bumpyride

From the NY Times. The is the most accurate treatise that I've seen on Masks. Worth a read. Yes, the Coronavirus Is in the Air Transmission through aerosols matters — and probably a lot more than we’ve been able to prove yet. By Linsey C. Marr Ms. Marr is a professor of engineering. July 30, 2020 A sneeze. And what it spreads. Just how much does the new coronavirus circulate in the tiny airborne aerosols we spew out by just breathing?Credit...Bettmann, via Getty Images Plus Finally. The World Health Organization has now formally recognized that SARS-CoV-2, the virus that causes Covid-19, is airborne and that it can be carried by tiny aerosols. As we cough and sneeze, talk or just breathe, we naturally release droplets (small particles of fluid) and aerosols (smaller particles of fluid) into the air. Yet until earlier this month, the W.H.O. — like the U.S. Centers for Disease Control and Prevention or Public Health England — had warned mostly about the transmission of the new coronavirus through direct contact and droplets released at close range. The organization had cautioned against aerosols only in rare circumstances, such as after intubation and other medical procedures involving infected patients in hospitals. After several months of pressure from scientists, on July 9, the W.H.O. changed its position — going from denial to grudging partial acceptance: “Further studies are needed to determine whether it is possible to detect viable SARS-CoV-2 in air samples from settings where no procedures that generate aerosols are performed and what role aerosols might play in transmission.” I am a civil and environmental engineer who studies how viruses and bacteria spread through the air — as well as one of the 239 scientists who signed an open letter in late June pressing the W.H.O. to consider the risk of airborne transmission more seriously. A month later, I believe that the transmission of SARS-CoV-2 via aerosols matters much more than has been officially acknowledged to date. In a peer-reviewed study published in Nature on Wednesday, researchers at the University of Nebraska Medical Center found that aerosols collected in the hospital rooms of Covid-19 patients contained the coronavirus. This confirms the results of a study from late May (not peer-reviewed) in which Covid-19 patients were found to release SARS-CoV-2 simply by exhaling — without coughing or even talking. The authors of that study said the finding implied that airborne transmission “plays a major role” in spreading the virus. Accepting these conclusions wouldn’t much change what is currently being recommended as best behavior. The strongest protection against SARS-CoV-2, whether the virus is mostly contained in droplets or in aerosols, essentially remains the same: Keep your distance and wear masks. Editors’ Picks A Two-Bedroom Rental in Long Island City for $3,000? One New York Couple Test Their Budget. What Does It Mean to ‘Look Like a Mom’? Tailors Know New Yorkers’ Pandemic Secret: ‘Everybody Got Fat!’ Continue reading the main story Rather, the recent findings are an important reminder to also be vigilant about opening windows and improving airflow indoors. And they are further evidence that the quality of masks and their fit matter, too. The W.H.O. defines as a “droplet” a particle larger than 5 microns and has said that droplets don’t travel farther than one meter. In fact, there is no neat and no meaningful cutoff point — at 5 microns or any other size — between droplets and aerosols: All are tiny specks of liquid, their size ranging along a spectrum that goes from very small to really microscopic. (I am working with medical historians to track down the scientific basis for the W.H.O.’s definition, and we have not found a sensible explanation yet.) Yes, droplets tend to fly through the air like mini cannonballs and they fall to the ground rather quickly, while aerosols can float around for many hours. But basic physics also says that a 5-micron droplet takes about a half-hour to drop to the floor from the mouth of an adult of average height — and during that time, the droplet can travel many meters on an air current. Droplets expelled in coughs or sneezes also travel much farther than one meter. Here is another common misconception: To the (limited) extent that the role of aerosols had been recognized so far, they were usually mentioned as lingering in the air, suspended, and wafting away — a long-distance threat. But before aerosols can get far, they must travel through the air that’s near: meaning that they are a hazard at close range, too. And all the more so because, just like the smoke from a cigarette, aerosols are most concentrated near the infected person (or smoker) and become diluted in the air as they drift away. A peer-reviewed study by scientists at the University of Hong Kong and Zhejiang University, in Hangzhou, China, published in the journal Building and Environment in June concluded, “The smaller the exhaled droplets, the more important the short-range airborne route.” So what does this all mean exactly, practically? Can you walk into an empty room and contract the virus if an infected person, now gone, was there before you? Perhaps, but probably only if the room is small and stuffy. Can the virus waft up and down buildings via air ducts or pipes? Maybe, though that hasn’t been established. More likely, the research suggests, aerosols matter in extremely mundane scenarios. Consider the case of a restaurant in Guangzhou, southern China, at the beginning of the year, in which one diner infected with SARS-CoV-2 at one table spread the virus to a total of nine people seated at their table and two other tables. Yuguo Li, a professor of engineering at the University of Hong Kong, and colleagues analyzed video footage from the restaurant and in a preprint (not peer reviewed) published in April found no evidence of close contact between the diners. Droplets can’t account for transmission in this case, at least not among the people at the tables other than the infected person’s: The droplets would have fallen to the floor before reaching those tables. But the three tables were in a poorly ventilated section of the restaurant, and an air conditioning unit pushed air across them. Notably, too, no staff member and none of the other diners in the restaurant — including at two tables just beyond the air conditioner’s airstream — became infected. Similarly, just one person is thought to have infected 52 of the other 60 people at a choir rehearsal in Skagit County, Wash., in March. Several colleagues at various universities and I analyzed that event and in a preprint (not peer-reviewed) published last month concluded that aerosols likely were the dominant means of transmission. Attendees had used hand sanitizer and avoided hugs and handshakes, limiting the potential for infection through direct contact or droplets. On the other hand, the room was poorly ventilated, the rehearsal lasted a long time (2.5 hours) and singing is known to produce aerosols and facilitate the spread of diseases like tuberculosis. What about the outbreak on the Diamond Princess cruise ship off Japan early this year? Some 712 of the 3,711 people on board became infected. Professor Li and others also investigated that case and in a preprint (not peer reviewed) in April concluded that transmission had not occurred between rooms after people were quarantined: The ship’s air-conditioning system did not spread the virus over long distances. The more likely cause of transmission, according to that study, appeared to be close contact with infected people or contaminated objects before the passengers and crew members were isolated. (The researchers did not parse precisely what they meant by contact, or if that included droplets or short-range aerosols.) But another, recent, preprint (not peer reviewed) about the Diamond Princess concluded that “aerosol inhalation was likely the dominant contributor to Covid-19 transmission” among the ship’s passengers. It might seem logical, or make intuitive sense, that larger droplets would contain more virus than do smaller aerosols — but they don’t. A paper published this week by The Lancet Respiratory Medicine that analyzed the aerosols produced by the coughs and exhaled breaths of patients with various respiratory infections found “a predominance of pathogens in small particles” (under 5 microns). “There is no evidence,” the study also concluded, “that some pathogens are carried only in large droplets.” A recent preprint (not peer reviewed) by researchers at the University of Nebraska Medical Center found that viral samples retrieved from aerosols emitted by Covid-19 patients were infectious. Some scientists have argued that just because aerosols can contain SARS-CoV-2 does not in itself prove that they can cause an infection and that if SARS-CoV-2 were primarily spread by aerosols, there would be more evidence of long-range transmission. I agree that long-range transmission by aerosols probably is not significant, but I believe that, taken together, much of the evidence gathered to date suggests that close-range transmission by aerosols is significant — possibly very significant, and certainly more significant than direct droplet spray. The practical implications are plain: Social distancing really is important. It keeps us out of the most concentrated parts of other people’s respiratory plumes. So stay away from one another by one or two meters at least — though farther is safer. Wear a mask. Masks help block aerosols released by the wearer. Scientific evidence is also building that masks protect the wearer from breathing in aerosols around them. When it comes to masks, size does matter. The gold standard is a N95 or a KN95 respirator, which, if properly fitted, filters out and prevents the wearer from breathing in at least 95 percent of small aerosols. The efficacy of surgical masks against aerosols varies widely. One study from 2013 found that surgical masks reduced exposure to flu viruses by between 10 percent and 98 percent (depending on the mask’s design). A recent paper found that surgical masks can completely block seasonal coronaviruses from getting into the air. To my knowledge, no similar study has been conducted for SARS-CoV-2 yet, but these findings might apply to this virus as well since it is similar to seasonal coronaviruses in size and structure. My lab has been testing cloth masks on a mannequin, sucking in air through its mouth at a realistic rate. We found that even a bandanna loosely tied over its mouth and nose blocked half or more of aerosols larger than 2 microns from entering the mannequin. We also found that especially with very small aerosols — smaller than 1 micron — it is more effective to use a softer fabric (which is easier to fit tightly over the face) than a stiffer fabric (which, even if it is a better filter, tends to sit more awkwardly, creating gaps). Avoid crowds. The more people around you, the more likely someone among them will be infected. Especially avoid crowds indoors, where aerosols can accumulate. Ventilation counts. Open windows and doors. Adjust dampers in air-conditioning and heating systems. Upgrade the filters in those systems. Add portable air cleaners, or install germicidal ultraviolet technologies to remove or kill virus particles in the air. It’s not clear just how much this coronavirus is transmitted by aerosols as opposed to droplets or via contact with contaminated surfaces. Then again, we still don’t know the answer to that question even for the flu, which has been studied for decades. But by now we do know this much: Aerosols matter in the transmission of Covid-19 — and probably even more so than we have yet been able to prove. Linsey C. Marr is the Charles P. Lunsford Professor of Civil and Environmental Engineering at Virginia Tech. @linseymarr.

