Thursday, July 23, 2020

Hospital Air Shows Heavy Presence of SARS-Cov-2

Co-written by: Dr. Robert L. Bard / Research & Edits by: Lennard M. Gettz

August 13, 2020 - Recent headlines show evidence of Coronavirus pathogens in hospital air supply and air passageways- creating a systemic hazard for the staff and patients under critical care. Substantial controversy about the role played by SARS-CoV-2 in aerosols in disease transmission, due in part to detections of viral RNA but failures to isolate viable virus from clinically generated aerosols[1]. 

Excerpt of active study Abstract (posted 8/4) held by Dr. John Lednicky and research team from the University of Florida: "Air samples were collected in the room of two COVID-19 patients, one of whom had an active respiratory infection with a nasopharyngeal (NP) swab positive for SARS-CoV-2 by RT-qPCR. By using VIVAS air samplers that operate on a gentle water-vapor condensation principle, material was collected from room air and subjected to RT-qPCR and virus culture. The genomes of the SARS-CoV-2 collected from the air and of virus isolated in cell culture from air sampling and from a NP swab from a newly admitted patient in the room were sequenced. Findings - Viable virus was isolated from air samples collected 2 to 4.8m away from the patients. ... Those with respiratory manifestations of COVID-19 produce aerosols in the absence of aerosol-generating procedures that contain viable SARS-CoV-2, and these aerosols may serve as a source of transmission of the virus".

Similar studies have been conducted in prior months to support this theory of airborne pathogens in urgent care centers, including one from February 19 through March 2, 2020 by the CDC. A study was performed in a small sample from regions with few confirmed cases (which might not reflect real conditions in outbreak regions where hospitals are operating at full capacity). In this study, CDC officials tested intensive care units (ICU) and a general COVID-19 wards (GW) at Huoshenshan Hospital in Wuhan, China.  "Air and Surface samples were tested to determine distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards. Contamination was greater in intensive care units than general wards. Virus was widely distributed on floors, computer mice, trash cans, and sickbed handrails and was detected in air ≈4 m from patients. [3]

As of March 30, 2020, approximately 750,000 cases of coronavirus disease (COVID-19) had been reported globally since December 2019 (1), severely burdening the healthcare system (2). The extremely fast transmission capability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has aroused concern about its various transmission routes. This study led to 3 conclusions. First, SARS-CoV-2 was widely distributed in the air and on object surfaces in both the ICU and GW, implying a potentially high infection risk for medical staff and other close contacts. Second, the environmental contamination was greater in the ICU than in the GW; thus, stricter protective measures should be taken by medical staff working in the ICU. Third, the SARS-CoV-2 aerosol distribution characteristics in the ICU indicate that the transmission distance of SARS-CoV-2 might be 4 m. [3]

Initiatives are in full swing from health departments and hospital safety leaders to advance sanitization measures and decontamination initiatives in hospitals. Agencies indicate that without adequate environmental controls, patients with airborne infectious disases will pose a risk to other patients and healthcare workers. Heating, Ventilation and Air Conditioning (HVAC)  expertise is essential for proper environmental management when planning control of airborne infectious disease outbreaks.   This may include frequent inspection and upgrades of air filtration systems- such as HEPA Filtering and proper discharging of air to the outside (by creating negative room pressure in patient rooms and airflow management). Other initiatives like stepping up hospital safety inspections and advancing disinfecting, and sanitizing measures to include more current technologies like UV-C light disinfection.




HEPA FILTERS (Source: EPA.gov)
HEPA is a type of pleated mechanical air filter. It is an acronym for "high efficiency particulate air [filter]" (as officially defined by the U.S. Dept. of Energy).  This type of air filter can theoretically remove at least 99.97% of dust, pollen, mold, bacteria, and any airborne particles with a size of 0.3 microns (µm). The diameter specification of 0.3 microns responds to the worst case; the most penetrating particle size (MPPS). Particles that are larger or smaller are trapped with even higher efficiency. Using the worst case particle size results in the worst case efficiency rating (i.e. 99.97% or better for all particle sizes).

MERV RATING
Minimum Efficiency Reporting Values, or MERVs, report a filter's ability to capture larger particles between 0.3 and 10 microns (µm).
  • This value is helpful in comparing the performance of different filters
  • The rating is derived from a test method developed by the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) [see www.ashrae.org].
  • The higher the MERV rating the better the filter is at trapping specific types of particles.
  • See complete rating chart from 1-16
Consider using portable air cleaners to supplement increased HVAC system ventilation and filtration. Directing the airflow so that it does not blow directly from one person to another reduces the potential spread of droplets that may contain infectious viruses. Air cleaning may be useful when used along with source control and ventilation, but it is not a substitute for either method. Source control involves removing or decreasing pollutants such as smoke, formaldehye or particles with viruses. The use of air cleaners alone cannot ensure adequate air quality, particularly where significant pollutant sources are present and ventilation is insufficient. See ASHRAE and CDC for more information on air cleaning and filtration and other important engineering controls. [6]


FROM THE MEDICAL FIELD
By: Megan Meller, MS, MPH

I can’t recommend a specific product but want to emphasize the importance of building HVAC systems and the number of air exchanges that take place in a room. Below I’ve included a table that summarizes guidelines from the CDC for air exchanges in various healthcare settings.


When COVID-19 made it’s presence known, we worked closely with our Facility Operations department to ensure that our exam rooms and hospital rooms were meeting these requirements. In some cases, adjusts were needed and were made. We do use HEPA filters throughout our organization which is a fairly standard technology in healthcare. We do use portable filters but only in select departments (e.g. Oncology) and have not added more for COVID-19. HEPA filters in theory are able to capture coronavirus particles but we don’t know how practical this is and I would not rely solely on this to prevent infection. Afterall, COVID-19 spread appears to be primarily occurring via droplets.   It is much easier to maintain centralized units than individual ones. In addition to shoring up our ventilation systems for COVID, we also implemented physical barriers to protect our patients and staff against COVID including: dedicated negative pressure hospital units, respirators, and organizational wide face masking requirements. The key that I want to stress here is the emphasis on ventilation rather than filtration as complementary to other measures such as social distancing and masking.


