Figster Posted May 5, 2020 Posted May 5, 2020 17 minutes ago, Bob in Mich said: Aren’t you defeating the purpose of the mask if it is pushing your breath up and out past your glasses rather than going through the filtering of the mask? Good point, on the other hand though, If its not an N95 mask its more about small droplets of spittlle IMO. On the exhale which does become a problem with a cheaper poor fitting mask eye glasses can fog up. From a spittle standpoint , I don't see the small amount of air loss as a danger to yourself or others IMO. (correct me If I'm wrong on this Hapless) Myself personally, having to reach up and remove your glasses because you can't see creats even more of a health risk Been there, done that...
Hapless Bills Fan Posted May 5, 2020 Author Posted May 5, 2020 https://www.facebook.com/permalink.php?story_fbid=10102407690695372&id=3112789 Journal of New York Presbyterian Physician Jason Hill. If parts of this don't stay with you - the stepladder, the crochet needle, the Maker love - I don't know what to say. Thanks for all the bday wishes. Several people have asked me about what it's been like in the ER with Covid. I'd done some journaling the last couple weeks. As I turn forty this is how my head, heart, and soul have been occupied. Covid at 40. The eyes stay with you. In peace time most of those we intubate are chronically ill, or profoundly confused, or unconscious and unaware of the world around them. Covid has changed the equation. Most of my patients now remain awake and alert until the end. These days the ER is permeated with frank conversations about death and dying and what a chance to live entails. It is a hard thing to tell a healthy and functional person who felt fine and well six days ago they may be dead in a day or two and humbly ask how aggressive they want us to be. A chance to live comes with the risk of dependence on life support and pain. The alternative is the guarantee of an imminent but peaceful death. I have never had more harrowing, more frequent, more brutally honest, more meaningful, more exhausting conversations in my life. Complete strangers open up to you in profound ways during such times and you can only hope both your expertise and your humanity serve them well. And the eyes stay with you. For those I intubate, those who choose intubation, I often find myself having a final stare. After all the words are spoken, the decisions made, the medications drawn, the bed positioned, the tubes and drips and ventilators readied, there is a final stare. It is a stare of intention. It is a moment of humanity. It is a shared space, a hallowed space, the final moment of someone’s awareness, possibly forever. It is a space where fear and hope mingle, where autonomy fades into trust, uncertainly into acceptance, and all they have left is placed firmly in your gloved hands. It’s brief, and you’re busy, and time is essential, but you find a few seconds to share this final breath. That stare lasts a moment. That stare lasts a lifetime. And the eyes stay with you. I see them often in my mind, and although haunting I am glad to keep them with me. I warm my hands on the raw humanity inherent in such moments and they empower me to carry on. For carry on we must because the room is full of agony and sickness and fear that must be attended to quickly and humanely. // I am asleep before a long night shift. I awake to the sound of cheers and yells. To hooting and hollering. To the clanging of cow bells and the banging of drums. They yell and shout and scream to honor us. They shout from rooftops and ground floors and all the windows and balconies in between. I am asleep before a long night shift. It wakes me up. I am scared shitless. I think the building is on fire. I run around panicked and confused for several minutes. Why do the fire sirens sound like drums and cowbells? Do I even have a fire escape?? WTF is going on?? Oh. Ohhhhhhh. Ok. I get it now. My heart is still racing, but now I’m grinning. Thanks. I feel grateful…mostly. // Oxygen Rounds is a new term we have become all too familiar with. I have a hospital full of medications. Antibiotics and anti-virals and sedatives and vasopressors and steroids and opiates. But the only truly effective medicine we have is Oxygen. We blow it at high flow rates into people’s mouths and nostrils, a crutch to help the lungs that are struggling and staggering. And it’s in a shorter supply than I’d like. It flows forever from spickets on the walls, but we have many times more patients than spickets and even fewer rooms so an ever increasing number of patients on stretchers line hallways further and further from the spickets on the walls. We place portable tanks next to stretchers, but the tanks run out and we can’t refill them fast enough. Once per hour, sometimes twice, I walk the halls, hunting for gauges approaching empty and hoping the cabinet holds a replacement. Invariably I find empty ones and hope it hasn’t been empty long. Invariably someone is turning blue. It’s no one’s fault. it’s everyone’s fault. it’s Covid’s fault. And there just aren’t enough eyes and hands to keep up. I mutter a promise to check three times next hour. I pull a step ladder from the utility closet and string plastic connecters end to end to end threading them from wall spickets through corrugated ceiling tiles to drop down above patients’ heads in the hallway so they aren’t reliant on a tank. It’s hard to tell which knob goes to who, but at least it doesn’t run out. It’s a strange time when a step ladder becomes a more useful tool than a stethoscope. // I admitted four of my colleagues today. Four of them. They had the usual symptoms. A week or so of cough and chills, fever and body aches, fatigue and loss of smell. They stayed at home and took Tylenol and sipped chicken soup and wondered which patient they had gotten it from. They stayed inside and washed their hands and waited to feel better. But better never came. The cough worsened, they had trouble walking around their home without getting winded, and they knew all too well what that meant, so they came, each of them, not knowing the others were doing the same. I’m in a room with four chairs housing four colleagues with oxygen flowing into their four noses. I’m used to seeing strangers, people I care about because they’re human, but a stranger still. I can maintain a detached distanced. This is different. These are my