The Risks – Know Them – Avoid Them

Where are people getting sick?
How much Virus is released into the environment?
Erin Bromage – May 6

A Bathroom: Bathrooms have a lot of high touch surfaces, door handles, faucets, stall doors. So fomite transfer risk in this environment can be high. We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk.
A Cough: A single cough releases about 3,000 droplets and droplets travels at 50 miles per hour. Most droplets are large, and fall quickly (gravity), but many do stay in the air and can travel across a room in a few seconds.
A Sneeze: A single sneeze releases about 30,000 droplets, with droplets traveling at up to 200 miles per hour. Most droplets are small and travel great distances (easily across a room).
If a person is infected, the droplets in a single cough or sneeze may contain as many as 200,000,000 (two hundred million) virus particles which can all be dispersed into the environment around them.
A breath: A single breath releases 50 – 5000 droplets. Most of these droplets are low velocity and fall to the ground quickly. There are even fewer droplets released through nose-breathing. Importantly, due to the lack of exhalation force with a breath, viral particles from the lower respiratory areas are not expelled.
Remember the formula: Successful Infection = Exposure to Virus x Time
If a person coughs or sneezes, those 200,000,000 viral particles go everywhere. Some virus hangs in the air, some falls into surfaces, most falls to the ground. So if you are face-to-face with a person, having a conversation, and that person sneezes or coughs straight at you, it’s pretty easy to see how it is possible to inhale 1,000 virus particles and become infected.
Speaking increases the release of respiratory droplets about 10 fold;
What is the role of asymptomatic people in spreading the virus?
Symptomatic people are not the only way the virus is shed. We know that at least 44% of all infections–and the majority of community-acquired transmissions–occur from people without any symptoms (asymptomatic or pre-symptomatic people). You can be shedding the virus into the environment for up to 5 days before symptoms begin.

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For Renaissance Italians, combating black plague was as much about politics as it was science, according to Stanford scholar

MAY 12, 2020 [EXCERPTS]
The inability of 14th-century medicine to stop the plague from destroying societies throughout Europe and Asia helped advance scientific discovery and transformed politics and health policy, says Stanford historian Paula Findlen.

BY MELISSA DE WITTE – For Italians in the 14th-century, the bubonic plague at first seemed extraordinary but its repeated return made it so much a part of daily life that it became an economic annoyance and an administrative problem to resolve, and eventually led to advances in medicine and public health, according to Stanford historian and scholar of Renaissance Italy, Paula Findlen.

As the world confronts another global pandemic, Findlen spoke to us about the problems Renaissance Italians faced related to the Black Death, including ones that might seem familiar to us today, such as the difficulties of reliably reporting the disease, misinformation campaigns, and political tensions between states around their response.

Since antiquity, people have debated whether to remain or flee during an epidemic, and how to prevent others from coming. “Quarantine” is a specific legacy of how late medieval and Renaissance cities responded to plague, not during the initial pandemic of 1346-53, but after its return. The first known legislation (by the Venetians) in 1377 only specified thirty days but it evolved into forty, which is what quarantina means. Forty made more sense to physicians who read Hippocrates on the typical length of a highly contagious disease and also knew, as Christians, that this was the duration of Lenten fasting.

To read more, and find out about the answers to the following questions:
How did the bubonic plague change the relationship between science, government and society?
In what ways did the Black Death change medicine and scientific research?
You have studied the history of scientific networks and the spread of news and information. As scientists from around the world race to find treatment and a vaccine for COVID-19, are there lessons from the past that are applicable today?
Was there a figure like Anthony Fauci (director of the U.S. National Institute of Allergy and Infectious Diseases) in Renaissance Italy?
What enduring legacy did the bubonic plague leave on life in Italy and beyond?
What are the lessons from Renaissance Italy that can inform our response to COVID-19?
click on For Renaissance Italians, combating black plague was as much about politics as it was science


Doctors keep discovering new ways the coronavirus attacks the body

Damage to the kidneys, heart, brain — even ‘covid toes’ — prompts reassessment of the disease and how to treat it

By Lenny Bernstein and Ariana Eunjung Cha MAY 10, 2020

002ea3 Deborah Coughlin was neither short of breath nor coughing. In those first days after she became infected by the novel coronavirus, her fever never spiked above 100 degrees. It was vomiting and diarrhea that brought her to a Hartford, Conn., emergency room on May 1.

“You would have thought it was a stomach virus,” said her daughter, Catherina Coleman. “She was talking and walking and completely coherent.”

But even as Coughlin, 67, chatted with her daughters on her cellphone, the oxygen level in her blood dropped so low that most patients would be near death. She is on a ventilator and in critical condition at St. Francis Hospital, one more patient with a strange constellation of symptoms that physicians are racing to recognize, explain and treat.

At the beginning, we didn’t know what we were dealing with,” said Valentin Fuster, physician-in-chief at Mount Sinai Hospital in New York City, the epicenter of the U.S. outbreak. “We were seeing patients dying in front of us. It was all of a sudden, you’re in a different ballgame, and you don’t know why.”

Today, there is widespread recognition the novel coronavirus is far more unpredictable than a simple respiratory virus. Often it attacks the lungs, but it can also strike anywhere from the brain to the toes. Many doctors are focused on treating the inflammatory reactions it triggers and its capacity to cause blood clots, even as they struggle to help patients breathe.