At least I hope the vaccine works.

I used to think that Bill Gates was pretty evil, and rightly so with his business practices and information technologies. I now think that having so much wealth in his hands has changed his perspective. Hard to spend $17 Million a day no matter who you are, and when he can make a better world for his children by doing what he can to save us from ourselves, I do have to believe it's wealth in a very good place.

Not looking particularly promising. This is Britain, and they're much closer to reasonable than the US. Conspiracy theories and misinformation, spread widely on social media platforms, have fueled distrust of a coronavirus vaccine. As a result, regardless of when a coronavirus vaccine becomes available, an even bigger challenge may be getting the public to embrace it. Nearly one-third of Britons may refuse to take a vaccine for coronavirus, according to a poll released last week. The survey, conducted by YouGov for the Center for Countering Digital Hate, found that 6% of respondents would definitely refuse a vaccine, and a further 10% said they would “probably not” accept it. Another 15% said they were not sure.

I spent the day removing/replacing/and caulking dryer vents at our HOA, to prevent having to reside the buildings. How's that for fun? Actually I enjoy it. There's only so much biking and hiking a guy can do all summer.

I've totally given up boarding for 20-21. Having serious doubts about 21-22 the way this great nation of individualists are going to refuse to give a damn about anyone. Only hope is for all the states to get on board and follow New Zealands lead. Fat chance.

This is heartbreaking. Essential workers giving their lives for next to nothing and having to deal with people who think they're more important than anyone and everyone else. If one of us gets sick, these are the people that will have deal with the mess we created. Anthony Almojera is a New York City paramedic. - - - Nobody wants to know about what I do. People might pay us lip service and say we're heroes, but our stories aren't the kind anyone actually wants to hear about. Kids in this country grow up with toy firetrucks, or maybe playing cops and robbers, but who dreams of becoming a paramedic? That's ambulances. That's death and vulnerability - the scary stuff. We're taught in this culture to shun illness like it's something shameful. We'd rather pretend everything's fine. We look the other way. That's what's happening now in New York. We just had 20,000-some people die in this city, and already the crowds are lining back up outside restaurants and jamming into bars. This virus is still out there. We respond to 911 calls for COVID every day. I've been on the scene at more than 200 of these deaths - trying to revive people, consoling their families - but you can't even be bothered to stay six feet apart and wear a mask, because why? You're a tough guy? It makes you look weak? You'd rather ignore the whole thing and pretend you're invincible? Some of us can't stop thinking about it. I woke up this morning to about 60 new text messages from paramedics who are barely holding it together. Some are still sick with the virus. At one point we had 25% of EMTs in the city out sick. Others are living in their cars so they don't risk bringing it home to their families. They're depressed. They're emotionally exhausted. They're drinking too much. They're lashing out at their kids. They're having night terrors and panic attacks and all kinds of outbursts. I've got five paramedics in the ground from this virus already and a few more on ventilators. Another rookie EMT just died by suicide. He was having trouble coping with what he was seeing. He was a kid - 23 years old. He won't be the last. I have medics who come to me every day and say, "Is this PTSD I'm feeling?" But technically PTSD comes after the event, and we're not there yet. It's ongoing stress and trauma, and we might have months to go. Do you know how much EMTs make in New York City? We start at $35,000. We top out at $48,000 after five years. That's nothing. That's a middle finger. It's about 40% less than fire, police and corrections - and those guys deserve what they get. But we have three times the call volume of fire. There are EMTs on my team who've been pulling double shifts in a pandemic and performing life support for 16 hours, and then they go home and they have to drive Uber to pay their rent. I'm more than 15 years on the job, and I still work two side gigs. One of my guys does part-time at a grocery store. Heroes, right? The anger is blinding. One thing this pandemic has made clear to me is that our country has become a joke in terms of how it disregards working people and poor people. The rampant inequality. The racism. Mistakes were made at the very top in terms of how we prepared for this virus, and we paid down here at the bottom. It started around the middle of March when the call volume began to spike in the poorer neighborhoods. The stay-home order in New York hadn't even gone into effect at that point. Trump was telling us he had everything under control. The mayor was saying we had great health care, and we wouldn't get hit as bad as other countries, so we should keep on going to the movies. But for us, it was wheezing, trouble breathing, heart palpitations, cardiac arrest, cardiac arrest. This virus stresses out the heart in a bunch of different ways. I'd look at our dispatch screen sometimes and see 30 possible cardiac events happening at any one time across the city, mostly in the immigrant neighborhoods. It felt like watching a bomb go off in slow motion. You had time to see who was going to get hit and who had the ability to escape. I saw in Manhattan, on the East Side, people clearing out of the city to set up shop in the Hamptons or rent property upstate. The business class packed up their computers and went off to work elsewhere. Meanwhile, the rest of us were huddling with no ventilators, like fish in the barrel. It got so quiet sometimes that all you could hear were our sirens. The most 911 calls we'd ever had was back on September 11th, and we broke that record every day for two weeks straight. My station is right in Brooklyn's Chinatown, so it's a lot of new Chinese immigrants, sometimes 10 or 12 people living in a small place. They tend not to call 911 unless it's absolutely necessary, but they were calling. One woman was apologizing for bothering us while we were trying to get a pulse back on her uncle. The Dominicans and Puerto Ricans in Sunset Park got hit hard. Sometimes those families will pray over you while you're doing CPR. The Middle Eastern neighborhoods in Bay Ridge got hit. The African American communities, where hypertension is a big thing. The nursing homes in Far Rockaway. The housing projects in East Flatbush. We weren't carrying too many stretchers into the fancy brownstones. I'm a lieutenant and vice president of the union, so I cover a big area, and I mostly go to the big traumas. I grew up in Brooklyn, and I know every street in this city. I can whip it. Doesn't matter where the call is. I'm two minutes out. I had one guy with COVID who was talking to me in his fifth-floor apartment. He was breathing heavy, so we loaded him on the stretcher, and by the time the elevator hit the lobby, he didn't have a pulse. I went to another high-rise for an unresponsive elderly woman, and then I realize, two days before we were in the same place because her husband had dropped. Both of them died. We sometimes had 400 emergency calls sitting on hold. People were waiting hours for an ambulance on the more minor stuff. I pronounced more deaths in the first two weeks of April than I have in my career. I got one call at the height of the madness, another cardiac arrest, and it was a Latin guy, young guy, unresponsive and passed out in a room with bunk beds. There wasn't enough space to work, so we dragged him out into the living room to start giving him CPR. This guy had no pulse. That's clinical death, but biological death doesn't come until about six minutes later. That's our window to bring you back. That's why we do this job. Now this guy was 31. He was strong, healthy. His mother told us he'd just gone out. As a medic, you hear that and your eyes start to get big. It's like, OK, maybe this is one we can save. It was four guys and me. That's the crew. The two EMTs were bagging him up to get oxygen in his lungs. The medics were starting to intubate and calculating the meds. Everything they can do for you in a hospital, EMS brings to you. We carry 60 medications. We hook up the heart monitor. It all happens so fast, and there's barely time to talk. It's scalpel, needle, put in the IV, pace it, shock it, check on the heart rhythms. It's like a symphony, and you have to know your part. The team kept working, and I went over to get information from the mother. There was a little girl standing behind her, 7 years old, and it turns out she's the daughter. They told me he'd been sick four or five days, but he worked at a bodega and he couldn't afford to take off. He'd come home from work and collapsed a few minutes later. Now I'm getting upset. Here we're supposed to be this great society, and this guy can't even miss one paycheck. There's no safety net. The system we have is broken, and this 7-year-old is seeing her dad get CPR. We kept working. After a few minutes, we got a pulse back. I told the family: "He's not out of the woods yet, but we might have a shot here." We rushed him into the truck and over to the hospital, and then he died a while later. I did 14 cardiac arrests that day. I didn't save anybody. The thing about being a paramedic is you need to have some reservoir of hope. This job is the ultimate backstage pass. It can make you believe in humanity, but it can also suck the humanity out of you. You see death, suffering - grief in its rawest forms. I've been shot at on this job. I've been beaten and cursed at. But then every year, we go to the Second Chance Brunch, and we get to meet some of the people we saved. There's no drug on the planet like that. There's no job that matters more. It keeps you going. But then we came into this virus, and we weren't bringing people back. The virus kept winning. It always ended the same way. I'd go park the truck at the beach after a double and try to calm myself down and gather my thoughts. I've gained weight during this pandemic. I don't sleep well anymore. Emotionally, I've been feeling a little numb. They teach you as a Buddhist that life is suffering, and I believe that. You have to stay in the suffering. You can't deny reality and turn the other way. I've been in therapy for 17 years, and lately what keeps coming up is that reservoir of hope. It's starting to feel more and more empty. Our call volume has been down for the last month, but I'm worried it won't stay there. I don't have that much faith in what we are anymore. America is supposed to be the best, right? So why aren't we united at all? Why aren't we taking care of each other? The virus is hanging around, waiting for us to make more mistakes, and I'm afraid that we will.