friends and colleagues. These are the people I suit up with and go to battle beside. This is my team. I’ve had harrowing experiences beside them for years. They keep me sane and effective and capable. Together we’ve saved lives and lost lives and everything in between. But now they are on the other side of the curtain. Their coughs hurt my ears more, their fear becomes my fear, I check on the them to the point of harassment, can’t help it, can’t fix it, they’re on a path I can’t cure, can only support through. Can only stand beside them and hope. They try to reassure me, a strange role reversal that belies their strength. I well up with a deep respect. I well up with tears. The front line really feels like the front today. // The makers are my favorite people this week. Several days ago I intubated without a face shield. It was three in the morning and we had run out. There were simply more intubations than face shields and we had burned through the stash. But a patient came in and was suffocating in their own lungs and needed a breathing tube, so they got one, and they got one from me, and I did not have the proper armor. Today I stand in a room with hundreds and hundreds of face shields. They are pulled hot off the 3D printers like newspapers off a press. They are arranged on tables by volunteers who add elastic bands and attach shields to complete the ensemble. In the background the gentle hum of a dozen printers working around the clock is an echo of the thousands of engineers and designers, seamstresses and manufacturers, cooks and delivery workers and writers all contributing to the cause. Each shield is a person protected. Each volunteer is a soldier in the fight. I feel less alone. // Oxygen means something different in this new reality. In peace time an oxygen level below 95% is bad. An oxygen level below 95% on a non-rebreather face mask is terrifying. That’s a no-brainer. That gets fixed quickly or that gets intubated. Everything is different now. We hang facemasks of oxygen on people with 85-90% saturations for days. They are on the edge of the cliff with one foot dangling and there they stay. Will they inevitably fall off? Are we helping or merely delaying? No one knows. Ventilators are in short supply, ICU beds are full, and ICU docs are tired. We’re all tired. So we temporize, hoping a few will sneak by and not get intubated. Hoping someone doesn’t fall off the cliff when we aren’t looking. The monitors don’t help. They are all beeping and blaring all the time from every direction. The background music of a pandemic. They only tell us what we know, everyone is sick. Only our eyes and experience can help us now. I take another lap around the ER to check the cliffsides. // I’m baking a mask tonight. My single use N95 has been on my face for days. The backs of my ears are raw from the rubbing of its straps and my nostrils are filled with the scent of fibers mixed with my coffee flavored breath. My mask bakes and bakes, sterilizing it and killing any viral hitchhikers that attached themselves today. I wish I could do the same for someone’s lungs. It comes out warm and toasty and clean. It comes out safe. I set it on the windowsill to cool, like an apple pie from easier days. Worst desert ever. // All hands were on deck today. Elective surgeries have been cancelled and the surgeons and anesthesiologists and neurologists and orthopedists and urologists and rehab specialists and pediatricians have been deputized as ER and ICU docs. Urology attendings and shoulder surgeons are rounding with ICU teams, adjusting ventillators, and drawing blood gases. Pediatricians are seeing adult patients and monitoring oxygen levels. Outpatient docs are working in tents in front of the ER to decompress volume. General surgeons are going from room to room to room putting in Central lines and Arterial lines on our sickest patients. Anesthesiologists are running in to intubate. It remains busy. It remains overrun with sickness and suffering. But today we have more help. Today we have reinforcements. Today we feel like one big army devoted to one fight. Today it feels like maybe, just maybe, we can keep up. // Es El Fin. Today I’m a palliative care doc. This man is not doing well. This man needs intubation to survive. He’s 67 and only speaks Spanish. He’s healthy. He’s dying. His oxygen is very low. His respiratory rate is very high. He’s getting tired. He’s suffocating in his own body. He needs to be intubated. He doesn’t want to be intubated. He doesn’t want to be on a machine. We ask if we can help call his family to say goodbye. He looks at us puzzled, somehow still not fully understanding. Esta Muriendo senior. Es el fin. This is the end. He gets it. He’s stoic despite the tears. He’s strong. If this disease attacked character instead of lungs he would have a fighting chance. We set up a video call with his family. He says goodbye. They say they love him in a dozen different ways. He touches the screen. A digital hand hold in a pandemic age. We make him comfortable. He’s still drowning but he can’t feel it. He says thank you before his eyes close. I can’t help but wonder if he would have survived had he been intubated. The odds say no. The sense of defeat within me screams maybe. I try to remind myself this is what he wanted. That this is for the best. I quickly forget. // I give out more juice and blankets than I ever have. In peace time the ER is busy, always busy, but most people are not dying. Very few are dying, and even fewer are acutely and actively dying. The scourge of Covid has rewritten those rules. Everyone in the ER tonight is too sick to go home. Many are dying. Many will never leave the hospital. Many will never have a meal or a juice box again. In peace times I often can’t be bothered to bring someone juice. It’s not a priority. Tonight anyone asking gets juice. Even those not asking get juice. Often it’s the only comfort I can provide. A small ease of suffering. A brief distraction from the fear. It may be the last juice they ever drink. Some nights it’s the best medicine I have. // We had a patient tonight that impaled her hand with a crochet needle. Right through her hand. Simple stuff for us. Easy to take care of. Three of us ran over. Two more than was necessary. An orthopedist playing ICU doc was walking by. He ran over. He was excited. We were all excited. This was not Covid. This was something we could fix. We