In Singapore, preschool students and their teachers will receive face shields when they return to school next month. Local health experts recommended teachers in Philadelphia wear shields when schools reopen, and a teachers union in Palo Alto, Calif. requested them as well.
If you think about it, “the face mask is the condom of our generation,” says Brian Castrucci, the president of the de Beaumont Foundation, a public-health nonprofit. Castrucci spent a decade working in state and local health departments, and he remembers when the HIV epidemic made condoms mainstream in the United States. No one was especially thrilled about it, but as the dangers of unprotected sex became clear, people came to accept them.
The same can now be said of face masks, which have gone from seeming like a silly overreaction to a ubiquitous pandemic necessity. Parents are pulling them onto their toddlers. Waiters are wearing them. Pool-goers might don them. There’s even a disturbing-looking contraption that lets you eat with one on.
Other health organizations recommend cloth face masks for some categories of healthcare as well. Cloth masks are recommended for healthcare workers who are not providing direct patient care. This includes teammates who bring supplies to our units, working in our kitchens and cafeterias, and our pharmacy technicians.
We therefore strongly believe that the face mask need is here to stay.
Sources: The Atlantic , New York Times
]]>
Dr. Lipsitch is a co-author of two recent analyses — one from the Center for Infectious Disease Research and Policy at the University of Minnesota, the other from the Chan School published in Science — that describes a variety of shapes the pandemic wave might take in the coming months.
The Minnesota study describes three possibilities:
Dr. Lipsitch is a co-author of two recent analyses — one from the Center for Infectious Disease Research and Policy at the University of Minnesota, the other from the Chan School published in Science — that describes a variety of shapes the pandemic wave might take in the coming months.
The Minnesota study describes three possibilities:
Scenario No. 1 depicts an initial wave of cases — the current one — followed by a consistently bumpy ride of “peaks and valleys” that will gradually diminish over a year or two.
Scenario No. 2 supposes that the current wave will be followed by a larger “fall peak,” or perhaps a winter peak, with subsequent smaller waves thereafter, similar to what transpired during the 1918-1919 flu pandemic.
Scenario No. 3 shows an intense spring peak followed by a “slow burn” with less-pronounced ups and downs.
The authors conclude that whichever reality materializes (assuming ongoing mitigation measures, as we await a vaccine), “we must be prepared for at least another 18 to 24 months of significant Covid-19 activity, with hot spots popping up periodically in diverse geographic areas.”
These scenarios may in fact even vary from state to state. Each state has had a different stay-at-home and reopening order strategy. It is likely that these various strategies will for a natural experiment with different outcomes.
Here are some pandemic progression curves for a few different states.
Some states are re-opening for business while the pandemic is still in a growing phase. Example: Texas, Alabama or South Dakota.
While other states like New York or Hawaii seem to still push away the re-opening even though the epidemic seems to have slowed down:
It is also likely that with the re-opening some people will be less careful at wearing face masks, gloves, washing their hands or respect social distancing.
In all cases, it appears in the graphic above that in all scenarios the epidemic will still be around in one shape or another for at least 1 to 2 years and we should plan accordingly.
Sources:
https://www.nytimes.com/2020/05/08/health/coronavirus-pandemic-curve-scenarios.html
https://www.nytimes.com/interactive/2020/us/states-reopen-map-coronavirus.html
Valves defeat that second purpose.
]]>
Example of another N95 face mask with valve.
In the age of COVID-19, we wear masks when out and about for two reasons: First, we hope they might protect us from other people, at least a little bit.
The second reason is more significant: they protect us from infecting others if it turns out we are infected and don’t know it.
Valves defeat that second purpose. A valved mask is letting your breath out unfiltered; the valve acts as a little escape hatch for any virus-laden droplets you’re breathing out. Some municipalities that require masks have specified that masks with valves do not count. You also won’t typically see valved masks in healthcare settings for the same reason. As the CDC explains:
respirators with exhalation valves should not be used in situations where a sterile field must be maintained (e.g., during an invasive procedure in an operating or procedure room) because the exhalation valve allows unfiltered exhaled air to escape into the sterile field.
