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Sean Clouston

Sean Clouston. Photo by Rachel Kidman

By Daniel Dunaief

The same wind that powers sailboats, makes kites dart through the air, and causes flags to flutter can make being outdoors in a group safer, particularly during the pandemic.

While public health officials have suggested that being outdoors with others amid the pandemic is safer than remaining inside, the strength of the wind can affect the level of protection provided by wide open spaces.

That’s the conclusion Sean Clouston, Associate Professor in the Program in Public Health and the Department of Family, Population and Preventive Medicine at the Renaissance School of Medicine at Stony Brook University, reached after studying public health data from 96,000 cases of COVID in Suffolk County from March 16, 2020 to December 31, 2020.

By combining public health data with the daily reports from the National Oceanic and Atmospheric Administration, Clouston found that days in which the temperature was between 60 and 84 degrees Fahrenheit and in which the wind was about 5 miles per hour or less had higher COVID-19 transmission than those days in which the wind speed was faster.

This kind of study, which was recently published in the journal BMC Infectious Disease, might affect the guidance policy makers provide to reduce the risk of COVID transmission during outdoor gatherings.

“If you’re imaging yourself as a policy maker and you want to contain COVID, what do you do?” Clouston asked rhetorically. Vaccines and masks are established tools. Ensuring airflow is higher might also be important, he suggested.

Indeed, amid the early days of the pandemic in 2020, public officials closed parks in Suffolk County for a while and eventually reopened them.

An alternative could be to provide access to parks where wind speed is also protective, or to reduce the use of parks where social distancing is difficult and where wind speed is lower.

At the same time, residents might want to protect themselves by putting out fans in their backyard or some other airflow devices to keep the flow of air moving during a social gathering, reducing the chance of transmitting the virus. People might want to avoid using tents that reduce the flow of air around them.

Additionally, people could eat out at restaurants where the airflow is stronger. 

Diners can search for places where the air “moves around, so the outdoor experience is as protective as possible,” Clouston said. He recognized that the data had some variability between when people who went outside might have contracted COVID. The air flow could increase and then decrease and the average length of time from exposure to symptoms and testing could differ between people.

“Any time we deal with humans, this is the problem,” Clouston said. Researchers can’t control for everything. Instead, they have to assume people make decisions in a consistent, but variable, way.

The larger data set, with close to 100,000 cases, enabled Clouston and his colleagues to average out the effects of the time when people reported their positive COVID tests.

For numerous cases, people had a good idea where and how they contracted COVID. Even when they were at outdoor events, such as a barbecue, some people had indoor parties where they ate together.

In addition, merely being outdoors didn’t reduce the risk if people were standing in the equivalent of stale air, where wind couldn’t reach them and help carry viral particles away from others who attended these events.

Being outside if the air isn’t moving is similar to being indoors in a space with a very large ceiling and a wide space between walls, he explained. It is safer than a small room, but it is not inherently safe on its own.

As for air circulation indoors, Clouston said people have suggested that moving air in buildings could reduce the spread of the virus.

Testing the effects of having HEPA filters or air filtration systems run continuously in hospitals  compared to areas that don’t have such units could reveal the benefit of having these air flow systems. Some studies have been done on this, although more work is ongoing, he said. 

Clouston suggested that other environmental conditions could also impact the transmissibility of the virus. The heat index, for example, might explain why wind speed might be important.

The heat index “might diminish the effect or make it stronger,” Clouston said. “It can push people indoors.”

Clouston worked on this study with Stony Brook colleagues in the Department of Family, Population and Preventive Medicine Assistant Professor Olga Morozova and Professor Jaymie Meliker. The team has worked with the Suffolk County Department of Health since 2020 on different aspects of COVID modeling.

Clouston was surprised that the research revealed a threshold model wind speed. He was also surprised to see that the speed was so low. “You only need a little airflow,” he explained.

The Stony Brook scientist looked at where the positive cases were located by zip code. The summer distribution and the spatial distribution was somewhat unclear, he said.

The spread of COVID was distributed by population size and density. Population size and density are likely more important than alterations in microclimate in the summer.

The analysis is important for places when and where outdoor exposures are most common, he explained.

“This may be true in the summer on Long Island or in the winter in southern states like Louisiana when outdoor activities are more comfortable,” he wrote in an email.

Clouston has several ongoing projects. He has papers discussing the role of social inequalities and COVID, a paper looking at clinical risk factors for COVID at Stony Brook Hospital, and one describing the initial wave of COVID in World Trade Center responders.

He would like to look at the effect of outdoor protests during 2020 on the spread of COVID, which would require data on attendance at those events and at the ones in New York City.

