Tag: Covid

Algorithm Spots COVID-19 Cases from Eye Images

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A small study shows artificial intelligence can pick out individuals with coronavirus infections, but ophthalmologists and AI experts say the approach is far from proven to be capable of distinguishing infections with SARS-CoV-2 from other ills.

by Anthony King

Scientists describe a potential screening method for COVID-19 based on eye images analyzed by artificial intelligence. Scanning a set of images from several hundred individuals with and without COVID-19, the tool accurately diagnosed coronavirus infections more than 90 percent of the time, the developers reported in a preprint posted to medRxiv September 10.

“Our model is quite fast,” Yanwei Fu, a computer scientist at Fudan University in Shanghai, China, who led the study, tells The Scientist. “In less than a second it can check results.”

Currently, screening for coronavirus infection involves CT imaging of the lungs or analyzing samples from the nose or throat, both of which take time and require professional effort. A system based on a few images of the eyes that could triage or even diagnose people would save on both costs and time, says Fu. But the investigation by Fu’s team is preliminary and both ophthalmologists and AI specialists say they’d want to see much more information on the technique—and its performance—before being convinced it could work.

Volunteers at Shanghai Public Health Clinical Centre in Fudan each had five photos of their eyes taken using common CCD or CMOS cameras. Of 303 patients, 104 had COVID-19, 131 had other pulmonary conditions, and 68 had eye diseases. A neural network tool extracted and quantified the features from different regions of the eye and an algorithm recognized the ocular characteristics of each disease. A neural network is a series of algorithms for solving AI problems, learning as it goes along in a way that mimics the human brain. The researchers then carried out a validation experiment on a small dataset from healthy people, COVID-19 patients, pulmonary patients, and ocular patients.

Of 24 people with confirmed coronavirus infections, the tool correctly diagnosed 23, Fu tells The Scientist. And the algorithm accurately identified 30 out of 30 uninfected individuals.

Coronavirus infections, not just those caused by SARS-CoV-2, have long had associations with the eye, causing inflammation of the transparent membrane that covers the inside of the eyelid and whites of the eyeball, a condition called conjunctivitis, or pink eye. The eyes also offer a route to infection for respiratory viruses, including coronaviruses.

Human coronavirus NL63, which causes common cold symptoms, was first identified in 2004 in a baby with bronchiolitis and conjunctivitis. Subsequent studies showed that a minority of children infected with this coronavirus suffer from this eye condition.

Although conjunctivitis remains a potential symptom of coronavirus infections, less than 5 percent of COVID-19 patients actually present with eye symptoms, notes Daniel Ting, ophthalmologist at the Singapore National Eye Centre, who has published on this topic and deep learning in ophthalmology. “If you look to develop an AI system to detect COVID-19 based on [limited numbers of] eye images, I think the performance is not going to be great,” especially given the low prevalence of eye symptoms. He doubts the performance of the algorithm also because “a lot of eye manifestations could be due to reasons other than COVID-19.”

Ting cautions that the sample size of 303 patients and 136 healthy individuals in the Shanghai study is too small to draw strong conclusions. “To develop a good deep learning system to automatically detect some unique features from any medical imaging requires more patients,” he says. “In order to increase the reliability of this study, the same size would need to be multiplied by at least ten times, so, thousands of patients.”

Fu has started down this road, increasing the number of participants and broadening the types of subjects. “We are now doing more double-blind tests in the hospitals, with patients, some with eye diseases,” he says. The group also plans to introduce an online screening platform that uses the algorithm to screen for COVID-19.

“As an ophthalmologist it would be very surprising if there is a distinct COVID viral conjunctivitis pattern as opposed to other similar forms of viral conjunctivitis,” ophthalmologist Alastair Denniston, the director of the Health Data Research Hub for Eye Health in Birmingham, UK, writes in an email to The Scientist. “This is unlike building an algorithm for conditions which are biologically more distinct like macular degeneration,” he writes.

He notes that if there were a unique pattern evident in COVID-19 cases, “then the comparison for training and testing should be against cases that look similar,” such as non–COVID-19 viral conjunctivitis or other causes of a red eye associated with colds caused by adenovirus or rhinovirus. He also faults the paper in not providing “the necessary description to really critique the science in terms of how they built and (tried to) validate the model.”

Denniston recently reviewed more than 20,000 AI studies on detecting disease from medical imaging, but found that less than 1 percent were sufficiently robust in their design and reporting that independent reviewers had high confidence in their claims. This led him to convene a group of experts to define the international standards for the design and reporting of clinical trials of AI systems. These standards were published this month in Nature Medicine, The BMJ, and Lancet Digital Health and are supported by leading medical journals.

The Shanghai study has some potentially controversial applications, even if the AI works. Their algorithm could be used in public places, Fu says, though this would raise data privacy concerns in many countries. “In China, for example, we have a lot of high-resolution cameras everywhere,” he notes. “In airports or at train stations, we could use these surveillance cameras to check people’s eyes.” The program would be most accurate if people looked directly at the camera, but Fu says “as long as our camera can clearly watch the eye region it would be good enough.”

Screening the public without expressed consent using this algorithm would be ruled out of bounds in some parts of the world. “In Europe, this would be highly problematic and most likely illegal, in violation of the EU Charter of Fundamental Rights and general data protection legislation,” says computer scientist Barry O’Sullivan of University College Cork in Ireland who is an expert in AI. The gathering of health data and biometric data in Europe requires consent.

O’Sullivan echoes the concern that the paper falls short on detail regarding its methodology. “It is an interesting hypothesis,” he says. But, as currently written, it isn’t ready for publication in a machine learning journal, he concludes.

https://www.the-scientist.com/news-opinion/algorithm-spots-covid-19-cases-from-eye-images-preprint-67950?utm_campaign=TS_COVID_2020&utm_medium=email&_hsmi=95982719&_hsenc=p2ANqtz-9Yy1B2Xmi9R6CwrN9ytEJhx3fVqUcuwGY-VPFb8WfDvmsP-YpW1o88w_FFE4c2gEC3FaXCS8EcsQJE9dcmxX3h1iub7A&utm_content=95982719&utm_source=hs_email

Your ‘Surge Capacity’ Is Depleted — It’s Why You Feel Awful

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By Tara Haelle

It was the end of the world as we knew it, and I felt fine. That’s almost exactly what I told my psychiatrist at my March 16 appointment, a few days after our children’s school district extended spring break because of the coronavirus. I said the same at my April 27 appointment, several weeks after our state’s stay-at-home order.

Yes, it was exhausting having a kindergartener and fourth grader doing impromptu distance learning while I was barely keeping up with work. And it was frustrating to be stuck home nonstop, scrambling to get in grocery delivery orders before slots filled up, and tracking down toilet paper. But I was still doing well because I thrive in high-stress emergency situations. It’s exhilarating for my ADHD brain. As just one example, when my husband and I were stranded in Peru during an 8.0-magnitude earthquake that killed thousands, we walked around with a first aid kit helping who we could and tracking down water and food. Then I went out with my camera to document the devastation as a photojournalist and interview Peruvians in my broken Spanish for my hometown paper.

Now we were in a pandemic, and I’m a science journalist who has written about infectious disease and medical research for nearly a decade. I was on fire, cranking out stories, explaining epidemiological concepts in my social networks, trying to help everyone around me make sense of the frightening circumstances of a pandemic and the anxiety surrounding the virus.

I knew it wouldn’t last. It never does. But even knowing I would eventually crash, I didn’t appreciate how hard the crash would be, or how long it would last, or how hard it would be to try to get back up over and over again, or what getting up even looked like.

In those early months, I, along with most of the rest of the country, was using “surge capacity” to operate, as Ann Masten, PhD, a psychologist and professor of child development at the University of Minnesota, calls it. Surge capacity is a collection of adaptive systems — mental and physical — that humans draw on for short-term survival in acutely stressful situations, such as natural disasters. But natural disasters occur over a short period, even if recovery is long. Pandemics are different — the disaster itself stretches out indefinitely.

“The pandemic has demonstrated both what we can do with surge capacity and the limits of surge capacity,” says Masten. When it’s depleted, it has to be renewed. But what happens when you struggle to renew it because the emergency phase has now become chronic?

