Journal of Modern Healing

Saturday, January 23, 2021

THE PULSE OXIMETER + SMART WEB SEARCHING

Does the Pulse Oximeter Belong in Your Home Health Monitoring Kit?
by: Dr. Robert L. Bard

Almost a year into the pandemic, we have seen waves of empty shelves of specific items due to panic shopping or the recent burst of proactive health trends. This reflects a significant part of "the Covid Culture"- comprising the demand for personal safety measures (beyond the holy trinity of masking, distancing and hand hygiene). A large part of our population also subscribes to proactive health measures in the home which includes a daily regimen of immune-boosting health supplements. In addition, more and more drug store shelves continue to stock up on self-check devices including the hand-held infrared THERMOMETERS, BLOOD PRESSURE CUFFS, SPIROMETERS and THE PULSE OXIMETER.

THE PULSE OXIMETER- is an electronic device that clips onto a patient’s finger to measure heart rate and oxygen saturation in his or her red blood cells—the device is useful in assessing patients with lung disease.

According to a report from the Yalemedicine.org, "Pulse oximeters started to fly off store (and online) shelves when people learned that low oxygen saturation levels can be a sign of COVID-19. The logic is that shortness of breath, a symptom of the disease, may not be easy—or even possible—for a person to reasonably self-assess. What’s more, doctors report that some COVID-19 patients suddenly develop a condition called “silent hypoxia,” where people look and feel comfortable—and don’t notice any shortness of breath—but their oxygen levels are dangerously low. It happens to patients both in the hospital and at home, but it is a particular problem in the latter case because the symptom may indicate severe COVID-19-related pneumonia, requiring a ventilator. That’s why some people may want or need to monitor their oxygen saturation levels at home." [1]

There are various schools of thought when it comes to this device. Physicians often use this as a preliminary for gathering a patient's vitals. Though highly useful for its quick and portable data-grab, common belief is that the oximeter is not relied upon for more than this. In fact, interviews with paramedics have recommended the use of the Capnograph vs. the Oximeter as a portable diagnostic for presence of lung disease and forms of congenital heart disease. [2]

The idea of home testing remains a valid protocol for wellness maintenance and prevention, and having a small arsenal of home testing devices (if used correctly) can certainly support this. Regular self-checks of one's circulatory performance strongly supports a lifestyle of safety and survivorship from the pandemic and disease in general. But nothing tops primary monitoring like watching for coughs, shortness of breath, muscle pain and loss of taste and smell [1].

How to get a Proper OxySat Reading
In symptomatic patients, monitoring with HOME PULSE OXIMETRY is recommended (due to asymptomatic hypoxia). The limitations of home pulse oximeters should be recognized, and validated devices are preferred. Multiple readings should be taken over the course of the day, and a downward trend should be regarded as ominous. Baseline or ambulatory desaturation < 94% should prompt hospital admission. The following guidance is suggested:

o Use the index or middle finger; avoid the toes or ear lobe
o Only accept values associated with a strong pulse signal
o Observe readings for 30–60 seconds to identify the most common value
o Remove nail polish from the finger on which measurements are made
o Warm cold extremities prior to measurement

[3] Source: FLCCC.net (Front Line Covid-19 Critical Care Alliance) / Contributor: Dr. Pierre Kory

The ARDS / Covid-19 Connection?

Acute Respiratory Distress Syndrome (aka: Acute Lung Injury / Noncardiac Pulmonary Edema) is a serious lung condition that causes low blood oxygen where fluid builds up inside the tiny air sacs of the lungs (alveoli). This condition disables air from properly entering the lungs and moving enough oxygen into the bloodstream and throughout the body. [4] Experts from Yale Medicine state that "when the virus that causes coronavirus disease enters the body, it frequently attaches to cells in the upper airway... When this occurs, COVID-19 can lead to ARDS, typically setting in about eight days after the onset of initial symptoms. Certain risk factors increase the likelihood of the development of ARDS in people with COVID-19, including advanced age, diabetes, and high blood pressure". [5]

Covid-19 Resources: WHO (and HOW) to Believe

"In our complex information age, what we choose to believe defines us." The explosion of materials about the Coronavirus pandemic has reshaped the relationship between digital media and public readership. Today's web searcher is inundated by a tsunami of information, such that selective and intelligent searching, fact-checking and source-validating (or vetting) has become a major necessity in the daily course of education through the web.

