Erasmus : Government concern with coronavirus is the 5% significant complication rate of a proposed 20% population infection rate. In Australia these figures suggest that 250,000 people may require intensive care support to recover from viral infection in a country where essentially only 160,000 people can be supported by the existing intensive care system.
So any strategy which reduces the severity of infection, especially at the most severe in the spectrum, will substantially reduce the impact on health system and substantially reduce the need for isolation actions with social and economic disruption side-effects, being necessary to be used in an attempt to control the disease.
Corona Virus infection infects lives.
Erasmus : Current strategies involve separation and barrier protection. These include such items such as facemasks, Perspex barriers, social separation, closing social venues, reducing socialisation functions such as funerals or weddings or parties, self-isolation at home or in supervised accommodation.
Don't do it.
Unfortunately none of the strategies control disease severity which is the key crunch point for the impact of the coronavirus and health system. What the strategies do is spread the peak so that the health system has a greater time to adapt to the impact of the disease. In short, if the viral epidemic takes longer to run its course, we effectively have more intensive care beds available to treat ill people.
Dr Xxxxx : A typical critically ill patient uses an intensive care bed for up to 10 days. So if the epidemic is over in 10 days, our existing intensive care beds can only be used once. If the epidemic runs over 100 days, intensive care beds can be used 10 times each.
Erasmus : As stated, this strategy does not change the severity of the disease. IIPI aims to address this deficiency.
The human family - affected by the virus
1. Reinforce Basic Health: IIPI
Dr Xxxxx : Strategy one: Underlying Health
Premise: this healthy immune system can fight infection.
Action: A regular intake of a multi-vitamin with possible supplementation of vitamin B12 and folic acid. If you have a deficiency of B12 or Folate especially- your immune system can be compromised.
Action: Accelerated zinc intake: Use high-dose zinc and vitamin C. You can take up to 9 zinc pills a day (short-term) if you wish to try to enhance the action of your immune system – to try to reduce infection. Take this as 3 pills @ 3 times a day with food. The main problem with zinc is the nausea which occurs with high dose intake. This will limit patients’ intake through tolerance issues. Vitamin C is useful as an accelerator of zinc mineral absorption.
Zinc is an important immune activator, It works at two levels. Firstly, making the immune reactions occur. Secondly, it provided the energy for the immune defence reaction. this gives a double whammy.
Zinc is very poorly absorbed. The vitamin C taken with each lot of zinc pills will help absorption. Zinc comes as 20 to 30 mg “elemental” pills. This means that the amount of zinc “metal” in each zinc pill weighs approximately 20 to 30 mg.
Another way of describing these pills is that the pills comprise 200 to 300 mg of zinc as an amino acid chelate.
This is exactly the same as the 20 to 30 mg of elemental zinc. In one method of weighing the pill, we just weigh the zinc metal. In the other way of weighing the pill, we weigh the zinc and its chemical packing. These 2 sets of numbers essentially represent the same sized pill.
Likely gains: immune functions enhanced by 10%,
Caution: Mono variable analysis is not suitable for assessment of multivariable interventions, especially where not all effects may be as positive as initially anticipated.
2. Primary Colonisation Site Control
Dr Xxxxx : Strategy Two: Primary Colonisation Site Control
Premise: Control infection at the throat and there will be fewer germs to spread through the rest of the airway.
Probable yield: Up to 70% initial infection control.
Identification: Coronavirus especially acts through aerosol dissemination routes. Microscopic particles evaporate and dry easily. Drying is particularly damaging to and enveloped virus. This means that large particles are the predominant disease carriers. These have difficulty turning with airflow at the back of the throat, resulting in many particles impacting directly on the stratified squamous epithelium on the back of the throat. Remember our coronavirus facts summary has revealed that some sources have related that coronavirus can infect non-keratinising stratified squamous epithelia. This is unusual. There are not many viruses which will impact directly on the throat lining – directly at the back of the throat.
Streptococcal throat: typical
This gives a potential definite identification point for identification of coronavirus infection. Coronavirus is likely to cause a significant throat infection which is persistent and out of the patient’s usual experience, affecting a part of the throat that is not usually infected – namely the stratified squamous epithelia directly at the posterior part of the throat.