If you have a stash of N95s that you previously used as dust masks, or if you’re considering buying a designer cloth mask that has a valve (somehow the fancy ones all seem to have valves), be aware that they only filter your inhaled air, not your exhaled air. And right now, that’s not good enough.
Example of N95 like mask style with valve
As the saying goes, “your mask protects me, my mask protects you,” so please use a valve-less mask to do your part in reducing transmission.
Here are examples of face mask with valves that do NOT protect anybody else except the wearer:
Example of textiles mask with valve
Please avoid this type of masks.
]]>
While some steps in the vaccine timeline can be fast-tracked or skipped entirely, approvals aren’t one of them. There are horror stories from the past where vaccines were not properly tested. In the 1950s, for example, a poorly produced batch of a polio vaccine was approved in a few hours. It contained a version of the virus that wasn’t quite dead, so patients who got it actually contracted polio. Several children died.
Source: https://www.nytimes.com/interactive/2020/04/30/opinion/coronavirus-covid-vaccine.html
]]>The grim truth behind this rosy forecast is that a vaccine probably won’t arrive any time soon. Clinical trials almost never succeed. We’ve never released a coronavirus vaccine for humans before. Our record for developing an entirely new vaccine is at least four years — more time than the public or the economy can tolerate social-distancing orders.
There are already at least 254 therapies and 95 vaccines related to Covid-19 being explored.
Companies with vaccine trials underway dozens of vaccines are starting clinical trials. Many use experimental RNA and DNA technology, which provides the body with instructions to produce its own antibodies against the virus.
Despite the unprecedented push for a vaccine, researchers caution that less than 10 percent of drugs that enter clinical trials are ever approved by the Food and Drug Administration.
Less than 10 percent of drug trials are ultimately approved
Probability of success at each phase of research
Fortunately, we already have a head start on the first phase of vaccine development: research. The outbreaks of SARS and MERS, which are also caused by coronaviruses, spurred lots of research. SARS and SARS-CoV-2, the virus that causes Covid-19, are roughly 80 percent identical, and both use so-called spike proteins to grab onto a specific receptor found on cells in human lungs. This helps explain how scientists developed a test for Covid-19 so quickly.
The potential Covid-19 vaccines now in the pipeline might be more likely to fail because of the swift march through the research phase, said Robert van Exan, a cell biologist who has worked in the vaccine industry for decades. He predicts we won’t see a vaccine approved until at least 2021 or 2022, and even then, “this is very optimistic and of relatively low probability.”
And yet, he said, this kind of fast-tracking is “worth the try — maybe we will get lucky.”
While some steps in the vaccine timeline can be fast-tracked or skipped entirely, approvals aren’t one of them. There are horror stories from the past where vaccines were not properly tested. In the 1950s, for example, a poorly produced batch of a polio vaccine was approved in a few hours. It contained a version of the virus that wasn’t quite dead, so patients who got it actually contracted polio. Several children died.
Covid-19 lives in the shadow of the most vexing virus we’ve ever faced: H.I.V. After nearly 40 years of work, here is what we have to show for our vaccine efforts: a few Phase 3 clinical trials, one of which actually made the disease worse, and another with a success rate of just 30 percent.
Researchers say they don’t expect a successful H.I.V. vaccine until 2030 or later, putting the timeline at around 50 years.
That’s unlikely to be the case for Covid-19, because, as opposed to H.I.V., it doesn’t appear to mutate significantly and exists within a family of familiar respiratory viruses. Even still, any delay will be difficult to bear.
“If we do it the conventional way, there’s no way we’re going to be reaching that timeline of 18 months,” said Akiko Iwasaki, a professor of immunobiology at Yale University School of Medicine and an investigator at the Howard Hughes Medical Institute.