The widely promoted prevention protocols (of masking, distance and hand hygiene) have conditioned us all toward proactive health consciousness- driving us to want to learn more and stay in touch with the current pandemic updates. Public health agency sites like CDC.gov, NIH.gov and the WHO.int are some of the top sources for these updates, offering a comprehensive list of resources and the latest proven information on personal safety, care, prevention and treatment solutions.

Meanwhile, medical experts and societies have also joined this worldwide coalition for public awareness and info-sharing. One such association is the IDSA (Infectious Disease Society of America), a 50+ year old community of public health experts allied with major groups like the American Federation for Clinical Research (AFCR), the American Society for Clinical Investigation (ASCI), and the Association of American Physicians (AAP). The ISDA formed a branch called the Covid-19 Real-Time Learning Network, featuring a complete, well-maintained resource forum for the general public and the medical community. (see: link) This type of institutional resourcing brought full access to expert information, empowering the proactive researcher to a wider level of understanding- from current health news, updates on Covid safety guidelines and infection prevention.

How Healthcare Pros Battle the Pandemic

By: Evan M. Ludin , MS, OTR/L, CHT

Due to the many risks in outpatient care, I hope that my receiving the first dose and publicly promoting it will encourages cohorts, colleagues, patients and others to follow suit in registering to receive theirs. Pfizer, Moderna and so many others are reputable Biotech/Pharm companies with a long history of success in their respective field. This vaccine stands for so much today in the eye of public health and science. With the advancements in science, the opportunity to push forth with mRNA vaccines for other diseases and viruses sheds light on future health. With early work showing a 94/95% success rate, that demonstrates and presents an opportunity for those at risk for getting ill, or those at high risk due to comorbidities of getting ill a sense of hope and resolution. The question will be- for how long?

As for prevention and prophylaxis, constant hand washing and gloves have always been a part of my routine, however face masks will definitely become an everyday routine. I have always been an advocate for overall wellness and health. At present, I personally find comfort in taking daily multivitamins in addition to vitamin C, Vitamin D and Zinc, all of which “may help in supporting a healthy immune system. I encourage others to be sure to consult with their pharmacist to discuss possible interactions and to consider taking as well.

Image Source: Evan Ludin's Linkedin post

Additional Features:

HEALTH & SAFETY MOVEMENT 2021: "GET THE SHOT"

NYCRA NEWS and PREVENTION101 continues its mission to share the viewpoints of experts, renowned educators and health advocates in the spirit of expanding public knowledge. For this series, we connect with healthcare worker Dr. Michael Schulder, a leading Northwell Health neurosurgeon in Manhasset, NY. He is one of the first to share his insights and his personal research on the safety and efficacy of the recently deployed Coronavirus vaccine. Dr. Schulder also addresses his views on public skepticism about the vaccine over some of the unknown factors of the coronavirus. He shares his confidence in the science and the preventive strategy of the vaccine as well as its social impact on the global stage. See Feature article

MEDICAL IMAGING REVIEW: WHAT DOES A COVID LUNG LOOK LIKE?

All research and testing programs undergo an evolutionary staging of its data-gathering and problem solving approach. In the case of testing for the physiological effects of Covid-19, researchers have employed standard medical diagnostic protocols from genetic/blood testing to biopsies to all available medical imaging devices) to gather all necessary data. These protocols independently and in concert provide the necessary answers leading to treatment, prevention and early detection. (See Feature article)

References

1) Yale Medicine: Should You Really Have a Pulse Oximeter at Home? By: K. Katella 5/8/2020 / https://www.yalemedicine.org/news/covid-pulse-oximeter

2) Capnography: Wikipedia source (link)

3) Front Line Covid-19 Critical Care Alliance / FAQ: https://covid19criticalcare.com/

4) Acute Respiratory Distress Syndrome: https://www.nhlbi.nih.gov/health-topics/acute-respiratory-distress-syndrome

5) Yale Medicine: What is the relationship between COVID-19 and ARDS? https://www.yalemedicine.org/conditions/ards

CONTRIBUTORS (in order of appearance)

ROBERT L. BARD, MD, PC, DABR, FASLMS

Advanced Imaging & Diagnostic Specialist & recipient of the 2020 nationally acclaimed Ellis Island Award for his lifetime achievement in advanced cancer diagnostic imaging. Dr. Bard 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)

