Thursday, December 17, 2020

Survival Guide from ICU Docs & the "Four D's" of Airborne Transmission

"Arguably, most doctors are not like us... we are the last line with the dying and (those with) the most severe illnesses. We are conditioned to work creatively and more aggressively under a major time limit... to reverse life threatening disorders."

Dr. Pierre Kory: Interview with an ICU Critical Care Physician

ON PREVENTION: I'm probably not the best example of maintaining health through Covid because it's pulled me in many different directions that personal health is not a premium. I've been just working, I'm working on fighting and writing and getting involved with trying to help folks treat this disease. I mean, exercise has been definitely on the back burner, but certainly now that things have calmed down a little bit, certainly exercise is a premium for me. 

Ever since the early pandemic, when quite a few healthcare providers got sick, INFECTION CONTROL was really consistent with what you needed in order to operate in a clinical area, whether it's COVID or any other event. The routine mask wearing regular hand-washing and gown donning has gotten us all through. 

 I did five weeks straight in an ICU since May- it was all COVID and none of us got ill.  In fact, when I was at Mt. Sinai/Beth Israel, not one intensivist in that division (pulmonologists) who were seeing patients in all spheres both on and off ventilators contracted the virus.  You have to understand a person on a ventilator is much less risky because you're on a ventilator, it's kind of a closed system. So their exhaled air is not going to expose to providers. There's patients who are not on ventilators, who are breathing very heavy. They're spewing a lot of virus in the hair. And WEARING A MASK CONSISTENTLY throughout the day is really important.  Those three things-  HAND WASHING, MASK WEARING and GOWNS- they will carry you through.  I'm at this now six months and I haven't gotten sick- knock on wood. My wife is pulmonary critical care specialist. She sees as much Covid as I have, but none of us have gotten nailed just by sticking to the basics. 

ON SUPPLEMENTS: Certainly vitamin D vitamin C, Zinc and Quercetin are some of the essentials. Though it's not clear if we're taking enough concentrations to help, but there's some supportive evidence for it. But certainly C and D seems to be key in not only mitigating the development or the acquisition of the attraction, but also the severity and impact.  The other one that I take routinely for years is Melatonin at night and tell him it appears to be very protective against acquiring the infection.  They're cheap, they're easy - taking supplements is really a kind of a no brainer with very little down sides.

ON THE THEORY OF AN AIRBORNE PATHOGEN: I feel very strongly about it. Since early May, we noticed how people got ill and the ways in which they got ill early on, it was clearly airborne. So many people have been debating this for months- something like 275 scientists wrote open letter to the world health organization in July telling them that all the evidence suggests that this is airborne transmission.  There's a multitude of events  which clearly supports this-  that's why it's really important that we all wear a mask, especially indoors. 

The real factors that would lead to airborne transmission is for me is generally occurring indoors- from what I call THE FOUR D's, which is the DURATION that you'll spend in that room, the DIMENSIONS of the room- this reflects on less ambient air flow in a smaller space where there's more of a likelihood that the exhaled virus can  build up to a sufficient concentration for you to inhale it. Next is the DENSITY or the crowd size that raises your probability.  And then there's the presence of a DRAB. There's a number of experiments and publications have shown just having an open window in a room appears to be very protective because it dilutes the concentration of the exhale virus. And so it makes it much less likely you're going to get infected. You have to inhale a significant concentration of a virus- what's called INOCULUM. If you're in someplace with ambient air for short term or a very large room, it's very unlikely that you're going to get infected. And so it's really about small confined, poorly ventilated spaces with a lot of people like ours- and places like bars where everyone's on top of each other or the crowded areas where you might have a high density of people. 

ON MASKS:  Based on just tons of epidemiologic data, which shows that the incidence of infection and transmission plummets when you have a certain percentage of people even wearing standard masks. My opinion on this subject evolved since in the beginning, the way I understood the airborne transmissions that everybody needed an N95 in order to fully protect themselves. But if everybody around you is wearing a mask, (as well as you) the dual mask wearing is as good as if one of you had an N95 to protect themselves. And the reason for that is because those tiny droplets that you can inhale are bursts from larger droplets. And if you're wearing any covering the big spindle or the large droplets that emit when you talk, they all get trapped in those standard masks. They're actually quite protective. So my belief is masks for all!

Respirator vs. Surgical Mask - What's the Difference?
Written by: Dr. Robert Bard, MD, PC, DABR, FASLMS  |  Edited by: Lennard M. Gettz

Months into the pandemic, we have confirmed that following CDC safety and prevention guidelines of wearing some approved form of face covering in public (or around others) is directly connected to the reduction and control of Covid-19 infection rates.  Time and time again, scientists and medical experts have valid proof that viruses travel through micro-droplets in the form of airborne contaminants. 