That’s been the case for a few H.I.V. drugs and vaccines for dengue fever, because of a process called vaccine-induced enhancement, in which the body reacts unexpectedly and makes the disease more dangerous.
So researchers might produce a viable vaccine in just 12 to 18 months, but that doesn’t mean you’re going to get it. Millions of people could be in line before you. And that’s only if the United States finds a vaccine first. If another country, like China, beats us to it, we could wait even longer while it doses its citizens first.
Therapeutic drugs, rather than vaccines, might likewise change the fight against Covid-19.
Source: https://www.nytimes.com/interactive/2020/04/30/opinion/coronavirus-covid-vaccine.html
]]>However, the researchers and other experts say there’s a big caveat: If your mask leaks around the edges, unlike the tightly fitted N95, your homemade filter will lose its effectiveness.
Tighter-woven cotton alone was found to be effective, particularly two layers of 600 thread-per-inch cotton. So was a cotton quilt made of two 120 thread-per-inch cotton sheets, with a 0.5-centimeter batting of cotton, polyester and other fibers. Four layers of silk — imagine someone bundled up in a scarf — also performed well.
But the best overall filtration was provided by a sandwich consisting of one layer of the tighter-woven cotton plus two layers of silk, or two layers of chiffon, or one layer of flannel — because of the electrostatic filter created by the non-cotton layers.
“We speculate that the enhanced performance of the hybrids is likely due to the combined effect of mechanical and electrostatic-based filtration,” the study said. “Combining layers to form hybrid masks ... may be an effective approach."
In our case we always use 2 layers of tight-oven cotton, from brand new material. ( Do you want to put on your face somebody's used sheets?). And in the middle we use 1 or 3 layers of non-woven polypropylene.
We have built an extensive source of scientific data on our website which points out the benefits and advantages of using non-woven filtration as we believe it is better than woven materials for filtration.
The problem is around the edges.
“The bad thing about using masks that have really high filtration is that, if there are any gaps in the mask, the air is just going to go through those gaps than through the filter,” Crittenden said in a telephone interview with the Globe. "It’s important to have a mask that has high breathability and high airflow, and that’s not typical of cloth masks.”
This is why we came up with a more anatomically fit face mask with elastics which fits closer to the face and has fewer gaps.
We continue to wait for the testing results from the lab we have contracted to rate the bacterial filtration efficiency and viral filtration efficiency for our 5-layer masks. We will publish more information as soon as we receive the test results.
]]>"If you are going to be in a situation, in public, where you come into contact with other people in a situation that is not socially distanced, you must have a mask or a cloth covering nose and mouth," Cuomo said from Albany.
Cuomo said he'd leave enforcement up to local jurisdictions, though no civil penalties or fines would be levied against those not wearing masks unless there is widespread noncompliance.
He added that people should wear masks in places like public transportation or crowded intersections, but it was not necessary for more remote areas where there were fewer people and effective social distancing could be maintained.
Illinois wants all shoppers to wear masks at the grocery store. Enforcing that rule is trickier.
Customers and employees will have to start wearing masks in Illinois stores starting May 1 under the modified stay-at-home order Gov. J.B. Pritzker announced Thursday.
Major chains like Walmart, Target, Whole Foods, CVS and Walgreens say they have already mandated all store employees wear masks or facial coverings. Enforcing the same rule for customers can be more challenging.
Approaches have varied in suburbs that have already adopted similar rules. Some grocery stores in suburbs that require masks be worn in public say they are turning away shoppers who arrive bare-faced. Others say confronting customers could put employees’ safety at risk.
Residents in El Paso County will now be required to wear face masks or cloth coverings when out in public, El Paso’s mayor and county judge said Thursday afternoon.
The requirement — an addendum to the city-county COVID-19 emergency directive — applies to people ages two and up.
“It’s especially mandated for employees of essential businesses, should’ve been to begin with,” Mayor Dee Margo said during an online city briefing.
The city said the rule would take effect at 11:59 p.m. Thursday.