PIERRE KORY, M.D., M.P.A.
Board Certified in Internal Medicine, Critical Care, and Pulmonary Medicine. He served as the Medical Director of the Trauma/ Life Support Center at the University of Wisconsin. 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. (www.covid19criticalcare.com/)

EVAN M. LUDIN, MS, OTR/L, CHT
Practices in the Commack community, specializing in orthopaedic rehabilitation and splinting for sports related injuries, as well as fabricating custom mold splints for post-op care and conservative management of CTS, DeQuervains, trigger finger, arthritis, wrist fractures, elbow & forearm fractures. He works alongside many Stony Brook University MD's listed in "Top Docs" for 20 years, in addition to the many other Orthopaedic and Plastic Surgeons. (www.Ludinhandtherapy.com)

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Tuesday, January 19, 2021

"GETTING THE SHOT" (part 2)- with Rebecca Nazario

Prevention101.org is proud to introduce our next pandemic health support advocate, Mrs. Rebecca Nazario, vice president of Consultative Care for The Medical Group of ChristianaCare (a major Delaware healthcare provider and private employer). With a longstanding leadership career in the healthcare industry, Rebecca is responsible for the strategic and operational direction of ChristianaCare's specialty services, including their Helen F. Graham Cancer Center & Research Institute, the Center for Heart & Vascular Health, and over 10 additional sub-specialty departments including Endocrinology and Neurology. This work includes bringing to life their momentous initiatives around Population Health for the Delaware community and its surrounding areas.

Through LinkedIn, we recently noted Mrs. Nazario's efforts to shed light and add support to ChristianaCare’s efforts to roll out the vaccine to employees – which ChristianaCare refers to as “caregivers” and the community. She modeled these efforts both by getting vaccinated and helping her colleagues register for the first dose of the vaccine.

A Move Towards Progress...TOGETHER!

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.

United Global Network

It will take time to get everyone vaccinated. Therefore, in order to maintain the progress we are making in this pandemic we need to ensure we are also inhibiting further spread of the virus. Everyone can do this by wearing our masks properly when in public or around others, maintaining good hand hygiene with frequent washing or sanitization, and remaining socially distant when necessary.

One other strong recommendation I have is that if you have any questions or concerns about the vaccine, or you want to get more specific information about what this process would mean for you, speak to your primary care provider. Your primary care provider can be a great resource for information, especially applicable to your specific healthcare needs and concerns. If you do not have one, now is the time to get one. If you are worried about going to a doctor's office and getting exposed, it’s important to know that many hospitals and doctors’ offices now offer virtual visits through your phone or computer. ChristianaCare, for example, developed a strong virtual primary care practice, as well as subspecialty access to virtual visits for many specialists, like an endocrinologist for diabetes or a behavioral health specialist for behavioral health needs, so you can access timely care.

Remember that through knowledge and communication you can keep yourself and your loved ones safe and healthy.

ChristianaCare has been vaccinating its caregivers and the community during the COVID-19 pandemic. These sample video clips are part of their Covid-19 Vaccine FAQ section. It is filled with the most insightful information about this treatment protocol. For more videos on this topic, visit: https://christianacare.org/coronavirus-vaccine/
After the vaccine, do I still need to wear a mask? YES. Not enough information is currently available to say if or when CDC will stop recommending that people wear masks and avoid close contact with others to help prevent the spread of the virus that causes COVID-19. The combination of getting vaccinated and following CDC’s recommendations to protect yourself and others will offer the best protection from COVID-19.	What side effects can I expect? It is important to know that the side effects are your body’s way of telling you that it is mounting an immune response to protect you from COVID-19. Data from the clinical trials, which included tens of thousands of participants, show that side effects of the vaccine are typically mild, and they are more common after the second dose than the first dose.
For more information, visit www.cdc.gov/coronavirus

ADDITIONAL FEATURES:

HEALTH & SAFETY MOVEMENT 2021: "GET THE SHOT"

MEDICAL IMAGING REVIEW: WHAT DOES A COVID LUNG LOOK LIKE?

Also see: PREVENTION MEASURES FOR AIRBORNE TRANSMISSION

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. Based on 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. ...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.

