"The Coronavirus Still Doesn’t Care About Your Feelings"

This is a short blog post because I want you to click on the link at the bottom and read the whole article.

It’s "The Coronavirus Still Doesn’t Care About Your Feelings” from The Nation, Oct. 13, 2023. 

The title stems from the history of the government’s repeatedly telling us how we should feel about the latest covid-19 development. As in “don’t panic”. But this particular message "puts the cart before the horse unless tangible measures are being taken to prevent panic-worthy outcomes.” 

As we said in our Aug. 31st, 2023 blog, the amount of covid-19 virus in circulation is “at an historically medium level, not counting the huge Omicron surge of the winter of 2022-2023. At the current level, in the past when we were counting carefully, there were 300-600 deaths a day attributable to covid-19. That means 100,000+ a year!” Here is the current national graph:

Wastewater graph

And some more snippets from the article:

"Despite the end of the Public Health Emergency in May, Covid-19 remains a pandemic, by definition.”

 “[To achieve] a good outcome, concrete interventions are required—including improvements in air quality and other measures aimed at limiting spread in public buildings…”

"Despite messages to the contrary, our situation remains unstable, because the virus continues to evolve rapidly…” 

"If our increasingly relaxed attitude toward public health measures and the relatively unchecked spread of the virus continue, most people will get Covid at least once a year; one in five infections leads to long Covid. Although it’s not talked about a lot, anyone can get long Covid; vaccines reduce this risk, but only modestly.”

Here’s the link—there’s a lot to ponder here:

https://www.thenation.com/article/society/covid-pandemic-panic-calm-advice/

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The Best Masks for the Immunocompromised

7 Million People

"Immunocompromised people account for at least 2.7% of U.S. adults—about 7 million people,” according to the American Medical Association (AMA). This includes those with primary immunodeficiency, as well as those whose immune system has been medically suppressed due to recent procedures including organ transplants and cancer treatments.

https://www.ama-assn.org/delivering-care/public-health/what-tell-immunocompromised-patients-about-covid-19-vaccines

Of course the immunocompromised are at greater risk for all communicable diseases including covid-19. For example, they accounted for 12% of all adult COVID-19 hospitalizations in a 2022 study.

https://www.cdc.gov/mmwr/volumes/71/wr/mm7127a3.htm

I had a call on this subject a few days ago, so I thought this would be a good time to share what we have discovered and developed regarding masks for the immunocompromised (and everyone else).

The Best Masks and How to Use Them:

Easy-to-breathe, 100% effective fan/HEPA filter mask. We have been using these since April 2021, the "BROAD AirPro Mask Rechargeable Reusable Air Purifying Respirator with a HEPA Filter”, from Amazon ($46) and other sellers. The HEPA filter is 99.97% effective for virus-sized particles, and the fan slightly pressurizes the mask, giving you a much higher percentage of cool, fresh air compared to regular N95 or N100 masks. Really a breath of fresh air! Replacement HEPA filters, rechargeable batteries, etc. are readily available.

Another nice feature about this system is that you can pair the fan/filter mechanism with any N95 mask of your choice. (You can use any mask really, but the N95 works best for us—our current favorite is the Kimberly-Clark PROFESSIONAL N95 Pouch Respirator (53358), NIOSH-Approved, Made in U.S.A., from Amazon or others.)

In the blog posts, we have talked about these Airpro masks several times over the last two years. Our Jan. 4, 2022 blog post includes helpful information with four videos sharing information on the Airpro mask, how to sterilize masks, as well as how to modify an N95 mask to fit the Airpro hose. And there is a post about safe air travel using them [see Sept 2, 2022 blog post].

For the immunocompromised, we sell a version that we have modified to give slightly better performance for $100 plus shipping.

Masks with Exhalation Valves. If you are not contagious, you can use this type of mask without endangering those around you. These masks are a simpler version of the Airpro mask in that they give you a higher percentage of cool, fresh air—better quality air to breathe and less of your own exhaled air. They are also your best protection if you have to be out in the smoke-filled air from wildfires or locally-generated dust.