Learning about a new disease on the fly, with more than 78,000 U.S. deaths attributed to the pandemic, they have little solid research to guide them. The World Health Organization’s database already lists more than 14,600 papers on covid-19. Even the world’s premier public health agencies, including the Centers for Disease Control and Prevention, have constantly altered their advice to keep pace with new developments.

“We don’t know why there are so many disease presentations,” said Angela Rasmussen, a virologist at the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health. “Bottom line, this is just so new that there’s a lot we don’t know.”

More than four months of clinical experience across Asia, Europe and North America has shown the pathogen does much more than invade the lungs. “No one was expecting a disease that would not fit the pattern of pneumonia and respiratory illness,” said David Reich, a cardiac anesthesiologist and president of Mount Sinai Hospital in New York City.

It attacks the heart, weakening its muscles and disrupting its critical rhythm. It savages kidneys so badly some hospitals have run short of dialysis equipment. It crawls along the nervous system, destroying taste and smell and occasionally reaching the brain. It creates blood clots that can kill with sudden efficiency and inflames blood vessels throughout the body.

It can begin with a few symptoms or none at all, then days later, squeeze the air out of the lungs without warning. It picks on the elderlypeople weakened by previous disease, and, disproportionately, the obese. It harms men more than women, but there are also signs it complicates pregnancies.

To read the full article, click on Doctors keep discovering new ways the coronavirus attacks the body


Canada’s for-profit model of long-term care has failed the elderly, says leading expert

“Elderly care needs to be recognized for the skilled work that it is”, says Pat Armstrong
CBC Radio · Posted: Apr 24, 2020 5:49 PM ET | Last Updated: April 24

To read the full article, click on: Canada’s for-profit model of long-term care has failed the elderly, says leading expert

Pat Armstrong is a distinguished research professor in sociology at York University and a fellow of the Royal Society of Canada. (Submitted by Pat Armstrong)

“We haven’t placed a high priority on providing care in nursing homes. I think that basically we’d rather not think about them,” Pat Armstrong told Michael Enright of The Sunday Edition.

“When Roy Romanow did his Royal Commission [on the Future of Health Care in Canada], he said that the health care we get is a matter of values — and I think that this is making our values pretty evident.”

Armstrong is one of Canada’s foremost thinkers on long-term care. She is a distinguished research professor in sociology at York University and a fellow of the Royal Society of Canada. 

Long-term care, she says, is one of the major gaps in Canada’s universal health-care system.
“It’s not clearly covered by the principles of the Canada Health Act, or in the funding,” she said. Instead, the act is “basically focused on hospitals and doctors. It was developed at a time, initially, when most care was provided in hospitals.”
Today, the country’s elderly population is increasingly in need of chronic care — and far more of that care is provided in nursing homes than in the past, Armstrong added.

‘The business of making a profit’
According to a report from the Canada Health Coalition in 2018, just under half of all long-term care facilities in the country are private, for-profit entities. 
But when it comes to health-care services as essential as long-term care, we can’t trust markets to do what is in seniors’ best interests, Armstrong said.

“We know from the research that for-profits tend to have lower staffing levels. They tend to have more transfers to hospitals. They tend to have more bed ulcers,” she said. “There are some good for-profit homes, just like there’s some poor not-for-profit homes, but the general pattern is there.”

Years of for-profit care has meant a serious deterioration in the labour conditions inside nursing homes, she said.

“If you’re in the business of making a profit … in nursing homes, the overwhelming majority of the cost is labour. And that’s where you are going to try and save money.”

The easiest way to cut labour costs, Armstrong added, is through “hiring more people part-time, more people casual, more people at the last minute when you need them — rather than staffing up with full-time workers that you have to pay benefits to and provide things like sick leave for.”

Given these conditions, it should come as no surprise that care providers would work at multiple sites to make ends meet, Armstrong said.
“It is about needing full-time work but not being offered full-time work in the home where they’re working,” she said. “And a significant proportion in our country are people who are new to Canada, who have very few employment options.”


Surgeries across the country will slowly resume using a triage system…..

“Surgeries across the country will slowly resume using a triage system, health ministries and doctors say, starting with the most urgent cases.
If it can continue to ramp up surgical volumes, Keshavjee hopes to be caught up on “time-sensitive” surgeries by the fall.  

It’s not clear how long it will take to catch up on other surgeries. It will depend on when procedures get back to a normal pace, as the backlog grows the more time passes, experts say.   

Three key factors must be in place before a surgical ramp-up can proceed, Keshavjee said:

• Government funding to pay for surgical overtime, including running evenings and weekends.

• Enough COVID-19 testing kits for every patient to check if they are infected before undertaking surgery.

• A reliable supply of personal protective equipment (PPE) for surgical staff as well as the rest of the hospital.”

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Rural Emergency Departments & COVID19


The Canadian Association of Emergency Physicians & The Society of Rural Physicians of Canada


1. National licencing/credentialing: establishment of emergency pan-Canadian licensure of health care workers. Create a standardized national system for rapid / dynamic intra-provincial and cross-provincial regulatory licensing. Improving provincial health authority credentialing and privileging for multiple jurisdictions (rural to urban, urban to rural).

2. Utilize new grads: mandate that recently graduating MDs with provisional licenses (because of delayed formal certification exams) can do locums, be assigned billing numbers and sign employment contracts.

3. Increased Funding and coverage: Federal and provincial funding mandated to respond immediately to increase number of temporary rural positions. The majority of rural EDs are staffed with single physician coverage.

4. Create Rapid Rural Relief Teams: creation and deployment of centralized provincial teams that include MDs, core generalist specialties, RNs and Respiratory Therapists.

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