By my May 26 psychiatrist appointment, I wasn’t doing so hot. I couldn’t get any work done. I’d grown sick of Zoom meetups. It was exhausting and impossible to think with the kids around all day. I felt trapped in a home that felt as much a prison as a haven. I tried to conjure the motivation to check email, outline a story, or review interview notes, but I couldn’t focus. I couldn’t make myself do anything — work, housework, exercise, play with the kids — for that whole week.

Or the next.

Or the next.

Or the next.

I know depression, but this wasn’t quite that. It was, as I’d soon describe in an emotional post in a social media group of professional colleagues, an “anxiety-tainted depression mixed with ennui that I can’t kick,” along with a complete inability to concentrate. I spoke with my therapist, tweaked medication dosages, went outside daily for fresh air and sunlight, tried to force myself to do some physical activity, and even gave myself permission to mope for a few weeks. We were in a pandemic, after all, and I had already accepted in March that life would not be “normal” for at least a year or two. But I still couldn’t work, couldn’t focus, hadn’t adjusted. Shouldn’t I be used to this by now?

“Why do you think you should be used to this by now? We’re all beginners at this,” Masten told me. “This is a once in a lifetime experience. It’s expecting a lot to think we’d be managing this really well.”

It wasn’t until my social media post elicited similar responses from dozens of high-achieving, competent, impressive women I professionally admire that I realized I wasn’t in the minority. My experience was a universal and deeply human one.

An unprecedented disaster

While the phrase “adjusting to the new normal” has been repeated endlessly since March, it’s easier said than done. How do you adjust to an ever-changing situation where the “new normal” is indefinite uncertainty?

“This is an unprecedented disaster for most of us that is profound in its impact on our daily lives,” says Masten. But it’s different from a hurricane or tornado where you can look outside and see the damage. The destruction is, for most people, invisible and ongoing. So many systems aren’t working as they normally do right now, which means radical shifts in work, school, and home life that almost none of us have experience with. Even those who have worked in disaster recovery or served in the military are facing a different kind of uncertainty right now.

“I think we maybe underestimate how severe the adversity is and that people may be experiencing a normal reaction to a pretty severe and ongoing, unfolding, cascading disaster,” Masten says. “It’s important to recognize that it’s normal in a situation of great uncertainty and chronic stress to get exhausted and to feel ups and downs, to feel like you’re depleted or experience periods of burnout.”

Research on disaster and trauma focuses primarily on what’s helpful for people during the recovery period, but we’re not close to recovery yet. People can use their surge capacity for acute periods, but when dire circumstances drag on, Masten says, “you have to adopt a different style of coping.”

Understanding ambiguous loss

It’s not surprising that, as a lifelong overachiever, I’ve felt particularly despondent and adrift as the months have dragged on, says Pauline Boss, PhD, a family therapist and professor emeritus of social sciences at the University of Minnesota who specializes in “ambiguous loss.”

“It’s harder for high achievers,” she says. “The more accustomed you are to solving problems, to getting things done, to having a routine, the harder it will be on you because none of that is possible right now. You get feelings of hopelessness and helplessness, and those aren’t good.”
That’s similar to how Michael Maddaus, MD, a professor of thoracic surgery at the University of Minnesota, felt when he became addicted to prescription narcotics after undergoing several surgeries. Now recovered and a motivational speaker who promotes the idea of a “resilience bank account,” Maddaus had always been a fast-moving high achiever — until he couldn’t be.

“I realized that my personal operating system, though it had led to tremendous success, had failed me on a more personal level,” he says. “I had to figure out a different way of contending with life.”

That mindset is an especially American one, Boss says.

“Our culture is very solution-oriented, which is a good way of thinking for many things,” she says. “It’s partly responsible for getting a man on the moon and a rover on Mars and all the things we’ve done in this country that are wonderful. But it’s a very destructive way of thinking when you’re faced with a problem that has no solution, at least for a while.”
That means reckoning with what’s called ambiguous loss: any loss that’s unclear and lacks a resolution. It can be physical, such as a missing person or the loss of a limb or organ, or psychological, such as a family member with dementia or a serious addiction.

“In this case, it is a loss of a way of life, of the ability to meet up with your friends and extended family,” Boss says. “It is perhaps a loss of trust in our government. It’s the loss of our freedom to move about in our daily life as we used to.” It’s also the loss of high-quality education, or the overall educational experience we’re used to, given school closures, modified openings and virtual schooling. It’s the loss of rituals, such weddings, graduations, and funerals, and even lesser “rituals,” such as going to gym. One of the toughest losses for me to adapt to is no longer doing my research and writing in coffee shops as I’ve done for most of my life, dating back to junior high.

“These were all things we were attached to and fond of, and they’re gone right now, so the loss is ambiguous. It’s not a death, but it’s a major, major loss,” says Boss. “What we used to have has been taken away from us.”

Just as painful are losses that may result from the intersection of the pandemic and the already tense political division in the country. For many people, issues related to Covid-19 have become the last straw in ending relationships, whether it’s a family member refusing to wear a mask, a friend promoting the latest conspiracy theory, or a co-worker insisting Covid-19 deaths are exaggerated.

Ambiguous loss elicits the same experiences of grief as a more tangible loss — denial, anger, bargaining, depression, and acceptance — but managing it often requires a bit of creativity.


A winding, uncharted path to coping in a pandemic

While there isn’t a handbook for functioning during a pandemic, Masten, Boss, and Maddaus offered some wisdom for meandering our way through this.

Accept that life is different right now
Maddaus’ approach involves radical acceptance. “It’s a shitty time, it’s hard,” he says. “You have to accept that in your bones and be okay with this as a tough day, with ‘that’s the way it is,’ and accept that as a baseline.”

But that acceptance doesn’t mean giving up, he says. It means not resisting or fighting reality so that you can apply your energy elsewhere. “It allows you to step into a more spacious mental space that allows you to do things that are constructive instead of being mired in a state of psychological self torment.”

Expect less from yourself

Most of us have heard for most of our lives to expect more from ourselves in some way or another. Now we must give ourselves permission to do the opposite. “We have to expect less of ourselves, and we have to replenish more,” Masten says. “I think we’re in a period of a lot of self discovery: Where do I get my energy? What kind of down time do I need? That’s all shifted right now, and it may take some reflection and self discovery to find out what rhythms of life do I need right now?”

She says people are having to live their lives without the support of so many systems that have partly or fully broken down, whether it’s schools, hospitals, churches, family support, or other systems that we relied on. We need to recognize that we’re grieving multiple losses while managing the ongoing impact of trauma and uncertainty. The malaise so many of us feel, a sort of disinterested boredom, is common in research on burnout, Masten says. But other emotions accompany it: disappointment, anger, grief, sadness, exhaustion, stress, fear, anxiety — and no one can function at full capacity with all that going on.

Recognize the different aspects of grief

The familiar “stages” of grief don’t actually occur in linear stages, Boss says, but denial, anger, bargaining, depression, and acceptance are all major concepts in facing loss. Plenty of people are in denial: denying the virus is real, or that the numbers of cases or deaths are as high as reported, or that masks really help reduce disease transmission.
Anger is evident everywhere: anger at those in denial, anger in the race demonstrations, anger at those not physically distancing or wearing masks, and even anger at those who wear masks or require them. The bargaining, Boss says, is mostly with scientists we hope will develop a vaccine quickly. The depression is obvious, but acceptance… “I haven’t accepted any of this,” Boss says. “I don’t know about you.”

Sometimes acceptance means “saying we’re going to have a good time in spite of this,” Boss says, such as when my family drove an hour outside the city to get far enough from light pollution to look for the comet NEOWISE. But it can also mean accepting that we cannot change the situation right now.

“We can kick and scream and be angry, or we can feel the other side of it, with no motivation, difficulty focusing, lethargy,” Boss says, “or we can take the middle way and just have a couple days where you feel like doing nothing and you embrace the losses and sadness you’re feeling right now, and then the next day, do something that has an element of achievement to it.”

Experiment with “both-and” thinking

This approach may not work for everyone, but Boss says there’s an alternative to binary thinking that many people find helpful in dealing with ambiguous loss. She calls it “both-and” thinking, and sometimes it means embracing a bit of the irrational.