The best models are “N100” masks, tested to be 100% effective. I tried out one of these (3M Personal Protective Equipment Particulate Respirator 8233, Amazon, $10/mask) and found it to be serious, well-made, and readily adjustable for a good fit. Breathing was no more annoying than with N95 masks.

Our current favorite N95 valved mask is the Dräger X-plore 1350 V N95 Particulate Respirator with Exhalation Valve (Amazon, $26 for ten). However, they are not always a tight fit around everyone’s face and may be too loose at the chin. (See July 20, 2023 blog post.)

A good fit around all the edges is essential for any mask. (Not so much for the Airpro, where a little air leaking out is normal.) If you exhale, and feel air leaking out, perhaps blowing toward your eyes, then there also will be unfiltered air leaking in when you breathe in. Try bending the nose area of the mask. If you can’t get a good fit, you may need to select another brand.

Hot air mask sterilization and reuse. There was a study done in August 2020 at the University of Illinois which documented how to sterilize your disposable masks, rather than throwing them away after each use (https://hmntl.illinois.edu/news/17342). We have a video demonstrating this—all it takes is a standard crockpot set on “Low”! See Sterilizing Masks video.

Note that sterilizing the Airpro mask is not so important since the incoming virus is trapped in the HEPA filter, not in the mask. Do not put the fan-filter unit in your crockpot — this would reduce the lifetime of the lithium battery.

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Long Covid - A Year of Bad News

Nine million Americans report that they currently have Long Covid.

https://www.cidrap.umn.edu/covid-19/survey-18-million-americans-say-they-have-long-covid

person holding head and chest

“Long COVID [is] a condition with no known cure and is defined by long-lasting symptoms following a case of COVID-19. More than 200 symptoms are associated with Long COVID, commonly including fatigue, cognitive dysfunction, intolerance to exercise, chronic pain, and more.”

https://time.com/6309054/long-covid-recovery-rare/

The statistics and the stories are sobering, and full recovery remains elusive. Here is a selection of important news stories over the past year.

September 2023: "Long COVID is a roller coaster.”

"Ask Patricia Anderson how she is doing, and you probably will not get a routine answer. 'Today, I’m working and I’m fine,' she said on a recent Tuesday. 'Saturday and Sunday, I was bedridden. Long COVID is a roller coaster.' …

The virus caused extreme chills, shortness of breath, a nervous system disorder and such cognitive decline that, for months, Anderson was unable to read a book. 'I was very sick for a long time, and I never really got better,' she said."

https://www.seattletimes.com/nation-world/long-covid-poses-special-challenges-for-seniors/

August 2023: Long COVID Recovery Remains Rare.

One doctor says: "A small number, no more than 10%, have stubborn symptoms that don’t get better, no matter what. … A big chunk see some improvement, but remain sick. And [only] about 15% to 20% report full recovery."

https://time.com/6309054/long-covid-recovery-rare/

"still sick" pillow

July 2023: Doctors Unable to Work

The report at the following link is from a survey of 600 doctors with long covid. It found that nearly half of them can no longer work full time.

https://www.bmj.com/content/382/bmj.p1529

October 2022, from the Washington Post:

"On [Oct. 5, 2022], the Centers for Disease Control and Prevention, … released data on long covid. [They found] that more than 80 percent of people with long covid experience limitations in day-to-day activities. 'We want to highlight that there are quite a few people in the country whose day-to-day activities are still significantly impacted by long covid.”

https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm?

September 2022: Long Covid Is Not Just for Adults

The researchers conducted MRIs of the lungs. "Our study demonstrates widespread functional lung alterations are indeed present in children and adolescents."

https://www.cidrap.umn.edu/news-perspective/2022/09/some-kids-teens-have-long-term-lung-damage-after-covid-19

person in MRI

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Practical Steps to Healthy Fresh Air Ventilation

Last time [see Aug. 31, 2023 blog post] we reviewed the Top Five Best Practices to Minimize Covid-19 Spread. The first three all deal with fresh air ventilation, where we advocate having a fresh air level that complies with CDC, WHO, State of Vermont, and our own recommendations. The approximate carbon dioxide (CO2) level that corresponds with these recommendations is less than 800 parts per million (ppm). The amount of fresh air goes down as CO2 readings go up. The CO2 level in unpolluted outside air is about 400 ppm.