References: 
1) Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients
2) Study finds evidence of COVID-19 in air, on hospital surfaces
3) Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020 https://wwwnc.cdc.gov/eid/article/26/7/20-0885_article
4) Minesotta Dept of Health (Airborne Infectious Disease Management): 








UV-C AIR SANITIZING INSTALLED IN HVAC SYSTEMS
In 2006, the U.S. Environmental Protection Agency approved a test plan for Biological Inactivation Efficiency by HVAC In-Duct Ultraviolet Light Air Cleaners. (1) The tests were conducted using three organisms, two bacteria (Bacillus atrophaeus and Serratia marcescens) and one bacterial virus (MS2).  These organisms were selected because their sizes, shapes and susceptibility to UV inactivation make them reasonable surrogates for biological warfare agents (BWAs). Generally, vegetative bacteria are readily killed and bacterial spores are more difficult. To model use in a VAC system, RTI used a test duct designed for testing filtration and inactivation efficiencies of aerosol, bioaerosol, and chemical challenges.  The bioaerosol inactivation efficiencies calculated for the three organisms were 9% for B. atrophaeus, 99.96% for S. marcescens and 75% for MS2. The irradiance was measured as 1190 W/cm2 at 161 cm(63 in.) upstream from the lamps with an airflow of 0.93 m3/sec (1970 cfm). The system had four lamps that were burned in for 100 hours prior to measurements.

Due to the recent pandemic, companies developing this technology are (now) on the fast track to advance UVC installations for a wide range of professional and commercial environments.  Specific testing is currently underway as to the efficacy against SARS-CoV-2 (the virus that causes COVID-19) but historically, systems like those developed by Fresh-Aire UV have been tested and proven effective against pathogens that require even greater UVC dosages.  "Every microorganism requires a specific UVC dosage for inactivation including the novel coronavirus. UV disinfection has been employed for decades in water treatment; these microwatt values have been used for reference to gauge UVC efficiency against a large cross-section of microorganisms. UV disinfection systems for room, surface & HVAC are (also) an ideal proactive measure to complement filtration", stated Aaron Engel, VP of Business Development at Fresh-Aire UV.

UV lamps have been used to inactivate airborne microorganisms for many years. Much of the early work was directed at the control of very infectious microorganisms (particularly Mycobacterium tuberculosis, the causative agent of tuberculosis), often in medical facilities. Wavelengths within the short wave, or C band of UV light (UVC), were found to be the most effective germicidal light wavelengths. UVC usually is generated by use of UVC fluorescent lamps. These lamps use electrical discharge through low-pressure mercury vapor enclosed in a glass tube that transmits UVC light (primarily at the mercury wavelength of 253.7 nm). Because this wavelength has been found to be about the optimum for killing microorganisms, UVC from mercury lamps also is referred to as UVG to indicate that it is germicidal. UVG has been shown to inactivate viruses, mycoplasma, bacteria, and fungi when used appropriately.


--------------------------------------------------------------------------------------------------------------------------



HISTORY
Niels Ryberg Finsen (1860-1904) was the first to employ UV rays in treating disease. He was awarded the Nobel Prize for Medicine in 1903 for his invention of the Finsen curative lamp, which was used successfully through the 1950s. [01]  Updates in the technology for commercial use evolved as UV-C germicidal lamps in the 1930's and have been primarily used in healthcare facilities. UVGI is highly recognized for addressing airborne microbial disease prevention (including influenza and tuberculosis). UVC is proven to prevent airborne transmission by deactivating airborne pathogens, but public use has been curtailed due to its potential to cause cancers and cataracts upon direct contact. [02]

The history of UVGI air disinfection has been one of promise, disappointment, and rebirth. Investigations of the bactericidal effect of sunlight in the late 19th century planted the seed of air disinfection by UV radiation. First to nurture this seed was Richard L. Riley and his mentor William F. Wells, who both discovered the spread of airborne infection by droplet nuclei and demonstrated the ability of UVGI to prevent such spread. With the enduring research of Riley and others, and an increase in tuberculosis (TB) during the 1980s, interest in UVGI was revitalized. With modern concerns regarding multi- and extensive drug-resistant TB, bioterrorism, influenza pandemics, and severe acute respiratory syndrome, interest in UVGI continues to grow. Research is ongoing, and there is much evidence on the efficacy of UVGI and the proper way to use it, though the technology has yet to fully mature.  [3]

...................................................................................................................................................................
Epilogue: Straight Answers from the CDC
In our commitment to publish helpful information about innovative solutions, we rely on top health  authorities to provide us with unbiased clarity and technical standards. We inquired about how UV-C Disinfecting technology truly ranked as the future solution to defeating viruses and transmitted diseases. Steve Martin, PhD, an engineer in NIOSH’s Respiratory Health Division provided us with these valuable statements:

Q: Does the CDC see UV-C Disinfecting as the next trend- evolving from chemical spray sanitizing?
A: No.  CDC understands that germicidal UV technologies, including patient room terminal cleaning devices (sometimes called UV robots), can provide enhanced surface disinfection over the use of chemical disinfectants alone. However, UV technologies, as they currently exist, will never replace manual chemical cleaning in healthcare spaces.  While UV can be very efficient at inactivating pathogens on surfaces, UV-C energy cannot substantially penetrate blood and other bodily fluids, or through other simple spills and splashes that occur in the course of patient care, even those that have dried and left residues. Thus, healthcare surfaces need to first be thoroughly cleaned to remove gross contamination before the UV energy can directly impact the surfaces and provide the most disinfection benefit. Then, UV systems that are properly applied can effectively inactivate many of the pathogens that manual cleaning may have left behind.

Q: From an original post on 2016, CDC warned about potential OZONE output from UV.  It has been evident that companies have since been addressing the testing, preventing and validating of ozone output.  Does CDC have enough data on this upgrade?
A: Concerns about UV lamps producing ozone have existed for decades and there have not been any significant “upgrades” since 2016.  There are some UV-C lamps designed specifically to produce ozone.  Ozone-producing lamps generally do not use an internal coating on the glass (or quartz) tube so UV energy at wavelengths below 200 nm (predominantly 185 nm) is emitted from the lamp. These wavelengths are responsible for ozone production.  There is a separate group of UV-C lamps designed specifically not to produce ozone.  This group is the low-pressure mercury vapor lamps used for germicidal ultraviolet (GUV) applications.  GUV lamps have interior coatings to block UV energy at wavelengths below 200 nm from escaping the tube, so ozone is not created. Unfortunately, ozone-producing lamps and GUV lamps of the same type and size can often be powered using the same electrical connectors and electronic drivers (ballasts).  So, it is critical for the end user to choose the proper lamp for their application.  If they choose a typical GUV lamp for a germicidal application, then ozone is not a concern.  If an end user unknowingly chooses an ozone-producing lamp that happens to fit properly into their GUV device, then ozone exposures will happen. CDC always recommends that end users communicate with the UV device manufacturer or a reputable UV system designer when purchasing replacement UV lamps.