did it together. Eight hands to do the job of two. We removed the needle, help it up like a trophy, washed it off and gave it back. Our patient smiled, said thank you, and went home in one piece. It was the best we’d felt in days. // My colleagues are tired. The patients keep coming. The ER is wall to wall misery and mayhem. Only five people died on me today. Only five. But everyone there is dying to varying degrees and at various rates. The ER is a cross section of the disease. The well who will stay well. The well who will come back much worse. The sick who are stable. The sick who are crashing. It’s all around us. It keeps coming in through the front door. It keeps coming in through the ambulance bay. And my colleagues are tired. We give oxygen. Everyone staying gets oxygen. Needs oxygen. We try antibiotics. We try antivirals. We try hydroxychloroquine. This week we use steroids. This week we limit IV fluids. This week we give blood thinners. Does anything work? Are we saving anyone or just supporting them as they go along a path pre-determined by the virus coursing through their insides? Is the inevitable inevitable? Some days we just feel like spectators, front row observers going through the necessary motions of a play whose final act has already been written. So much death. So much dying. And my colleagues are tired. We’re all tired. And yet somehow, for some reason, I find there’s no place I’d rather be. I leave the ER, the sun has come up and I walk around enjoying its warm tendrils. Its quiet. Stores are shuddered, streets are empty, and sidewalks are bare. It seems peaceful. Its an illusion. But I appreciate it. Time to go home. Time to recharge. Tired won’t last forever. Covid won’t last forever. And there is still plenty of fight in us. 3
Hapless Bills Fan Posted May 5, 2020 Author Posted May 5, 2020 1 hour ago, Bob in Mich said: Aren’t you defeating the purpose of the mask if it is pushing your breath up and out past your glasses rather than going through the filtering of the mask? We use what we got. If all we got is a mask that can't be adjusted to not fog up the glasses, then by all means anti-fog treat the glasses so you don't need to fiddle with them and fiddle with the mask in public (putting potentially dirty hands up near eyes out in public high risk) The mask will still block droplet transmission by you, should you be infected and asymptomatic. For me, personally, I would put some "brain sweat" into modifying the mask so that it makes a better fit and doesn't fog the glasses because I view the fogging as a symptom of poor mask fit. What exactly to try, varies with the mask. If the mask doesn't have a wire to shape around the nose, that's where I'd start. Heavy-duty wire tie of the sort that come off coffee bags; doubled pipe-cleaner or single heavy-duty pipe cleaner; 16 gauge wire about 5" long - look around at what you have. Attach it somehow a bit down from the top of the mask - hot glue, stitch through it if possible, put it inside a piece of shoelace and stitch the shoelace down. A pipecleaner or 16 gauge wire folded inside a bandana and not sewn will stay in place well enough on the top edge, I've done the experiment. The other thing to look at is the ties, if the mask uses them. Try putting the ties in different locations if it's a tie mask. My friend's mask had non-stretchy fabric ties and her mask was fogging because they kept loosening and the mask kept slipping down. I got her one of those spring toggles to hold the straps tighter and that helped. Some people have a face too narrow for a standard medical mask and it slips down. A strap sized to fit behind the head, with buttons sewn on each end to hold the earloops will help. A shoelace through the loops and tying at the top of the head will help. Even tieing a knot at the top of the ear loop on each side can help. It's worth a bit of fiddling to get a better mask fit, and of course if you have more than one similar mask once you got it, it's easier with the next one. 3
Figster Posted May 5, 2020 Posted May 5, 2020 (edited) 1 hour ago, BillsFan4 said: Cuomo, in the face of adversity, continues to impress... Edited May 5, 2020 by Figster 3 1
Hapless Bills Fan Posted May 5, 2020 Author Posted May 5, 2020 48 minutes ago, Figster said: Cuomo, in the face of adversity, continues to impress... I'll put it out there: Cuomo and DiBlasio screwed up Big Time initially by telling people "unless you're high risk, go about your life" (March 11th, day Washington state closed the schools) and by keeping bars, restaurants, and schools open at a point where the State of Washington had been suggesting telecommuting for almost 2 weeks and had already achieved about a 25% reduction in people's movement. A week delay is huge when dealing with epidemic disease. Tom Frieden (former CDC director) is probably correct to suggest that an earlier shutdown could have saved a lot of lives. But since then, Cuomo appears to have gotten to grips with the crisis and he seems to be making overall reasonable decisions and telling it straight. I personally think it would be better to have a public health/epidemiologist leading the briefings as Washington state has done, but it has to be the right guy or gal, too. 2
K-9 Posted May 5, 2020 Posted May 5, 2020 (edited) 22 minutes ago, Hapless Bills Fan said: I'll put it out there: Cuomo and DiBlasio screwed up Big Time initially by telling people "unless you're high risk, go about your life" (March 11th, day Washington state closed the schools) and by keeping bars, restaurants, and schools open at a point where the State of Washington had been suggesting telecommuting for almost 2 weeks and had already achieved about a 25% reduction in people's movement. A week delay is huge when dealing with epidemic disease. Tom Frieden (former CDC director) is probably correct to suggest that an earlier shutdown could have saved a lot of lives. But since then, Cuomo appears to have gotten to grips with the crisis and he seems to be making overall reasonable decisions and telling it straight. I personally think it would be better to have a public health/epidemiologist leading the briefings as Washington state has done, but it has to be the right guy or gal, too. Well, by the same token, Cuomo’s decision to create the New Rochelle containment area on March 10th preceded any other mitigating action taken by other governors. No doubt actions in NYC were a day late and a dollar short, but De Blasio has more to answer for in that regard, imo. His rhetoric was downright dangerous early on. Edited May 5, 2020 by K-9 1