Fact: ANY PPE is better than NO PPE!  The science of prevention states that measures toward a reduction in risk can greatly support life-saving others - and yourself.  Meanwhile, discerning the difference between face coverings, specifically MASKS vs RESPIRATORS can be useful in identifying which situation to use which type of mask. There is a significant difference between the two, and wearing one vs. the other provides differing results.

The FDA defines a surgical mask as a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. If worn properly, a surgical mask is meant to help block large-particle droplets (NOT MICRO-DROPLETS), splashes, sprays, or splatter that may contain germs (viruses and bacteria), keeping it from reaching your mouth and nose. Surgical masks may also help reduce exposure of your saliva and respiratory secretions to others. While a surgical mask may be effective in blocking splashes and large-particle droplets, a face mask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the mask and your face.

Meanwhile, an N95 respirator is an "efficient filter and a respiratory protective device designed to PROTECT YOU from airborne particles". Note that the edges of the respirator are designed to form a seal around the nose and mouth. Surgical N95 Respirators are commonly used in healthcare settings and are a subset of N95 Filtering Facepiece Respirators (FFRs), often referred to as N95s because it is actually rated by NIOSH to keep out or resist an estimated 95% of the harmful particulates in the air. [11]

"GETTING THE SHOT"- A Move Towards Progress  By: Rebecca Nazario
Getting the vaccine is a key way that we can protect ourselves, our families, our community and our colleagues. The vaccine is safe and effective. Although its development happened quickly, it went through all the same kinds of testing and rigorous approval that any vaccine does.  I posted my selfie on LinkedIn "getting the shot" because there's so much apprehension out there... especially in our minority communities.  As a Cuban American I know there’s a lot of the mistrust and fear is based on rumors that run rampant through our communities, not the science.  I strongly believe we can lead through example, and a picture is worth a thousand words! My goal is to be a small drop that creates a lot of ripples that ultimately instills more confidence. We need to empower each other to pass that message along, and dispel the rumors in whatever way possible.

IVERMECTIN: A Covid-19 Game-Changer?
On Dec 8, 2020, committee chairman Republican Sen. Ron Johnson called ICU Pulmonary specialist Dr. Pierre Kory of the Aurora St. Luke’s Medical Center (WI) and president of the FLCCC to the US Senate Homeland Security and Governmental Affairs Committee.  The hearing was called “Early Outpatient Treatment: An Essential Part of a COVID-19 Solution, Part II.”  Dr. Kory gave his testimony on behalf of frontline physicians about the current state of care in the Covid pandemic and what his group specifies as the logic-based treatment with scientifically proven data that he pleads the NIH to review.  (
See complete video and Transcript of Dr. Kory's Testimony)


COVID-19 was rapidly understood as a disease caused by severe and widespread inflammation and “hypercoagulability” (a tendency to spontaneously form clots in the blood vessels. Autopsies have revealed extensive small vessel strokes, with such strokes often occurring despite aggressive blood thinner treatment and regardless of the timing of the disease course, suggesting that it plays a role very early in the disease process. In one autopsy series, there was a widespread presence of small clots with acute stroke observed in over 25%. In a recent review of the incidence of stroke in COVID-19, almost 2% of all hospital patients suffered a stroke, which is 8x higher than in patients with influenza. More worrisome is that this is almost definitely a gross underestimate given the many likely missed strokes in patients who died on ventilators who were too ill to obtain imaging, the general restrictions on and lack of autopsies, and the well-recognized decrease in the number of patients with acute stroke symptoms seeking medical attention in the COVID-19 era.  (go to complete article)

THE KIRBY PROJECT: Re-assessing the "Deadly" Cost of Cancer Meds
According to a report from the NIH, "the cost of cancer care is the most rapidly increasing component of U.S. health care spending and will increase from $125 billion in 2010 to an estimated $158 billion in 2020, a 27% increase. Most experts agree that the current escalation of costs is unsustainable and, if left unchecked, will have a devastating effect on the quality of health care and an increasing negative financial impact on individuals, businesses, and government."  A coalition of patient advocates kickstared by 2x cancer victim Kirby Lewis enacted an initiative to speaks for the countless cancer patients in this country that are drowning from the high cost of cancer meds. "Insurance never covers everything- especially when it comes to drastic cases like cancer. If you're lucky, most insurance covers 50% - or even at the very best, 90% - and a vial of chemo that might be $20,000 you still have to pay a balance or a copay that can easily wipe your family out!" (see complete article)

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