Note that these are all RECOMMENDATIONS, not mandatory or legal requirements. Fresh air ventilation in buildings is only loosely regulated, by design standards for a new or renovated building, and never “enforced” after construction that I have heard of. The only mandatory standard is from OSHA, which is 5000 ppm CO2 over an eight-hour period. (At this level, there is almost no fresh air ventilation and I would hope people would be complaining of the bad smell of the air long before this reading is reached.)

Having excellent fresh air, with CO2 less than 800 ppm, which is “in the green” on our Safetulator meters, reduces the spread of covid-19 and other respiratory illness by a factor of five [see Jun. 10, 2022 blog post], allows our brains to function at a normal high level [see Oct. 14, 2023 blog post], and also dilutes all other smells and air pollutants that might be coming from inside the building, including airborne PCBs.

Last time, we included a handy checklist for taking CO2 readings and being sure HVAC equipment is doing its job. We got some questions on exactly how to implement these practices. Here are the points raised, and the answers.

• How exactly do we do the CO2 tests?

===> To test, enter the room (with typical occupancy), go to a representative spot (not where any air is blowing on the sensor, and not within two feet of a person), wait two minutes for the reading to stabilize, then read the meter.

Small CO2 meter

• How frequently and over what period of time should we collect the CO2 tests?

===> First take baseline tests with the windows closed, and all HVAC systems running normally. If it’s all good, then you don't need to test again unless something changes. You could test once or twice more this school year if you want to be sure something hasn't broken and not been noticed.

• What are the courses of action that need to be taken if elevated CO2 levels are found in classrooms?

===> Step 1: Simply open windows. This will almost always be an adequate solution from a CO2 standpoint, but as the weather gets cold, opening windows will not be acceptable unless the covid-19 virus spread returns to crisis levels. But opening windows buys you time to take care of the more permanent measures, shown below. You can experiment to determine how much window opening is needed—for rooms with all the windows in one wall, often it is just two windows that need to be fully opened.

===> Step 2: Involve your staff or contracted HVAC technicians and check each HVAC unit that provides fresh air to be sure it is passing the fresh air on into the rooms. From the checklist, you already know that the intake openings through the walls or roof are working and that the unit's filters are clean. Now check the inside of the units—follow the path of the fresh air flow and make sure there are no obstructions, or closed dampers. Dampers or their motors may be stuck or failed or may have slipped. There may be an adjustment or setting for the amount of fresh air being delivered, and this setting can usually be increased.

===> Step 3. If there are just a few rooms that are not getting enough fresh air, and if it is acceptable for the doors to these rooms to be open to an adjoining space with better fresh air, these open doors may do the trick. If needed, you can try a small fan blowing in or out through each doorway.

===> Step 4: An excellent way to add "ventilation" is with in-room air purifiers--see our Jan. 11, 2022 blog post. Contrary to that post, the manufacturer ended up NOT discontinuing our favorite model, the Classic 205, and there is also the Classic 280i which is slightly fancier but at the same or lower price. Please consult a mechanical engineer to find out the number of air purifiers needed. Note that air purifiers alone are never enough, as you still need some real fresh air, just not as much of it.

205 Air Purifier

===> Step 5: For long-term HVAC revisions or equipment replacements, consult a mechanical engineer. A complete design guide to this work can be found on our web site at COVID-19 Mechanical Engineering Recommendations (PDF) .

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Your School Can Minimize Covid--Without Masks Or Remote Learning

Back In The Covid Life Again

It’s been 3-1/2 years since the Covid-19 pandemic began. We have all the experience and tools we need to manage the virus and prevent outbreaks and surges, and to prevent large numbers of cases, hospitalizations, deaths, and life-altering “long covid”.