I've decided that I'm not buying a season's pass at this time. I'll wait and see, but I have very little hope that things will become any less dangerous. My wife was a Microbiologist for 41 years, and has heard Osterholm speak several times before she retired. She has come back and told me that he was spot on, and completely credible. He was very involved with the Obama Administration in preparation for a pandemic response. COVID-19: Straight Answers from Top Epidemiologist Who Predicted the Pandemic By Dan Buettner, Blue Zones Founder [Interview conducted on May 29, 2020. Published on June 6, 2020] We’ve been told alternatively to not wear masks, to wear masks, to stay home, and to get out and reinvigorate the economy. Hydroxychloroquine and remdesivir both got our hopes up but now have largely fizzled. We’ve heard estimates that as many as two million Americans will die and now, with 100,000 deaths, we’ve heard we’re near the end of the crisis. Is a vaccination forthcoming? How likely we to get the disease? What exactly should we do with our aging parents who are at the most risk? To get some clear answers, I called Michael Osterholm, PhD, MPH, an internationally known expert in infectious disease epidemiology who has advised both Democratic and Republican Presidents. I know Dr. Osterholm from the University of Minnesota (our academic partner for the first Blue Zones explorations) where he serves as the Director of the Center for Infectious Disease Research and Policy. He has also served as interim Director of the Centers for Disease Control (CDC). In short, Dr. Osterholm is arguably one of the most dependable, non-political sources for straight answers on what COVID-19 means to us and our world in the immediate future. In his 2017 book, Deadliest Enemy, he correctly foretells a global pandemic and offers the best strategy for fighting it now and avoiding it in the future. Here are the highlights of our conversation. But if you really want to understand this disease, read the whole interview. This disease may be the biggest event of our lifetimes. 3 months ago, COVID-19 was not even in the top 75 causes of death in this country. Much of the last month, it was the #1 cause of death in this country. This is more remarkable than the 1918 Flu pandemic. There is no scientific indication Covid-19 will disappear of its own accord. If you’re under age 55, obesity is the #1 risk factor. So, eating the right diet, getting physical activity, and managing stress are some of the most important things you can do to protect yourself from the disease. One of the best things we can do for our aging parents is to get them out into the fresh air, while maintaining physical (not social) distancing. Wearing a cloth mask does not protect you much if you’re in close contact with someone who is COVID-19 contagious. It may give you 20 minutes, instead of 10, to avoid contracting the disease. We can expect COVID-19 to infect 60% – 70% of Americans. That’s around 200 million Americans. We can expect between 800,000 and 1.6 million Americans to die in the next 18 months if we don’t have a successful vaccine. There is no guarantee of an effective vaccination and even if we find one, it may only give short term protection. Speeding a vaccination into production carries its own risks. The darkest days are still ahead of us. We need moral leadership, the command leadership that doesn’t minimize what’s before us but allows everyone to see that we’re going to get through it. Dan Buettner: The 1918 Spanish Flu broke out in the spring, kind of went semi-dormant in the summer and then came back with a lethal vengeance in the fall. Do you worry we might see a similar pattern with COVID-19? Dr. Osterholm: One of the things we have to understand is that this virus is operating under the laws of physics, chemistry, and biology. It doesn’t in any way, shape, or form bend itself to public policy. Right now, about 5% of the US population has been infected; although it’s higher in places like New York City and some urban areas, across the world it’s about 5%. A virus like this is transmitted by the respiratory route. I call it the leaky bucket virus because if there’s one little crack somewhere, it will get out and will infect people. Why is that important? Because we know that it will continue to infect people into 60 to 70% of the population over time. When this happens, it’s called herd immunity where these people are immune rods in the transmission reaction. That means that if I’m in contact with four people and three of them are already protected because they have antibody from having had the illness or been vaccinated, I don’t transmit to them. So the bottom-line message here is that this virus is going to keep transmitting to others until it hits that 60 or 70% level. And even then, it’s like a plane at 30,000 feet when the pilot announces we’re going to be dropping for landing. It doesn’t just suddenly land, it’ll just slow down. So, we’re really confronted with having this virus in our population for months to years ahead if we don’t get a successful vaccine. So to answer your question of how we are going to get to that 60 or 70%, that’s what we don’t know. We’ve never had a coronavirus pandemic infection like this. It may have happened centuries ago, but we didn’t see it. If it’s like influenza, of which there have been 10 such pandemics in the last 250 plus years, three started in our North American winter, two in our spring, three in our summer, and two in our fall. And in each instance when that happened, there was a wave that lasted several months, much like we’re seeing now around the world that seemed to disappear after several months. We don’t know what happens to the virus and it is not just based on season — it’s always just after a few months. In every instance the virus came back with a second wave. And when that happened, usually three to four months after that initial wave was over, it tended to be much, much more severe. This is not just the 1918 pandemic because even in 2009 with H1N1, we saw that same thing happening with a much less severe pandemic. We saw an early Spring peak of cases when it first emerged in March, April, and May. Then it disappeared and came back in late August / early September and then took off with a peak in October. So that’s one model that could happen. But because this is a coronavirus [not an influenza virus], we don’t know what might happen for sure. Our group has actually put a paper on our website and the scenarios for what this might look like. We said, well, maybe it’s not going to be like a flu virus, maybe it’ll just be a slow burn and just keep doing what it’s doing now for potentially months and months to come if we don’t get a vaccine. Or we could see more of these kinds of peaks and valleys where basically certain areas light up for anywhere from a month to six weeks, and we work hard to suppress it, and then it disappears, but then it lights up somewhere else. And any of these are still possibilities. But I can say with certainty, what I call the laws of virus physics, is that this is going to continue to transmit until we see a large part of the population infected. When you think about only 5% of this country’s been infected to date, and you understand the pain, the suffering, the death, and economic disruption that’s occurred with just 5%, then you can imagine what it’s going to take for us to get to 60 or 70%. DB: There’s no chance it will just mysteriously disappear after the first or second wave? MO: We have no reason to think that that will happen. Put it in this context: If we drop 1000 books, we can pretty well predict moment after moment after moment in every instance, where each book is going to go when it hits the floor. And the same thing is true with viruses like this. There’s nothing in our past history that would suggests that it would just suddenly disappear and die off. While it does change genetically over time, it’s still a very stable virus. There’s no evidence that somehow it might just mutate itself away. That’s just not going to happen. DB: So there’s a lot of hope around a vaccination. But we haven’t been able to find a vaccination for herpes or for the common cold. Is there any reason to have any greater hope for COVID-19 than we’ve had for these common diseases that have been around for decades or centuries? MO: The one thing we’ve done here is we’ve put probably the hundred best hockey players we can on the vaccine ice. And so, we’re getting lots of shots on goal and they’re as good as they’re going to get. So that part is very positive. The world has responded. There are over 120 vaccine candidates being evaluated right now. But to go to the heart of your question, will any of them make it in the goal? We don’t know. There are challenges with coronaviruses. We know that from two other coronavirus infections called SARS and MERS; in both instances, we were not able to get easily and effectively applied vaccines. We also know that it’s possible we could get some short-term immunity with these vaccines. That means you may not be able to develop what we call durable immunity that lasts a long time. That would be a real challenge, because then you’d have to keep re-vaccinating people if that would even work. The final piece is safety as we do have challenges with this virus. We know that there’s a condition called antibody dependent enhancement, which is a condition where you make just a little bit of antibody, but not enough to protect yourself. There’s also an immune enhancement phenomena where your body goes out of whack in terms of immune response. And so, one of the things that we are having to look at very carefully is the safety of these vaccines. I would say at this point we can all be hopefully optimistic. But we know hope is not a strategy. I think the key message is that, first of all, is that if it does happen, it’s not going to happen soon. The idea that we’re going to have a readily available vaccine by the end of this year is just not realistic. And while we all want to be aspirational, we also have to be highly practical in how we plan. I