The inflammation pattern is likely to be a disseminated or diffuse red pattern, not the usual postnasal drip throat infection pattern with thickening of the throat lining. (It is of course possible to combine patterns of infection so that the diffuse inflammatory overlay of the coronavirus is laid on top of chronic problems such as postnasal drip arising from allergy or chronic low-grade bacterial throat infection) as immunity to the coronavirus is not common in our community, we see throat infections which are significantly worse than usual, and more persistent than usual.
Erasmus : So I see a definite impression here that the coronavirus infection starts as a distinctive and unique type of throat infection very different to the usual or common types of throat infection mediated by usual throat germs.
Dr Xxxxx : Yes. Bacterial infection certainly will occur in coronavirus infection but as a secondary effect. The basic premise is that:
An Infecting Virus
Will Cause Damage
Causing Bacteria to Grow.
So a throat infection, even with a viral cause, rapidly develops bacterial secondary infection. This bacterial secondary infection is important because it enhances the spread of the virus by disrupting epithelial lining and causing more damage enabling more viral replication. In short, attacking this process may be a critical disease control measure.
Facial respiratory cavities : sinuses and passages.
Erasmus : Fortunately we have some super weapons in our arsenal, exactly for this purpose.
Dr Xxxxx : Action: Povidone-iodine also known as Betadine is one of the most effective topical agents for the destruction of viruses, bacteria and even fungi. Povidone-iodine has been shown to be active against a large number of viral species such as adenovirus, mumps virus, rotavirus, poliovirus, Coxsackie virus, rhinovirus, herpes simplex virus, rubella virus, measles virus, influenza virus and HIV virus. It has even been suggested as a control measure for gonorrhoea throat infections – in an era where drug resistance by the gonococcus is becoming more commonplace.
Other commercially available antiseptics such as chlorhexidine, alkyl Diamino Ethel – glycine HCl and, benzalkonium chloride are all also likely to be effective especially against a fragile target such as an enveloped virus. The viral structure incorporating a lipid bi- layer means it is very susceptible to both antiseptic action and detergent action. (Drying the throat is more likely to damage the throat epithelia than the virus. This is not a useful strategy for the control of infection in the throat.)
Due to the fragile nature of the virus, almost any mouthwash can be useful.
Dr Xxxxx : Action: The secondary range of problems arising bacterial infection. Streptococcus is the most common invading bacteria in the throat region – though not the only one. Anti-bacterial antibiotics such as amoxicillin are very useful for controlling Streptococcus and should be combined with agents such as Povidone-iodine on mouthwashes/throat washes to control both virus and bacteria and limit throat damage.
If bacterial resistance appears, changing antibiotic treatment could well regain control of bacterial infection. Remember we only need to win to “an extent”. We want to buy time to allow natural immune processes to occur to control infection.
3: Accessory Site Control.
Dr Xxxxx : Strategy 3: Accessory Site Control.
Premise: Control infection in sites adjacent to the throat area will result in fewer particles to spread through the rest of the respiratory system.
Infection of the respiratory epithelia of the nose and other airways also occurs. This is not a commonly treated site by topical agents. Consequently we have little experience with topical agents in this part of the body. This so the tolerance of the columnar cells and the cilia lining of these cells for topical agents needs to be assessed, prior to widespread use of an agent such as Povidone-iodine in these sites.
My guess is that the sites are sensitive to osmolality related damage and to toxicity factors directly arising from the carrier solutions as well as the Povidone-iodine.
Dr Xxxxx : Action: My proposal would be to consider the use of Humanised Saline solution (e.g. Hartman’s solution) being used as a carrier for a 1/100 to a 1/200 dilution of Povidone-iodine. I would suggest the use of a pump spray to distribute the solution in the nasal airways.
Now here’s where it gets interesting. We have noted in our reading that some of the coronavirus proteins interfere with interferon effects. So it may be possible and useful in our sicker patients to use interferon with our delete Povidone-iodine through a nebuliser – breathed in through the nasal and upper respiratory areas.
Dr Xxxxx : Action: If the solution is able to be micronized down to approximately 1 µm particle size, it may be possible to deliver this solution right down to the alveoli. It would of course be critical to assess the tolerability of alveoli cells to these agents prior to use as well. We are capable of substantial assessment of airway diffusion through complex lung function tests. These may provide assistance with the assessment of the issue of tolerability.
