The COVID-19 pandemic has exposed major gaps in our understanding of the transmission of viruses through the air. These gaps slowed recognition of airborne transmission of the disease, contributed to muddled public health policies and impeded clear messaging on how best to slow transmission of COVID-19. In particular, current recommendations have been based on four tenets: (i) respiratory disease transmission routes can be viewed mostly in a binary manner of ‘droplets’ versus ‘aerosols’; (ii) this dichotomy depends on droplet size alone; (iii) the cut-off size between these routes of transmission is 5 µm; and (iv) there is a dichotomy in the distance at which transmission by each route is relevant. Yet, a relationship between these assertions is not supported by current scientific knowledge. Here, we revisit the historical foundation of these notions, and how they became entangled from the 1800s to today, with a complex interplay among various fields of science and medicine. This journey into the past highlights potential solutions for better collaboration and integration of scientific results into practice for building a more resilient society with more sound, far-sighted and effective public health policies.

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In early 1937, one-third of sixth graders in a school near Leningrad were not passing their Russian-language course. Their teacher, Tomsinskaia, told the school director that the failures were due to circumstances beyond her control: children had received inadequate preparation in previous grades, textbooks were in short supply, and pupils had “weak reading habits.” Other teachers in the Krasnosel'skii district offered similar justifications for pupils' poor performance. Sakhanova claimed that low levels of achievement were due to “bad home conditions.” Velichko asserted that her seventeen failing pupils all suffered from inherited conditions such as “mental retardation,” “underdevelopment,” or “congenital laziness.” Semenovskii, who had completed higher education and considerable teaching experience, admitted he had no explanation why one-half of his pupils were failing every year.

Background The Russian influenza, which began in late 1889, has long been recognized as a major global epidemic yet available statistical evidence for morbidity and mortality has not been fully examined using historical and epidemiological tools. This study of cases and deaths in Indiana during the extended time period associated with the Russian influenza is the first scholarly effort to determine the number of victims from this influenza outbreak across a broad regional case study in the US. Methods The sources for this study include historical records from the US Census, Annual Reports from the Indiana State Board of Health, and death notices published in newspapers. The available evidence is analyzed using historical and epidemiological methods to determine the consistency of reporting categories, the accuracy of death records, and the applicability of contemporary categories for measuring mortality. Results In the 3 years during and following the outbreak of “Russian influenza” in January 1890 in the state of Indiana, approximately 3200 died specifically of this disease while a total of 11 700 died of influenza and other respiratory diseases. These results confirm that extremely widespread influenza contributed to higher than normal death rates by causing additional deaths in related categories, especially pneumonia and other respiratory diseases. Conclusions More reliable and thorough analysis of morbidity and mortality during the Russian influenza based on systematic and critical review of local, regional, and national statistics can inform contemporary understanding of the long‐term history of influenza epidemics.

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