Friday, January 15, 2021

"GET THE SHOT!" - Taking the Covid Vaccine (part 1)

NYCRA NEWS and PREVENTION101 continues its mission to share the viewpoints of experts, renowned educators and health advocates in the spirit of expanding public knowledge. For this series, we connect with healthcare worker Dr. Michael Schulder, a leading Northwell Health neurosurgeon in Manhasset, NY. He is one of the first to share his insights and his personal research on the safety and efficacy of the recently deployed Coronavirus vaccine. Dr. Schulder also addresses his views on public skepticism about the vaccine over some of the unknown factors of the coronavirus. He shares his confidence in the science and the preventive strategy of the vaccine as well as its social impact on the global stage.

VACCINE CONFIDENCE FROM A HEALTHCARE WORKER

Transcript by: Dr. Michael Schulder

As of now, there has been no requirement to take the Coronavirus vaccination. I chose to “get the shot” because it is my belief that you can't practice any kind of medicine (neurosurgery included) if there's not some element of trust in the peer review process (or) in the general research process. This process has been overseen by academic organizations and by governmental organizations such as the Centers for Disease Control (CDC) and the Food and Drug Administration (FDA). So we need to accept this as a baseline allowing for the fact that though human errors may occur, those errors tend to flatten out over the course of large studies that involve a much larger number of people. That's what makes those results credible.

When vaccine trial results had been reported, it involved tens of thousands of people over months, clearly reporting no major side-effects. I believe the randomization to these trials was done on a 2:1 basis, where two thirds or of people got the vaccine. If there were going to be major safety concerns, we would've known about it for sure, because it would have happened during these trials. This is equally true if the randomization was 1:1.

The underlying science of the messenger RNA (or mRNA) based vaccines from Pfizer and Moderna is understandable and makes sense. The descriptions of the safety of the vaccines are credible and I'm relying on all those things for safety. Regarding efficacy, it is natural to have some skepticism because the idea of a 90- 95% infection prevention rate sounded too good to be true. Many of my colleagues and I have many curbside conversations about this sort of thing. If it was going to be as good as the flu vaccine, meaning an est. 70% infection prevention rate, that's still pretty darn good, especially if societally, it gets us ultimately to herd immunity. Either way, this is really why I and many people who work in my field signed up to get vaccinated as soon as possible.

WHAT DOES IT MEAN- AND WHAT IT DOESN’T MEAN TO BE VACCINATED?

Yes, you still need to mask up and social distance! The vaccine is not an invisible shield -- and it's only part of the ongoing process that we need to do to finally suppress the virus and get out of the pandemic. Even if it is 95% efficacious, it's still not enough... it's still 5% non-efficacious. Antibacterial antibiotics don't work 100% of the time. If you're one of those 95 out of a hundred people for whom it's going to be effective, you won't get infected or develop the COVID-19 illness. But nobody wants to be in that 5%.

What we don't know is whether you can still transmit the virus; that's still an unknown. But in advance of you getting vaccinated, we don't know if you're going to be one of the people who still gets infected despite the vaccine. Our societal goal is not to use the virus to prevent infection in everybody. It's to create herd immunity like the smallpox, polio and the MMR (measles, mumps and rubella) vaccines that have made those illnesses no longer a public health threat to the general population -- (and) get us to the point of eradicating it. The CDC states that “the goal is to make coronavirus like the common cold… it'll be around… you might get some seasonal illness from it, but it won't be a pandemic”-- and it won't be life-threatening in the way that it has been over the last 10 months.

I posted my message in social media in response to the many billions worldwide currently affected by this virus socially, economically and physically. I urge my colleagues to get vaccinated and to get the word out there that it's safe and it's effective and everyone should do it ASAP.

VIEWPOINTS

STEPHEN A. CHAGARES, MD FACS- Cancer Surgeon/ General,Laparoscopic, Robotic Surgery
“A popular concern from people is contracting the virus from this vaccine; NO, it's a piece of RNA, and not a live virus. For this m-RNA virus, the vaccines that we have out now are extremely effective- over 95%. And for that other theory that 'they rushed the vaccine'... this vaccine came about when the government elected to fund over 125+ labs at once- researching and developing a working vaccine. They collected all that data, totaling about 62.5 years’ worth of science bunched into six months. And now that we can duplicate genetic sequencing, it's really helping to plug it in. So that even in the future, as other viruses come up, the companies are now able to plug that new RNA, whether it's M-RNA -- they'll be able to plug that in and put out a vaccine even quicker because now they have the technology to do it."