Imaging of small areas of ciliated epithelia in the nasal lining on a 15 minute basis with computer counting of recorded images may give us an index of the effect on nasal cilia and cells. The critical issue is to limit columnar cell lysis. You cannot prevent viral colonisation if damage to the respiratory lining is increased with your treatment.
Dr Xxxxx : Action: Other ancillary treatments: Heat treatment has long been proposed for the upper airways. Decongesting the nasal airways can substantially reduce nasal secretions – which may reduce particle generation and propagation into the lower airways through the process of breathing. Mucopolysaccharide gel lining the airways may reduce particle generation and propagation. Other topical neutralising agents may have cause to be considered. In vitro analysis of a number of proposed agents could well give us a number of options for respiratory lining treatment.
Erasmus : These strategies all challenge the basic doctor’s premise: it’s a virus and there’s nothing you can do about it. Experience with treating minor respiratory tract infections in general practice patients has shown that it is possible to make a difference even in “viral” infections.
4: Viral Replication Control Agents
Dr Xxxxx : Strategy 4: Viral Replication Control Agents
We need to keep in mind that we are aiming for opening a 10% improvement. So drugs that are of borderline effectiveness may be useful.
Premise: Even borderline reductions in viral replication can translate into reductions in patient caseload requiring intensive care support.
Action: Give every patient with significant infection Kaletra (lopinavir/Ritonivir) at presentation and in the early phases of the infection.
? ??? Hydroxychloroquine
Pills : there are many but not all are the same.
Consider the use of animals’ sourced antibodies to angiotensin converting enzyme type II receptors. These can be delivered by liberalisation to the lower airways. Yes there may be immunity developing to the recurrent usage. But we only need to deliver these treatments once. To help us win at a critical time in a patient’s life – to avoid the need to use a scarce resources such as a ventilator.
5: Address Virulence Factors
Dr Xxxxx : Strategy 5: Address Virulence Factors
Premise: Our knowledge of the immune system and its functions can allow us to choose treatment strategies which can impact infectivity.
Very significant impacts are likely to be achieved through LLIAP and CRRI control strategies especially combined.
Alcohol to a concentration of .05 - . 08 BAC can improve cell membrane fluidity for lymphocytes and macrophages, enhancing infection control.
Essential oils especially targeting Palmitoyl can improve cell membrane fluidity for lymphocytes and macrophages enhancing infection control. High-dose high-intensity intake of omega 3 and omega 6 fatty acids can change lipid cell membrane bilayer oil concentrations– altering lymphocyte and macrophage function.
6: Gas Exchange Management
Dr Xxxxx : Strategy 6: Gas Exchange Management
Premise: A number of strategies may be relevant to maintaining gas exchange in coronavirus affected patients.
The end game target for the Corona Virus infection.
The critical front line for coronavirus infections lies in keeping people breathing and oxygen flowing into the body. The traditional method of ensuring gas exchange is to put people on ventilators with increased pressure within the respiratory tree – pressure being maintained at higher than ambient levels to essentially push fluid back into the alveolar walls – keeping the alveoli clear for gas exchange.
Erasmus : Yes. Pneumonitis is what is talked about a lot on TV. Is this the problem?
Dr Xxxxx : Problems can arise in the lower respiratory tree for a number of reasons:
A. Overwhelming infection causing pneumonitis. This can occur either through high infective doses of the coronavirus. Alternately this can occur if the patient’s immune functions are compromised and the virus is able to replicate in an uncontrolled fashion. We have many drugs affecting immune function: high-dose steroids, methotrexate, many complex monoclonal antibody treatments modulating immune activity for many diseases such as psoriasis, and rheumatoid arthritis. Diseases such as Leukaemia, lymphoma and many cancers are often treated with cell killing drugs which almost invariably have as an effect damage to the cells of the immune system – hence immunosuppression.
Alternately there may be some simple mechanisms helping the virus spread through the lower bronchitis and to the alveoli. For example swimming regularly in a pool with high concentrations of chlorine can cause low grade aerosol damaged to portions of the alveoli as well as the bronchi. This may assist the development of florid local infections – pneumonitis.