For the families of soldiers missing in action in Vietnam that Boss studied early in her career, or the family members of victims of plane crashes where the bodies aren’t recovered, this type of thinking means thinking: “He is both living and maybe not. She is probably dead but maybe not.”

“If you stay in the rational when nothing else is rational, like right now, then you’ll just stress yourself more,” she says. “What I say with ambiguous loss is the situation is crazy, not the person. The situation is pathological, not the person.”

An analogous approach during the pandemic might be, “This is terrible and many people are dying, and this is also a time for our families to come closer together,” Boss says. On a more personal level, “I’m highly competent, and right now I’m flowing with the tide day-to-day.”

It’s a bit of a Schrödinger’s existence, but when you can’t change the situation, “the only thing you can change is your perception of it,” she says.

Of course, that doesn’t mean denying the existence of the pandemic or the coronavirus. As Maddaus says, “You have to face reality.” But how we frame that reality mentally can help us cope with it.

Look for activities, new and old, that continue to fulfill you

Lots of coping advice has focused on “self-care,” but one of the frustrating ironies of the pandemic is that so many of our self-care activities have also been taken away: pedicures, massages, coffee with friends, a visit to the amusement park, a kickboxing class, swimming in the local pool — these activities remain unsafe in much of the country. So we have to get creative with self-care when we’re least motivated to get creative.

“When we’re forced to rethink our options and broaden out what we think of as self-care, sometimes that constraint opens new ways of living and thinking,” Masten says. “We don’t have a lot of control over the global pandemic but we do over our daily lives. You can focus on plans for the future and what’s meaningful in life.”

For me, since I missed eating in restaurants and was tired of our same old dinners, I began subscribing to a meal-kit service. I hate cooking, but the meal kits were easy, and I was motivated by the chance to eat something that tasted more like what I’d order in a restaurant without having to invest energy in looking through recipes or ordering the right ingredients.

Okay, I’ve also been playing a lot of Animal Crossing, but Maddaus explains why it makes sense that creative activities like cooking, gardening, painting, house projects — or even building your own imaginary island out of pixels — can be fulfilling right now. He references the book The Molecule of More, which explores how dopamine influences our experiences and happiness, in describing the types of activities most likely to bring us joy.

“There are two ways the brain deals with the world: the future and things we need to go after, and the here and now, seeing things and touching things,” Maddaus says. “Rather than being at the mercy of what’s going on, we can use the elements of our natural reward system and construct things to do that are good no matter what.”
Those kinds of activities have a planning element and a here-and-now experience element. For Maddaus, for example, it was simply replacing all the showerheads and lightbulbs in the house.

“It’s a silly thing, but it made me feel good,” he says.

Focus on maintaining and strengthening important relationships

The biggest protective factors for facing adversity and building resilience are social support and remaining connected to people, Masten says. That includes helping others, even when we’re feeling depleted ourselves.

“Helping others is one of those win-win strategies of taking action because we’re all feeling a sense of helplessness and loss of control about what’s going on with this pandemic, but when you take action with other people, you can control what you’re doing,” she says. Helping others could include checking in on family friends or buying groceries for an elderly neighbor.

Begin slowly building your resilience bank account

Maddaus’ idea of a resilience bank account is gradually building into your life regular practices that promote resilience and provide a fallback when life gets tough. Though it would obviously be nice to have a fat account already, he says it’s never too late to start. The areas he specifically advocates focusing on are sleep, nutrition, exercise, meditation, self-compassion, gratitude, connection, and saying no.

“Start really small and work your way up,” he says. “If you do a little bit every day, it starts to add up and you get momentum, and even if you miss a day, then start again. We have to be gentle with ourselves and keep on, begin again.”

After spending an hour on the phone with each of these experts, I felt refreshed and inspired. I can do this! I was excited about writing this article and sharing what I’d learned.
And then it took me two weeks to start the article and another week to finish it — even though I wanted to write it. But now, I could cut myself a little more slack for taking so much longer than I might have a few months ago. I might have intellectually accepted back in March that the next two years (or more?) are going to be nothing like normal, and not even predictable in how they won’t be normal. But cognitively recognizing and accepting that fact and emotionally incorporating that reality into everyday life aren’t the same. Our new normal is always feeling a little off balance, like trying to stand in a dinghy on rough seas, and not knowing when the storm will pass. But humans can get better at anything with practice, so at least I now have some ideas for working on my sea legs.

https://elemental.medium.com/your-surge-capacity-is-depleted-it-s-why-you-feel-awful-de285d542f4c

‘Too many are selfish’: U.S. nears 5 million virus cases as Americans resist curbs on everyday life

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By PHIL MARCELO, CARLA K. JOHNSON and LISA MARIE PANE

Big house parties and weddings, summer camps, concerts, crowded bars and restaurants, shopping trips without masks — Americans’ resistance to curbs on everyday life is seen as a key reason the U.S. has racked up more confirmed coronavirus deaths and infections by far than any other country.

The nation has recorded more than 155,000 dead in a little more than six months and is fast approaching an almost off-the-charts 5 million COVID-19 infections.

Some Americans have resisted wearing masks and social distancing, calling such precautions an over-the-top response or an infringement on their liberty. Public health experts say such behavior has been compounded by confusing and inconsistent guidance from politicians and a patchwork quilt of approaches to containing the scourge by county, state and federal governments.

“The thing that’s maddening is country after country and state after state have shown us how we can contain the virus,” said Dr. Jonathan Quick, who is leading a pandemic initiative for the Rockefeller Foundation. “It’s not like we don’t know what works. We do.”

The number of confirmed infections in the U.S. has topped 4.7 million, with new cases running at over 60,000 a day. While that’s down from a peak of well over 70,000 in the second half of July, cases are on the rise in 26 states, many of them in the South and West, and deaths are climbing in 35 states.

On average, the number of COVID-19 deaths per day in the U.S. over the past two weeks has gone from about 780 to 1,056, according to an Associated Press analysis.

In Massachusetts, leading physicians, including the president of the Massachusetts Medical Society, have been calling on Republican Gov. Charlie Baker to consider scaling back the state’s phased reopening because of an uptick in cases.

Massachusetts health officials said they are investigating at least a half-dozen new clusters of cases connected to such events as a lifeguard party, a high school graduation party, a prom party, an unsanctioned football camp and a packed harbor cruise trip.

One recent house party on Cape Cod has led to more than a dozen new cases and prompted some restaurants to close or limit service at the height of tourist season because seasonal workers had attended the gathering.

Elsewhere around the state, a Springfield hospital is dealing with an outbreak of more than 40 cases linked to a staffer who recently returned from an out-of-state vacation and then spread the virus to colleagues while eating lunch in a break room.

Hot spots around the U.S. are cropping up in what once seemed like ideal places to ride out the outbreak: rural, less populated and with lots of outdoor space. In South Dakota, a spike erupted at a Christian youth summer camp in the Black Hills, with cases growing to 96 among 328 people who attended.

In Virginia, cases have surged so much in cites like Norfolk and Virginia Beach that Democratic Gov. Ralph Northam placed limits last week on the region’s alcohol sales and gatherings of more than 50 people. Northam, the nation’s only governor who is a doctor, cited rising infections among young people and said the problem is that “too many people are selfish.”

“We all know that alcohol changes your judgment,” he said. “You just don’t care as much about social distancing after you’ve had a couple of drinks. That’s when the virus gets spread.”

Dr. Demetria Lindsay, the Virginia Department of Health’s district director for Virginia Beach and Norfolk, said there has been a pronounced spike among people ages of 20 to 29. She said factors behind the surge include gatherings of people not wearing masks or keeping a safe distance.

“Father’s Day, Memorial Day, graduations, birthdays, backyard barbecues, you name it,” Lindsay said.

The wedding industry likewise is seeing no-mask receptions with crowded dance floors and no social distancing.

Wedding planner Lynne Goldberg has a December wedding scheduled for 200 guests at the home of the bride’s parents in upstate New York.