...................................................................................................................................................................

CONTRIBUTORS

ROBERT L. BARD, MD, PC, DABR, FASLMS
Advanced Imaging & Diagnostic Specialist
Dr. Bard received the 2020 nationally acclaimed Ellis Island Award for his lifetime achievement in advanced cancer diagnostic imaging. He co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital imaging technology and has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered sonograms, Power Doppler Histogram, sonofluoroscopy, 3D/4D image reconstruction and the Power Doppler Histogram  are safe, noninvasive, and do not use ionizing radiation. 

MEGAN MELLER, MS, MPH is an Infection Preventionist with Gundersen Health System based in La Crosse, Wisconsin. From a young age, Megan has been passionate about science and the world of infectious diseases. Megan received her Master of Science in Microbiology at Indiana University-Bloomington where she studied alphavirus replication and her Master of Public Health (MPH) from the University of Wisconsin School of Medicine and Public Health. While working on her MPH, Megan worked closely with Infection Control departments and the communicable disease section at the Wisconsin Department of Health Services. In her current role, Megan is the lead Infection Preventionist for Gundersen’s outpatient departments and works closely with infection control partners located at regional hospitals. Megan is also a media consultant for the Infection Control and Infectious Disease departments and serves as an infection control consultant for numerous organizational groups.  


PIERRE KORY, M.D., M.P.A.
Dr. Kory is Board Certified in Internal Medicine, Critical Care, and Pulmonary Medicine. He served as the Medical Director of the Trauma and Life Support Center at the University of Wisconsin where he was an Associate Professor and the Chief of the Critical Care Service. He is considered a pioneer and national/international expert in the field of Critical Care Ultrasound and is the senior editor of the widely read textbook “Point-of-Care Ultrasound” (winner of the President’s Choice Award for Medical Textbooks from the British Medical Association in 2015).  Most recently, Dr. Kory joined the emergency volunteer team during the early COVID-19 pandemic in NYC at Mount Sinai Beth Israel Medical Center. He is also a founding member of the Front Line COVID-19 Critical Working Group (flccc.net) composed of 5 critical care experts that devised the COVID-19 treatment protocol called MATH+. (www.covid19criticalcare.com/)

AARON ENGEL
Mr Engel is Vice-President of Business Development for Fresh-Aire UV, a global leader in UV disinfection technologies. Aaron has 20 years experience in the design, manufacturing and marketing of UV disinfection systems for domestic and international applications including those for residential, commercial and healthcare. Aaron has worked on projects with various groups & associations including the definitive study on UV inactivation of airborne bioterrorism agents sponsored by RTI, the United States EPA & US National Homeland Security. Aaron is frequent guest speaker and lecturer and contributes to publications on IAQ technologies and UV disinfection. Aaron is a member on various ASHRAE committees including TC2.9 Ultraviolet Air and Surface Treatment and the Programs Chair for TC2.9.  www.freshaireuv.com



2) Disinfection and Sterilization Guideline for Disinfection and Sterilization in Healthcare Facilities (2008)
3) US National Library of Medicine National Institutes of Health: The History of Ultraviolet Germicidal Irradiation for Air Disinfection  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789813/
4) Far-UVC light: A new tool to control the spread of airborne-mediated microbial diseases

©Copyright Intermedia Worx Inc./Prevention 101. All Rights Reserved.

Wednesday, July 22, 2020

DOES UV-C HOLD THE PROMISE OF SAFE SANITIZING?

"My disease has played a very great role for my whole development… I was of course interested to know what benefit the sun really gave. During my work towards this goal I encountered several effects of light-- I then devised the treatment of small-pox in red light (1893) and further the treatment of lupus (1895)."-  Niels Ryberg Finsen


Written by: Cheri Ambrose  /   Introduction by: Dr. Robert L. Bard

In our current health crisis, prevention terms like DISINFECTING, SANITIZING or ANTI-BACTERIAL treatments are part of our common reality. Until recently, noxious "bio-killing" chemicals in atomized /spray form has been the most widely available choice on the market. With proper repeated use, fogging, spraying or ionizing chemistries in our living space are the popular option in contaminant prevention, but public concerns about the many possible physiological side effects of atomizing toxins into our air supply call for new alternatives.

Per-room disinfecting UV-C "Robot" (Skytron)
A sustainable upgrade in sanitizing was developed through the use of UV-C light. The CDC recognizes this innovation as one of the 'best disinfecting practices'. Ultraviolet germicidal irradiation (or UVGI) is the use of ultraviolet (UV) energy (electromagnetic radiation with a wavelength shorter than that of visible light) to kill or inactivate viral, bacterial, and fungal species. The UV spectrum is commonly divided into UV-A (wavelengths of 400 nm to 315 nm), UV-B (315 nm to 280 nm), and UV-C (280 nm to 200 nm). The entire UV spectrum can kill or inactivate many microorganisms, but UV-C energy provides the most germicidal effect, with 265 nm being the optimum wavelength. [1]

"VIRAL INACTIVATION": INSIGHTS FROM THE INDUSTRY
(From an interview with Skytron technology)
The earlier studies on the germicidal efficacy of far UVC light were performed exposing bacteria irradiated on a surface or in suspension. Modern developments have since honed the science of deactivating viruses and their ability to contaminate and transmit diseases with proven success when directly applying 222-254nm of UVC light on airborne viruses and microbes. [4]

On a recent interview, UVC expert Michael Czechowskyj of Skytron, a leading domestic manufacturer of infection prevention technologies presents valuable insight on the effectiveness of light disinfectants and the recent market expansion of UVC devices and installations. He discussed its ease-of-use and integrative friendliness of how a UVC device can take over the age-old spraying solutions.

"Today's UVC lamps are fully automated with complete safety features in place. You literally plug it in, start it up and leave the room to go about your day. Once the machine is done, it's perfectly safe that you can enter immediately. Not all sprayers and foggers can let you do that. And under the wait period, especially with ozone foggers, there's no ongoing chemicals that you're spraying or ongoing chemicals to buy either. Another difference is the coverage; with spray sanitizers, the sprayer can often MISS areas, or not spray enough solution in a specific area that needs it. This manual process of spraying leaves so much room for error and uncertainty. Irradiating a room with a UVC system does it all for you. It calculates the treatment time, intensity and because it's light, it gets into all the nooks and crannies to ensure a complete application."