B. Hyperactive Bronchial Airways (as in asthma triggered by infection) – obstruct. This results in mucus being unable to be drained from the narrowed bronchi within the lungs. Fluid begins to pool within the lungs.
The asthma group of patients needs to be managed early and aggressively.
Immunosuppressants such as high-dose steroids need to be minimised especially in the early phases.
I would propose that early “asthma” in coronavirus patients be suppressed with combination agent such as LABA, LAMA, leukotriene inhibitors such as Monteleukast sodium, possibly antihistamines or broad-spectrum allergy blockers such as Ketotifin, methyl xanthine derivatives (long out of fashion but still very useful), with minimal use of combination bronchodilator/aerosol steroids.
Aerosol steroids are probably best reserved for a late stage infection when the immune suppression resulting is not significant within the context of the progress of the infection. I.e. the immune suppression resulting from the use of these agents is far outweighed by the reduction of swelling in the airways and Bronchi. In reducing bronchial swelling, high-dose oral steroids may need to be used, as generally aerosol steroids are not able to penetrate the mucous barrier on the hyperactive bronchi.
In the overwhelming infection category: I would propose aggressive multimodal combination and anti- infection therapy. Possibilities include:
Nebulised immunoglobulins – especially those sourced from patients who have recovered from the coronavirus.
Nebulised micronized nano dose interferon: to overcome the interferon antagonism which would appear to be one of the key “win” strategies for the virus.
Oxygen supplementation from an early phase as an immune enhancement mechanism not just as a gas exchange promoter. These patients may also benefit from intravenous zinc and phosphate – again as immune enhancers.
The possibility exists that we may be able to find a topical agent, safe for use in cellular environments which can cause changes in the function of the cell membranes of enveloped viruses such as the coronavirus. The coronavirus envelope is a very obvious and very fragile target for treatment. Perhaps even the Achilles heel of the virus. If the cell membrane of the enveloped virus can be compromised, infection can be reduced.
Intravenous immuno – globulin especially that sourced from patients have recovered from the coronavirus.
CPAP with full cycle positive backpressure in awake patients may be an alternative to ventilation. Patients on ventilators are extremely uncomfortable if conscious with tubes blocking their trachea in place. CPAP patients routinely sleep all night wearing the mask. The main issue is CPAP is that only relatively lower pressures can be generated in the airways – making it not suitable for the more ill patients. The issue is perhaps that not everyone who required airways support, requires full support as in ventilator ventilation. Even if high continuous pressure CPAP is applicable to 10% of patients, this is 10% less patients going down the ventilator path. The numbers of ill patients requiring ventilation with which the health system is being challenged become reduced again.
Measurement is critical to provide a guide for success.
Strategy 7: Measurement
Dr Xxxxx : Strategy 7: Measurement: Clinical & Situational
Premise: To know what to do, you need to get continuous feedback from a number of variables on the success of your strategies. This allows the optimisation of strategies – optimising the quantity of treatment delivered and prioritising the types of treatment that can be offered. If problems appear – they can be identified and addressed early.
Typical medical measurements include:
* Temperature (Not necessarily a simple variable with one answer. When you begin to monitor temperatures with infrared thermometers it becomes obvious that the body has many different temperature zones in many different places. It may be possible to measure the temperature over different lung fields from the front or back of the thoracic area. It may be possible to measure the temperature of different parts of the throat and nasal passages.
* Pulse and Blood Pressure
* Oxygen Saturation
* In Complex Lung Function tests: gas diffusion (DO), PEFR, FEV1, lung capacity (FVC or TC).
* Death rates, time on ventilator, pressures required in ventilators, time spent in intensive care. Outcome measurement such as death rates or time spent in intensive care may well be too clumsy to be useful. It may be very difficult to show an improvement in these sorts of variables because random events obscure the outcome data. A single bad day for one person can change the appearance of the success of treatment strategy – which on the numbers may be proving effective.
* Viral Count this is an easy test to measure for viruses which have blood as the transmission media for example HIV or hepatitis C. Where mucus is harvested by a swap for a PCR test, it may be very difficult to obtain quantitative feedback. Knowing the viral count per microlitre of mucus may well be a very important indicator of the success or failure of a treatment strategy. This information is critical in the management of HIV infection. It’s all about the numbers. The better the numbers are, the more chance you have of coming close to a better outcome. The more chance you have of making the right treatment decision.