“They have emphatically shared that this pandemic is not going to get in the way of their wedding plans and that there will be no masks handed out and no signs promoting social distancing at their wedding,” she said. “The bride has said that when she shows her children her wedding video, she doesn’t want it to be a documentary of the 2020 pandemic.”

https://www.boston.com/news/coronavirus/2020/08/04/too-many-are-selfish-u-s-nears-5-million-virus-cases-as-americans-resist-curbs-on-everyday-life

Mounting evidence suggests coronavirus is airborne — but health advice has not caught up

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by Dyani Lewis

General view as customers return to the Regal Moon JD Wetherspoons pub in Rochdale, England.
As restrictions are lifted, many researchers worry that the risk of catching COVID-19 will go up in crowded indoor spaces.Credit: Anthony Devlin/Getty

In Lidia Morawska’s home city of Brisbane on Australia’s east coast, roadside signs broadcast a simple message: ‘Wash hands, save lives.’ She has no problem with that: “Hand washing is always a good measure,” says the aerosol scientist, who works at the Queensland University of Technology. But the sign might be outdated.

Converging lines of evidence indicate that SARS-CoV-2, the coronavirus responsible for the COVID-19 pandemic, can pass from person to person in tiny droplets called aerosols that waft through the air and accumulate over time. After months of debate about whether people can transmit the virus through exhaled air, there is growing concern among scientists about this transmission route.

This week, Morawska and aerosol scientist Donald Milton at the University of Maryland, College Park, supported by an international group of 237 other clinicians, infectious-disease physicians, epidemiologists, engineers and aerosol scientists, published a commentary (1) in the journal Clinical Infectious Diseases that urges the medical community and public-health authorities to acknowledge the potential for airborne transmission. They also call for preventive measures to reduce this type of risk.

The researchers are frustrated that key agencies, such as the World Health Organization (WHO), haven’t been heeding their advice in their public messages.

In response to the commentary, the WHO has softened its position, saying in a press conference on 7 July that it will issue new guidelines about transmission in settings with close contact and poor ventilation. “We have to be open to this evidence and understand its implications regarding the modes of transmission, and also regarding the precautions that need to be taken,” said Benedetta Allegranzi, technical leader of the WHO task force on infection control.

Morawska is “really pleased, relieved, and amazed”, by the WHO’s statement.

For months, the WHO has steadfastly pushed back against the idea that there is a significant threat of the coronavirus being transmitted by aerosols that can accumulate in poorly ventilated venues and be carried on air currents. The agency has maintained that the virus is spread mainly by contaminated surfaces and by droplets bigger than aerosols that are generated by coughing, sneezing and talking. These are thought to travel relatively short distances and drop quickly from the air.

This type of guidance has hampered efforts that could prevent airborne transmission, such as measures that improve ventilation of indoor spaces and limits on indoor gatherings, say the researchers in the commentary: “We are concerned that the lack of recognition of the risk of airborne transmission of COVID-19 and the lack of clear recommendations on the control measures against the airborne virus will have significant consequences: people may think that they are fully protected by adhering to the current recommendations, but in fact, additional airborne interventions are needed for further reduction of infection risk.”

This is particularly important now, as government-mandated lockdowns ease and businesses reopen. “To control [the pandemic], we need to control all the means of infection,” says Morawska, who first contacted the WHO with her concerns and published a summary of the evidence (2) in early April.

But this conclusion is not popular with some experts because it goes against decades of thinking about respiratory infections. Since the 1930s, public-health researchers and officials have generally discounted the importance of aerosols — droplets less than 5 micrometres in diameter — in respiratory diseases such as influenza. Instead, the dominant view is that respiratory viruses are transmitted by the larger droplets or through contact with droplets that fall on surfaces or are transferred by people’s hands. When SARS-CoV-2 emerged at the end of 2019, the assumption was that it spread in the same way as other respiratory viruses and that airborne transmission was not important.

The WHO is following the available evidence, and has moderated its earlier opposition to the idea that the virus might spread through aerosols, according to Allegranzi. She says that although the WHO acknowledges that airborne transmission is plausible, current evidence falls short of proving the case. She adds that recommendations for physical distancing, quarantine and wearing masks in the community are likely go some way towards controlling aerosol transmission if it is occurring.

Age-old debate

The debate over transmission routes has big implications for efforts to stop the virus from spreading. Smaller, lighter aerosols can linger and accumulate in the air and travel long distances on air currents. But studies going back to those of engineer William Wells in the 1930s have suggested that large droplets fall out of the air within about 2 metres.

When SARS-CoV-2 emerged, health officials recommended frequent hand washing and maintaining a physical distance to break droplet and contact transmission routes. And some researchers and clinicians say these approaches are enough. Contact-tracing data support those measures, says Kate Grabowski, an infectious-disease epidemiologist at Johns Hopkins University in Baltimore, Maryland. “The highest-risk contacts are those that are individuals you share a home with or that you’ve been in a confined space with for a substantial period of time, which would lead me to believe it’s probably driven mostly by droplet transmission,” she says, although she says that aerosol transmission might occur on rare occasions.

But other researchers say that case studies of large-scale clusters have shown the importance of airborne transmission. When the news media reported large numbers of people falling ill following indoor gatherings, that caused Kim Prather, an aerosol scientist at the University of California, San Diego, to begin questioning the adequacy of the social-distancing recommendations from the US Centers for Disease Control and Prevention (CDC), which call for people to stay 6 feet (1.8 metres) apart. The indoor spread suggested the virus was being transmitted in a different way from how health authorities had assumed. “For an atmospheric chemist, which I am, the only way you get there is you put it in the air and everybody breathes that air,” says Prather, who joined the commentary. “That is the smoking gun.”

Many researchers concerned about airborne transmission point to the example of a fateful choir rehearsal that took place an hour’s drive from Seattle, Washington, on 10 March. Sixty-one members of the Skagit Valley Chorale gathered for a practice that lasted two-and-a-half hours. Despite there being hand sanitizer at the door, and choir members refraining from hugs and handshakes, at least 33 choristers contracted SARS-CoV-2, and two eventually died. Investigators concluded that the virus could have spread in aerosols produced by singing, and a ‘super-emitter’ who produced more aerosol particles than is typical, although they couldn’t rule out transmission through objects or large droplets (3).

But Morawska has modelled the conditions in the rehearsal hall and says there is no need to invoke the idea of a superspreader (4). Inadequate ventilation, the long exposure time and the singing were sufficient to explain the number of people who became infected. And no amount of ventilation could have reduced the risk to an acceptable level for the two-and-a-half-hour rehearsal, she says.

In another case, researchers used a tracer gas to show that aerosols carried on currents from an air-conditioning unit in a restaurant in Guangzhou, China, were to blame for an outbreak affecting ten diners from three separate families. None of the staff or patrons seated near other air-conditioning units were infected (5).

Meanwhile, a tour-bus passenger in Hunan province in China infected 8 of the 49 people on the bus. One of those sat 4.5 metres away from the infected person and entered and exited the bus through a different door. “That excludes the possibility of contacting each other or [being] in very close contact,” says Yang Yang, an epidemiologist at the University of Florida in Gainsville who is co-authoring a report on the case. “I think there is enough evidence for us to be very concerned in indoor environments, especially in confined spaces,” he says.

Dangerous droplets

Case studies can provide circumstantial evidence that aerosols are carrying the virus, but researchers want to nail down how and when that happens. The problem is catching aerosols in the act.

Laboratory studies going back to the 1930s and 1940s concluded that droplets expelled through talking or coughing are larger than aerosols. These bigger droplets, more than 5 micrometres in diameter, drop out of the air quickly because they are too heavy to ride on light air currents.

But more-sensitive experiments are now painting a more complex picture that points to the importance of aerosols as a transmission route. A study published in May used laser-light scattering to detect droplets emitted by healthy volunteers when speaking. The authors calculated (6) that for SARS-CoV-2, one minute of loud speaking generates upwards of 1,000 small, virus-laden aerosols 4 micrometres in diameter that remain airborne for at least 8 minutes. They conclude that “there is a substantial probability that normal speaking causes airborne virus transmission in confined environments”.

Another study (7) published by Morawska and her colleagues as a preprint, which has not yet been peer reviewed, found that people infected with SARS-CoV-2 exhaled 1,000–100,000 copies per minute of viral RNA, a marker of the pathogen’s presence. Because the volunteers simply breathed out, the viral RNA was likely to be carried in aerosols rather than in the large droplets produced during coughing, sneezing or speaking.