“Wearing a face covering is not a substitute for maintaining 6-feet social distancing and hand-washing, as these remain important steps to slowing the spread of the virus,” a city statement read.
]]>It is critical to emphasize that maintaining 6-feet social distancing remains important to slowing the spread of the virus. CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.
The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.
This recommendation complements and does not replace the President’s Coronavirus Guidelines for America, 30 Days to Slow the Spreadexternal icon, which remains the cornerstone of our national effort to slow the spread of the coronavirus. CDC will make additional recommendations as the evidence regarding appropriate public health measures continues to develop.
]]>USPS has the following changes to their service:
For more information about any USPS service disruptions to businesses, refer to USPS® Coronavirus Updates for Business Customers.
For more information about USPS post office closures, refer to USPS Business mailers service disruptions.
For more information about which countries USPS is no longer shipping to, refer to USPS's international service disruptions.
For more information about USPS's updated operations, refer to their changes to retail stores and changes to delivering shipments.
For more information on USPS's latest announcements, refer to USPS's official statements.
]]>A view of the analytics tools:
These tools can be accessed here.
These tools, for example, predict the following map of active cases on April 17th 2020 (today):
The COVID-19 pandemic is raising critical questions regarding the dynamics of the disease, its risk factors, and the best approach to address it in healthcare systems. MIT Sloan School of Management Prof. Dimitris Bertsimas and nearly two dozen doctoral students are using machine learning and optimization to find answers. Their effort is summarized in the COVIDanalytics platform where their models are generating accurate real-time insight into the pandemic. The group is focusing on four main directions; predicting disease progression, optimizing resource allocation, uncovering clinically important insights, and assisting in the development of COVID-19 testing.
“The backbone for each of these analytics projects is data, which we’ve extracted from public registries, clinical Electronic Health Records, as well as over 120 research papers that we compiled in a new database. We’re testing our models against incoming data to determine if it makes good predictions, and we continue to add new data and use machine-learning to make the models more accurate,” says Bertsimas.
The first project addresses dilemmas at the front line, such as the need for more supplies and equipment. Protective gear must go to healthcare workers and ventilators to critically ill patients. The researchers developed an epidemiological model to track the progression of COVID-19 in a community, so hospitals can predict surges and determine how to allocate resources.
The team quickly realized that the dynamics of the pandemic differ from one state to another, creating opportunities to mitigate shortages by pooling some of the ventilator supply across states. Thus, they employed optimization to see how ventilators could be shared among the states and created an interactive application that can help both the federal and state governments.
“Different regions will hit their peak number of cases at different times, meaning their need for supplies will fluctuate over the course of weeks. This model could be helpful in shaping future public policy,” notes Bertsimas.
Recently, the researchers connected with long-time collaborators at Hartford HealthCare to deploy the model, helping the network of seven campuses to assess their needs. Coupling county level data with the patient records, they are rethinking the way resources are allocated across the different clinics to minimize potential shortages.
The third project focuses on building a mortality and disease progression calculator to predict whether someone has the virus, and whether they need hospitalization or even more intensive care. He points out that current advice for patients is “at best based on age, and perhaps some symptoms.” As data about individual patients is limited, their model uses machine learning based on symptoms, demographics, comorbidities, lab test results as well as a simulation model to generate patient data. Data from new studies is continually added to the model as it becomes available.
“We started with data published in Wuhan, Italy, and the U.S., including infection and death rate as well as data coming from patients in the ICU and the effects of social isolation. We enriched them with clinical records from a major hospital in Lombardy which was severely impacted by the spread of the virus. Through that process, we created a new model that is quite accurate. Its power comes from its ability to learn from the data”, says Bertsimas.
“By probing the severity of the disease in a patient, it can actually guide clinicians in congested areas in a much better way,” says Bertsimas.
Their fourth project involves creating a convenient test for COVID-19. Using data from about 100 samples from Morocco, the group is using machine-learning to augment a test previously designed at the Mohammed VI Polytechnic University to come up with more precise results. The model can accurately detect the virus in patients around 90% of the time, while false positives are low.