HOW DOES IT WORK?
UV-C devices and lamps uses light wavelengths of around 254 nanometers, which denatures the DNA of the microbe. It creates a Thymine Dimer Pair, which prevents them from replicating. So it essentially does not kill the virus. It prevents it from reproducing, which means it prevents it from being infectious. Within a century of its existence, UV-C technology has maintained a constant design using the 254nm setup with a low pressure mercury amalgam bulb. The latest technology change was the bulb, where we eliminated ozone production. They have a special covering on them, which means that blocks the certain nanometers of light that produces ozone because ozone can be detrimental to humans as well.

Our devices all have a predetermined endpoint- much like filling a bucket of water.  Based on our research and lab studies, our machines identify when to turn itself off once it hits that mark of disinfecting the room. On a safety aspect, its 'dose' or application cycle is contingent upon the exact size of that room. There will be a faint, minor smell (most likely caused by irradiating the many particulates in the air) after the room and we call it "the new smell of clean".

'C. DIFF' TESTED- TOP MARKS IN "KILLING" AIRBORNE VIRUSES
There’s been very few studies done on the SARS COVID-19 virus. Most studies are done on surrogate pathogens. Corona viruses is recognized as a lipid based envelope virus and is fairly easy to kill. As with washing your hands, soap and water alone does a good job of killing this virus. We've also used a lot of similar studies on other types of CoronaViruses like MERS and SARS 14 COVID. Our devices are also calibrated for C-Diff (a spore producing bacteria known to cause a range if disorders from diarrhea to life-threatening inflammation of the colon- a bacteria that is very hard to kill, inactivate or sterilize). It is this lab standard that fosters the health industry's confidence in UVC technology's ability to inactivate the coronavirus.

Our industry undergoes strict efficacy studies with third party labs (to ensure the validity of the data) which is what are our end points were based on. Because of the nature of disinfecting, it's important to gain the confidence of the end user like a hospital- where we try to find more visualization for our clients. Something like a dosimeter color changing device (a device used to measure an absorbed dose of ionizing radiation) lets the director of a medical facility identify the right end point that they're looking for- and to make sure that they know the treatment is working properly.

RECENT APPLICATIONS
Facilitating health and safety protocols in this pandemic, UV-C disinfecting has been made available in smaller and larger applications. There's a smaller device that will disinfect masks in about six minutes. We defer to a lot of what the CDC has done with decontaminating N-95's. We know that not all UVC is created the same-- different bulbs, UVC output, wattage etc. And so, you know, we're real careful to make sure that we're keeping the clinicians as safe as possible and giving the people the information. When disinfecting an entire room, we use something called "dose assurance technology". This feature constantly reads the UVC field in real time; it reads the UVC that's being put out by the lamps and the UVC that is being reflected. We calibrated to a predetermined dose, that when they get to that end point, the machines then shut off knowing they've done their job well - within a specified time vs. ray intensity.

For additional information on UV-C technology or SKYTRON, visit www.skytron.com or contact Mr. Czechowskyj directly at mczechowskyj@skytron.com.



--------------------------------------------------------------------------------------------------------------------------


Images courtesy of www.freshaireuv.com

In 2006, the U.S. Environmental Protection Agency approved a test plan for Biological Inactivation Efficiency by HVAC In-Duct Ultraviolet Light Air Cleaners. (1) The tests were conducted using three organisms, two bacteria (Bacillus atrophaeus and Serratia marcescens) and one bacterial virus (MS2).  These organisms were selected because their sizes, shapes and susceptibility to UV inactivation make them reasonable surrogates for biological warfare agents (BWAs). Generally, vegetative bacteria are readily killed and bacterial spores are more difficult. To model use in a VAC system, RTI used a test duct designed for testing filtration and inactivation efficiencies of aerosol, bioaerosol, and chemical challenges.  The bioaerosol inactivation efficiencies calculated for the three organisms were 9% for B. atrophaeus, 99.96% for S. marcescens and 75% for MS2. The irradiance was measured as 1190 W/cm2 at 161 cm(63 in.) upstream from the lamps with an airflow of 0.93 m3/sec (1970 cfm). The system had four lamps that were burned in for 100 hours prior to measurements.

UV lamps have been used to inactivate airborne microorganisms for many years. Much of the early work was directed at the control of very infectious microorganisms (particularly Mycobacterium tuberculosis, the causative agent of tuberculosis), often in medical facilities. Wavelengths within the short wave, or C band of UV light (UVC), were found to be the most effective germicidal light wavelengths. UVC usually is generated by use of UVC fluorescent lamps. These lamps use electrical discharge through low-pressure mercury vapor enclosed in a glass tube that transmits UVC light (primarily at the mercury wavelength of 253.7 nm). Because this wavelength has been found to be about the optimum for killing microorganisms, UVC from mercury lamps also is referred to as UVG to indicate that it is germicidal. UVG has been shown to inactivate viruses, mycoplasma, bacteria, and fungi when used appropriately.

Due to the recent pandemic, companies developing this technology are (now) on the fast track to advance UVC installations for a wide range of professional and commercial environments.  Specific testing is currently underway as to the efficacy against SARS-CoV-2 (the virus that causes COVID-19) but historically, systems like those developed by Fresh-Aire UV have been tested and proven effective against pathogens that require even greater UVC dosages.  "Every microorganism requires a specific UVC dosage for inactivation including the novel coronavirus. UV disinfection has been employed for decades in water treatment; these microwatt values have been used for reference to gauge UVC efficiency against a large cross-section of microorganisms. UV disinfection systems for room, surface & HVAC are (also) an ideal proactive measure to complement filtration", stated Aaron Engel, VP of Business Development at Fresh-Aire UV. 
--------------------------------------------------------------------------------------------------------------------------


HISTORY
Niels Ryberg Finsen (1860-1904) was the first to employ UV rays in treating disease. He was awarded the Nobel Prize for Medicine in 1903 for his invention of the Finsen curative lamp, which was used successfully through the 1950s. [01]  Updates in the technology for commercial use evolved as UV-C germicidal lamps in the 1930's and have been primarily used in healthcare facilities. UVGI is highly recognized for addressing airborne microbial disease prevention (including influenza and tuberculosis). UVC is proven to prevent airborne transmission by deactivating airborne pathogens, but public use has been curtailed due to its potential to cause cancers and cataracts upon direct contact. [02]