Other laboratory studies suggest that aerosols of SARS-CoV-2 remain infectious for longer than do aerosols of some related respiratory viruses. When researchers created aerosols of the new coronavirus, they remained infectious for at least 16 hours, and had greater infectivity than aerosols of the coronaviruses SARS-CoV and MERS-CoV, which cause severe acute respiratory syndrome and Middle East respiratory syndrome, respectively (8).

Outside the lab, it is much more of a challenge to detect aerosols and show that they can transmit the virus. In one study, researchers in Wuhan, China, detected SARS-CoV-2 RNA in aerosol samples collected in a hospital (9). But the WHO and others have criticized studies such as this because they detect only viral RNA, not infectious virus. “All these researchers are struggling to find the viable virus” in clinical settings, says Allegranzi. “Whenever this is found, it will be really very relevant.”

One of the problems researchers face in studying virus viability in aerosols is the way that samples are collected. Typical devices that suck in air samples damage a virus’s delicate lipid envelope, says Julian Tang, a virologist at the University of Leicester, UK. “The lipid envelope will shear, and then we try and culture those viruses and get very, very low recovery,” he says.

A few studies, however, have successfully measured the viability of aerosol-borne virus particles. A team at the US Department of Homeland Security Science & Technology Directorate in Washington DC found that environmental conditions play a big part in how long virus particles in aerosols remain viable. SARS-CoV-2 in mock saliva aerosols lost 90% of its viability in 6 minutes of exposure to summer sunlight, compared with 125 minutes in darkness (10). This study suggests that indoor environments might be especially risky, because they lack ultraviolet light and because the virus can become more concentrated than it would in outdoor spaces.

Researchers say that one big unknown remains: how many virus particles are needed to trigger an infection? That’s one reason that Allegranzi would like to see randomized trials that demonstrate that interventions aimed at controlling aerosols actually work. One example, she says, would be a trial showing that tight-fitting respirator masks offer better protection than looser-fitting medical masks in a health-care setting.

Tang, who contributed to the commentary, says the bar of proof is too high regarding airborne transmission. “[The WHO] ask for proof to show it’s airborne, knowing that it’s very hard to get proof that it’s airborne,” he says. “In fact, the airborne-transmission evidence is so good now, it’s much better than contact or droplet evidence for which they’re saying wash [your] hands to everybody.”

Policy evolution

Ultimately, says Morawska, strong action from the top is crucial. “Once the WHO says it’s airborne, then all the national bodies will follow,” she says.

In the commentary in Clinical Infectious Diseases, she and the other researchers argue that studies on SARS-CoV-2 and other viruses strongly suggest that airborne transmission of SARS-CoV-2 is an important pathway (1). The commentary urges public-health organizations, including the WHO, and the medical community to take into account the possibility of the airborne route.

The WHO says it is paying attention to such concerns. It will “continue to examine everything that is emerging”, says Allegranzi. But last week, she questioned the qualifications of those driving the debate. “There is this movement, which made their voice very loud by publishing various position papers or opinion papers,” she says. “Why don’t we ask ourselves … why are these theories coming mainly from engineers, aerobiologists, and so on, whereas the majority of the clinical, infectious-diseases, epidemiology, public health, and infection-prevention and control people do not think exactly the same? Or they appreciate this evidence, but they don’t think that the role is so prominent?”

Is the coronavirus airborne? Experts can’t agree

Morawska disputes this characterization. And the list of people who joined the commentary reveals 40 physicians, virologists and infectious-disease epidemiologists, along with at least 20 aerosol scientists who work directly on transmission of infectious agents.

During the 7 July press conference, Maria Van Kerkhove, the WHO’s technical lead for COVID-19, said about the commentary; “Many of the signatories are engineers, which is a wonderful area of expertise, which adds to growing knowledge about the importance of ventilation.”

Governments have started to move on their own to combat airborne transmission. In May, the guidance from the German department of health changed to state explicitly that “Studies indicate that the novel coronavirus can also be transmitted through aerosols … These droplet nuclei can remain suspended in the air over longer periods of time and may potentially transmit viruses. Rooms containing several people should therefore be ventilated regularly.” The CDC doesn’t mention aerosols or airborne transmission, but it updated its website on 16 June to say that the closeness of contact and the duration of exposure is important.

A spokesperson for the UK’s Scientific Advisory Group for Emergencies says there is weak evidence for aerosol transmission in some situations, but the group nonetheless recommends “that measures to control transmission include those that target aerosol routes”. When the United Kingdom reviewed its social-distancing guidelines, it advised people to take extra precautions in situations where it isn’t possible to stay 2 metres apart. The advice includes recommendations to wear a face mask and to avoid face-to-face interactions, poor ventilation and loud talking or singing.

Allegranzi says that the WHO’s panel of 35 experts that vets emerging evidence has discussed airborne transmission on at least four occasions, and that the WHO is working with aerobiologists and engineers to discuss emerging evidence and develop better ventilation guidelines.

This is not the first time during the pandemic that clinicians and researchers have criticized the WHO for being slow to update guidelines. Many had called on the agency early on to acknowledge that face masks can help to protect the general public. But the WHO did not make an announcement on this until 5 June, when it changed its stance and recommended the wearing of cloth masks when social distancing wasn’t possible, such as on public transport and in shops. Many countries were already recommending or mandating their use. On 3 April, the CDC issued recommendations to use masks in areas where transmission rates are high. And evidence backs up those actions: a systematic review found ten studies of COVID-19 and related coronaviruses — predominantly in health-care settings — that together show that face masks do reduce the risk of infection (11).

Allegranzi acknowledges that regarding the WHO’s position on masks, “the previous [advice] maybe was less clear or more cautious”. She says that emerging evidence that a person with SARS-CoV-2 is able to pass it on before symptoms have started (pre-symptomatic) or without ever showing symptoms (asymptomatic), factored into the decision to change the guidance. Additional research — commissioned by the WHO — showing that cloth face masks are an effective barrier, was also an important factor.

Researchers who argue for the importance of aerosols say that governments and businesses should take specific steps to reduce this potential route of transmission. Morawska would like to see recommendations against air recirculation in buildings and against overcrowding; and she calls for standards that stipulate effective levels of ventilation, and possibly ones that require air systems to filter out particles or use ultraviolet light to kill airborne viruses (12).

Allegranzi maintains that current WHO recommendations are sound. “It’s a bundle of precautions, including hand hygiene, including masks, including the distancing, which are all important,” she says. “Some of these measures will have an impact also on aerosol transmission, if it’s a reality.

doi: 10.1038/d41586-020-02058-1

References
1. Morawska, L. & Milton, D. Clin. Infect. Dis. https://doi.org/10.1093/cid/ciaa939 (2020).

2. Morawska, L. & Coa, J. Environ. Int. 139, 105730 (2020).

3. Hamner, L. et al. Morb. Mortal. Wkly Rep. 69, 606–610 (2020).

4. Buonanno, G., Morawska, L. & Stabile, L. Preprint at medrXiv https://doi.org/10.1101/2020.06.01.20118984 (2020).

5. Li, Y. et al. Preprint at medrXiv https://doi.org/10.1101/2020.04.16.20067728v1 (2020).

6. Stadnytskyi, V., Bax, C. E., Bax, A. & Anfinrud, P. Proc. Natl Acad. Sci. USA 117, 11875–11877 (2020).

7. Ma, J. et al. Preprint at medrXiv https://doi.org/10.1101/2020.05.31.20115154 (2020).

8. Fears, A. C. et al. Emerg. Infect. Dis. https://doi.org/10.3201/eid2609.201806 (2020).

9. Liu, Y. et al. Nature 582, 557–560 (2020).

10. Shuit, M. et al. J. Infect. Dis. https://doi.org/10.1093/infdis/jiaa334 (2020).

11. Chu, D. K. et al. Lancet 395, 1973–1987 (2020).

12. Morawska, L. et al. Environ. Int. 142, 105832 (2020).

Medical study published in The Lancet shows that Americans who stayed home before they were told to saved lives

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By Lauren Mascarenhas and Sandee LaMotte

If you were one of the Americans who decided to self-isolate before you were required to by state or local mandate, good for you.