Figster Posted May 6, 2020 Posted May 6, 2020 9 hours ago, K-9 said: Well, by the same token, Cuomo’s decision to create the Nen w Rochelle containment area on March 10th preceded any other mitigating action taken by other governors. No doubt actions in NYC were a day late and a dollar short, but De Blasio has more to answer for in that regard, imo. His rhetoric was downright dangerous early on. Talking about dangerous rhetoric, how about the CDC telling people not to wear a mask unless you have Covid 19. The US Surgeon General meanwhile is advising the public not to buy masks. So we end up with people who have Covid 19 and they can't get a proper mask to contain it. The rest of the public has zero protection. Myself personally, by telling the public not wear a mask early on, especially where big out breaks were occurring. It sent the wrong message to everyone. Countless lives were lost because of it in my humble opinion. 2
BillsFan4 Posted May 6, 2020 Posted May 6, 2020 6 hours ago, Figster said: Talking about dangerous rhetoric, how about the CDC telling people not to wear a mask unless you have Covid 19. The US Surgeon General meanwhile is advising the public not to buy masks. So we end up with people who have Covid 19 and they can't get a proper mask to contain it. The rest of the public has zero protection. Myself personally, by telling the public not wear a mask early on, especially where big out breaks were occurring. It sent the wrong message to everyone. Countless lives were lost because of it in my humble opinion. IMO the biggest mistakes have been made by our federal government. It was their policies that kept us from being able to test and screen in the very crucial early days of this virus. It was federal policies that didn’t screen passengers traveling from virus epicenters in Europe. It was their policies that put super strict guidelines on who could get a covid test during the early days of the virus. It was their policies that banned states from being able to produce their own covid tests (until early March anyway). It was the federal govt. that ignored the early intel they received from their health agencies. Washington state defied the CDC’s orders and produced their own covid tests early. That’s how they identified their outbreak. IMO it did NOT have to get this bad in the US. We are capable of fighting this virus so much better than we are. Our CDC is a world leader in fighting infectious disease. and it doesn’t have to get worse (but it likely will by reopening before we’re ready, and it seems they’re kind of even admitting that they’re opening before we’re ready and things are going to get worse). 1
ALF Posted May 6, 2020 Posted May 6, 2020 22 hours ago, Bob in Mich said: Aren’t you defeating the purpose of the mask if it is pushing your breath up and out past your glasses rather than going through the filtering of the mask? It shows what type of mask is effective or not . All new to me , until they have enough N95
BillsFan4 Posted May 6, 2020 Posted May 6, 2020 https://www.nytimes.com/2020/05/05/us/jared-kushner-fema-coronavirus.html#click=https://t.co/955k2OBOFW Wow. 1
Hapless Bills Fan Posted May 6, 2020 Author Posted May 6, 2020 1 hour ago, BillsFan4 said: IMO the biggest mistakes have been made by our federal government. It was their policies that kept us from being able to test and screen in the very crucial early days of this virus. It was federal policies that didn’t screen passengers traveling from virus epicenters in Europe. It was their policies that put super strict guidelines on who could get a covid test during the early days of the virus. It was their policies that banned states from being able to produce their own covid tests (until early March anyway). It was the federal govt. that ignored the early intel they received from their health agencies. Washington state defied the CDC’s orders and produced their own covid tests early. That’s how they identified their outbreak. IMO it did NOT have to get this bad in the US. We are capable of fighting this virus so much better than we are. Our CDC is a world leader in fighting infectious disease. and it doesn’t have to get worse (but it likely will by reopening before we’re ready, and it seems they’re kind of even admitting that they’re opening before we’re ready and things are going to get worse). We're trying hard to avoid politics in this thread but it's a tough line sometimes. I have to score this one as "facts". It's a fact that whatever one believes about origin or about the Chinese response, other countries - given the same information - developed tests in time; implemented effective, risk-based entry control strategies; effectively supported people directed to self-isolate or quarantine; procured and husbanded PPE effectively; and protected their citizens - AND KEPT THEIR BUSINESSES OPEN. Their economies are in much much better shape than ours. It's a fact that FDA policy prevented university and state health departments from developing tests for the disease and raised unreasonable barriers through Jan and Feb, nor did the FDA solicit test development from major clinical test companies for their automated instrument platforms in that time frame. Singapore, S. Korea, and Taiwan all did that. Meanwhile, the CDC fumbled the snap and put out a faulty test, and when fixed, it used equipment many public health departments didn't have. As a result, other countries had eyes while we were flying blind. There is an article published in Lancet 24 January from Chinese scientists and physicians describing the disease outbreak and providing the exact test they used to detect it. 24 January. Here it is: The presence of 2019-nCoV in respiratory specimens was detected by next-generation sequencing or real-time RT-PCR methods. The primers and probe target to envelope gene of CoV were used and the sequences were as follows: forward primer 5′-ACTTCTTTTTCTTGCTTTCGTGGT-3′; reverse primer 5′-GCAGCAGTACGCACACAATC-3′; and the probe 5′CY5-CTAGTTACACTAGCCATCCTTACTGC-3′BHQ1. Conditions for the amplifications were 50°C for 15 min, 95°C for 3 min, followed by 45 cycles of 95°C for 15 s and 60°C for 30 s The paper shows that the test is not great - only 41 of 59 suspect patients tested positive - 70% - but