Flying Blind - And Low?

The amount of covid-19 virus in circulation in New Hampshire was trending lower when the “emergency” tracking ended on May 11th. My guess is that levels will stay fairly low for the next few months as the weather improves and people spend more time gathering outside and opening windows. But, on the other hand, when we have more days where the air conditioning is running, then the amount of fresh air will be reduced and the number of infections will rise. (Not that ventilation should be reduced of course—it should continue at healthy levels year round!)

Below is a graph from Covid ActNow, showing the most reliable metric we had—hospitalizations. The low point of the seven-day average was 17 on June 22, 2021, just before the Delta variant arrived. This means just 17 people in the whole state (1.4 million people). You can see that on May 11th, 2023 we were a bit higher (29).

We used hospitalizations instead of cases because the numbers of cases being tracked were just the tip of the iceberg, as people used home tests, rode it out without testing, or didn’t even know they were infected.

The state of New Hampshire tracked the numbers differently, and unfortunately did not post hospitalization numbers. The graph below shows cases—and these ended at about twice the low point of 18 on June 26, 2021. The breakdown of deaths by age is useful—but of course the numbers and severity of "long covid" are not reflected in these graphs.

The virus level was not quite down to the 2021 low points, but its affect on children has been so small that we have ended our practice of antigen tests for children before family gatherings. We are continuing our testing of adults for family gatherings, and of daily testing for the workplace.

India has had a covid surge, there are reports that China is heading into one, and the US mostly has stopped even counting! We are left to be flying blind — maybe at low levels, maybe not. Personally, I know of many cases in the last few weeks.

We think there will be some level of tracking continuing, but it seems that the agencies doing it haven’t figured out their new systems. We have some hope that wastewater sampling for the covid-19 virus is continuing at many locations.

We’ll give you an update when we know more!

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The Covid-19 "Emergency" Is Over, But We Still Have Lots to Learn

Here are some of the things we still have to learn, as reflected in recent news stories.

Covid-19 is still here, with a new variant, and a new symptom: pinkeye

Nationally, covid-19 deaths are around 150 per day, down from 300-500 per day during the previous 12 months. The virus is down but not out. And the latest variant, XBB.1.16, dubbed Arcturus, is growing in the U.S. and has a new common symptom: pinkeye. Here’s a report from India, where the variant caused a spike in infections before moving on to the rest of the world:

https://www.livemint.com/news/india/conjunctivitis-among-42-kids-experts-on-ten-common-covid-symptoms-amid-current-surge-11682171015647.html <https://www.livemint.com/news/india/conjunctivitis-among-42-kids-experts-on-ten-common-covid-symptoms-amid-current-surge-11682171015647.html>

Gathering thousands of people indoors will spread the disease

Most of the time, no one tracks cases after such events, so the super-spreaders or just regular spreaders never become news. But if you’re the CDC, gathering 2000 of your best and brightest for a four-day conference, while ignoring testing and, I presume, turning a blind eye to fresh air ventilation, then the resulting 35 cases (as of a week ago) can attract attention. Did the agency respond by saying, oops, maybe we should have been more careful? No. But take heart, they will "conduct a rapid epidemiological assessment … to determine transmission patterns.”

https://www.washingtonpost.com/health/2023/05/02/covid-outbreak-cdc-annual-conference/

Ventilation, Ventilation, and More Ventilation

Here is a news article interviewing doctors from Canada and India, who share this view:

"Both experts strongly believe that the easiest and the most 'painless' way of avoiding future infections is by upgrading indoor air quality systems in every building. It works! There are studies that show children that go to schools with good ventilation are 75 percent less likely to get sick.”

https://news.yahoo.com/covid-19-emergency-over-who-statement-reaction-doctors-205917048.html

See the previous blog post (April 27, 2023 blog post) for more information.

And there is hope that some national actions may finally be taken, although they will take several years to roll out.

"The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE)—an independent body that [recommends] indoor air quality standards—will soon release new measures in response. Many states and institutions will then accordingly upgrade their systems in order to meet the new air quality standards. This is crucial to reducing viral transmission of respiratory illnesses in closed spaces."

https://observer.case.edu/the-post-pandemic-existence-are-we-ready-for-it/

Yes, it does matter if you keep getting Covid-19 over and over

"Having COVID-19 more than once is worse than having it just once. “It’s not really surprising,” Al-Aly says. If you get hit in the head twice, he says, it will be worse than one blow. People with repeat infections were twice as likely to die and three times as likely to be hospitalized, have heart problems or experience blood clots than were people who infected only once. In a surprising twist, vaccination status didn’t seem to have an impact "

https://www.nature.com/articles/d41586-023-01371-9?

If you’re sick, stay home from work!