think the second piece of it is that if we do get a vaccine, it’s not going to happen overnight in terms of making it or distributing it. There are 8 billion people in the world that want this vaccine right now. What happens if China has an effective vaccine before we do, are we going to get any of it? And so, there are still many challenges yet that are before us in terms of what happens even if we do get an effective vaccine. DB: Good answer. A Blue Zones core value is honoring older people. For people who have aging parents or relatives, do they need to sit at home by themselves for the next year? Or how do we best protect them? MO: This is a challenge that is as daunting as any I’ve ever faced in my public health career, including HIV / AIDS or any other condition. How do we try to protect those people who are at the highest risk of having a severe outcome? And right now, if you’re over age 65, you’re male, if you have underlying heart disease, hypertension, diabetes, renal disease, certain lung cancers or blood cancers or if you’re moderately to severely obese, then these are all risk factors for developing the disease. And I might add to the obesity piece, which is something very near to the hearts of your readers here — healthy lifestyles are so important in reducing your risk for severe disease. Right now, among those people who we see having severe disease under age 55, obesity is the number one risk factor for [COVID-19]. For people under age 55, obesity is the number one risk factor for severe COVID-19.CLICK TO TWEET So what do we do to protect these people? We don’t have a ready answer. Locking people up to bubble them from this virus for 18 or more months, or however long it might take to get a vaccine, is a severe challenge. Mental health-wise — we have to understand the issues. I categorically reject the concept of social distancing. It’s physical distancing. I hope we never social distance, ever. Minimizing your contact with large groups, numbers of people, will surely help. We know that you can reduce transmission that way. Beyond that, wearing a mask will reduce your risk and not in a major way, but it’s another possible means of reducing transmission. But in the end, this is why we so desperately need to get a vaccine. DB: Let’s say you have two 80-year-old parents who live in a house by themselves. What do they do for the next year? MO: Again, I would limit the number of contacts they have outside the home. If they are out in public, they can wear a mask but that’s of limited protective value. When outside, stay away from large groups. Don’t spend lots of time next to someone. This virus doesn’t magically jump between two people — it’s time and dose. Don't spend lots of time next to someone. COVID-19 doesn't magically jump between two people -- it's time and dose.CLICK TO TWEET For example, if you’re riding in a car with someone who’s infected, you may become infected yourself by just breathing their air within 10 minutes. If they have a cloth mask on, then that may move it to 20 minutes but it doesn’t eliminate it. The same thing is true if you’re going to a large social event, like a church event. The problem is that this virus is transmitted largely by what we call aerosols, those little things that we breathe, and we put out hundreds of thousands of these every minute when we talk. If you’re in church setting, particularly where there’s singing, we know that there have been a number of outbreaks that have occurred where the source has been someone infected in a church setting. So, should they go to church on a Sunday? That’s a real challenge. Again, if they’re at increased risk for severe disease, I have to tell them that they are taking this risk on. This has been a very difficult part of this pandemic to try to provide meaningful and thoughtful risk-based information that doesn’t scare people needlessly, but at the same time, doesn’t put them in harm’s way for what can happen. To give you some perspective on what this virus has done: 85 days ago, this virus as a cause of death was not even the top 75 causes of death in this country. Much of the last month, it was the number one cause of death in this country. Nothing has done that since the 1918 influenza. That gives you some sense of the impact that this has had. DB: To summarize a few things that you’ve said: we’re going to herd immunity of 60 to 70%, and it’s people over 65 who are at highest risk. It almost seems like a death sentence to let your 80-year-old parents go outside over the next few years. MO: The message I think we have to say is being outside is really a very important thing [for Covid-19]. It’s getting fresh air, and being able to move and exercise. It turns out that being in the outside environment dissipates these aerosols very, very quickly. Of all the outbreaks that happened in Wuhan, China where people get together with one infected individual and then transmission occurred — all but one of them occurred inside. Being outside is really a very important thing for Covid-19 because you're getting fresh air and movement. It also turns out that being in the outside environment dissipates these aerosols very, very quickly.CLICK TO TWEET So, I think this is the time of year when people need to take advantage of parks and walks separated by 6, 10, 12 feet knowing they can feel very safe about that. It’s time and dose, so you’re not going to get infected by passing somebody on the path. That’s the good message: Get people out, get them exercising, and take them out. The challenge is going to family events. We’ve had a number of outbreaks where funerals, weddings, and family events in general were the source because people congregated together in tight spaces for a long period of time. But if you’re not doing that, then I think the risk is actually quite small. DB: Another one of our core observations from Blue Zones research is that people living long lives are eating more plant-based foods. What role do you think the industrialized meat production plays in the emergence of diseases like COVID-19? MO: Well, one of the things that is very clear is that the human-animal interface is a very, very important source for these infectious agents. When you’re looking at bushmeat or something from the wild that may come from any number of exotic animal species, in many parts of the world this is an important source of protein for families. One of the things we realize though, is in the process of contact with that animal — cleaning it, preparing it for food, consumption — these all contain exposure to blood or other body fluids that might transmit any number of different viruses or agents. We know certain kinds of bats are much more likely to harbor some of these exotic viruses that don’t kill the bats but can transmit it to humans or other animals. So the wild bushmeat is a very important area, in the kinds of market situations we see largely in Asia but also in other places around the world. Africa also can play a role, as we saw with the Ebola virus. So that’s the one area with animal contact that’s by far the highest risk. In terms of domesticated animals like cattle, hogs, pigs, etcetera — the risk there is just common food-borne disease where we continue to see huge challenges there like with salmonella and e. coli. These all play an important role in human disease and particularly today in antibiotic resistance transfer because we’re seeing the increasing use of antibiotics in raising these animals. Because they too are suffering from infectious diseases, and the more antibiotics used the more antibiotic resistance you get, which means the more antibiotics you use. So we don’t see the exotic viruses for the most part with domesticated animals except for very occasionally. DB: I read the theory that the 1918 flu virus mutated in a pig and then jumped to humans. MO: We don’t know the exact origin of the 1918 virus. We call it a swine flu because the genes on it look very much like it probably spent time at a pig. Pigs are very important animals in making viruses for humans that can be very dangerous. The reason for that is that flu viruses originate in aquatic birds, particularly ducks and so forth. These viruses can very rarely jump to humans, but typically humans can’t then transmit them on to others. But when a pig becomes infected with one of those bird viruses, they also have the ability to get infected with human viruses because of the receptor sites in their lung cells. And when those two viruses get together in a pig cell, they often swap out genes, which then makes a virus that’s unique, new, and now able to infect humans. Pandemics begin when a brand-new virus infects a human who also at that point is able to transmit the virus to other humans. So, it’s not just to humans, but transmission by humans. The 1918 virus is one that we’ve resurrected because we didn’t even have the ability to grow viruses back in 1918. We didn’t really understand them. But now we can come back to it and say that this virus likely emerged out of a pig source with a human virus involved and then somehow it jumped into humans. But where it jumped into humans is still a question that we all have. DB: Great answer. Let’s say you have the full support of the president and a sufficient budget. If you were willing and took on the job of “COVID-19 czar,” what strategy would you pursue at this point? MO: The first thing I would do is identify an FDR or a Winston Churchill. Because I know that over the months ahead, we’re going to have a great deal of difficulty working through this pandemic. The darkest days are still ahead of us. And we need that moral leadership, that command leadership that doesn’t minimize what’s before us but allows everyone to see that we’re going to get through it. And we will — we’re going to get through this. We need that kind of leadership. It’s not a partisan statement. It’s not anything about the politics of the day, it’s just what we as a society are going to need to get through. That may seem simple, but that is right up there with the magic wand issue of also having a vaccine. I would continue to push forward