there's no reason the FDA couldn't have authorized labs to use that test provisionally while a better test was developed (I know @BillsFan4 knows this, but almost every clinical lab has PCR equipment and reagents, so the few sentences above plus an order to a group making DNA primers is literally all that would be needed to start testing. Given the network of collaborations, I'm sure there were scientists and physicians in the US who had the info in that article earlier. "Dont let the Great be the enemy of the Good" "Fight with the weapons you have" etc etc. 70% vision is better than total blindness. It's a fact that the US, in the CDC, in the EIS (epidemic intelligence service) literally wrote the book on how to fight epidemic disease. We simply and 100% didn't follow the book we wrote, and we're still not following it. I've hesitated to put this article up, but IMO it's a very good comparison of how Washington and NY handled the emerging outbreak - to somewhat different results so far. (IMO it understates the effect U of Wash test had on political decisions - epidemiologists could take hard evidence and say "it's here, act now") It's a fact that the US CBP did not question nor recommend self-isolation or quarantine for people returning from Europe, even while the disease was raging across Italy and Spain in mid to late March. They didn't do it because they weren't directed to do it by the Federal government. My daughter's roommate flew back from Spain while the disease was surging in their country, in late March. No one asked him where he had been, or gave him a mask, or suggested he quarantine. He flew into Boston Logan, showed his US passport, walked through the terminal, used the restrooms, bought himself a coffee, retrieved his baggage, rented a car, and drove off. He quarantined, got sick, and recovered (and is not part of the statistics on covid-19, not tested) - but not everyone did nor did the families they rejoined. He is one of literally thousands of "study abroad" students, vacationers, and businesspeople who flew back from raging epidemic conditions in Spain and Italy and flew into major US airports with no questions during Feb and March. Whatever one thinks about the origins of the virus or how China handled it, the fact remains that a number of countries which were far closer to the epicenter, including some that have far less resources than we do and are fighting it far far more effectively - largely doing things we could do, but aren't. Remember that, folks: it did not have to be this way. Most of this could have been prevented, by actions of the United States Government that were taken or not taken, totally independent of what any other country did or did not do. As far as I'm concerned, those are Facts, written in Blood - in the book the CDC EIS wrote, and the US of A did not follow. A lot of what is being said about Federal vs State response is also total bull-pucky. The National Health Service, the CDC and the EIS, the FDA - were all developed because it was recognized that in a country where state borders are lines on a map and interstate travel is free and unrestricted, there HAS to be a federal-level coordinated response to some things. War is one of those things. Public Health emergencies of contagious disease is another. 1 1 1
K-9 Posted May 6, 2020 Posted May 6, 2020 11 minutes ago, Hapless Bills Fan said: There is an article published in Lancet 24 January from Chinese scientists and physicians describing the disease outbreak and Remember that, folks: it did not have to be this way. Most of this could have been prevented, by actions of the United States Government that were taken or not taken, totally independent of what any other country did or did not do. As far as I'm concerned, those are Facts, written in Blood - in the book CDC EIS wrote, and the US of A did not follow. It can’t be a surprise, though. I mean, we aren’t even following the federal government’s own guidelines for reopening. Guidelines they were trumpeting when they announced them weeks ago with painstaking detail as each phase was explained. Just another example of the feckless nature of the corona virus response team and why disbanding them won’t make a bit of difference.
Hapless Bills Fan Posted May 6, 2020 Author Posted May 6, 2020 9 hours ago, Figster said: Talking about dangerous rhetoric, how about the CDC telling people not to wear a mask unless you have Covid 19. The US Surgeon General meanwhile is advising the public not to buy masks. So we end up with people who have Covid 19 and they can't get a proper mask to contain it. The rest of the public has zero protection. Myself personally, by telling the public not wear a mask early on, especially where big out breaks were occurring. It sent the wrong message to everyone. Countless lives were lost because of it in my humble opinion. I think you're completely right about lives lost and the wrong message that is still being sent about mask-wearing. It is still not being emphasized. Our leaders are not demonstrating mask-wearing. Their supporters have made mask-wearing political and some kind of manliness/warrior spirit thing - Real Men Don't Wear Masks. That's like saying "Real Men Don't Hold Babies" or "Real Men don't Show Chivalry and Protect the Vulnerable" to me. Real Men do both. And they sometimes eat quiche. Well, Maybe. The CDC advice was also trying ineffectively to compensate for lack of effective government action. Other countries ramped up mask production in early February, even using their equivalent of National Guard, and took control/distribute supplies of medical masks and PPE. There could also have been a nationally mandated effort to develop and implement sterilization procedures and re-use N95 masks. Our government did nothing. It still hasn't taken effective federally coordinated action even though our Defense Logistics Agency is supposed to be the best in the world at overseeing supply and distribution. In fairness, with "don't wear mask unless sick", the CDC was giving what they considered to be advice aligned with the best science known at the time: 1) Limited studies on non-medical masks and influenza show a slightly increased rate of flu transmission TO the mask wearer, probably due to adjusting the mask in public or to the cloth mask becoming wetted and transmitting particles on the surface inward. So there are data saying a cloth mask is not necessarily