Of course the CDC has not learned this lesson, and has stuck to their erroneous go-back-after-five-days policy even though they knew that a large portion of the people would still be contagious. (See June 30, 2022 blog post.) They decided a contagious worker was better than no worker at all. In a study, about half of health care workers agreed with them.

https://www.beckershospitalreview.com/infection-control/half-of-healthcare-workers-with-covid-19-may-still-show-up-to-care-for-patients-study.html

These aren’t the only things we have to learn; I’ll be talking more about this in a future blog, but this is it for today . . .

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Schools Yearning to Breathe Free

By now, you know many of the benefits of adequate fresh air ventilation, including:

- 80% reduction in transmission of covid-19 and other airborne infections [see Dec. 16, 2022 blog post];

- better functioning of our brains, as measured by cognitive tests [see Oct. 14, 2022 blog post];

- probably happier building occupants (although I've never measured this or seen a study on it).

But I was reminded this week that the forces working in the opposite direction are still strong and often prevailing--let's cut down or cut off the fresh air, because we have figured out that this will save some energy and dollars needed to heat up all that fresh air before we send it into the building.

Of course energy saving is important, but we now have many many ways to do this without sacrificing the primary purpose of buildings, which is to provide a healthy and effective indoor space for people.

For decades, I have found that some building operators have intentionally cut off the fresh air. I remember one case a decade ago where they didn't really understand what that big piece of equipment did, except that when they turned off the switch, the utility bill went down. "But this is the only device that provides fresh air to your library!" I exclaimed. We turned it back on.

Here are some more real-world examples:

- Classroom unit ventilator fresh air intake blocked off with styrofoam.

- Fresh air intake intact (center) but the corresponding relief air blocked off (left and right)--all the fresh air intakes need corresponding outgoing air or we would be trying to inflate buildings like balloons!

- The fresh air intakes for the gym air handling unit--where hundreds of people can gather--almost completely blocked off with sheet metal, a serious project!

- Ventilators simply turned off at their disconnect switches or electrical panels, resulting in somewhat smelly classrooms and very high CO2 readings.

So, if you wonder if this is happening in your buildings, take a stroll around--you might be surprised! (Sometimes there is nothing that is easy to see, but you can always tell by measuring the carbon dioxide in rooms that are occupied--see Jan. 20, 2022 blog post.)

PS - Complete design-level guides for equipment and controls for good levels of fresh air ventilation, meeting the WHO, CDC, and State of Vermont levels (about 30 cfm per person, which corresponds to less than 800 ppm CO2) are available free on our website under “Resources”: COVID-19 Mechanical Engineering Recommendations (PDF).

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Singing Safely

One of the early “super-spreader” covid-19 events was a 2-1/2 hour chorus rehearsal in Skagit Valley, Washington on March 10, 2020 (the day before the World Health Organization declared the pandemic). "In the weeks that followed, more than 50 people from that rehearsal would contract the disease—almost everyone who attended—and two died.” (Singing unmasked…)

CU Boulder Today, 9/17/2020

This event triggered research during the next few years studying how various aspects of singing (such as volume, rehearsal time, and even language) affected the aerosol transmission of the virus. (Louder Singers …)

It also spawned studies exploring various mitigation measures such as “singer’s masks" and increased fresh air ventilation. (How Safe …)

The bottom line is that singing (along with other behaviors that increase respiration, such as shouting or physical exercise) increases the risk of transmission. Even though less virus is in circulation, it still accounts for more than 200 deaths a day nationally, more than any other communicable disease, and it is still prudent to avoid it where possible, especially when vulnerable individuals are part of your group.

Luckily, this is easily done. For today’s group gatherings, where mask wearing is not a popular practice, while singing or otherwise, the simplest and best solution is covid-19 antigen testing prior to gathering. (See Aug. 5th, 2022 blog post.)

If groups decide not to do this at every rehearsal, then providing good fresh air ventilation (CO2 less than 800 ppm) will reduce the risk by perhaps 80% (See Dec. 16th, 2022 blog post). The more fresh air, and air filtration, the better, and of course being outdoors is best.

And if antigen testing is not done at the numerous rehearsals, then at least do it for all performances! Performances combine all the highest-risk factors of singers being even closer together than at rehearsals, singing perhaps with even more gusto, potentially exposing the audience, and being in indoor spaces where the amount of fresh air may be unknown or uncontrollable.

It’s always time to sing, and we can sing safely!

Village Harmony 30th Anniversary singing with Larry Gordon.

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The Covid-19 End(emic) Game

Here to Stay

Covid-19 is here to stay, but the mass outbreaks may be over for the time being. A new variant could occur at any time, perhaps is brewing now, but barring that, we can be cautiously optimistic.