everything I could on vaccine research and development, looking at drug therapies, and also doing anything I could to improve on the production of protective equipment for healthcare workers. Right now, over 600 healthcare workers in this country have died as a result of Covid-19 infection acquired on the job. They are now on the frontline of this war against this virus. And because of our lack of preparedness, we don’t have enough respirator masks and the kinds of things that they should have on to protect themselves when working with patients. They don’t have all the protective equipment they need. And our consumption of it has been so high just trying to provide care to the patients, that we haven’t been able to get ahead. We’re always falling further and further behind what’s needed. That has to be a very high priority. Finally, I would really work on and develop the kinds of protocols and information sources for the public to better understand what’s going on. Right now, I think the public feels whipsawed back and forth. What is my risk? The questions you asked me — how do I protect my aging parents? Is it safe to go to work? What do I have to be concerned about with my kids in school? We really need to have as much information in the hands of the public. We can’t answer all the tough questions. We can’t solve all the tough problems, but we can be a partner in helping the public understand what we know and what we don’t know. I call it straight talk. Not happy talk, just straight talk. If I were czar, I would make sure that all the people that I worked with would espouse that very important goal. DB: Two final questions: What do you think the best-case scenario and the worst-case scenario are for COVID-19? MO: My worst-case scenario is that we see it suddenly start to disappear from this country right now. And people say what, how could that be worst case? That’s the worst because if that happens, it means that it’s not disappearing due to human behavior or anything we’ve put in place to reduce transmission. That would tell me that this is now acting like a flu virus even though it is a coronavirus. If it looks like a pandemic flu virus, then that would suggest that in late summer or early fall we could have a very significant wave of activity that would overwhelm society as we know it, healthcare wise and otherwise. That would be really a very unfortunate situation. My best scenario is that this just continues to burn on — it’s with us, but it doesn’t ever overtake us. We learn to live with the virus, and we are able to suppress it without destroying society as we know it. And we get a vaccine in 12 more months, and we’re able to get that into people and it works effectively, at least for the short term. So we’re somewhere between those two. What we don’t understand is exactly where yet. DB: In that worst-case scenario, given the fact we have to get to some form of herd immunity – can you estimate how many Americans die? MO: Well, I think you can do your own math in the sense that if 5% of the population has been infected to date and we have 100,000 deaths, it’s a 12-fold increase to get to 60 or 70%. Now, some of these people will be at lower risk of dying than the people in the first 100,000 deaths, because we are, in a sense, burning through long-term care facilities right now in a really terribly, terribly tragic way. But they’re developing herd immunity in many of these facilities because there have been so many cases. So, the death rate per hundred thousand people will drop as we have more people infected. But because we have so many more people that are in that top of the pyramid, that smaller part of the population distribution, we still will have lots of deaths. So it would not be unreasonable to say based on what I just shared with you with 100,000 deaths for 5% of the population infected, that somewhere between 800,000 and 1.6 million people could easily die from this over the course of the next 12 to 18 months if we don’t have a successful vaccine. DB: Well, that is scary. There’s this strongly held view by some that we should follow a modified Sweden model. They point out that there’s all this death and pain and suffering from a collapsed economy. And that if we’re going to herd immunity and as long as the healthcare system can absorb the cases, we should just speed to herd immunity. What’s wrong with that thinking? MO: First of all, the Sweden model no longer exists. It was a myth to begin with. And it now is even being heavily criticized within Sweden to the point where there’s actually a criminal investigation going on about what did or didn’t happen in their long-term care. Sweden has one of the highest death rates in the world in terms of number of people that have died per population. They have not advanced any meaningful way towards a herd immunity level and are not much higher than the United States is right now. And they recognize in retrospect that maybe they didn’t accomplish all that they thought they were going to. The adjoining countries of Denmark, Finland, and Norway – who did go into more extensive lockdown activities — have kept their death rates significantly lower than Sweden has. And they’re bringing back the economy, very similar to Sweden is doing. So, I think that one of the problems we have is everybody seems to have a magic answer for what’s going on. And my response is that it might be a magic answer today, but let’s wait a week and see what happens. And that has happened time and time again. We’ve heard about how China was successful in tamping down that initial outbreak in Wuhan and throughout Hubei. But now we see they’re having a resurgence of infection with large parts of Wuhan now being tested again and other major outbreaks in China. So everyone may have a perfect solution today, but following my leaky bucket concept it may not be that way tomorrow at all. DB: So we should be continuing to lockdown and wear masks and proceed with caution. MO: I think one of the things we have to understand is we can’t just lockdown. I look at this with two guardrails. On one side is a guardrail where we are locked down for 18 months to try to get us all to a vaccine without anyone having to get infected or die. We will destroy not just the economy but society as we know that if we try to do that. The other guardrail is to just let it go and see what happens. We will see the kinds of deaths we just talked about and we will see healthcare systems that will literally implode. And not just for COVID-19 care, but for heart attack, stroke, and all other causes of disease in our communities. That’s not acceptable. And so we’ve got to thread the rope through the needle in the middle. The very question you asked me about, what do we recommend to our older citizens of this country — our parents, our grandparents — what do we tell them? That’s the part that we haven’t done a good job of addressing. We have to learn not only how to die with this virus, which tragically we’ve had to do, but we also have to learn how to live with it. Those are the kinds of discussions we need to have now. If we’re not going to lock up and we’re not going to open up willy-nilly, then what is the approach? And what we’ve been trying to do is facilitate those very discussions so that people can make hard choices. What are the things that we can do to change society that will help us maintain society to the best we know but at the same time also reduce transmission? That’s a key activity right now that public health needs to be playing a very important role in. DB: What a phenomenal and articulate informed answer, Michael. MO: Well it’s all I know, and it’s where we’re at. DB: It’s not binary. We need to find the Goldilocks — the sweet spot. MO: And then consensus. I see what this is doing to our country — it’s tearing it apart. I’ve said this to others that for years and years, I could never stand what it must have been like to be a father who sends half his sons off to the north to fight and half to the south during the Civil War. Today, I’m seeing families going through exactly that over these issues. It’s really tragic. What is happening with COVID-19 is that it’s not just about the severe disease, but it’s also exacerbating many underlying issues we have in this country today. I think this is a real point of learning for us. DB: I have a final personal question. My 60th birthday is coming up. I live on Lake of the Isles and I was thinking of putting an open-air dining room up for a dinner party of 10 people or so outside. Is that a bad idea? MO: If you’re outside, the aerosols dissipate much, much faster. So any air movement at all will help move those. Again, I can’t say that it’s perfectly safe. Remember the choir participant who sang for two hours and transmitted the virus to 42 out of 60 people. But exposure as a dose is a combination of time and amount. So, if you’re in a situation where you are basically spending an hour or two in an outdoor area, it’s likely that even if somebody was infected there, you wouldn’t have the same dose at all. As I pointed out before, virtually all the outbreaks we’ve seen have occurred indoors. DB: Okay, so I can go ahead or are you advising against it? MO: [laughing] Well I can’t say yes or no, I’m giving you the best advice I have. We’re all looking for the Holy Grail right now. DB: Well, this has been fantastic. You’re always busy, so thank you for taking the time to educate us. How can we learn more on this pandemic and for what the future holds? MO: My book Deadliest Enemy: Our War Against Killer Germs was published in 2017. Chapter 13, ironically, is about SARS and MERS, and about why coronaviruses are going to keep being a huge challenge. Chapter 19 is about what an influenza pandemic would look like, and if you just cross the word out influenza and put in coronavirus, it details what’s happening now — 25% unemployment, no summer baseball season, and what we’re facing now. https://www.bluezones.com/2020/06/covid-19-straight-answers-from-top-epidemiologist-who-predicted-the-pandemic/?fbclid=IwAR2BzHaNh7SzMLtRi9bXN_rPOcfj2od9fi-78BKLG0u7oNtnZzlrCMSC_XQ