AMANI JAMBHEKAR, MD, MBA - Breast Surgical Oncologist (Millennium Physicians)

"As a surgical oncologist predominantly taking care of patients who have cancer ...I believe it's important that all healthcare providers be advocates and be transparent about their experiences. I would like to encourage my patients to get the vaccine but also those in communities where there's a lot of medical mistrust and they may not have the resources to learn about it. Currently, I am seeing a big drive in the healthcare community, probably 80-90% of physicians are getting the vaccine! I know in Texas are enthusiastically receiving it because they want to protect their immunocompromised patients, whether they be patients who are actually on immunosuppressive or getting chemotherapy, or they're elderly patients, diabetics who otherwise would have risk factors. Healthcare providers are definitely stepping forward and getting vaccinated more than I thought..." [The info provided in this statement is published - 3/17/2021]

ELLEN MATLOFF- Genetic Counselor/Founder - My Gene Counsel, LLC

"(As of) today, more than 65M Americans have now received at least one dose of 1 of the 3 Covid-19 vaccines that currently have FDA approval in the United States (Pfizer, Moderna, J&J). That means that approximately 21% of all Americans have now received at least one vaccine dose. Yes, many people remain concerned to get a vaccine when their turns comes up in line. These concerns are understandable, and we should be empathetic to people feeling these concerns, since all 3 vaccines were developed in less than one year. However, we need to balance the risks of the vaccine against the risk of getting Covid-19, spreading it to friends, family and others, and developing long-hauler effects from Covid-19 that may last weeks, months, or may be permanent. " [The data provided in this statement is based on the date of this entry - 3/15/2021]

REBECCA NAZARIO, MBA - VP of Consultative Care /The Medical Group of ChristianaCare

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. (see complete article)

EVAN LUDIN - Hand and Occupational Therapy PLLC

"Due to the many risks in outpatient care, I hope that my receiving the first dose and publicly promoting it will encourages cohorts, colleagues, patients and others to follow suit in registering to receive theirs. Pfizer, Moderna and so many others are reputable Biotech/Pharm companies with a long history of success in their respective field. This vaccine stands for so much today in the eye of public health and science. With the advancements in science, the opportunity to push forth with mRNA vaccines for other diseases and viruses sheds light on future health. With early work showing a 94/95% success rate, that demonstrates and presents an opportunity for those at risk for getting ill, or those at high risk due to comorbidities of getting ill a sense of hope and resolution..." (see full interview)

* Opinions expressed in this VIEWPOINTS section are supportive comments about the contents of this article and are solely those from the contributors credited.

The ARDS / Covid-19 Connection?

Covid-19 Resources: WHO (and HOW) to Believe

Michael Schulder, MD, is vice chair of neurosurgery at North Shore University Hospital and Long Island Jewish Medical Center. He is director of the Brain Tumor Center at Northwell Health's Institute for Neurology and Neurosurgery, co-director of the Center for Stereotactic Radiosurgery and program director of neurosurgical residency training at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, where he is a professor of neurosurgery. A practicing neurosurgeon for more than 30 years, Dr. Schulder is expert in a full range of brain surgery techniques. His particular areas of focus include image-guided brain tumor surgery, stereotactic radiosurgery and functional neurosurgery.

Monday, January 11, 2021

What's REALLY in the Air?

A Study on Hospital Air: Reviewing the Presence of SARS-Cov-2

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. Reports showing "substantial controversy whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be transmitted through aerosols."[1- Intl. Journal of Infectious Diseases].

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 ... 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" [1].

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). [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... [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

https://www.ijidonline.com/article/S1201-9712(20)30739-6/fulltext

2) Study finds evidence of COVID-19 in air, on hospital surfaces

https://www.cidrap.umn.edu/news-perspective/2020/04/study-finds-evidence-covid-19-air-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):

https://www.health.state.mn.us/communities/ep/surge/infectious/airbornenegative.pdf
5) Indoor Air Quality (IAQ) -https://www.epa.gov/indoor-air-quality-iaq/what-merv-rating-1
6) Air cleaners and HVAC filters in Offices, Schools, and Commercial Buildings
https://www.epa.gov/coronavirus/air-cleaners-hvac-filters-and-coronavirus-covid-19

Oct 7, 2020, Prevention101 conducted an in-depth interview with Ms. Teri Hulett, professional infection prevention consultant and educator. She provided valuable insight on the branch of service supporting standardized safety protocols in the patient care industry. Having started a career in nursing (neonatal ICU) since 1979, Teri transitioned to focus work in infection prevention due to outbreaks in her facility. This discipline became a full-time commitment which she converted into a national program that called on a significant demand due to the current Covid-19 pandemic.