Assays of viral effect
We may need to look at other outcome measurements such as, epithelial damage per square millimetre, cilial function, amount extent and type of bacterial colonisation for damaged airways, throat erythema, throat swelling, extent of throat infection, nasal lining swelling. To optimise treatments in an IPPI protocol is likely to evolve the measurement of a large number of variables we currently ignore. Computer scanning and interpretation of clinical photographs may be a new frontier – the software becomes available.
With some of the more complex interventions such as LLIAP or CRRI protocols, measurement of
(Censored by Order of the Commandant / security staff :
Frobisher & Beethoven :) ????? May become necessary.
But these are measurements with which we currently have very very little experience.
Hot statistics: to enable appropriate intervention and to enable early introduction of “unproven” treatments, daily statistical analysis of outcomes can provide information on success or failure of treatments and can suggest advice to optimise treatment protocols. This does obviate many of the arguments for slow introduction of drugs and vaccines.
8: Legal Support and Financial Support
Erasmus : Strategy 8: Legal Support and Financial Support
If you are undertaking interventions with no “proven” success, you are asking to be deregistered by your health practitioner authority, sued by your patients and in the event of even the slightest setback – denigrated by the media and your peers. Even if you are successful in what you do – with statistics showing effective treatment, you are still open to the allegation that something else may have worked better, something else could have been used, or that something you did may have had deleterious effects in this one person even though it helped many others.
It is probable reason why most doctors do not innovate. You’re not allowed to experiment on patients. The safest thing to do (careerwise) is to let them (patients) die. You will earn very little thanks for your successes and a lot of angst and vilification for your failures. Vaccines and drugs used before a full complement of research is completed, leave it open to the allegation of experimenting on your patients. The fact that they have no chance of living without such experimentation, does not justify offering them experimental treatment options. And then there are the complex situations. The drug is excellent if used in the nebulised fashion in specific circumstances but much less useful if used intravenously or orally. (Or vice versa).
The social and economic community underlie our efforts at control.
I think there needs to be a rethink of just what can be reasonable in different circumstances. Because a failure to rethink the circumstances of “experimentation” implies that the death of 5% of the population and doing one hundred trillion dollars of economic damage is less of a problem than taking a chance on doing some good to a single life. If however society balances the scales of justice for experimentation in just such a fashion – so be it.
These inventions demand a lot of research in a short time using specialised tools by people who are not familiar with the usage of the tools, people not familiar with the situations in which they may be used, doctors unfamiliar with the protocols by which they may be used, doctors and staff unfamiliar with the complications of the treatments.
So if you want to succeed in doing a lot of research and a lot of new interventions in a short period of time: with the potential goal of saving the world economy $100 trillion and millions of lives – perhaps you need to be a little bit more flexible with how the law may apply to the situations.
The finance issues are world issues. Financing much of this work in a short time demands a lot of investment across a lot of the world community.
Strangely enough, although we have broached many technical issues in fighting the infection, it is the social factors which are often the hardest to overcome.
9: Infective Dose Control & Co-morbidities
Erasmus : Strategy 9: Infective Dose Control
Premise: The more germs there are present, the more likely they are to cause problems.
I will now introduce a new concept called “infective dose”.
If you are exposed to a lot of the virus, you are likely to be a lot sicker. If you are exposed to only a bit of the virus, you are likely to be only a bit sick. Even if you have not fully avoided being exposed to the virus, reducing your “infective dose”, can make a big difference to you.
Don’t let people breathe on you. Standing beside or behind people is a lot safer for you, than standing facing people. Face-to-face carries the highest risk of being exposed to virus within respiratory droplets. If you are both breathing forward, even if you are in close proximity, your “infective dose” will be substantially reduced.
If you have a sick person in the family, you can look after them. However, even if you are exposed – this is not a reason to give up all precautions.
I will say the mantra of “infective dose” again. If you are exposed to a lot of the virus, you are likely to be a lot sicker. If you are exposed to only a bit of the virus, you are likely to be only a bit sick. Even if you have not fully avoided being exposed to the virus, reducing your “infective dose”, can make a big difference to you.