protective TO THE WEARER (and why I'm a fan of a cloth pocket mask with some kind of filter, shop towel, cheap HEPA vac bag etc) 2) Early reports from China, including the WHO-China joint commission, did not show the very large proportion of asymptomatic carriers later discovered as contact tracing and widespread testing ramped up. Early estimates were 1-2% truly asymptomatic. The belief was directing people "if you have symptoms, Stay Home", wash hands to avoid infecting yourself, don't touch face, would be more effective to prevent transmission 3) Because of limited testing, early CDC tracing reports relied upon symptoms to decide who got a test. This showed a high attack rate within families or close co-workers, and a low attack rate outside close personal contact (and didn't spend enough time asking OK, so how did it get into those family groups or infect that co-worker?) This is consistent with a droplet-transmission mode where risk of infection drops quickly and sharply with distance. Thus the advice to space people 6 feet apart and that occasional closer contacts as on a trail or walking past in the hallway would not cause significant transmission, especially "if you have symptoms, Stay Home". So what's changed? 1) We now know that there are large numbers of asymptomatic carriers, especially among young health adults. Missouri just tested 2,367 workers at a St Joseph, MO meat packing plant after 34 workers were found to be infected. They have found ~378 additional positive tests so far (with a bunch pending) - at this time, asymptomatic. 2) The focus thus turns to mask wearing to prevent OTHERS from being infected, since "stay home if you're sick" is totally ineffective disease prevention if large numbers of asymptomatic or presymptomatic people are strolling around shedding infectious droplets like so many little rays of sunshine 3) Rather flimsy masks have actually been shown to be effective at reducing droplet spread FROM the person wearing the mask. Mask wearing should be seen as a social good, a gesture of protecting others. Anyway, @Figster, while you're correct at the end that not wearing masks has cost lives, I do understand the information and decision making that drove the initial advice, as well as the information that caused them to pivot. I just wish our government were behind the decision and we didn't have politicians out there going "oh, it's a personal choice whether to wear a mask, it shouldn't be enforced" Here's the hard fact: we aren't going to reopen and get back to normal until we tame this thing. And given the large number of asymptomatic carriers, we aren't going to tame this thing until everyone WEARS A MASK in public, at least indoors or when maintaining 6 foot distance outdoors is not possible. IMO, it is TOTALLY IRRESPONSIBLE for any political leader to say or do anything that suggests otherwise. Look at the economies that are still open and functional. Almost everyone is masked up. Coincidence? I say "Not". 1 1 1
K-9 Posted May 6, 2020 Posted May 6, 2020 2 hours ago, Hapless Bills Fan said: I think you're completely right about lives lost and the wrong message that is still being sent about mask-wearing. It is still not being emphasized. Our leaders are not demonstrating mask-wearing. Their supporters have made mask-wearing political and some kind of manliness/warrior spirit thing - Real Men Don't Wear Masks. That's like saying "Real Men Don't Hold Babies" or "Real Men don't Show Chivalry and Protect the Vulnerable" to me. Real Men do both. And they sometimes eat quiche. Well, Maybe. The CDC advice was also trying ineffectively to compensate for lack of effective government action. Other countries ramped up mask production in early February, even using their equivalent of National Guard, and took control/distribute supplies of medical masks and PPE. There could also have been a nationally mandated effort to develop and implement sterilization procedures and re-use N95 masks. Our government did nothing. It still hasn't taken effective federally coordinated action even though our Defense Logistics Agency is supposed to be the best in the world at overseeing supply and distribution. In fairness, with "don't wear mask unless sick", the CDC was giving what they considered to be advice aligned with the best science known at the time: 1) Limited studies on non-medical masks and influenza show a slightly increased rate of flu transmission TO the mask wearer, probably due to adjusting the mask in public or to the cloth mask becoming wetted and transmitting particles on the surface inward. So there are data saying a cloth mask is not necessarily protective TO THE WEARER (and why I'm a fan of a cloth pocket mask with some kind of filter, shop towel, cheap HEPA vac bag etc) 2) Early reports from China, including the WHO-China joint commission, did not show the very large proportion of asymptomatic carriers later discovered as contact tracing and widespread testing ramped up. Early estimates were 1-2% truly asymptomatic. The belief was directing people "if you have symptoms, Stay Home", wash hands to avoid infecting yourself, don't touch face, would be more effective to prevent transmission 3) Because of limited testing, early CDC tracing reports relied upon symptoms to decide who got a test. This showed a high attack rate within families or close co-workers, and a low attack rate outside close personal contact (and didn't spend enough time asking OK, so how did it get into those family groups or infect that co-worker?) This is consistent with a droplet-transmission mode where risk of infection drops quickly and sharply with distance. Thus the advice to space people 6 feet apart and that occasional closer contacts as on a trail or walking past in the hallway would not cause significant transmission, especially "if you have symptoms, Stay Home". So what's changed? 1) We now know that there are large numbers of asymptomatic carriers, especially among young health adults. Missouri just tested 2,367 workers at a St Joseph, MO meat packing plant after 34 workers were found to be infected. They have found ~378 additional positive tests so far (with a bunch pending) - at this time, asymptomatic. 