The history of UVGI air disinfection has been one of promise, disappointment, and rebirth. Investigations of the bactericidal effect of sunlight in the late 19th century planted the seed of air disinfection by UV radiation. First to nurture this seed was Richard L. Riley and his mentor William F. Wells, who both discovered the spread of airborne infection by droplet nuclei and demonstrated the ability of UVGI to prevent such spread. With the enduring research of Riley and others, and an increase in tuberculosis (TB) during the 1980s, interest in UVGI was revitalized. With modern concerns regarding multi- and extensive drug-resistant TB, bioterrorism, influenza pandemics, and severe acute respiratory syndrome, interest in UVGI continues to grow. Research is ongoing, and there is much evidence on the efficacy of UVGI and the proper way to use it, though the technology has yet to fully mature.  [3]

...................................................................................................................................................................
Epilogue: Straight Answers from the CDC
In our commitment to publish helpful information about innovative solutions, we rely on top health  authorities to provide us with unbiased clarity and technical standards. We inquired about how UV-C Disinfecting technology truly ranked as the future solution to defeating viruses and transmitted diseases. Steve Martin, PhD, an engineer in NIOSH’s Respiratory Health Division provided us with these valuable statements:

Q: Does the CDC see UV-C Disinfecting as the next trend- evolving from chemical spray sanitizing?
A: No.  CDC understands that germicidal UV technologies, including patient room terminal cleaning devices (sometimes called UV robots), can provide enhanced surface disinfection over the use of chemical disinfectants alone. However, UV technologies, as they currently exist, will never replace manual chemical cleaning in healthcare spaces.  While UV can be very efficient at inactivating pathogens on surfaces, UV-C energy cannot substantially penetrate blood and other bodily fluids, or through other simple spills and splashes that occur in the course of patient care, even those that have dried and left residues. Thus, healthcare surfaces need to first be thoroughly cleaned to remove gross contamination before the UV energy can directly impact the surfaces and provide the most disinfection benefit. Then, UV systems that are properly applied can effectively inactivate many of the pathogens that manual cleaning may have left behind.

Q: From an original post on 2016, CDC warned about potential OZONE output from UV.  It has been evident that companies have since been addressing the testing, preventing and validating of ozone output.  Does CDC have enough data on this upgrade?
A: Concerns about UV lamps producing ozone have existed for decades and there have not been any significant “upgrades” since 2016.  There are some UV-C lamps designed specifically to produce ozone.  Ozone-producing lamps generally do not use an internal coating on the glass (or quartz) tube so UV energy at wavelengths below 200 nm (predominantly 185 nm) is emitted from the lamp. These wavelengths are responsible for ozone production.  There is a separate group of UV-C lamps designed specifically not to produce ozone.  This group is the low-pressure mercury vapor lamps used for germicidal ultraviolet (GUV) applications.  GUV lamps have interior coatings to block UV energy at wavelengths below 200 nm from escaping the tube, so ozone is not created. Unfortunately, ozone-producing lamps and GUV lamps of the same type and size can often be powered using the same electrical connectors and electronic drivers (ballasts).  So, it is critical for the end user to choose the proper lamp for their application.  If they choose a typical GUV lamp for a germicidal application, then ozone is not a concern.  If an end user unknowingly chooses an ozone-producing lamp that happens to fit properly into their GUV device, then ozone exposures will happen. CDC always recommends that end users communicate with the UV device manufacturer or a reputable UV system designer when purchasing replacement UV lamps.


...................................................................................................................................................................


CONTRIBUTORS

ROBERT L. BARD, MD, PC, DABR, FASLMS
Advanced Imaging & Diagnostic Specialist
Dr. Bard received the 2020 nationally acclaimed Ellis Island Award for his lifetime achievement in advanced cancer diagnostic imaging. He co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital imaging technology and has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered sonograms, Power Doppler Histogram, sonofluoroscopy, 3D/4D image reconstruction and the Power Doppler Histogram  are safe, noninvasive, and do not use ionizing radiation. 

PIERRE KORY, M.D., M.P.A.
Dr. Kory is Board Certified in Internal Medicine, Critical Care, and Pulmonary Medicine. He served as the Medical Director of the Trauma and Life Support Center at the University of Wisconsin where he was an Associate Professor and the Chief of the Critical Care Service. He is considered a pioneer and national/international expert in the field of Critical Care Ultrasound and is the senior editor of the widely read textbook “Point-of-Care Ultrasound” (winner of the President’s Choice Award for Medical Textbooks from the British Medical Association in 2015).  Most recently, Dr. Kory joined the emergency volunteer team during the early COVID-19 pandemic in NYC at Mount Sinai Beth Israel Medical Center. He is also a founding member of the Front Line COVID-19 Critical Working Group (flccc.net) composed of 5 critical care experts that devised the COVID-19 treatment protocol called MATH+. (www.covid19criticalcare.com/)



MICHAEL CZECHOWSKYJ MSN, RN
Taking care of patients at the bedside is where Mike Czechowskyj started his nursing career.  After caring for patients in the Progressive Care and Burn ICU, he advanced into different leadership positions at Spectrum Health.  There he helped educate new staff, build new programs and advanced nursing practice.  He then joined the Spectrum Health Innovations team where he worked with local businesses, health systems, and universities to create new medical devices that would help patients and healthcare providers.  This led him to one of their partners, Skytron, where Michael now provides leadership for the Infection Prevention team. www.skytron.com


AARON ENGEL
Mr Engel is Vice-President of Business Development for Fresh-Aire UV, a global leader in UV disinfection technologies. Aaron has 20 years experience in the design, manufacturing and marketing of UV disinfection systems for domestic and international applications including those for residential, commercial and healthcare. Aaron has worked on projects with various groups & associations including the definitive study on UV inactivation of airborne bioterrorism agents sponsored by RTI, the United States EPA & US National Homeland Security. Aaron is frequent guest speaker and lecturer and contributes to publications on IAQ technologies and UV disinfection. Aaron is a member on various ASHRAE committees including TC2.9 Ultraviolet Air and Surface Treatment and the Programs Chair for TC2.9.  www.freshaireuv.com


2) Disinfection and Sterilization Guideline for Disinfection and Sterilization in Healthcare Facilities (2008)
3) US National Library of Medicine National Institutes of Health: The History of Ultraviolet Germicidal Irradiation for Air Disinfection  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789813/
4) Far-UVC light: A new tool to control the spread of airborne-mediated microbial diseases

©Copyright Intermedia Worx Inc./Prevention 101. All Rights Reserved.