If you've done your history on what happened when they opened up too early for the 1918 Flu (when they thought the curve flattened) we're all pretty screwed. Granted the Flu mutated, and that's still an unknown. Montana is opening up. Governor is leaving it up to Schools to determine whether or not to open on May 4th, which puts the onus on local school officials. Restaurants and Bars can open with some protocols (like 50% occupancy) so try explaining that to a drunk. Remember, it started with ONE PERSON. https://www.history.com/news/spanish-flu-second-wave-resurgence

Listening to the news. New Zealand street once again the world's steepest after Guinness World Records reverses decision. I ran it years ago. Our friends went to town and picked up fresh greens and produce for us, saving us a trip into civilization. Won't have to go into town for weeks. First day out in the mountains at 7500 feet with a baseball cap instead of anything covering my ears. Sitting on a swing made out of a chairlift with my wife, staring at Lone Peak, deep blue sky without a cloud, and not a soul around.

As soon as our "CORPORATE FATHERS" deem the crisis over, you can be pretty much assured that all hell will break loose, and that will include those that insist on having packed chruches.

This from my Brother in Law that's working on the spread in Minnesota: Our governor, based on U of M epidemiological models predicts 40-80% of Minnesotans will get it.

WARNING! WARNING! WARNING! If you're thinking about delaying your mortgage payments, PLEASE watch this. It may be a trap by Big Banks; If you don't belong to facebook, the gist is that if you're looking for a deferral of your mortgage payment, at the end of the time period they may require you to pay all past months payments. If you don't you may be in default. You have to read the fine print very carefully. Here's another take without facebook. https://www.facebook.com/virginialawoffice/videos/241821810305247/

What does flattening of the curve really look like when we have idiots surrounding us?

The whole pandemic started with 1 case. Then it spread, and it doesn't matter who, what country, or how many. It started with 1 case. The whole cycle can again be started with 1 case unless all protocols are followed. Now it's running rampant in the US. Until it's virtually eliminated (which is probably impossible given the state of the laissez faire attitude of some politicians and a good portion of the public), it will continue to spread in waves. There will be pockets of infection, and those will spread, just as you see the maps showing where the cases are ramping up, and those red circles continue to expand. All it take is 1 case, and it can be asymptomatic, to start the cycle all over again. Just spoke with our good friends at Big Sky. They're 40 years old. The resort closed down, and he is going down to Bozeman almost every other day to buy guns and ammunition with absolutely no protection. They're having friends over in the evenings and playing games. No one knows who has what, and they don't seem to be worried about it, and that seems to be the case as I watch the full time residents up here congregate. Until it starts striking those that think they are immune, you're going to continue to have the disease spread. Nearly 40% of patients who were hospitalized in the US were under 55 and 20% were between 20 and 44 . When hospitals are overcrowded and ventilators are not available, those that think they are immune are going to start dying in increasing numbers, and that may wake up some of those that are not too worried about it. Hopefully those of us that do become infected and survive will acquire immunity (although that's a still unanswered question). Be vigilant to excess and cross your fingers. When the vaccine comes, you'll still have the anti-vaxers, to contend with.

With the rapidly spreading coronavirus in Washington State in early March, leaders of the Skagit Valley Choir debated whether to rehearse weekly. The virus was already killing people in the Seattle area, about an hour’s drive south. But Skagit County has not reported any cases, schools and businesses have remained open, and bans on large rallies have yet to be announced. On March 6, Adam Burdick, choirmaster, informed 121 members in an email that, in the midst of “stress and tension from concerns about the virus”, the practice would take place as planned at the Presbyterian Church from Mount Vernon. “I plan to be there on Tuesday March 10, and I hope many of you will be too,” he wrote. Mount Vernon Presbyterian Church in Mount Vernon, Wash. (Karen Ducey / for the Times) Sixty singers showed up. A receptionist offered hand sanitizer at the door, and members refrained from the usual hugs and handshakes. “It seemed like a normal rehearsal, except that the choirs are huge places,” said Burdick. “We were making music and trying to keep some distance between us.” After two and a half hours, the singers separated at 9 p.m. Almost three weeks later, 45 were diagnosed with COVID-19 or ill with symptoms, at least three were hospitalized and two died. The epidemic stunned county health officials, who concluded that the virus was almost certainly transmitted by air from one or more people without symptoms. “That’s all we can think of right now,” said Polly Dubbel, county communicable disease and environmental health manager. In interviews with the Los Angeles Times, eight people at the rehearsal said that no one coughed, sneezed, or looked sick. Everyone came with their own score and avoided direct physical contact. Some members helped install or remove folding chairs. Some used mandarins which had been placed on a table in the back. Experts have said the choir epidemic is consistent with a growing body of evidence that the virus can be transmitted by aerosols – particles less than 5 microns in size that can float in the air for minutes or more. The World Health Organization has minimized the possibility of transmission in aerosols, noting that the virus is spread by much larger “respiratory droplets”, which are released when an infected person coughs or sneezes and quickly falls to the surface. . But a study published March 17 in the New England Journal of Medicine found that when the virus was suspended in a fog under laboratory conditions, it remained “viable and infectious” for three hours – although the researchers said that the period of time would probably not be more than half an hour under actual conditions. One of the authors of this study, Jamie Lloyd-Smith, a researcher in infectious diseases at UCLA, said that it was possible that the powerful breathing action of the song had dispersed viral particles in the church hall which were largely inhaled. “You would imagine that really trying to project your voice would also project more droplets and aerosols,” he said. With three-quarters of the choir members testing positive for the virus or showing symptoms of infection, the epidemic would be considered a “mass event,” he said. Linsey Marr, environmental engineer at Virginia Tech and specialist in airborne virus transmission, said that some people are particularly good at exhaling fine materials, producing 1,000 times more than others. Marr said the hatching of a choir should be seen as a powerful warning to the public. “It can help people realize that, hey, we really have to be careful,” she said. *** The Skagit Valley Chorale attracts members from northwest Washington and often sells its winter and spring concerts at the 650-seat McIntyre Hall in Mount Vernon. Amateur singers interested in choral music tend to be older, but the group includes a few young adults. Burdick worked on hip-hop in one issue last year. The next big representation of the group’s schedule took place at the end of April, during the tourist season, when the annual Skagit Valley tulip festival attracts more than a million people to see brilliant colors in the meadows surrounding the Mont Vernon. The festival will soon be canceled, but nothing has been announced yet and the choir continues to prepare. Carolynn Comstock and her husband Jim Owen carpooled for the nearby town of Anacortes’ March 10 practice with their friends Ruth and Mark Backlund. Carolynn and Jim, who ran a home improvement business together, have been singing with the choir for 15 years and see it as a central force in their lives. They had presented the Backlunds to the choir. Jim Owen and Carolynn Comstock, singers of the Skagit Valley Choir, are seated in front of their house in Anacortes, Wash. (Karen Ducey / for the Times) The two couples entered the hall of the rented church – about the size of a volleyball court – and offered their hands for the disinfectant. The upholstered metal chairs extended into six rows of 20, with about one foot between the chairs and an aisle in the center. There were twice as many seats as people. Comstock, a soprano, and Owen, a tenor, took their usual seats side by side in the third row. The front rows and the center filled around them. Burdick, 49, stood in front of his choir, with an accompanist to his right seated at a grand piano. Given the anxiety over the coronavirus, the conductor decided to start with a play called “Sing On”. The singers took a deep breath and sang the refrain with enthusiasm: “Sing! Whatever your path, sing! Sing! ” The choir has moved on to other issues, including a popular spiritual piece written by gospel legend Thomas A. Dorsey: “If we have ever needed the Lord before, we certainly need him now. ” At one point, the members split into two groups, each standing around separate pianos to sing. When it was time to leave, Burdick’s wife Lorraine, a contralto who also sang professionally, refrained from her custom of kissing friends. Instead, she bowed out. *** Three days later, Comstock felt chills. A sweater didn’t help. She took her temperature: 99.3. She and Owen canceled their dinner plans that night with the Backlunds. At 9 p.m., she received an SMS from Ruth Backlund. Ruth, 72, and Mark, 73, had a fever. Burdick woke up the next day, March 14, with a fever. As his temperature rose to 103, he began to hear other choir singers. They felt tired and sore. Some had fever, cough and shortness of breath, which they said were symptomatic of COVID-19. Some had nausea and diarrhea. On March 15, Comstock, 62, noticed something strange when she made pasta. She couldn’t taste the sauce, a spicy Italian sausage. She would soon learn that loss of taste and odor was also a common symptom. When Owen, 66, first felt sick that day, he found that his temperature was below normal, a symptom that persisted. The same day, the Backlunds tested negative for the flu. Their clinic sent their samples for coronavirus tests, which would come back four days later showing that they both had COVID-19. On March 17, a member of the choir alerted Skagit County public health to the epidemic. Working from the choir membership list, a dozen health workers rushed for three days to contain the epidemic. They called each member to determine who attended the rehearsal. They asked each person with symptoms to list their close contacts during the 24 hours before the illness started. Then they called these people, telling anyone who felt sick to quarantine. “We think it was just a really very unfortunate and high risk event,” said Dubbel, the county health official. Mark Backlund felt like he was slipping, but not as bad as a 10-year-old friend, a runner, who was rushed to hospital with pneumonia. The two men would eventually recover. On March 18, Burdick received a message from Nancy “Nicki” Hamilton, an 83-year-old soprano known for her political activism and international travel stories. She was worried about a colleague. Three days later, he received another call. Hamilton had been taken to hospital shortly after he spoke with her and now she was dead. The news quickly spread among the choir members, many of whom were sick and left to cry at home alone. Health officials said that the 28 choir members tested for COVID-19 were infected. The remaining 17 with symptoms were never tested, either because the tests were not available or – like Comstock and Owen – the singers felt that only people in critical condition were eligible. The youngest patient was 31, but averaged 67, according to the health department. In their two-story house, Burdick and his wife kept the distance between them for a week. But Lorraine still fell ill. The Burdicks had been encouraged to learn that another woman in the hospital – a viola in her forties – seemed to be getting better. But last Friday, the conductor received another call. She was dead. Another woman, a tenor, had been rushed to the hospital. Others felt that the disease was decreasing. A fortnight after the rehearsal, Comstock injected shampoo into his hand and felt a strange and pleasant sensation. It smelled. Like coconut. *** Marr, the Virginia Tech researcher, said the hatching of the choir reminded her of a classic case study on the spread of infectious diseases. In 1977, an Alaska Airlines flight returned to Homer, Alaska, after experiencing engine problems and sitting on the tarmac for four hours with the ventilation system turned off. Of the 49 passengers on board, 35 developed flu symptoms and five were hospitalized. The researchers eventually traced the epidemic to a woman who felt good when she got on board, but then fell ill. The case prompted epidemiologists to realize that the flu could spread through the air. Research has already shown that coronavirus is almost twice as contagious as the flu and much more deadly. There is still a lot to learn about the choir epidemic, starting with the source of the virus. Dubbel, the county official, said she hoped that a study would one day be carried out to determine how the infection was spreading. But for now, his team is overwhelmed trying to contain additional epidemics. Marr said the researchers will ask the choir members many questions. Did the singers sit in the usual seats, allowing them to remember their location that night and help rebuild the layout of the hall and its occupants? Could the 15 people who didn’t get sick sit together? On Sunday, 99 people tested positive in Skagit County. It could take months before the choir meets again. The Backlunds, however, started to sing again – a viola and a bass together in their living room. The couple, and Comstock and Owen, would like to know if they have antibodies to the virus, so it would be safe for them to deliver meals and find other ways to help as the infection spreads. Comstock marveled at the randomness of it all. “These are just normal random people doing things they like to do, and suddenly some people are dead,” she said. “It is very disappointing. ”