As we once again gather together in schools and other buildings, the amount of virus in our communities is on the rise. In the U.S., the only reliable current monitoring comes from sampling for the amount of the virus in sewage at the treatment plants. These numbers are now at an historically medium level, not counting the huge Omicron surge of the winter of 2022-2023. At the current level, in the past when we were counting carefully, there were 300-600 deaths a day attributable to covid-19. That means 100,000+ a year!

[https://biobot.io/data/covid-19]

Although barely reported, current covid-19 outbreaks are temporarily shutting down or affecting operations in multiple schools and other buildings throughout the U.S., including an emergency call center in Kentucky.

https://spectrumnews1.com/ky/louisville/news/2023/08/30/lexingtons-health-department-recognizing-potential-covid-case-increase-

And yet, many people don’t seem to know that they have missed doing the most effective measures for control of covid-19, and instead seem to be resigned to their fate of continuing frequent cases. A spokesperson at the call center said “We had in place precautions … hand washing, the masks, and we had hand sanitizing stations …” 

This might sound OK until you realize that hand washing and sanitizing come from the early and wrong advice about how the virus spreads [see Mar. 21, 2022 blog post], and that masks reduce the risk by only about 25% [see item #1 in the March 10, 2022 blog post]. Here’s how we can do better. (Check the referenced previous issues of this blog for all the details.)

Top Five Best Practices to Minimize Covid-19 Spread

1. Great fresh air ventilation in buildings. This is like having everyone wear a really really good mask without the hassles, and has been shown to cut the number of cases of covid-19 and other airborne infectious diseases by 80%! [See Dec. 16, 2022 blog post and Oct. 14, 2022 blog post and Dec. 6, 2021 blog post.]

2. Monitor carbon dioxide (CO2) to make sure you are achieving #1. In Vermont, for example, the state issued to every public school an advanced CO2 meter that also measures small particle air pollution as from wildfires. Keep the CO2 reading below 800 ppm, as the state recommends. [COVID-19 Mechanical Engineering Recommendations] The rooms need to be monitored when they have normal occupancy. Some buildings have automatic electronic systems that do this, or you can take around your hand-held meter. Some buildings have large, permanent meters installed to show people that the building fresh air is “in the green zone”—this is an excellent practice. [See #3 in the Apr. 29, 2022 blog post.]

CO2 Meter in school corridor

3. Be sure your building’s mechanical ventilation systems are set right and working well. There’s a ton of information on this topic here in our blog and website. And here’s a new, simple checklist for the start of the school year.

HVAC Checklist

Checklist (PDF)

4. Establish a culture that it’s OK to stay away when you’re sick, and have the best facilities and practices when someone gets sick during the day. In 2020, Vermont encouraged all schools to set up Isolation Rooms where sick people can avoid infecting anyone else because the air from the room is exhausted, not recirculated. If your school does not have this, you can set it up in any room with a window and a window fan to exhaust the air. [See Feb. 9, 2023 blog post.]

5. Use covid-19 antigen tests—now less than $5 each. [See Dec. 16, 2022 blog post.] These tests give results in 10-20 minutes, use a short nose swab (not those terrible long ones from the early days of the pandemic!), and tell you definitively whether or not someone is contagious to spread the virus today [see Aug. 5, 2022 blog post]. They are not sensitive enough to detect a low level of the disease, below the level where you are contagious. So someone with symptoms and a negative test should still be sent home for the day and asked to stay home as long as there are symptoms, and to re-test daily. 

The antigen tests also can be used by people who want to be sure they are not contagious when they gather with other people—family gatherings, teacher meetings, singing rehearsals, nursing home staff, etc. I have not seen any studies on this, but my feeling is that the dollar cost of these tests turns out to be less than the cost of absent teachers and students, medical expenses, and the anxiety associated with covid-19 outbreaks or continuing cases and risk.

InBios Antigen Self-Test

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