Monday, July 20, 2020

Sonographic signs and patterns of COVID-19 pneumonia

by: Giovanni Volpicelli & Luna Gargani  / Published: 21 April 2020





Abstract
The pandemic of COVID-19 is seriously challenging the medical organization in many parts of the world. This novel corona virus SARS-CoV-2 has a specific tropism for the low respiratory airways, but causes severe pneumonia in a low percentage of patients. However, the rapid spread of the infection during this pandemic is causing the need to hospitalize a high number of patients. Pneumonia in COVID-19 has peculiar features and can be studied by lung ultrasound in the early approach to suspected patients. The sonographic signs are non-specific when considered alone, but observation of some aspects of vertical artifacts can enhance the diagnostic power of the ultrasound examination. Also, the combination of sonographic signs in patterns and their correlation with blood exams in different phenotypes of the disease may allow for a reliable characterization and be of help in triaging and admitting patients.

Chest imaging is in the front door in the diagnostic approach to any patient with respiratory and infective symptoms during this COVID-19 outbreak. The novel corona virus has a specific tropism for the low respiratory airways and the main complication of the disease is pneumonia. Analysis of chest CT scans from patients with COVID-19 allowed important conclusions about the main aspects of the disease [1,2,3]. The characteristic feature visible in all patients with pneumonia is the Ground Glass Opacification (GGO), a descriptive term indicating interstitial alteration of the lung parenchyma. This was variably associated with peripheral consolidations and crazy paving, a more advanced interstitial alteration where the GGO is combined with interlobular thickening. COVID-19 typically induces an interstitial diffuse bilateral pneumonia with lesions in asymmetric and patchy distribution involving mainly the lung periphery, which makes it particularly suitable for an ultrasound investigation. Alternation of GGO with crazy paving and consolidations can be well depicted by lung ultrasound (LUS). Finally, LUS imaging is also useful to observe the regional distribution of these patterns and describe the patchy bilateral spread of lesions.

Main signs at lung ultrasound
The sonographic signs of interest in COVID-19 include all those which are well known in ARDS. These are the B-lines in various forms, both separate and coalescent, irregular or fragmented aspect of the pleural line, and small peripheral consolidations. Explanations and demonstrations of all these signs can be easily found in the vast existing literature on the topic [4]. However, in the diagnosis of COVID-19 some specificities need to be considered.

B-lines B-lines in COVID-19 pneumonia are visualized in all their possible forms. We may describe COVID-19 pneumonia as a storm of clusters of B-lines, both in separate and coalescent forms, sometimes giving the appearance of a shining white lung. They can arise from one point of the pleural line and from small peripheral consolidations and spread down like rays maintaining their brightness until the edge of the screen without fading. These artifacts represent the typical signs of the disease, but can be also observed in other interstitial diseases of various etiologies [4]. However, we are observing that one peculiar aspect of these artifacts is invariably visualized in the early phases of COVID-19 pneumonia (unpublished data). It is a shining band-form artifact spreading down from a large portion of a regular pleural line, often appearing and disappearing with an on–off effect in the context of a normal A-lines lung pattern visible on the background

In our opinion, this sign is demonstrative of a very acute phase of GGO lesions during the early spread of the active disease, when limited areas of lesions alternate with preserved lung parenchyma. Other Chinese authors called this sign “waterfall”, without further characterizing it [5]. They did not differentiate this vertical artifact from other less specific signs, like coalescent B-lines arising from peripheral consolidations or from a very irregular pleural line. We think that the name “light beam” can well describe this artifact, as a large beam of light sometimes appearing and disappearing during respiration. Identifying this band-form sign as the one arising from a large portion of a regular pleural line helps characterizing the LUS pattern. As a technical note, it is crucial to use a convex probe with a large emission surface and low frequency to visualize the light beam more reliably. It is also important to position the focus at the level of the pleural line to prevent misinterpretations of the vertical artifacts.

TO SEE COMPLETE ARTICLE, VISIT: THE ULTRASOUND JOURNAL/SPRINGER

References
1. Wu J, Wu X, Zeng W et al (2019) Chest CT findings in patients with corona virus disease 2019 and its relationship with clinical features. Invest Radiol. https://doi.org/10.1097/rli.0000000000000670

2. Zhao W, Zhong Z, Xie X et al (2020) Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: a multicenter study. Am J Roentgenol 3:1–6. https://doi.org/10.2214/AJR.20.22976

3. Zhou S, Wang Y, Zhu T et al (2020) CT features of coronavirus disease 2019 (COVID-19) pneumonia in 62 patients in Wuhan, China. Am J Roentgenol 5:1–8. https://doi.org/10.2214/AJR.20.22975

4. Volpicelli G, Elbarbary M, Blaivas M et al (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38(4):577–591. https://doi.org/10.1007/s00134-012-2513-4

5. Huang Y, Wang S, Liu Y et al (2020) A preliminary study on the ultrasonic manifestations of peripulmonary lesions of non-critical novel coronavirus pneumonia (COVID-19). SSRN. https://doi.org/10.2139/ssrn.3544750

6. Nazerian P, Cerini G, Vanni S et al (2016) Diagnostic accuracy of lung ultrasonography combined with procalcitonin for the diagnosis of pneumonia: a pilot study. Crit Ultrasound J 8(1):17. https://doi.org/10.1186/s13089-016-0054-8


Rights and Permissions
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Sunday, July 19, 2020

Chest Ultrasound- Smart Uses in identifying Respiratory Issues







“When conducting lung ultrasound scanning, you look for signs of B-LINES. The more B lines you have equals a bad lung ultrasound score – indicating a high risk of deterioration. For any treatment protocol, if a patient whose lung ultrasound scan was getting worse, I might want to start escalating my therapy.” – Dr. Philippe Kory, MATH+

Monday, July 6, 2020

COALITION OF GLOBAL SCIENTISTS IN SOLIDARITY TO SAVE LIVES

Collaborative Action Behind COVID-19 Tools R&D supported by The UN Foundation
By: Rachel Bridges-  Senior Global Health Advocacy and Communications Manager for the United Nations Foundation  |    Edited by: Prevention101.org


"The COVID-19 pandemic has demonstrated the interconnected nature of our world – and that no one is safe until everyone is safe.  Only by acting in solidarity can communities save lives and overcome the devastating socio-economic impacts of the virus.  In partnership with the United Nations, people around the world are showing acts of humanity, inspiring hope for a better future." - The United Nations, We’re All in This Together. 