2) The focus thus turns to mask wearing to prevent OTHERS from being infected, since "stay home if you're sick" is totally ineffective disease prevention if large numbers of asymptomatic or presymptomatic people are strolling around shedding infectious droplets like so many little rays of sunshine 3) Rather flimsy masks have actually been shown to be effective at reducing droplet spread FROM the person wearing the mask. Mask wearing should be seen as a social good, a gesture of protecting others. Anyway, @Figster, while you're correct at the end that not wearing masks has cost lives, I do understand the information and decision making that drove the initial advice, as well as the information that caused them to pivot. I just wish our government were behind the decision and we didn't have politicians out there going "oh, it's a personal choice whether to wear a mask, it shouldn't be enforced" Here's the hard fact: we aren't going to reopen and get back to normal until we tame this thing. And given the large number of asymptomatic carriers, we aren't going to tame this thing until everyone WEARS A MASK in public, at least indoors or when maintaining 6 foot distance outdoors is not possible. IMO, it is TOTALLY IRRESPONSIBLE for any political leader to say or do anything that suggests otherwise. Look at the economies that are still open and functional. Almost everyone is masked up. Coincidence? I say "Not". I said back in late January that the most insidious aspect of this new virus is its asymptomatic spread. It’s just so unlike anything I can remember in that regard. 1
GaryPinC Posted May 6, 2020 Posted May 6, 2020 2 hours ago, Hapless Bills Fan said: I think you're completely right about lives lost and the wrong message that is still being sent about mask-wearing. It is still not being emphasized. Our leaders are not demonstrating mask-wearing. Their supporters have made mask-wearing political and some kind of manliness/warrior spirit thing - Real Men Don't Wear Masks. That's like saying "Real Men Don't Hold Babies" or "Real Men don't Show Chivalry and Protect the Vulnerable" to me. Real Men do both. And they sometimes eat quiche. Well, Maybe. The CDC advice was also trying ineffectively to compensate for lack of effective government action. Other countries ramped up mask production in early February, even using their equivalent of National Guard, and took control/distribute supplies of medical masks and PPE. There could also have been a nationally mandated effort to develop and implement sterilization procedures and re-use N95 masks. Our government did nothing. It still hasn't taken effective federally coordinated action even though our Defense Logistics Agency is supposed to be the best in the world at overseeing supply and distribution. In fairness, with "don't wear mask unless sick", the CDC was giving what they considered to be advice aligned with the best science known at the time: 1) Limited studies on non-medical masks and influenza show a slightly increased rate of flu transmission TO the mask wearer, probably due to adjusting the mask in public or to the cloth mask becoming wetted and transmitting particles on the surface inward. So there are data saying a cloth mask is not necessarily protective TO THE WEARER (and why I'm a fan of a cloth pocket mask with some kind of filter, shop towel, cheap HEPA vac bag etc) 2) Early reports from China, including the WHO-China joint commission, did not show the very large proportion of asymptomatic carriers later discovered as contact tracing and widespread testing ramped up. Early estimates were 1-2% truly asymptomatic. The belief was directing people "if you have symptoms, Stay Home", wash hands to avoid infecting yourself, don't touch face, would be more effective to prevent transmission 3) Because of limited testing, early CDC tracing reports relied upon symptoms to decide who got a test. This showed a high attack rate within families or close co-workers, and a low attack rate outside close personal contact (and didn't spend enough time asking OK, so how did it get into those family groups or infect that co-worker?) This is consistent with a droplet-transmission mode where risk of infection drops quickly and sharply with distance. Thus the advice to space people 6 feet apart and that occasional closer contacts as on a trail or walking past in the hallway would not cause significant transmission, especially "if you have symptoms, Stay Home". So what's changed? 1) We now know that there are large numbers of asymptomatic carriers, especially among young health adults. Missouri just tested 2,367 workers at a St Joseph, MO meat packing plant after 34 workers were found to be infected. They have found ~378 additional positive tests so far (with a bunch pending) - at this time, asymptomatic. 2) The focus thus turns to mask wearing to prevent OTHERS from being infected, since "stay home if you're sick" is totally ineffective disease prevention if large numbers of asymptomatic or presymptomatic people are strolling around shedding infectious droplets like so many little rays of sunshine 3) Rather flimsy masks have actually been shown to be effective at reducing droplet spread FROM the person wearing the mask. Mask wearing should be seen as a social good, a gesture of protecting others. Anyway, @Figster, while you're correct at the end that not wearing masks has cost lives, I do understand the information and decision making that drove the initial advice, as well as the information that caused them to pivot. I just wish our government were behind the decision and we didn't have politicians out there going "oh, it's a personal choice whether to wear a mask, it shouldn't be enforced" Here's the hard fact: we aren't going to reopen and get back to normal until we tame this thing. And given the large number of asymptomatic carriers, we aren't going to tame this thing until everyone WEARS A MASK in public, at least indoors or when maintaining 6 foot distance outdoors is not possible. IMO, it is TOTALLY IRRESPONSIBLE for any political leader to say or do anything that suggests otherwise. Look at the economies that are still open and functional. Almost everyone is masked up. Coincidence? I say "Not". I agree with you about masks, but let's not forget Sweden (though they have not proven anything to me yet) and let's not forget that China, Japan, South Korea have mandatory BCG vaccines at birth though China's is a little sketchy before 1976. Just so much unknown right now, precaution is best. May and June are probably going to be messy here, let's hope we don't regress and overwhelm our health systems.