You saved lives.

That’s the finding of a study published Monday in the journal “The Lancet: Infectious Diseases,” which used mobile phone data to track how people behaved between January 1 and April 20, a time before widespread calls by state and local officials to stay at home.

The study found that individual decisions to stay put in homes, except for necessary outings for food and medical supplies, likely helped slow the spread of coronavirus before state or local stay-at-home orders were implemented by government officials.

Fast spread slowed by individual behavior

Within four months of Covid-19 first being reported in the US, the disease had spread to every state and to more than 90% of all counties.

The study found that social distancing measures and the slowdown of coronavirus were primarily driven by changes in individual behavior and local regulations, noting that state and federal regulations were implemented either too late or not at all.

In all 25 counties evaluated in the study, individuals moved around less six to 29 days before statewide stay-at-home orders were implemented.

In 21 counties, cell phone data found mobility slowed on an individual level even before local stay-at-home orders were in place, according to study author Lauren Gardner, an associate professor in the department of civil and systems engineering at the Johns Hopkins Whiting School of Engineering.

Is using cell phone data a good way to track behavior?

They are a “pretty good indicator of travel patterns because phones are often carried around by the person in question,” Flavio Toxvaerd, a lecturer in economics at the Interdisciplinary Research Centre at the University of Cambridge, said in an email.

“In any case, the results chime with those found using other data, such as transaction data from credit cards,” said Toxvaerd, who was not involved in the study.

From late January to mid-April, the study found people reduced their daily movements by varying amounts: In New York City, people reduced their normal activity by 35%; while people in Houston’s Harris County reduced their activity by 63% of what was typical.

The study found it took about nine to 12 days, on average, for the effects to begin showing in infection rates, which is somewhat consistent with the 5 to 14 day incubation period of the virus.

Gardner’s team said the strong connection between social distancing and decreased transmission rates means that a return to normal mobility around the country creates a significant risk of increased infections — one that will likely not be apparent for up to three weeks after people begin resuming their normal activity.

“Indeed, information here is key,” Toxvaerd said. “You cannot react to changes in infection risks if you don’t know what they are.

“There are those for which information may not change behavior,” he added. “For those people, we may have to provide incentives for desirable social distancing behavior, for example through fines and inducements to stay at home.”

Some limitations

The study did not differentiate among low-risk trips, like going to the park, and higher-risk trips, like going to the grocery store. Because the data did not include sociodemographic information, the researchers could not isolate information about older adults, those with medical disorders and underserved communities, for whom social distancing can be more difficult.

“If individual-level and local actions were not taken, and social distancing behavior was delayed until the state-level directives were implemented, COVID-19 would have been able to circulate unmitigated for additional weeks in most locations, inevitably resulting in more infections and deaths,” Gardner said in a statement.

“It is within the power of each US resident, even without government mandates, to help slow the spread of COVID-19,” she added.

https://www.cnn.com/2020/07/01/health/covid-19-staying-home-saved-lives-wellness/index.html

Spain’s oldest woman (113 years old) speaks about surviving COVID

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Branyas lives in Olot, a city in Catalonia.

By Jack Guy and Al Goodman

A 113-year-old woman, thought to be the oldest in Spain, has said she feels fine after surviving a brush with coronavirus.

Video footage of Maria Branyas, who was born on March 4 1907, shows the super-centenarian speaking to the director of the care home where she lives in Olot, Catalonia.

“In terms of my health I am fine, with the same minor annoyances that anyone can have,” said Branyas in the video. It was recorded Monday, a spokeswoman for the care home told CNN.

Branyas recovered after a mild case of Covid-19. Her battle started shortly after her family visited her on March 4 to celebrate her 113th birthday, the spokeswoman said.

The family has not been able to visit in person since then. Branyas has lived for 18 years in her own private room at the Santa Maria del Tura nursing home, which is run by the Institute of the Order of San Jose of Gerona, affiliated with the Roman Catholic Church, the spokeswoman said.

Branyas was born in San Francisco in the United States, where her father worked as a journalist, reports the AFP news agency.

Over the course of her long life she has survived two world wars as well as the 1918 flu pandemic, which killed more than 50 million people around the world.

Although Branyas recovered from coronavirus, two residents of the same home died of it. The situation at the care home has since improved, said the spokeswoman.

Spain’s state of emergency, in effect since March 14, has strict confinement measures that remain in place. But with the infection and death rates now declining, the government has lifted some lockdown measures in certain parts of the country, on what it says will be a gradual reopening of activity.

But the initial lifting of these restrictions did not apply to Olot, where Branyas lives.

https://www.cnn.com/2020/05/13/europe/spain-oldest-woman-coronavirus-survivor-scli-intl/index.html

Paul Matewele, who died from COVID-19, was known for discovering dangerous microbes on surfaces people touch every day.

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by Emma Yasinski

Paul Matewele, a microbiologist who identified pathogenic bacteria on surfaces that humans contact everyday, died as a result of COVID-19 on April 7 at the age of 62.

Matewele was a senior lecturer at London Metropolitan University for 30 years and is best known for his work characterizing potentially pathogenic microbes that people are likely to come in contact with in their homes and public places, according to Úna Fairbrother, an interim head of the School of Human Sciences at London Metropolitan University.

Matewele was born in Zimbabwe in 1958 and earned a master’s degree in biochemistry from St. Andrews University and a PhD in microbiology from Southampton University.

Partially inspired by the growing crisis of antibiotic resistance, Matewele conducted studies identifying sometimes-deadly microbes living on handbags, McDonald’s touch screens, reusable water bottles, makeup, vehicle air conditioners, drinks served in cinemas, London transport systems, and coins. His work on the London transportation system led to a deep cleaning of 50 stations in the London Underground in June 2017.

But among colleagues, he was best known for the time he spent lecturing and tutoring thousands of students. “Paul was a warm, kind, intelligent and conscientious man. He was dedicated to his students and a brilliant colleague to have,” Fairbrother tells The Scientist in an email. “He was a genuinely happy, open person and will be much missed from our team on a personal and professional level.”

Several of Matewele’s students and colleagues shared thoughts and memories in a tribute on the university’s webpage describing him as a “dedicated teacher,” “a kind soul,” and someone who “never stopped smiling.”

Sean Frost, a former colleague of Matawele who is currently a lecturer at the University of Hull, writes on the university page that Matewele “took on the biggest challenges and was never afraid to fight for what he believed in, McDonalds being particularly memorable. Even up until March he was broadcasting warnings about risk of infection from cash, Paul always took the side of the little guy, be it colleagues, students or society. He was a fine example of what an academic should aspire to become.”

Matawele is survived by his 18-year-old son, William.

https://www.the-scientist.com/news-opinion/microbiologist-who-studied-deadly-bacteria-in-public-places-dies-67452?utm_campaign=TS_DAILY%20NEWSLETTER_2020&utm_source=hs_email&utm_medium=email&utm_content=86856096&_hsenc=p2ANqtz-8BKRYRGs_fo90ZncO_fmihHmxcb7igfgKB79gkfdKckRdyLVHnViIWWELwSyNw7QIkAcI47O7ksk1iFQ0kJDaX39xITA&_hsmi=86856096

ICU Doctor on NYC’s front line Debunks 6 COVID myths

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It’s Easter Sunday, just after Passover, just after another exhausting13 hour shift. I can’t watch the news. I’m too busy and too frustrated by all the misinformation. Forgive me, but I need to debunk a few viral myths.

Myth #1: COVID-19 is a disease of the old and sick

This cannot be further from the truth. As a critical care physician, I’m caring for the sickest of the sick. I know the data. What little good data there is shows that 80% of ICU patients are under 65 (in a Wuhan study) or that 40% in ICU were under 60 (in an Italian study). The highest death age group was 60-69. The third highest was 50-59. The most common co-morbid conditions were high blood pressure, diabetes and obesity. These are not weird immune-related illnesses, they’re common, and this hits close to home. I’m 53, I have high blood pressure, diabetes and, like millions of Americans, I’m a little obese. Our stats? 60% of our intubated patients are under 65. Most of my ICU patients have never been sick enough to be hospitalized before this. Sure, many who die are old and have other illnesses, but the popular narrative almost says if you’re not in a nursing home you’re safe. Nothing can be further from the truth. It’s a myth.