Photo credit: Institut Pasteur (courtesy of the UN Foundation)
The United Nations Foundation (UN Foundation) is one of the fiduciary partners behind the COVID-19 Solidarity Response Fund for the World Health Organization (WHO).  The foundation supports WHO and partners’ efforts to prevent, detect, and respond to the global COVID-19 pandemic around the world, especially in vulnerable areas. The Coalition for Epidemic Preparedness Innovations (CEPI), an organization helping to lead the discovery of potential COVID-19 vaccines, received a $10 million disbursement through the Fund to help catalyze and coordinate global vaccine research and development. The UN Foundation also works closely with the WHO, and other partners, to help share the most up-to-date scientific information with the public about COVID-19 which WHO generates and amplifies through its global coordination of the COVID-19 response.

While research developments are still in early stages, we are seeing the fastest R&D efforts in human history unfold. Through WHO’s leadership, a genetic sequence of the novel coronavirus (COVID-19)—a previously unknown disease—was shared with the world just 2 weeks after its initial discovery. Through coordinated efforts led by WHO, research and development is rapidly moving forward so that everyone, everywhere can have access to tools to help prevent, detect, and respond to COVID-19. Some examples of these efforts include:
    Photo credit: University of Queensland (courtesy
    of  the UN Foundation)
  • WHO’s global Solidarity Trial aims to rapidly develop an effective treatment for COVID-19. As of mid-August 2020, the Solidarity Trial has more than 3500 patients enrolled with more than 100 countries participating, including more than 400 hospitals in 35 countries alone. According to the WHO, the Solidarity Trial will reduce the amount of time it normally takes for a drug trial to determine effectiveness by 80%. This, combined with the size and geographic breadth of the trial, will provide a strong evidentiary basis behind specific therapies that can then be acted upon quickly by health systems.
  • WHO has published a research and development roadmap, with a set of protocols for how studies should be done to create potential therapeutics or vaccines. 
  • WHO is already working with scientists across the globe on over 120 different candidate vaccines for coronavirus with eight already in clinical trials in record time — just a few months after sequencing the gene.
  • 10 vaccine candidates in clinical evaluation and 123 in pre-clinical evaluation
In addition to the R&D work WHO and the Fund are helping to support, resources through the Solidarity Response Fund are helping to supply critical personal protective equipment, biomedical supplies, and infection prevention and control measures for vulnerable populations like refugees and displaced people.

Photo credit: UNICEF
Photo credit: UNICEF
As a global effort, donors from more than a 190 countries generously gave to COVID-19 relief efforts through the COVID-19 Solidarity Response Fund. These resources are also helping to support countries around the world get vital information to help protect communities, as well as critical supplies to help prevent, detect, and respond to this global pandemic. As of the beginning of August 2020, WHO has shipped more than 200 million items of personal protective equipment and more than 5.6 million pieces of testing equipment to more than 130 countries. The Fund also supports the work of the World Food Programme, the UN refugee agency (UNHCR), UNICEF, and the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) to work in many vulnerable countries and settings including Bangladesh, Syria, Lebanon, Jordan, Gaza, Kenya, and South Sudan to support at-risk refugee or displaced populations. You can learn more about the Fund’s impact here.

The UN Foundation helps support COVID-19 treatment research through mobilizing resources via the COVID-19 Solidarity Response Fund, as well as supporting WHO and partners working to discover COVID-19 treatments through advocacy and communications efforts with policy makers, global funders, and the general public. We help share scientific information as its being discovered, as well as advocate for continued investments in this critical research and development efforts being coordinated by WHO and global partners like UNITAID, the Global Fund, and others through the ACT Accelerator. 

WHO plays a critical role in coordinating a range of global health initiatives, including the global response to COVID-19. To this point, it has served as the global coordinator of efforts to develop vaccines, tests and treatments; trained millions of health workers; distributed millions in medical supplies, while also continuing the fight against other major health threats that matter to Americans like malaria, measles, and HIV/AIDS.

Currently, WHO’s efforts and the global COVID-19 response are undergoing challenges due to political challenges between member states. However, WHO’s global scientific research initiatives continue to forge ahead toward its imperative to resolve the pandemic. Only though coordinated and collaborative action can we stop this virus for everyone, everywhere. To help support WHO and partners’ global COVID-19 response, visit the COVID-19 Solidarity Response Fund website.



ABOUT THE AUTHOR:

Rachel Bridges is passionate about creating impactful communications to help foster global change in her role as the Senior Advocacy and Communications Manager for Global Health for the United Nations Foundation. Prior to her time at the United Nations Foundation, she worked on various global health issues, including HIV/AIDS, tuberculosis, and neglected tropical diseases for the U.S. Agency for International Development. She holds a Master of Public Health degree from Washington University in St. Louis and a B.A. in English and French, with a minor in Women’s and Gender Studies, from Furman University. 





SCIENTIFIC ALLIANCES:  UNITED MINDS ON A COMMON MISSION
World medical conferences and international forums unite
multidisciplinary experts to continue global info-sharing

This pandemic has clearly illustrated that "Scientists by nature do not see borders or politics - only solutions", states Dr. Robert Bard, cancer diagnostics expert (NYC). "The spirit of teamwork is alive and well with this community- especially in a crisis. Historically, medical and scientific people have always raced to the front lines - always at the ready to pool resources and collaborate. Like the domestic and international health associations, we continue to see some of the sharpest clinical minds in the world- including American teams that are now coming out with promising protocols to help end this pandemic. To contain and eliminate this human threat means UNITING WITH SCIENCE AND WORKING TOGETHER ON A COORDINATED GOAL."

Such is the case with this remarkable grouping of like minds under a targeted objective. They call themselves The Front Line Covid-19 Critical Care Alliance - highly published critical care specialists from major academic medical centers with collectively over 1,000 medical publications.

Meet Some of the "Top Medical Minds in the Front Lines"
(Founding members & clinical advisors of MATH+ formed The Front Line Covid-19 Critical Care Alliance).