Virus on the Wind: a simulation of particles spreading in the air.
Premise: 2 infections is worse than 1.
Catching 2 things at the time is not good. Stay healthy and try to treat things early to avoid complications. Coronavirus plus other illness such as the influenza virus together, will make you extra sick.
Bacterial secondary infections associated with the coronavirus as previously mentioned need to be controlled much is possible. This leads into the use of antibiotics as your GP may prescribe. Antibiotics kill bacteria. They are directly useless against the coronavirus.
However the virus will damage the linings of your airways – your bronchi and throat area in particular and probably your nose as well.
Once the linings are damaged, bacteria, can multiply and attack into the tissues – enhancing damage and helping the virus to enter the tissues. So even if you have the coronavirus and even if this is causing your sore throat – it is unlikely that your sore throat will stay wholly due to your being infected with coronavirus for very long. Within 24 hours there is likely to be a significant bacterial infection enhancing and accelerating the existing viral infection.
In short, if you treat a 24-hour mark viral infection you can kill the bacteria coexisting with the coronavirus and slow down the developing infection. This strategy with antibiotics will only work for a day or two. At this point in time, another option is to then use a different antibiotic to try to limit a different group of bacteria which were resistant to the first antibiotic and have now taken the opportunity to invade the tissues damaged by the coronavirus.
Antibiotics may not help to kill the coronavirus. But they may well help to limit the spread of the coronavirus by limiting the "indirect" amount of tissue damage. In short viruses – cause damage – which allow bacteria to grow – accelerating infection.
Antibacterial Antibiotics may help you deal with viral infection indirectly.
Dr Xxxxx :
Premise: Other medical problems can combine with the coronavirus
to exacerbate illness.
Having 2 problems at one time is not good. Using immuno-suppressants during an epidemic may be dangerous. (Steroids and methotrexate are the more common type of immuno-suppressant medications used). Having uncontrolled diabetes is likely to exacerbate a coronavirus infection. In short, see your doctor about your general health. Work with your doctor to get you as well as you can be.
Erasmus : I think the final issues we need to consider are in regard to the usefulness of our standard infection control strategies.
Dr Xxxxx : Premise: Be Real
Coronavirus is a respiratory virus. Seeing teams of germ warfare suited people spraying some odd substance in city streets makes for good TV, but has very little relevance to reality. Corona virus spreads by people coughing on each other/breathing on each other/or talking to each other predominately.
There is possibly a role for disinfection in environments such as cafes. In this environment, people may well have coughed/talked or breathed upon the table tops – contaminating the table tops. It makes sense to wipe down a table top in a cafe after people have left a table and before new people arrive at that table. It’s the sort of thing that should have been happening routinely for some time – for lots of reasons besides coronavirus. This sort of thing should be so routine that it should be barely noticeable or even newsworthy.
We need to be realistic as to what we can achieve. How dangerous are many of the social activities we undertake : really? It all depends on "shared air" and "in your face time" measurement.
I watched on TV the other night as footballs at a football match were washed. It is of course possible to transmit infection by touching contaminated footballs. It is however 99% more likely to transmit infection through the in-your-face activities associated with sport. Also activity such as sharing water bottles, huddling in small groups, and sharing towels are probably far more dangerous. I’m not sure that washing footballs does much more than make for an interesting TV clip. It is unlikely to be useful and promoting such activities takes people’s attention away from avoiding many other far more risky activities.
Still, doing anything to protect you from infection is better than doing nothing.
Aussies have been practicing Social Isolation
for some time.
Touching other people/cleaning up.
Dr Xxxxx : Touching other people/cleaning up.
The current recommendation is that we do not shake hands with other people. The replacement activity is either an elbow bump or a knuckle touch. Overall I think this is a good change to undertake. My personal observations suggest that someone of the order of 70% of men who attend a public toilet do not wash their hands after the event. Probably about time we made some changes to our social repertoire – for our own good.