Myth number #2: The main concern is a lack of PPE and ventilators

Partially false. Sure, some NYC and UK caregivers have had to use cooking aprons, garbage bags, and other scraps to protect themselves, but many hospitals have all the PPE they need. Luckily, my hospital has been able keep up with all our PPE needs. But many unanticipated shortages go unreported: COVID test swabs, dialysis machines and dialysis fluid needed to keep people alive (COVID causes kidney failure), sedative medications, and we need more oxygen, we’re using so much.

But most of all, we need more amazing people. Especially nurses and respiratory therapists, because many are now sick and some have died. Over 100 doctors have died in Italy. Doctors, therapists, pharmacists, students, and others now have a new career as nursing assistants. No-one is a specialist anymore, we are all COVID care providers. Thank you to the many volunteer doctors and nurses from all across the US that have come to NYC to help. Recovery for patients can take weeks to months, so we’ll need your help and sacrifice for a while yet.

Myth #3: Hydroxychoriquine is a “game changer” and it’s safe.

This potentially false idea was launched on the back of a very small trial from France. I’ve read the paper and it has major flaws. Three larger and more recent trials were negative but they don’t get press. These “game changer” drugs have dangerous side-effects. A recent trial in Brazil was stopped early for fear that high-dose chloroquine was killing people. Other drugs, however, show promise. Watch this space but no “game changers” yet.

Myth #4: Social distancing is our only option and it’s easy to do

This is also untrue. My home, NYC, is one of the most densely populated cities in the world. Many of my patients are poor and immigrated here. They live in small apartments with large families. Social distancing is impossible for many parts of NYC. And in the US more than 10% of the work force is unemployed. Sure, we’re finally flattening the curve, but as a Korean-American, I am proud to say that South Korea did it better and they didn’t shut down their economy. They tested, tested, tested, tracked, and isolated people and provided a mobile app, food, masks, and a thermometer to track their fever. This was done for visitors as well as citizens. The US hasn’t tested widely or efficiently enough. And we need to talk about the painful economic and human impacts of social distancing. Banning all hospital visitors means many terrified patients dying lonely deaths. The loss of human dignity is unimaginable.

Myth #5: We can blame China for the current US pandemic

This is false. Recent research shows that our outbreak in NYC came from Europe. And how helpful are country labels anyway? The 1918 Spanish Flu apparently didn’t originate in Spain, so should we rename it? When it comes to infectious diseases, borders mean nothing in our global economic village, but anti-Asian sentiment has spiked all over the world. Just read the online hate speech about the “KungFlu” and the “WuhanVirus”. As an Asian American, who is doing as much as I can, this is very distressing.
Andrew Yang wrote “We need to step up, help our neighbors, donate … and do everything in our power to accelerate the end of this crisis.” This is what my wife and I and so many others are doing. I work 12-15 hours days alongside residents, doctors, nurses, pharmacists and others. (BTW, many of these heroes are Asian-American.) We’re active in our local church, and my wife has a Facebook group that donates tens of thousands of dollars to food and supplies for front-line workers. Daily, she buys food from struggling restaurants, delivers it to the hospital, and I distribute it in between seeing my patients. This has been our life for months and will be our future for a while.

Does it really matter if the virus is from China, Europe or Mars? Our response would have been the same: to save as many lives as we can.

Myth number #6: This is all overblown, COVID is just like the Flu

I’m just shocked by this one. The infectivity of COVID 19 is three times that of the flu, and it is 40 times more deadly (Dr. Fauci says “10 times”). On Good Friday in NYC, 783 patients died; that’s one death every 2 minutes. In the US, it was one death every 42 seconds. Brace yourself. This is nothing like the flu. If you don’t believe me, just walk into any emergency room in New York, Detroit, Miami, LA or New Orleans.

On a final and personal note, I’m blown away by the response of my residents, my colleagues, the people around me, and all NYC hospital staff. Never have I been more proud to be a health care worker and a residency director. I’m impressed by the sacrifice and commitment of all my residents. I’m in awe of their hard work. These are the finest people on earth. I am humbled by their sacrifice and courage to go above and beyond the call of duty. Oddly, it took a pandemic to bring us this level of mass cooperation. But it’s also frightening. I have practiced critical care medicine for more than 25 years and never have I been so challenged, saddened and emotional. Almost every hour of every shift, someone needs intensive care. I’m very used to comforting patients and their families to prepare for death. I used to do this for someone weekly; , now it’s hourly. Death has become very common: every shift, every ward, and in every emergency room. It feels like a bomb went off somewhere and the whole of New York is slowly suffocating.
The 7pm cheering for health care workers moves me. Previously, at parties, I’d say “I work in an ICU and I ventilate people”. That was a big conversation killer. Now, I feel like a rock star or a military veteran. Who knows? Maybe one day I’ll get to priority board an airplane. But seriously; this experience will lead to future PTSD, pain, scars, and tears, for me and so many residents and health care workers. For now, however, we really need your prayers and support.

I hope this demystifies a few things. Thanks for reading. #columbiamedicine #columbiastrong

With Humans Indoors, Animals Go Wild

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Across the globe, wildlife is exploring empty places usually occupied by people.

As humans are remaining indoors in response to the coronavirus pandemic, it appears that wildlife around the world took notice of our absence. There seems to be a never-ending list of animals becoming emboldened during this time to explore areas that are typically heavily populated: Buffalo have taken to the deserted highways in India. Mountain lions have rested in trees in Boulder, Colorado. Wild boar walk the streets of Barcelona while peacocks strut along open streets in Brazil.

Rats in New York City have somehow become even more confident in their quest for food. And a groundhog appeared to stare down two dogs watching through a window while eating a piece of pizza, which probably doesn’t have anything to do with the lockdown, but was a welcome distraction on social media nonetheless.

The Washington Post reports that a tribe of goats overtook the streets of Wales. Video taken by resident Andrew Stuart shows the animals nonchalantly roaming the empty streets and helping themselves to a meal of hedges and flower gardens.

According to SFGate, an employee from Yosemite National Park claims that since the park closed to the public in late March, the sightings of large animals including bears, bobcats, and coyotes have gone up fourfold.

“It’s not like [bears] aren’t usually here,” Yosemite employee Dane Peterson tells SFGate, “it’s that they usually hang back at the edges, or move in the shadows.”

In Mexico, crocodiles that generally stay hidden in lagoons near the beaches in La Ventanilla, Oaxaca, have been coming out in the open since the beaches were closed to the public about two weeks ago, Mexico News Daily reports.

Endangered sea turtles have also taken advantage of empty beaches to nest in Brazil and Florida. It’s too early to tell how lockdown measures will affect sea turtle numbers when it is time for the eggs to hatch. Decreased traffic could create less artificial light to confuse the hatchlings about which direction to go, Shanon Gann, the program manager at Brevard Zoo Sea Turtle Healing Center in Florida, tells weather.com.

A mixed bag for animals that depend on humans

In urban areas where wildlife is, for better or worse, dependent on human activity, the lockdown brings new challenges. The New York Times describes scenes in Thailand, where macaques have come to rely on humans for food. Their populations have become so dense in these areas because of that food supply that people staying home has quickly created a scarcity of resources, leading to aggressive behavior.

The same goes for duck ponds, ecologist Becky Thomas of Royal Holloway in London writes for The Conversation. Although feeding bread to ducks is harmful to their health and the water around them, there will be an adjustment as they compete for healthier resources.

Thomas notes that decreased traffic will lead to less hedgehog roadkill as well as reduced noise pollution that negatively affects the ability of bats, birds, and other animals to communicate.

The lack of human presence hasn’t benefited all animals, as the Times reports, particularly animals in African nature preserves. With fewer tourists around, poachers are killing rhinos with an increased frequency in Botswana and South Africa.

“We’re in a situation of zero income, and our expenses are actually going up all the time just trying to fight off the poachers and protect the reserve,” Lynne MacTavish, operations manager at Mankwe Wildlife Reserve in South Africa, tells the Times. “To say it’s desperate is an understatement. We’re really in crisis here.”