Based on the rapidly emerging research into COVID-19, the early clinical experience in China reflected by the Shanghai expert commission, and their decades-long clinical and research experiences in severe infectious diseases around the country, the 5 experts developed the MATH+ Hospital Treatment Protocol for Covid-19. It is intended for use early in the hospitalization of patients presenting with states of respiratory distress requiring supplemental oxygen. These 5 have since been joined by an increasing number of hospitalist and ICU physicians who recognize the sound physiologic rationale, the emerging published research in support of the components, and the data demonstrating good clinical outcomes in hospitals that have adopted the treatment regimen.

Methylprednisolone & MATH+: Treatment Success Data from the Nation's "HOT SPOTS"

With a confirmed global count of 9.27+ Million cases and 470,000+ deaths, the world continues its desperate search for a treatment that will save the lives of COVID-19 patients who come into the ER or hospital with low oxygen levels or struggling to breathe. Where the more popular treatment for patients in ICU is the use of ventilators, a reported 80-85% of Covid-19 patients on ventilators in New York end up dying (Associated Press and state and city officials).

The corticosteroid Methylprednisolone is a key component, based on large studies that have proven its effectiveness in prior viral pandemics‐ and whose potency is significantly increased when administered intravenously with high doses of the antioxidant Ascorbic acid (Vitamin C). Thiamine (Vitamin B1) is given to optimize cellular oxygen utilization and energy consumption, protecting the heart, brain, and immune system and the anticoagulant Heparin prevents (or breaks up) blood clots that increasingly appear as illness worsens. The + represents other supportive treatments by the administering doctor for patients who present other pre‐existing conditions (as needed). The group also plans to add or change components and dosing as published medical literature evolves.

LATEST UPDATES: According to physicians implementing the MATH+ Covid-19 treatment protocol, conclusive data shows significant success by as much as 97%, where only 3-6.6% mortality- from hospital reports including the VIRGINIA DEPT. OF HEALTH. (See complete report)

See LINK for complete "ESSENTIALS on MATH+ Covid-19 intervention protocols"




"MATH+ Saved my Life"- patient story

       


VIEWPOINTS


MEGAN MELLER, MS, MPH - Infection Control at Gundersen Health System
As soon as SARS-CoV-2 began generating international attention, I knew that the scientific community would rally. After working in a virus research lab for 3 years, I know that science and passion often go hand in hand. Collaboration is at the heart of research, especially successful research but it is also notoriously a slow and methodical process. Rushed science is often flawed, which is why peer-review and open access is so critical. … We live in historical times and pandemics set the stage for innovation (e.g. Solidarity Trial and Solidarity Response Fund). Most vaccine technology is the product of many years of hard work. International emergencies have a way of opening the peoples' eyes to fields that typically operate away from the worlds eyes (e.g. research, public health, Infection Control).




EPILOGUE:  Epidemiology

By: Lennard M. Gettz & Cheri Ambrose/ NY Cancer Resource Alliance

June 24, 2020- Months into the CoronaVirus pandemic, the tally of efforts expended by government health agencies and professionals worldwide has been noted to significantly exceed any global campaign in history.  Economists tend to use war terms to help put the pandemic's containment efforts and collateral damage in perspective.  IMF's chief economist Gita Gopinath,  (in an April 15 news conference) stated that "the best case scenario, the world is likely to lose a cumulative $9 trillion in output over two years"- making this a global war 3x the fiscal size of World War II.

As with past wars, alliances were formed, industries were committed to task and scientists worldwide have united by sharing information toward this single directive. The Department of Global Communications (U.N.) announced their drive to mobilize global cooperation in science-based COVID-19 responses, "The United Nations is mobilizing international cooperation to harness the power of science to tackle the coronavirus pandemic, while also working with partners to explore innovative crisis response tools."

Unlike the early months of the year, the second quarter showed the front lines to finally "catching up to the war efforts" with installments of these comprehensive containment measures:
  • a dedicated testing strategy & global data tracking
  • ample access to Covid tests and antibody testing
  • policy enforced education about preventive and safety guidelines
  • ample manufacturing of medical equipment and medicines
  • consistent PPE supply & distribution chains
  • trained critical care response personnel
  • lab research for therapeutics and vaccines






Other articles recently published in Prevention101.org

"The Power of Prevention of Covid-19 is in YOUR HANDS"
Source: MD Anderson Cancer Center
Watch how a blacklight reveals what improper hand washing can leave behind. According to Dr. Christina Le-Short of MD Anderson Cancer Center, "Cancer patients are at greater risk of developing complications from respiratory viruses... Effective hand-washing is your best defense against germs that cause the flu or Covid-19". 





Possible Health Hazards Behind the Mask
Source: NIOSH SCIENCE BLOG
Reports about Prolonged PPE Use by healthcare workers are aligned with health issues from abnormally elevated carbon dioxide (CO2) levels in the blood causing increased pressure inside the skull, nervous system changes, cardiovascular effects and reduced tolerance to lighter workloads that may lead to possible dizziness, hyperventilation and dehydration. View the report by the CDC about the many physiological effects of breathing increased concentrations of CO2 and the effects of failing overused respirator masks: See complete article






Suggested Safety Measures for Covid Prevention in Medical Offices  From respirators to hand sanitizers to regular use of hospital-grade disinfectants, the medical community is trusted to apply and set standards when it comes to safety measures, risk prevention strategies and sanitizing efforts. This new article offers a collective set of smart and sensible safety ideas from a group of doctors in your area. Promoting SAFETY GUIDELINES in any health practice is everyone's duty in our community.  See complete article




References:
1) Some doctors moving away from ventilators for virus patients: https://apnews.com/8ccd325c2be9bf454c2128dcb7bd616d



2) Global economy to be worst hit since Great Depression: Gita Gopinath, Chief Economist, IMF
















6) Study: 88% of coronavirus patients on ventilators died in NY




7) Coronavirus patients on ventilators are unusually likely to die, causing some doctors to change strategy




8) Texas Medical Center Data: https://www.tmc.edu/




9) Nearly 9 in 10 COVID-19 patients who are put on a ventilator die, New York hospital data suggests




10) Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area




11) Center for American Progress: Removing Barriers for Immigrant Medical Professionals Is Critical To Help Fight Coronavirus  https://www.americanprogress.org/issues/immigration/news/2020/04/02/482574/removing-barriers-immigrant-medical-professionals-critical-help-fight-coronavirus/




12) UN Foundation: HOW THE WORLD’S SCIENTISTS, DOCTORS, AND NURSES ARE UNITING TO FIGHT COVID-19  https://unfoundation.org/blog/post/how-worlds-scientists-doctors-and-nurses-uniting-fight-covid-19/




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