Sean Clouston

By Daniel Dunaief

Every year, the country pauses on 9/11, remembering the victims of the terrorist attacks and reflecting on the safety and security of the country. At the same time, a Stony Brook University study continues not only to remember the first responders but also to understand the physical and mental consequences of the work police, firefighters and other first responders performed in the immediate aftermath of the attacks.

Benjamin Luft

Recently, Sean Clouston, an associate professor in the Department of Family, Population & Preventive Medicine at SBU Renaissance School of Medicine, and Ben Luft, the director of the SBU WTC Health and Wellness Program since 2003, published research in which they demonstrated a link between a protein commonly connected with Alzheimer’s disease to post-traumatic stress disorder, or PTSD, in first responders.

In a small preliminary study, the researchers found a difference in the level of the protein between first responders who are battling chronic PTSD and those who aren’t battling the condition. The Stony Brook scientists published their work in the journal Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring.

The researchers cautioned that the presence of the markers doesn’t necessarily indicate anything about present or future changes in cognitive function.“We don’t know the specificity of the markers,” Luft explained in an email.

Amyloid is generally considered the earliest marker of Alzheimer’s disease, which includes cognitive decline. Some people, however, have significant amounts of amyloid and don’t develop problems with their thinking. Neurodegenerative diseases without amyloid rarely have severe symptoms, which don’t appear to worsen with time.

“This paper doesn’t look at cognitive symptoms,” Clouston said. “We do have papers looking at cognitive impairment and other memory-based differences. It wasn’t a part of this paper.”

The newest research is part of an ongoing program in which the university follows 11,000 responders who came to the World Trade Center. The study for this paper involved a smaller subset of this population. This type of research can and does have application to other studies of people who have traumatic experiences, the scientists suggest.

Most traumatic experiences are unique to each person, as people who suffer physical and emotional trauma in combat often confront the aftereffects of head injuries. Among the first responder population who survived the attacks on 9/11, most of them “faired pretty well physically,” Clouston said. 

“We didn’t have a lot of head injuries. Understanding PTSD in this crowd is really useful for the literature as a whole because it allows us to focus on the long-term psychiatric fallout of an event without worrying about exposures that are different.”

The scientists had at least some idea of the timing and duration of exposures. This research suggests that it might be helpful to think about the kinds of problems that cognitive impairment can cause, which might involve managing other health-related problems.

Luft added that the population they are studying shows the benefit of immediate care. “One thing for sure is that the care of the first responders has to occur very quickly,” he said. “Now that we know the history, the greatest chance you have in mitigating the effect of this type of trauma is to deal with the problem from the get-go.” 

Sean Clouston with his daughter Quinn at Benner’s Farm in Setaukt. with his daughter Quinn. Photo by Rachel Kidman

First responders have benefited from psychotherapy as well as from various pharmacological treatments. Luft suggested that they might even benefit from having therapists available in the field, where they can receive near instantaneous psychological support.

In addition to the psychological trauma, first responders have had physical effects from their work in the aftermath of the attacks, such as respiratory and gastrointestinal problems, as well as autoimmunity issues.

People have these problems because “of the pro-inflammatory effect of PTSD itself,” said Luft. The researchers believe trauma can affect the immune system and the brain.

According to Clouston, the next step with this work is to replicate it with a larger scale. The experiment was “fairly expensive and untried in this population and novel in general, so we started small,” he explained in an email. The scientists would like to “get a larger range of responders and to examine issues surrounding symptomatology and other possible explanations.”

Clouston has been at Stony Brook for six years. Prior to his arrival on Long Island, he worked on a collaborative project that was shared between University College London and the University of Victoria. 

An expert in aging, he felt like his arrival came at just the right time for the WTC study, as many of the first responders were turning 50. After giving talks about the cognitive and physical effects of aging, he met Luft and the two decided to collaborate within six months of his arrival.

Clouston is focused on whether PTSD caused by the terrorist attacks themselves have caused early brain aging. A self-proclaimed genetics neophyte, he appreciates the opportunity to work with other researchers who have considerably more experience in searching for molecular signatures of trauma.

Clouston said his family has suffered through the trauma of cognitive decline during the aging process. His family’s struggles “definitely bring [the research] home,” reminding him of the “terror that many family members feel when they start noticing problems in their siblings, parents, spouses, etc.”

As for his work on the recent study, he said he is excited about the next steps. “Little is known about the subtypes of amyloid,” he suggested and there’s a “lot more to explore about the role [of this specific type] in the population. I do think it could be really informative about the types of symptoms.”