We're in for a long ride. No guarantees for anyone, anywhere. Keep to yourselves, keep in contact, but remember you can't be sure of anyone other than the people in your household. This may go on for a year or more. It depends on how your neighbors get serious or just get it. There is no concrete proof of a waning during the summer seasons. Luckily I have a partner that knows how easily these things can go wrong, and how easily they can spread. She was in charge of the Microbiology in a large hospital, and was the person to make sure the lab was not compromised. She keeps me in check, and I do her. Follow all protocols and we have a better chance of getting out of this much sooner than if you don't. Some people hope that outbreaks of the new coronavirus will wane as temperatures rise, but pandemics often don’t behave in the same way as seasonal outbreaks. BBC Future looks at what we know. By Richard Gray 23rd March 2020 M Many infectious diseases wax and wane with the seasons. Flu typically arrives with the colder winter months, as does the norovirus vomiting bug. Others, such as typhoid, tend to peak during the summer. Measles cases drop during the summer in temperate climates, while in tropical regions they peak in the dry season. Perhaps unsurprisingly, many people are now asking whether we can expect similar seasonality with Covid-19. Since it first emerged in China around mid-December, the virus has spread quickly, with the number of cases now rising most sharply in Europe and the US. Many of the largest outbreaks have been in regions where the weather is cooler, leading to speculation that the disease might begin to tail off with the arrival of summer. Many experts, however, have already cautioned against banking too much on the virus dying down over the summer. You might also like: ● Drinking water will not kill the coronavirus ● How long does the coronavirus survive on surfaces? ● Does sunshine kill the coronavirus? And they are right to be cautious. The virus that causes Covid-19 – which has been officially named SARS-CoV-2 – is too new to have any firm data on how cases will change with the seasons. The closely related Sars virus that spread in 2003 was contained quickly, meaning there is little information about how it was affected by the seasons. But there are some clues from other coronaviruses that infect humans as to whether Covid-19 might eventually become seasonal. There is some hope that as temperatures warm up in the Northern Hemisphere, cases of coronavirus will start to fall (Credit: Getty Images) A study conducted 10 years ago by Kate Templeton, from the Centre for Infectious Diseases at the University of Edinburgh, UK, found that three coronaviruses – all obtained from patients with respiratory tract infections at hospitals and GP surgeries in Edinburgh – showed “marked winter seasonality”. These viruses seemed to cause infections mainly between December and April – a similar pattern to that seen with influenza. A fourth coronavirus, which was mainly found in patients with reduced immune systems, was far more sporadic. There are some early hints that Covid-19 may also vary with the seasons. The spread of outbreaks of the new disease around the world seems to suggest it has a preference for cool and dry conditions. An unpublished analysis comparing the weather in 500 locations around the world where there have been Covid-19 cases seems to suggest a link between the spread of the virus and temperature, wind speed and relative humidity. Another unpublished study has also shown higher temperatures are linked to lower incidence of Covid-19, but notes that temperature alone cannot account for the global variation in incidence. Further as-yet-unpublished research predicts that temperate warm and cold climates are the most vulnerable to the current Covid-19 outbreak, followed by arid regions. Tropical parts of the world are likely to be least affected, the researchers say. Pandemics often don’t follow the same seasonal patterns seen in more normal outbreaks But without real data over a number of seasons, researchers are relying upon computer modelling to predict what might happen over the course of the year. Extrapolating data about Covid-19’s seasonality based on endemic coronaviruses – meaning viruses which have been circulating in human populations for some time – is challenging. That's not least because endemic viruses are seasonal for a number of reasons that might not currently apply to the Covid-19 pandemic. Pandemics often don’t follow the same seasonal patterns seen in more normal outbreaks. Spanish flu, for example, peaked during the summer months, while most flu outbreaks occur during the winter. (Read more about what Spanish flu can teach us about Covid-19.) “Eventually we would expect to see Covid-19 becoming endemic,” says Jan Albert, a professor of infectious disease control who specialises in viruses at the Karolinska Institute in Stockholm. “And it would be really surprising if it didn't show seasonality then. The big question is whether the sensitivity of this virus to [the seasons] will influence its capacity to spread in a pandemic situation. We don’t know for sure, but it should be in the back of our heads that it is possible.” We need to be cautious, therefore, when using what we know about the seasonal behaviour of other coronaviruses to make predictions about the current Covid-19 pandemic. But why are related coronaviruses seasonal, and why does that offer hope for this outbreak? Coronaviruses are a family of so-called “enveloped viruses”. This means they are coated in an oily coat, known as a lipid bilayer, studded with proteins that stick out like spikes of a crown, helping to give them their name – corona is Latin for crown. There are currently few studies that look at the impact the weather has on Covid-19 (Credit: Getty Images) Research on other enveloped viruses suggests that this oily coat makes the viruses more susceptible to heat than those that do not have one. In colder conditions, the oily coat hardens into a rubber-like state, much like fat from cooked meat will harden as it cools, to protect the virus for longer when it is outside the body. Most enveloped viruses tend to show strong seasonality as a result of this. Research has already shown that Sars-Cov-2 can survive for up to 72 hours on hard surfaces like plastic and stainless steel at temperatures of between 21-23C (70-73F) and in relative humidity of 40%. Exactly how the Covid-19 virus behaves at other temperatures and humidity has still to be tested, but research on other coronaviruses suggests they can survive for more than 28 days at 4C. (Read more about how long Covid-19 can survive on surfaces.) A closely related coronavirus that caused the Sars outbreak in 2003 has also been found to survive best in cooler, drier conditions. For example, dried Sars virus on smooth surfaces remained infectious for over five days at between 22-25C and with a relative humidity of 40–50%. The higher the temperature and humidity, the shorter the virus survived. “Climate comes into play because it affects the stability of the virus outside the human body when expelled by coughing or sneezing, for example,” says Miguel Araújo, who studies the effects of environmental change on biodiversity at the National Museum of Natural Sciences in Madrid, Spain. “The greater the time the virus remains stable in the environment, the greater its capacity to infect other people and become epidemic. While Sars-Cov-2 has quickly spread all over the world, the major outbreaks have mainly occurred in places exposed to cool and dry weather.” A recent analysis suggests that this pandemic coronavirus will be less sensitive to the weather than many hope His computer models certainly seem to match the pattern of outbreaks around the world, with the highest number of cases outside of the tropics. Araújo believes that if Covid-19 shares a similar sensitivity to temperature and humidity, it could mean cases of coronavirus will flare up at different times around the world. “It is reasonable to expect the two viruses will share similar behaviour,” he says. “But this is not a one-variable equation. The virus spreads from human to human. The more humans at any given place and the more they get into contact with each other, the more infections there will be. Their behaviour is key to understanding the propagation of the virus.” A study from the University of Maryland has shown that the virus has spread most in cities and regions of the world where average temperatures have been around 5-11C (41-52F) and relative humidity has been low. But there have been considerable numbers of cases in tropical regions, too. A recent analysis of the spread of the virus in Asia by researchers at Harvard Medical School suggests that this pandemic coronavirus will be less sensitive to the weather than many hope. They conclude that the rapid growth of cases in cold and dry provinces of China, such as Jilin and Heilongjiang, alongside the rate of transmission in tropical locations, such as Guangxi and Singapore, suggest increases in temperature and humidity in the spring and summer will not lead to a decline in cases. They say it underlines the need for extensive public health interventions to control the disease. (Read more about why social distancing is so important.) Laboratory research and computer modelling suggest Covid-19 will be less able to survive in warm and humid conditions (Credit: Getty Images) This is because the spread of a virus depends on far more than simply its ability to survive in the environment. And this is where understanding the seasonality of diseases becomes complicated. For a disease like Covid-19, it is people who are now spreading the virus, and so seasonal changes in human behaviour can also lead to shifts in infection rates. Measles cases in Europe, for example, tend to coincide with school terms and decrease during the holidays when children are not spreading the virus to one another. The enormous migration of people around the Chinese Lunar New Year on 25 January has also been suggested to have played a key role in the spread of Covid-19 out of Wuhan to other cities in China and around the world. The weather can also mess with our own immune systems to make us more vulnerable to infections, too. There is some evidence to suggest the vitamin D levels in our bodies can have an affect on how vulnerable we are to infectious diseases. In the winter our bodies make less vitamin D from sunlight exposure, mainly because we spend more time indoors and wrap ourselves in clothing against the cold air. But some studies have found this theory is unlikely to account for seasonal variation seen in diseases like flu. More controversial is whether cold weather weakens our immune systems – some studies suggest it does, but others find the cold can actually boost the number of cells that defend our bodies from infection. There is stronger evidence, however, that humidity can have a greater impact on our vulnerability to disease. When the air is particularly dry, it is thought to reduce the amount of mucus coating our lungs and airways. This sticky secretion forms a natural defence against infections and with less of it, we are more vulnerable to viruses. Stopping contact between people should also bring down the infection rates One intriguing study by scientists in China suggests there is some sort of relationship between how deadly Covid-19 can be and the weather conditions. They looked at nearly 2,300 deaths in Wuhan, China, and compared them to the humidity, temperature and pollution levels on the day they occurred. Although it has yet to be published in an academic journal, their research suggests mortality rates were lower on days when the humidity levels and temperatures were higher. Their analysis also suggests that on days where the maximum and minimum temperature ranges were greater, there were higher levels of mortality. But this work is largely also based on computer modelling, so the exact nature of this relationship, and whether it will be seen in other parts of the world, is still to be explored. As the virus causing the Covid-19 pandemic is new, it is unlikely many people, if anyone, will have immunity against it until they have been infected and have recovered. This means the virus will spread, infect and cause disease in a way quite unlike endemic viruses. Air travel has been the main route by which the virus has spread around the world so rapidly, says Vittoria Colizza, director of research at the French Institute of Health and Medical Research. But once it starts spreading within a community, it is close contact between people that drives the transmission. Stopping contact between people should also bring down the infection rates. This is exactly what many governments have been attempting to do with the escalating lockdown of public places around the world. Even if cases of Covid-19 do fall over the summer months, it is unlikely to disappear entirely and will return later in the year (Credit: Getty Images) “There’s no evidence yet for a seasonal behaviour of Covid-19,” says Colizza. “The behavioural component may play a role, too.” But she warns it is too early to know if the measures put in place will be enough to stall the spread of the virus. “By itself, it may partially reduce effective contagiousness due to the reduction of contacts along which the disease could be transmitted.” And if cases of Covid-19 do indeed tail off over the coming months it could be for a number of reasons – prevention measures such as isolation and lockdowns are being successful; there is growing immunity in the population; or it may be an effect of the season, as Albert’s models suggest. “If there is a seasonal effect, it could mask the true impact of the other two,” warns Albert. “In countries where a strong lockdown has meant not many people have been exposed, then I wouldn’t be surprised that we will see a second wave come the fall and winter.” Even if Covid-19 does show some seasonal variability, it is unlikely to disappear entirely over the summer months, as some have suggested. But a dip in cases might bring some benefits. “The steps we are taking to flatten out the curve are expensive in economic terms, but they could help us push this pandemic into the summer,” says Albert. “If there is some seasonality, it might buy health systems the time they need to prepare.” And in a world scrambling to cope with the rapidly rising number of cases, it might just be time we desperately need. --