From the Source:

INFECTION PREVETION STRATEGIES

Teri Hulett, RN, BSN, CIC, FAPIC | www.ipstrategies.org

Infection prevention has become an area of intensified focus in dental offices and physician's offices. Infection prevention in ambulatory surgery centers (ASC) has been on the radar since 2009. Regulatory surveys assess compliance with mandated IP requirements. State surveyors go into facilities on behalf of CMS and make sure that from an infection prevention perspective, they're meeting all the minimum requirements that must be in place. like proper hand hygiene measures (as an example). Is the facility auditing hand hygiene compliance? Is staff education being provided? Is the facility providing facility compliance information back to the staff with identified opportunities for improvement?

This is where I come into the picture. Effective November 28, 2017 CMS (Centers for Medicare and Medicaid Services) required all long-term care (LTC) facilities to establish an infection prevention and control program (IPCP) to be phased in over 3 years and managed by an infection preventionist.(IP) who has had formal training. In preparation to meet the CMS requirements, I worked with long-term care facilities in Montana and Wyoming, in collaboration with other quality improvement organizations (QIOs), to provide 3-day LTC bootcamps. We walked attendees through the process of developing their program to meet CMS required elements. The IP program is developed based off a risk assessment (RA). We spent time walking attendees through building their program plan template. We helped them identify who they should work with and where to reach out to for the data to include in their plan. We also helped attendees identify where to access additional formal IP training and education.

With COVID-19, one of the main focuses has been in LTC facilities due to the many deaths experienced in the first three months of COVID-19. LTC settings were not set up to deal with this type of infectious disease. Most LTC facilities do not have negative pressure rooms. Staff were not fit tested and trained on proper use of N95 respirator masks. There were multiple gaps identified in the LTC setting that could not have been planned and prepared for with respect to what we saw with COVID-19. This identified need again provided the opportunity for me to work with facilities in identifying their gaps and developing interventions to prevent transmission and improve both staff and resident safety.

LTC facilities were overwhelmed; there was a lot of transmission and death. They needed help - someone with experience to walk them through what they needed to do, why they needed to do it, and then work with them to implement key interventions specific to COVID-19. We focused on dealing with immediate issues key to halting transmission, like acquiring enough personal protection equipment (PPE) supplies necessary to prevent transmission and resident deaths, and then aid the facility in developing a comprehensive sustainable program comporting infection prevention and control practices..

The CDC provides a robust resource of information - tools and guidelines available to all. Regulatory bodies like CMS and Joint Commission use nationally recognized guidelines to survey against. For the facilities we work with, we help them understand what guidelines to follow in developing their programs – writing their policies and procedures. We stress the importance of following nationally recognized, evidence- based guidelines. Many state health departments use the CDC resources to develop state-specific tools, of which some states will then use to develop toolkits accessible to anyone on their state’s website. An example is the Minnesota Department of Health COVID-19 Toolkit.

UV-C AIR SANITIZING INSTALLED IN HVAC SYSTEMS

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. (see complete article)

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.

Also see Dr. Pierre Kory's Prevention Measures of Airborne Transmission

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

References:

01) History of UV-C https://www.uvtechnology.co/history-of-uvc.html

02) Niels Ryberg Finsen-https://www.nobelprize.org/prizes/medicine/1903/finsen/biographical/

1) Source- CDC: https://www.cdc.gov/niosh/nioshtic-2/20034387.html

2) Disinfection and Sterilization Guideline for Disinfection and Sterilization in Healthcare Facilities (2008)

https://www.cdc.gov/infectioncontrol/guidelines/disinfection/index.html

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807439/

5) Riley & Wells: https://www.jhsph.edu/covid-19/articles/the-experiment-that-proved-airborne-disease-transmission.html