The Fourth Covid Winter

Here we go again

We are beginning another seasonal rise in covid-19 infections as we have more family gatherings, more airplane travel, and more time inside buildings with poor fresh air ventilation. The amount of covid-19 virus in circulation is on the upswing again—not quite up to the levels of a year ago, and perhaps headed for a peak similar to last year’s (but NOT the huge Omicron surge of January 2022!). In the national wastewater virus sampling graph shown below (from Biobot), you can see that such a peak would put us at about five times the low virus levels of this past summer.

Biobot graph

And we have several very effective ways to reduce the spread and reduce our own risk. All of these we have discussed before—here is a handy listing of them, and references to the more detailed reports.

Healthy fresh air ventilation

Of course, this is the least intrusive method—equivalent to a good mask for everyone, without the masks! And air purifiers can augment actual fresh air and save energy at the same time. There is a review of the practical methods to accomplish good fresh air ventilation in our Sept. 15, 2023 posting. If you are gathering in someone’s house and don’t have a Fresh Air (CO2) Meter, the simplest way to tell how much fresh air is enough is to open one or more windows fully, but not so many windows that your heating system cannot keep up with it. At our family’s Thanksgiving with seven people, we had one window open fully, the wood stove cranking away, and the CO2 always less than 700 ppm (“in the green”).

Photo of air purifier

“Sweet spot” humidity

This is a very important and usually ignored aspect of healthy indoor air quality - humidity, the moisture in the air. In the winter in cold climates, we ADD moisture to the air to achieve the ideal minimum of 40% RH (Relative Humidity). This level helps your air passages stay hydrated and be effective in their immune system function, and also impedes the airborne circulation of viruses. (See Dec. 1, 2022 post.)

Photo of humidifier

Antigen tests

For cases where you are gathering with like-minded people who want to avoid unnecessary covid-19 risk, the easiest way is for everyone to get a negative antigen test result that morning. [See Dec. 16, 2022 blog post.] These tests are now readily available and cost as little as $6.50 each (or free, in limited supply, from the federal government). The hardest part of this strategy is to have a compassionate and inclusive way to deal with those members of your group if anyone tests positive. While a negative test should mean the person is not contagious that day, I like having good fresh air ventilation also, which cuts by 80% the risk of transmission of all airborne diseases.

Photo of InBios self-test

The best masks

There is a very fine assortment of N95 or equivalent masks now, all readily available, as presented in our Oct. 19, 2023 post. Remember the first covid winter of 2020-2021? That year, when most people were wearing masks most of the time, there were hardly any flu cases in the U.S.! (https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm)

This is a testament to the effectiveness of masks, and perhaps other factors as well. Of course, the most important time to wear a mask is when you are part of a large number of people in close quarters, as on an airplane, or at a holiday music concert. Remember, more than one out of every 100 people is currently infected with covid-19 and many of them do not even know it.

Photo of mask

If you do get covid-19, you can avoid passing it on

If you do get covid-19 again and know it, you can follow the best practices to avoid spreading it to others in your family. See Feb. 9, 2023 Blog Post. I just heard from a reader who followed our instructions when one family member contracted covid-19, and everything worked perfectly—it did not spread! And you can avoid spreading it beyond the family if you delay returning to circulation until you get a negative antigen test. 

Again, we’re in much better shape than the huge Omicron surge of January 2022! Be well!


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"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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