The team is currently working on expanding the epidemiological model to a global scale, creating more accurate and informed clinical risk calculators, and identifying potential ways that would allow us to go back to normality.
“We have released all our source code and made the public database available for other people too. We will continue do our own analysis, but if other people have better ideas, we welcome them,” says Bertsimas.
Note: This work represents a collaborative effort with Hartford HealthCare and ASST Cremona which have been providing us with data and support through the model creation process.
]]>Therefore Apple published a tool, at this address, that allows anybody to see how well the stay-at-home orders are being followed in various countries, cities, and regions.
Apple is, of course, reassuring its users that this data is anonymized and provided following the best privacy core values possible.
Here is an example of results for New York City
As expected people tend to drive more and avoid common transportation. Similar results can be seen in Miami, LA, San Francisco, Chicago etc.
Dallas, Houston, and other large Texas cities seem to be following the stay-at-home orders the least well among all the large US cities we queried.
And an example of 4 different countries: United States, Italy, Germany, and the UK.
In this chart you can see that in Germany for example people have reduced their travelling (by foot, car , common transportation , etc.) by about 46%.
As you can see people seem to be following the stay at home orders better in Italy ( -85%) than in the US (-45%).
What does this mean?
It means that either the local authorities are enforcing the stay at home order better. Or it means that the local population is following instruction to stay at home more.
In general , by browsing more cities it appears that people are following the stay at home order quite well in major cities.
It also appears that in countries like France the stay at home order is followed to 90%.
France has already announced that they intend to start raising the stay-at-home orders around May 11th or about 2 months after they were put in place.
A perfectly followed stay at home order at 100% would mean that very few people will have caught Cov19. That is good news. However when the stay-at-home order is lifted, if there are any contagious cases left, it is likely that the cycle of contagion will repeat again.
A badly followed stay-at-home order usually means a completely overwhelmed medical system.
Therefore, perhaps, a stay-at-home ordered that is somewhere in the middle is better in the longer term as it allows a large percentage of the population to get over the Cov19 while not completely overwhelming the healthcare system.
By comparing how the Corona Virus pandemic will evolve in France and Italy vs the US in 3 or 4 months we will have more data to better understand what was the ideal strategy.
]]>Pros of elastic face masks
In our experience, it is much faster to put on a facemask with elastics. No need to tie anything and make knots behind your head.
Cons of elastic face masks
However, experience shows that wearing a mask with elastic around the ears for a few hours hurts the ears.
People have even 3d printed pieces to relieve elastic face mask wearers from the elastic pressure on the ears. Ears are fragile and are not built or used to constant pressure for hours at a time. Here is an example:
In addition, elastics are usually a single size fits all. So for people with smaller heads, the face mask may not be tight enough and for people with larger heads, the facemask may be too tight or hurt the ears more than necessary.
Cons of tie face masks
The main con of face masks with ties is that it takes a minute to put on. You have to knot the ties behind your head. Therefore if one needs to put on and take off a mask quickly or many times it is a problem. In this case, we have been lowering the mask and putting it back up while keeping it tied the entire time.
In addition, if you tie them and untie them, again and again, the ties may get a little damaged over time.
Pros of tie face masks
However, we find that ties have three large advantages:
1. Every person can tighten the face mask to their liking.
2. The ties do not put pressure on your ears and you can wear a face mask with ties for a long time comfortably.
3. One can separately adjust the tension of the top tie vs the lower tie. So you can make the mask tighter around the nose or loser around the nose independently of what you do around the chin or mouth.
Two tricks for facemasks with ties
The first trick for face masks with ties is to make sure the top ties do rest on top of your ears. This way the mask will stay high without having to make the ties too tight.
The second trick is that you can rotate the face mask around your head if you need to look at the knots and maybe sometimes to get out of a tight knot situation.