There is a lot of emphasis on cleaning up surfaces. Droplets from the airwaves range from about .6 to 1000 µm. Big droplets land quickly. Small droplets are essentially permanently airborne. Hence if you sit at a table talking to someone, it is thought that the table will be covered with many small particles. This is- sort of -true. People who sit and talk to each other for a while at a table, perhaps should indeed clean down the table to remove potential viral contamination of the surface – and to minimise the chance that fingers touching the surface may then touch your mouth through the instrument of a pen, food implements and even glasses.
However, the situation can be fairly complicated. Let’s look at the concept of humidity. Many parts of Australia have an arid or dry climate. Particles that are breathed out will evaporate quickly especially in many parts of inland Australia and in the southern states of Australia. Evaporation will tend to be much reduced in the coastal tropical zones (typically with high humidity).
So in humid climates particles from our airways (that are breathed out/coughed out/talked out) stay heavier for longer and tend to fall down faster, contaminating surfaces such as table tops.
Surface decontamination is therefore much more important in humid climates where people stay in close proximity to a surface such as a table top for significant periods of time.
But here is where the situation gets much more complex. Drying while it helps keep particles airborne longer also is likely to damage the viral structure. Particles that dry out, fall apart and lose their infectivity. Humid zones tend to be more to the northern coastal areas of the country. Here while the particles persist for long times (not drying out) – there is generally a lot more UV – which is extremely damaging to most biological agents such as viruses.
Dr Xxxxx : Masks
Masks have a complex effect on infection. They really do not do what most people think, which is to filter viruses away from the person wearing the mask.
Usual rectangular facemasks: When a person coughs/breathes /talks wearing a mask – some big particles may embed on the mask internal lining – but most particles will just come out the sides of the mask.
If both people are wearing a mask – people can sit facing each other with more safety.
If both people are wearing a mask – people sitting beside each other have increased risk of infection exposure.
Some masks have a small central area which allows air to travel through for breathing purposes and have tighter seals to the sides of the mask to stop sideways spread of germs. It is unfortunately very difficult to filter the air down to a 1 to 5 µm range and still allow for easy breathing. The small particle size that needs to be filtered, demands using a very tight dense filter that is hard to breathe through.
Masks are very difficult to use. In using a mask in normal work situations – glasses often get fogged up making vision difficult. Also they can get very uncomfortable due to the pressure on the nose and ears. Someone can wear these masks relatively comfortably for the first 30 minutes, but as hour after hour goes by, they become increasingly uncomfortable and difficult to continue wearing.
Dr Xxxxx : Premise: Be Real – for administrators.
If you don’t understand the numbers/ statistics you are using and where they come from, you are going to make wrong decisions.
My friends tell me that the media and the bureaucracy have adopted some definitions of illness which are not intuitive. Currently a case of coronavirus is defined as someone who has symptoms and who tests positive for the virus. (Except where the media gets hold of the report).
So if you have no symptoms and have a positive test for of the virus you are not recorded as being a Corona virus victim.
I think this is a situation that has developed in the Chinese statistics reported.
This has the effect of reducing the number of people who apparently have caught the coronavirus infection. This has the effect of increasing the number of people who seem to have died from the coronavirus infection. This distorted statistic has the effect of making it look like the government’s policies are working and that less people are coming down with the coronavirus – and that the infection must be a nasty one because so many people are dying.
I have seen media reports of between 1/20 to 1/ 50 people dying of coronavirus. But this may not be a true reflection of circumstances. It is possible there are many more victims of coronavirus who have such a mild infection that they are not recognised as having coronavirus infection.
I think much of the case diagnosis rate is based on PCR technology , not serology, so there is a substantial built-in bias in the numbers.
My own personal experience with influenza virus is that some of the people infected with the virus can be very mildly infected indeed. In some years it can be very difficult to identify flu virus infections in individuals because they are so mild that they do not look like the “classical” influenza case.
: The corona virus: it is unknown how much variation in illness severity occurs.
Dr AXxxxx : Caution:
Mono variable analysis is not suitable for assessment of multivariable interventions,
Especially where not all effects may be as positive as initially anticipated. Beware little monkey brains how you analyse things. Most of your current assessment protocols are totally unsuited to multivariate analysis of complex situations. It should be interesting to watch the fumbling is of feeble minds as they attempt to understand something that that they have never been taught.
Goo : I worry more that if you tell them you have an answer, that they will say they are too busy helping people hurt by the crisis to give us any time, money or help.