release in the air, depending on ventilation and humidity and all those other factors. So it definitely has a given life to air biology in a big way.

But that doesn't really matter if it's not actually making all of our lives better. And I think on that score, certainly in the United States at least, the evidence is quite mixed. These airborne disease researchers have been saying, you know, we need to have mandated standards for indoor air quality in terms of infectious disease.

If you're going to build a building or retrofit the building, you need to guarantee that people are not going to be at high risk of inhaling some dangerous disease.

just because you have unventilated air indoors. But no government that I'm aware of in the world has yet really put mandates in place. Belgium, as I understand it, is furthest along. Here in the United States, the Biden administration offered some best practices. They put it on a website. I just checked, and the Trump administration has taken that website down. So that's where we are.

And this is not acceptable when you're looking at bird flu here in the United States that's rampaging around in cow herds and among cats. It's mutating. And who knows if it will hop over and become a human-to-human disease that itself will be perhaps primarily airborne. We could be more prepared for the next airborne pandemic, right?

We'd be ready with ventilation. We'd be ready for air purification systems in schools, for example, ultraviolet light, what the Wells has dreamed of. That could be a part of it too. We could be prepared, but I don't see that much preparation happening, unfortunately. I mean, it's an interesting history repeating itself back to almost a Victorian era of let's keep the windows open. Almost weirdly back to your miasma stuff. And I think...

trite policy phrase is lessons learned then. And I think what you're saying there is there are clear lessons to be learned, but is anybody actually going to pick them up? It's fascinating seeing those echoes and those resonances through history. So Florence Nightingale, for example, she saved a lot of lives. She changed the way that hospitals are built, but she was committed to

to this view that diseases were spread by essentially miasmas. She did not actually believe in this crazy idea of germs and contagionism and so on. So she did a lot of good, not necessarily for the right scientific reasons, but that's just part of history. That's how history works.

So now some of those same ideas about ventilation and so on, we know that they actually are really important, even when you understand that infectious diseases are spread by viruses and bacteria and so on. So a lot of her principles still carry through, and yet...

here we are, not really acting on all that hard-earned knowledge. And there are things that can be done, but there's a lot of room for change and improvement. And what about your readers? What are you hoping that they'll take from this book? I mean, I think for me personally, it was this astonishment that

that this wasn't cut and dried a very, very long time ago. But what do you think other people will make of it? You know, I hope that it helps people to appreciate how the history of science is richer and messier and a lot more interesting than the kind of simple cardboard versions we sometimes build for ourselves. And, you know, and that insights can emerge and then get lost and then be rediscovered and lost again.

We can't just assume that science just magically takes care of itself. But, you know, and I also hope that readers will also just look up at the sky and look at it differently and see the aerobiome, which goes all the way up to the clouds and beyond. Carl Zimmer, thank you so much for joining me today. Thank you so much. Carl Zimmer there. His latest book, Airborne, The Hidden History of the Life We Breathe, is out now.

And that's it for episode 11 of Nature Hits the Books. If you have any feedback on the show, why not ping us an email to podcast at naturehitsthebooks. Otherwise, look out for the next episode soon. The music used in this episode was called Cloud Jumping by SPD via Getty Images and Triple Scoop Music. I'm Benjamin Thompson. Thanks for listening.

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