Posts Tagged ‘Covid’

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 But the sign might be outdated.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).

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


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

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

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


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

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

When the COVID-19 outbreak started to become increasingly prevalent in Northeast Ohio, Mitchell Thom, a first-year medical student at Case Western Reserve University, and his friends were looking for ways to help. The group started discussing how much physicians and health care employees on the front lines are juggling, so they came up with simple ways to take care of providers’ regular, everyday needs.

As Thom started reaching out to more teachers and students about the idea, someone mentioned Lyba Zia, a third-year student, was doing something similar. And, with that, Cleveland Students Supporting Health Workers was born.

These two students—who have never met in person—joined forces, creating a process to match student volunteers with physicians, nurses and other health care staff needing help with errands and chores outside of work. In less than a week, they signed up more than 100 volunteers to shop for groceries; prepare meals; tutor children online; feed, walk and take care of pets; and run much-needed errands for Cleveland health care workers.

Volunteers are provided with safety guidelines developed by doctors at MetroHealth and are encouraged to drop off deliveries without direct contact, if possible, Thom said.

“We want CWRU students from all schools who want to help. The more, the better,” said Thom, noting that the majority of its volunteers now are from the medical, nursing and dental schools. Thom also noted that his group can help students away from Northeast Ohio who want to help in their own communities.

What does this group need most? “We need health workers to take advantage of these volunteers,” said Zia. “Right now, we have only 24 physicians and staff signed up, and we’re ready to take on so many more. We have an army of students waiting to take a load off those who are working overtime to treat patients and save lives.”

Health workers and volunteer students can sign up by emailing their contact information to covidvolunteer.cwru@gmail.com. When emailing, please note how you would like to help or if you need assistance.

Students launch grassroots effort to assist health care workers during COVID-19


The roads may have fewer cars on them these days, but for many truckers, the journey feels a lot longer.

by CHRISTIAN COTRONEO

There’s no shortage of people facing extraordinary adversity to help us maintain some semblance of civilization in these pandemic times.

There are the usual suspects — doctors, nurses, firefighters — who make courage under fire seem so routine.

And then there are truckers.

Rain, shine or pandemic, the U.S. relies on about 3.5 million truck drivers to keep goods — the lifeblood of an economy — in circulation.

That includes canned foods and non-perishables like tuna and rice and beans, bound for small stores and shops in every nook of the country. And yes, there’s always a need for more toilet paper on Aisle 12.

There’s also Amazon — and the unending stream of smart speakers, cordless vacuums and pretzel crackers that Americans feel they need at a time like this.

That’s to say nothing of essential medical supplies and the equipment that’s sadly emblematic of our times: masks, ventilators, disinfectant. It’s not just about distributing those goods to stores and homes, but getting the raw materials, like plastic and pulp, to the manufacturers.

All of it is literally a trucker’s burden to bear. And that burden has never been heavier.

Taking truck drivers for granted

“I think people, quite frankly, take truck drivers for granted when things are normal,” Todd Jadin, of Wisconsin-based Schneider, which boasts 14,000 drivers under its umbrella, tells USA Today. “The work they do every day is that much more important right now.”

Sure, driving is a little easier these days — thanks to the millions of Americans who are staying home and trying to social distance the coronavirus to death.

But for truckers, already accustomed to driving as many as 11 hours per day, the road has gotten even longer. That’s because, for all the miles a trucker logs, there’s always been a bright beacon at the side of just about every highway: the iconic truck stop.

Maybe it’s a diner, where a driver can get a meal and even take a shower. Or a parking lot, where the engines finally go silent, and truckers catch some much-needed shut-eye.

The thing is, as Wired reports, those gleaming lights are going dark. Side-of-the-road eateries are closing to discourage public gatherings. State authorities are even shuttering places that specifically cater to truckers — spots at turnpikes that offer showers, parking and bathrooms.

One of American’s biggest travel center operators, TA-Petro, recently closed all of its driver lounges and fitness centers, Wired also notes.

The few facilities still open are crowded and, as you might imagine, an increasingly risky proposition in these viral times.

But that’s one area where you can help. Follow the lead of police officers in Eufaula, Alabama, who help truckers who can’t fit their rigs through the drive-thru — often the only option when restaurant dining rooms are closed.

“We will either go get something for you or give you a ride to the nearest drive-thru (if you don’t mind riding in the back seat!” the department posted on Facebook. “If manpower is such that we cannot assist, we will secure someone that can.”


Truck stops are closing down, giving drivers fewer opportunities to take a load off.

Truckers are parents, too

And truckers face other hurdles unique to these times.

“If a school system closes down, our employees may not have child care,” T.J. O’Connor of Kansas-based trucking-and-logistics company YRC Worldwide, tells USA Today. “Or we have a driver go out there to make a pickup and there’s a sign on the door that says one of the employees tested positive and they’re closed. What do you do?”

But these days, too much is riding on a trucker’s cargo for them to simply stay home.

“Times like this, people need to realize that everything you have is brought to you by truck drivers. Right now, we’re the ones out there taking chances on our health and our safety to make sure there’s food in the grocery stores,” Robert Stewart, a Pennsylvania-based trucker tells CBS News.

In other words, they deserve our admiration now more than ever.

As Deb Labree, an independent owner-operator based in Missouri, tells the industry journal Freight Waves, “When this pandemic is over, I hope truckers who were a huge part of keeping America moving and the shelves stocked realize they have achieved hero status in my book.”

https://www.mnn.com/green-tech/transportation/stories/truckers-coronavirus-heroes-pandemic-economy?utm_source=Weekly+Newsletter&utm_campaign=cc33a3c162-RSS_EMAIL_CAMPAIGN_WED0325_2020&utm_medium=email&utm_term=0_fcbff2e256-cc33a3c162-40844241