Some of the earliest widely shared reports of wildlife emerging in populated areas turned out to be false, according to National Geographic’s debunking of some of the more common untruths. One such tale says baby elephants in China got drunk on corn wine and passed out in a tea field, which might be very relatable during these times, but never happened. The absence of boats in the canals of Venice brought claims of dolphins appearing for the first time in decades, but the images were from the island of Sardinia, nearly 500 miles away.

There may not be dolphins in Venice, but the waters have gotten astonishingly clear, as the lack of gondolas and other boats on the water haven’t been stirring up sediment, CNBC reports.

Right now, it isn’t clear what the long-term effects of this lockdown will be on nature, primarily because this is occurring when many species in the Northern Hemisphere are mating, giving birth, or coming out of hibernation. Air pollution in some areas has been cut in half since the lockdowns began, Forbes reports, due to the lack of emissions from vehicles and factories. Some cities notorious for smoggy skies, including Los Angeles and Beijing, are enjoying some of the cleanest air they’ve experienced in decades. While the tolls of air pollution on human health are widely known, animals are also at risk, according to the National Wildlife Refuge System.

As many are still sheltering-in-places as we approach the 50th annual Earth Day, this resurgence of wildlife is giving some cause for hope that this evidence will ultimately lead to better policies to protect the environment and create a new normal.

“I am hopeful,” anthropologist Jane Goodall tells the Post. “I am. I lived through World War II. By the time you get to 86, you realize that we can overcome these things. One day we will be better people, more responsible in our attitudes toward nature.”

https://www.the-scientist.com/news-opinion/with-humans-indoors-animals-go-wild-67434?utm_campaign=TS_DAILY%20NEWSLETTER_2020&utm_source=hs_email&utm_medium=email&utm_content=86538478&_hsenc=p2ANqtz-92e5YchE_c5eEZJOR2VWChyXs-TUYFALDBiX0cEwNWRvtMhsuRr4MWSGBf0DCvU1hKkYi4eEAJ3QErLAitWrBijvumwg&_hsmi=86538478

Smoking marijuana, even occasionally, can increase your risk for more severe complications from Covid-19, the disease caused by the novel coronavirus.

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If you’re smoking weed to ease your stress during the coronavirus pandemic, experts say it’s time to think twice.

Smoking marijuana, even occasionally, can increase your risk for more severe complications from Covid-19, the disease caused by the novel coronavirus.

“What happens to your airways when you smoke cannabis is that it causes some degree of inflammation, very similar to bronchitis, very similar to the type of inflammation that cigarette smoking can cause,” said pulmonologist Dr. Albert Rizzo, chief medical officer for the American Lung Association. “Now you have some airway inflammation and you get an infection on top of it. So, yes, your chance of getting more complications is there.”

Hey wait, you might say, I’ve only just started and I’m not smoking much — so what’s the harm?
The problem, said Dr. Mitchell Glass, a pulmonologist and spokesperson for the American Lung Association, is that the last thing you want during a pandemic is to make it more difficult for a doctor to diagnose your symptoms.

“Covid-19 is a pulmonary disease,” Glass said. “Do you really want to have a confounding variable if you need to see a doctor or a healthcare worker by saying, ‘Oh, and by the way, I’m not a regular user of cannabis, but I decided to use cannabis to calm myself down.’

“You don’t want to do anything that’s going to confound the ability of healthcare workers to make a rapid, accurate assessment of what’s going on with you,” he added.

Is that cough from smoking or coronavirus?

“Chronic” marijuana smoking, defined as daily use, damages the lungs over a period of time. The end result “looks a lot like chronic bronchitis, which is of course one of the terms we use for chronic obstructive lung disease, or COPD,” Glass said.

Smokers, people with COPD and other chronic lung diseases, as well as people with moderate to severe asthma are among those at high risk for severe illness from Covid-19, including the worst-case scenario of being placed on a ventilator in order to continue breathing.

Signs of lung damage from smoking even just a few cigarettes can show up in a matter of days.

While a hit or two of marijuana doesn’t compare, there are some unique properties to a joint of weed that are definitely problematic for the lungs even if you’re a new smoker, Glass said.

Think of what happens to a cigarette when lit and left in an ashtray — it will burn quickly all the way down to the filter, with nothing left but ash.

“It’s surrounded by paper. It’s completely dried out. It is made to burn at a very high temperature,” Glass said.

Now think of how a joint burns — there’s always some weed left, the “roach,” as it is called.

“Marijuana burns at a much, much lower temperature than a commercially made cigarette,” said Glass. “Because of that, the person is inhaling a certain amount of unburnt plant material.”

That irritates the lungs in the same manner as ragweed, birch and oak pollen does for those allergic to them, he said.

“So right off the bat there are those patients who would be increasingly susceptible to having a bronchospasm or cough because they have a more sensitive airway.”

And since a dry cough is a key sign of Covid-19, any cough caused by smoking a joint of weed could easily mimic that symptom, making diagnosis more difficult.

The need for a clear head

There’s another factor as well. As we all know, weed not only calms you down, but it messes with your ability to function — and that does you no favors if you find yourself having a medical emergency during a pandemic.

“You’re reducing anxiety, but that is still a change in your thinking, a change in the way you are handling facts, how you’re grasping situations,” Glass said.

“Now there’s a healthcare worker who is gowned, gloved, possibly in a hazmat suit trying to get through to you. These are people who are trying to decide if you should be going home, coming into the emergency room, or worst case scenario, that you need to be put on a ventilator,” he continued.

“They want the person who’s agreeing and giving informed consent to be completely in control of their thought processes.”

More Americans are using weed

In 2018, more than 43 million Americans aged 12 or older reported using marijuana in the past year, according to the 2018 National Survey on Drug Use and Health (PDF).

Around four million of those are people with “marijuana use disorder, meaning that this has escalated to the point where it’s a problem in their lives,” said Jessica Hulsey, founder of the Addiction Policy Forum, which advocates on behalf of patients and families struggling with substance use disorder and addiction.

“Experts at the National Institutes of Health released some guidance for our patients and our families. saying marijuana use disorder could be a risk factor for complications from Covid-19,” Hulsey said.

“Because it attacks the lungs, the coronavirus that causes Covid-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape,” the NIH said in its announcement.

“We need to make sure that these users are aware that marijuana is in essence an underlying health condition,” Hulsey added. “They should take extra precautions by minimizing use to the extent that is possible, and even start virtual treatment and a recovery journey while everyone’s stuck at home.”

The national drug survey also found more than a third of young adults aged 18 to 25 said they used marijuana during 2018, along with more than 13% of adults aged 26 or older.

But it’s not just the young. Earlier this year, a study found use by older adults is rising sharply. In 2006, only 0.4% of people over 65 reported using marijuana products in the past year. By 2018, over 4% of those same aged seniors say they are now using, the study found.

“Marijuana use among seniors is not bouncing up and down like with other drugs. It’s a straight line up,” said study co-author Joseph Palamar, an associate professor of population health at New York University’s Grossman School of Medicine, in an interview in February.

Are even more Americans turning to weed during this time of crisis?

Simply put, no one knows. Each state handles reporting differently, Glass says, and sales estimates often combine both THC, the main psychoactive compound in marijuana that produces the “high,” and CBD, the medicinal compound that is now sold over the counter.

“I made a few phone calls and the numbers ranged quite literally from a million to 30 million. So who knows how many people are getting their hands on cannabis to relieve their anxiety during this time,” Glass said.

What to do?

If you’re not a regular smoker of marijuana, don’t start, experts say.

“Don’t confound your caregivers with trying to sort out whether your dry cough and change in behavior is due to the fact that you’re a novice with marijuana or it’s associated with Covid-19,” Glass said.

“If you do need to see a caregiver, be sure you’re very honest with them about when you last used, and how often you use,” Glass said, “so they can get a good, clear story on what the impact of inhaling marijuana is on you.”

Remember the bottom line when it comes to smoking and Covid-19, Rizzo said.

“It’s common sense that anything you inhale that has been combusted and contains particles or chemicals can inflame your airways,” he said. “So you’re already making your body fight off foreign particles before it even has to fight off the infection.”

https://www.cnn.com/2020/04/10/health/smoking-weed-coronavirus-wellness/index.html