Deb (wife who puts up with me) is making masks. They will be washable. The Virus dies at 132* F. A dryer on medium heat is 130 to 140* F. A dryer at high heat is 140 to150*F. An Iron is a whole lot hotter: Recommended ironing temperatures Textile Temperature Temperature Cotton 204 °C / 400 °F 180–220 °C Linen (flax) 230 °C / 445 °F 215–240 °C Viscose/Rayon 190 °C 150–180 °C Wool 148 °C / 300 °F 160–170 °C

Billings Montana are getting 3D printed masks out that can be used. They can use filter material from N95 masks (about 10 per mask) until they can get proper filter material. The masks can be easily sanitized between patients. Those with a 3D printer can join in. Protect our Healthcare Workers. https://www.fairfieldsuntimes.com/news/national/billings-clinic-asks-d-printer-owners-to-assist-with-ppe/article_aa630554-6c8b-11ea-91df-8b4b89321192.html

Here's another, broken down by state: https://covidactnow.org/?fbclid=IwAR0EyJCFx4aldeBXo2-3L8b9Dn2VhFsUJuZF1vdWrzPnkq46PbWID6rIKWw

Can an oil-based paint be used over a surface already painted with latex paint? The truthful answer to this question is that you shouldn’t paint an oil-based product directly over latex paint, but it can be done if a sealing coat is used to separate the layers. Because latex paint has built-in flexibility, it doesn’t make the ideal base for oil paint, which has a hard finish. It’s also far trickier to achieve a good result if the latex paint is relatively new. The task requires paying attention to preparation, which is the key to all successful DIY jobs.

If you're putting in T-nuts, it's much easier with a warm boot. Blow dryer to warm the plastic helps considerable.

Big Sky ends today. Lots of new freshies to end the season. Some of the best runs of the year. Unfortunately riding the lifts with people with snotty noses, and coughing and hacking, can all of a sudden be terrifying for some of the older crew. I'm staying in Big Sky till this blows over--maybe longer than I'm thinking but I'm allowing for 3 months minimum. We have back country skis and a split board. Seattle sounds like chaos. I feel for the people that arrived at any resort in the last few days. Our immediate neighbors got in last night. Stay safe. Lives definitely depend on it.