]]>
In a lot of countries walking, biking and jogging are welcome activities in these times of self-isolation. However, it is important to note that you need to avoid each other's particle stream when doing these activities. This comes out of the result of a study by the KU Leuven (Belgium) and TU Eindhoven (Netherlands).
The typical social distancing rule which many countries apply between 3 to 6 feet seems effective when you are standing still inside or even outside with low wind.
When someone during a run breathes, sneezes or coughs, those particles stay behind in the air. The person running behind you in the so-called slip-stream goes through this cloud of droplets.
Out of the simulations, it appears that social distancing plays less of a role for 2 people in a low wind environment when running/walking next to each other. The droplets land behind the duo.
When you are positioned diagonally behind each other the risk is also smaller to catch the droplets of the lead runner.
The risk of contamination is the biggest when people are just behind each other, in each other’s slipstream.
Based on these results, the scientists advise that for walking the distance of people moving in the same direction in 1 line should be at least 12–15 meters, for running and slow biking it should be 30 feet and for hard biking at least 60 feet.
Sources:
(3): http://www.urbanphysics.net/Social%20Distancing%20v20_White_Paper.pdf
]]>
CDC on Homemade Cloth Face Coverings
CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.
CDC also advises ...
]]>The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.
CDC on Homemade Cloth Face Coverings
CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.
CDC also advises the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.
Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.
Why wear face masks?
CDC continues to study the spread and effects of the novel coronavirus across the United States. We now know from recent studies that a significant portion of individuals with coronavirus lack symptoms (“asymptomatic”) and that even those who eventually develop symptoms (“pre-symptomatic”) can transmit the virus to others before showing symptoms. This means that the virus can spread between people interacting in close proximity—for example, speaking, coughing, or sneezing—even if those people are not exhibiting symptoms. In light of this new evidence, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.
Sources:
Use of Cloth Face Coverings to Help Slow the Spread of COVID-19
]]>Most pandemics have multiple waves. The 1918 Spanish flu had 3 waves with the 2nd wave being the most deadly and the worst one.
There were 3 different waves of illness during the pandemic, starting in March 1918 and subsiding by summer of 1919. The pandemic peaked in the U.S. during the second wave, in the fall of 1918. This highly fatal second wave was responsible for most of the U.S. deaths attributed to the pandemic.
In 1918 many cities imposed restrictions, lifted them too soon, then reimposed them. Covid-19’s average incubation period is more than double influenza’s, so compliance may have to be sustained for months, and openings and closings may also have to be repeated. Again, if the public is going to comply over time, they will have to be led, inspired or compelled.
Second wave starting in Asia
Countries in Asia are facing new waves of coronavirus infections after lockdowns lift. The same could happen in the rest of the world.
The 11-week coronavirus lockdown in Wuhan, China, ended Wednesday, allowing residents to leave their homes for periods of time with clearance from a government-sanctioned app.
Shops are beginning to open again, and people are leaving the city en masse. Schools remain closed, and residents are still encouraged to stay home as much as possible, but some people are beginning to congregate in the streets for conversation or games.
First, a small number of residents who were under lockdown could still have the virus when restrictions lift but not know they're sick. Those people could then spread it, starting a new wave of infections.
The latter seems to have sparked a surge of new infections in Hong Kong.
Second, international travelers could bring the virus back into the country.
"What happened in Wuhan and now what's happened in north Italy is not the peak of an epidemic. That's about a month away from the peak," he said. "They are still facing now, most likely, a second wave in one to two months' time. So are they going to shut down again?"
New waves could lead to multiple shutdowns
Along with barring foreigners from entering, some jurisdictions in China have already reimposed business closings shortly after lifting them.
Chinese scientists and health experts had previously downplayed the threat of another domestic wave of coronavirus infections, however.
"For me, a second outbreak (of coronavirus), a domestic outbreak in China, wouldn't be a great concern," Cao Wei, the deputy director of the Department of Infectious Diseases at the Peking Union Medical College Hospital, told Reuters on March 18.
Souces:
The Single Most Important Lesson From the 1918 Influenza
]]>