A huge winter surge did not occur this year, as many expected (myself included). In New Hampshire, for example, there was about a 50% increase in hospitalizations after the start of the school year, and again after the holiday season (shown circled below).

“Endemic” means that the disease is here to stay (true) and that the infection rates are fairly constant (we don’t know this yet). The graph for New Hampshire shows the low point for hospitalizations, last June, which was just 17 people for the whole state (1.4 million people). We may be approaching that low point again, with the latest number being about double the low point, and trending down. Spring weather should encourage this trend to continue downward.

The End Game

On the other hand, we still know people who have been infected (again) with covid-19. And every new infection is another roll of the dice as to severity and whether some Long Covid symptoms will stick around or pop up later. So, for those who want to reduce their risk at this point, here are some of the best things to do:

- Use daily antigen tests (virtually eliminates the risk). For short-term gatherings under your control—the workplace, choral rehearsals, family get-togethers, etc.—it’s simple to have everyone do an antigen test that day. If you have one-on-one sessions with people—dental hygienists, barbers, medical people, etc.—you can ask them to do a test, and probably provide the test. Sometimes they will say no, sometimes yes. And if you develop any kind of symptoms, do two antigen tests on successive days. See Aug. 5th, 2022 Blog Post.

- Continue to have great fresh air ventilation (reduces the risk by 80%). This is especially important where you are gathering with lots of other people, such as at restaurants or theaters. You can maintain your spaces, or check other spaces you enter, with a Safetulator Fresh Air Meter. And you can supplement actual fresh air with in-room air purifiers. See Jan. 11th, 2022 Blog Post and Sept. 2nd, 2022 Blog Post.

- Maintain a mask-friendly culture for those people who want to wear masks (properly-worn masks can reduce the risk by 25% or more). Better masks can be close to 100% effective. See Mar. 10th, 2022 Blog Post and Dec. 16th, 2022 Blog Post.

- If you do get covid-19 again and know it, follow the best practices to avoid spreading it to others in your family. And don’t return to circulation until you get a negative antigen test. See Feb. 9th, 2023 Blog Post.

The Finish Line

Hard to say exactly when and where it is, but for me, I’m thinking that when New Hampshire hospitalization rates stay at levels less than the 2021 lows, I’ll be setting aside my masks except for intense exposures like airplanes (where 100% of tested wastewater contains the covid-19 virus!). I’ll wait and see about the antigen testing—it will depend on what others want to do in the groups involved. And, of course, I will continue to pursue excellent fresh air ventilation for all its benefits that go far beyond covid-19.

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To Avoid Covid-19, Do as They Do, Not as They Say

Remember that you can gather safely by simply doing daily morning antigen testing for those who will be attending. (First discussed here: Aug. 5th, 2022 blog.)

While prominent people are telling us we generally don’t need to wear masks, or to be sure to have good ventilation, or to do testing, when they themselves are gathering, guess what they do? Testing ahead of time! Of course. Some recent examples:

Alaska legislators did “voluntary” testing after covid-19 spread through the group.

https://www.kinyradio.com/news/news-of-the-north/alaska-legislators-on-guard-after-multiple-covid-cases-are-confirmed-in-the-capitol/

After the Golden Globe awards were held (Jan. 10th, 2023) with no covid-19 safety measures, a number of celebrities came down with the disease. The next event, the Critics Choice Awards (Jan. 15th, 2023) took notice and required everyone have a negative test ahead of time.

https://deadline.com/2023/01/two-banshees-of-inisherin-stars-will-not-attend-the-critics-choice-awards-1235222460/

And when the world leaders gathered for Davos 2023 (January 16-20, 2023), you can be sure they had PLENTY of safety measures in place: testing, HEPA filters, and more. Bruce Y. Lee said in Forbes:

"There’s that old saying, 'Do as I say, not as I do.' So a big question is what are political and business leaders actually doing about Covid-19 precautions for themselves right now? Plenty of them have been publicly pushing for Covid-19 precautions to be dropped. In fact, some have even claimed that the pandemic is over … Yet, the pandemic doesn’t look too over at that annual gathering of political and business leaders at Davos, Switzerland, known as the World Economic Forum (WEF).” Read the rest of his story at: https://www.forbes.com/sites/brucelee/2023/01/20/world-economic-forum-is-taking-all-these-covid-19-precautions-at-davos/

Note that daily antigen testing is actually better than PCR testing for purposes of gathering together. PCR tests have to be sent to a lab for analysis, so they are two or three days old by the time the gathering begins, and someone could have contracted covid-19 in the time in between. Antigen tests can be done anywhere, they are less expensive (as low as $5), and they reflect the current health status.

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