Hapless Bills Fan Posted May 6, 2020 Author Posted May 6, 2020 33 minutes ago, GaryPinC said: I agree with you about masks, but let's not forget Sweden (though they have not proven anything to me yet) and let's not forget that China, Japan, South Korea have mandatory BCG vaccines at birth though China's is a little sketchy before 1976. Just so much unknown right now, precaution is best. May and June are probably going to be messy here, let's hope we don't regress and overwhelm our health systems. I think Sweden is a national, natural "Social Distancing" experiment and Hispanic/Mediterranean countries are um, NOT. But that's just my opinion. This is just all so preventable. It did not have to be this way. Current "hot spots" map (places where cases doubling most rapidly). Click to embiggen. Some may represent local jumps in testing (eg 412 cases associated with meat packing plant in St Joseph, MO) Some may represent outbreaks ready to flare. Guess we're going to "do the experiment".
Figster Posted May 6, 2020 Posted May 6, 2020 (edited) 4 hours ago, Hapless Bills Fan said: I think you're completely right about lives lost and the wrong message that is still being sent about mask-wearing. It is still not being emphasized. Our leaders are not demonstrating mask-wearing. Their supporters have made mask-wearing political and some kind of manliness/warrior spirit thing - Real Men Don't Wear Masks. That's like saying "Real Men Don't Hold Babies" or "Real Men don't Show Chivalry and Protect the Vulnerable" to me. Real Men do both. And they sometimes eat quiche. Well, Maybe. The CDC advice was also trying ineffectively to compensate for lack of effective government action. Other countries ramped up mask production in early February, even using their equivalent of National Guard, and took control/distribute supplies of medical masks and PPE. There could also have been a nationally mandated effort to develop and implement sterilization procedures and re-use N95 masks. Our government did nothing. It still hasn't taken effective federally coordinated action even though our Defense Logistics Agency is supposed to be the best in the world at overseeing supply and distribution. In fairness, with "don't wear mask unless sick", the CDC was giving what they considered to be advice aligned with the best science known at the time: 1) Limited studies on non-medical masks and influenza show a slightly increased rate of flu transmission TO the mask wearer, probably due to adjusting the mask in public or to the cloth mask becoming wetted and transmitting particles on the surface inward. So there are data saying a cloth mask is not necessarily protective TO THE WEARER. 2) Early reports from China, including the WHO-China joint commission, did not show the very large proportion of asymptomatic carriers later discovered as contact tracing and widespread testing ramped up. Early estimates were 1-2% truly asymptomatic. The belief was directing people "if you have symptoms, Stay Home", wash hands to avoid infecting yourself, don't touch face, would be more effective to prevent transmission 3) Because of limited testing, early CDC tracing reports relied upon symptoms to decide who got a test. This showed a high attack rate within families or close co-workers, and a low attack rate outside close personal contact (and didn't spend enough time asking OK, so how did it get into those family groups or infect that co-worker?) This is consistent with a droplet-transmission mode where risk of infection drops quickly and sharply with distance. Thus the advice to space people 6 feet apart and that occasional closer contacts as on a trail or walking past in the hallway would not cause significant transmission, especially "if you have symptoms, Stay Home". So what's changed? 1) We now know that there are large numbers of asymptomatic carriers, especially among young health adults. Missouri just tested 2,300 workers at a St Joseph, MO meat packing plant after 34 workers were found to be infected. They have found ~378 additional positive tests so far (with a bunch more to be run) - at this time, asymptomatic. 2) The focus thus turns to mask wearing to prevent OTHERS from being infected, since "stay home if you're sick" is totally ineffective disease prevention if large numbers of asymptomatic or presymptomatic people are strolling around shedding infectious droplets like so many little rays of sunshine 3) Rather flimsy masks have actually been shown to be effective at reducing droplet spread FROM the person wearing the mask. Mask wearing should be seen as a social good, a gesture of protecting others. Anyway, @Figster, while you're correct at the end that not wearing masks has cost lives, I do understand the information and decision making that drove the initial advice, as well as the information that caused them to pivot. I just wish our government were behind the decision and we didn't have politicians out there going "oh, it's a personal choice whether to wear a mask, it shouldn't be enforced" Here's the hard fact: we aren't going to reopen and get back to normal until we tame this thing. And given the large number of asymptomatic carriers, we aren't going to tame this thing until everyone WEARS A MASK in public, at least indoors or when maintaining 6 foot distance outdoors is not possible. IMO, it is TOTALLY IRRESPONSIBLE for any political leader to say or do anything that suggests otherwise. Look at the economies that are still open and functional. Almost everyone is masked up. Coincidence? I say "Not". I agree 100% Myself personally, If we could get our better half of the population (woman) on board with wearing facial protection over half the battle is won IMO. No macho man attitude to overcome. Allow them to lead by example. I mentioned a veil type face protection in an earlier post. Something more attractive and less restrictive. With much of the population resorting to a scarf or bandana type facial covering. I think its possible a veil made of the right material could offer a more suitable and desirable protective wear for both indoor and outdoor activities IMO. Children also need something less restrictive and easier to wear... https://www.newindianexpress.com/cities/bengaluru/2020/may/04/bengaluru-researchers-eye-static-electric-masks-to-repel-covid-19-2138848.html Going hand in hand with the veil possibly... Edited May 6, 2020 by Figster
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