McIlvaine Coronavirus Market Ale

Respiratory Droplets from Infected Individuals are a Major Mode of Transmission

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Shelter in place may have won the first battle but not the war with COVID. The war needs to be won not by defense but by attacking with the right strategy and weapons. Attacking without regard to lives lost is similar to the slaughter in the trenches in WWI.

The weapons are available to win the war with minimum sacrifice. New research shows that the enemy has airborne capabilities of which we previously were unaware. But there is newly developed technology for a successful attack. Coronavirus Technology Solutions provides the successful battle plan. It is based on understanding the needs and the ways to meet those needs.

It starts with anticipating the potential case load by season and country in the coming months under various scenarios. This analysis defines the needs.

A proactive program is then formulated around those needs. Implementation includes obtaining agreement as to the efficacy of the program. The new research shows that it is not the foot soldiers but the air force which is the biggest danger. This needs to be communicated. The devil is in the details. For each factor we need to consider a number of variables.

Potential Case Load: When there are reports of the minimum infectious dose being as low as 10 virions combined with reports that a lusty singer in a Washington state church choir was able to exhale thousands of virions per minute and infect 45 out 60 safely distanced members it is clear that the enemy air force is a real danger. McIlvaine has been involved for decades in the analysis of transmission of small particles in the air. This phenomenon is at the heart of air pollution, indoor air and cleanroom technology where McIlvaine has multiple publications.

The potential case load is also a function of development of new vaccines and therapies and the production of sufficient quantities to protect billions of people. This requires a huge investment not only by pharmaceutical companies but by contract manufacturing organizations (CMOs). McIlvaine has a service which is tracking the progress of each potential vaccine and therapy. Forecasts for a range filtration products are being made in part based on assumptions relative to the success and timing of vaccine and therapy availability.

Identify Needs: Removing aerosols requires filter media which removes 0.3 micron particles but allows the wearer to breathe easily. There is a scarcity of meltblown filter media but nanofiber membrane media is available which is washable and meets the requirements. McIlvaine is tracking the availability of media as well as reagents and other test kit components.

Design Proactive Program: There is a combination of systems, components and consumables which need to be available and in combination provide safety at reasonable costs. These products and services are being analyzed on a daily basis.

Implement the Program: McIlvaine is interfacing with hospitals, food processors, restaurants and other end users. It is conducting webinars with presentations by experts in filtration and healthcare. A bridge between suppliers and users is created.

Collaboration: The pandemic is a problem for the world. The fact that the demand is peaking at different times in different countries offers an opportunity for a world approach. The fact that South Korea can supply large numbers of test kits is because of a large investment in automated cleanrooms. It is no coincidence that Samsung Biologics provides more than a quarter of the world’s contract biopharmaceutical production. The first successful vaccine could come from any country. Suppliers can also collaborate to a much greater extent. Suppliers of foot sanitizers, walk through temperature scanners, fan filter units and air monitors all have complementary products.

Cost effective and Safe Solution: The program provides a way to return to near normal quickly and safely.

Experiments document the droplet size and distance traveled for droplets and micro droplets transmitted during a sneeze or cough. They do not address those exhaled in normal breath. They point out that microdroplets can contain a large number of viruses. When you consider that the minimum infection rate may be as low as 10 virions it is not hard to understand how even if a small fraction is transported to a distant location that infection is possible.

In our Alert yesterday we reported on restaurants who switched to disposable paper menus. We heard this from one of our subscribers. “Thank you for these updates. They are very helpful and interesting. I wonder why restaurants are using paper menus for one time use instead of an ordering app. There has to be something like that out there. People should be able to see the menu from their phones and then order. Less interaction with waitstaff”

Good points. Even paper menus have to be placed at the table. So this creates a minor risk. Then the initial interaction with the waitstaff is another. A third benefit is less interruption with the air flow. It has been determined that movement in a room disrupts laminar air flow and tends to aerolize particles on surfaces. So the less traffic the better.

Japan reports less than 600 COVID deaths while the U.S. reports over 80,000. Japan’s population is about 38% of the U.S., but even adjusting for population, the Japanese death rate is a mere 2% of America’s.

This comes despite Japan having no lockdown, still-active subways, and many businesses that have remained open—reportedly including karaoke bars, although Japanese citizens and industries are practicing social distancing where they can. Nor have the Japanese broadly embraced contact tracing, a practice by which health authorities identify someone who has been infected and then attempt to identify everyone that person might have interacted with—and potentially infected. So how does Japan do it? This was the question posed by David Ewing Duncan in an article he wrote for Vanity Fair. He interviewed those with answers.

“One reason is that nearly everyone there is wearing a mask,” said De Kai, an American computer scientist with joint appointments at UC Berkeley’s International Computer Science Institute and at the Hong Kong University of Science and Technology. He is also the chief architect of an in-depth study, set to be released in the coming days, that suggests that every one of us should be wearing a mask—whether surgical or homemade, scarf or bandana—like they do in Japan and other countries, mostly in East Asia. Among the findings of their research paper, which the team plans to submit to a major journal: If 80% of a closed population were to don a mask, COVID-19 infection rates would statistically drop to approximately one twelfth the number of infections—compared to a live-virus population in which no one wore masks.

De Kai’s solution, along with his team, was to build a computer forecasting model they call the masksim simulator. This allowed them to create scenarios of populations like those in Japan (that generally wear masks) and others (that generally don’t), and to compare what happens to infection rates over time. Masksim takes sophisticated programming used by epidemiologists to track outbreaks and pathogens like COVID-19, Ebola, and SARS, and blended this with other models that are used in artificial intelligence to take into account the role of chance, in this case the randomness and unpredictability, of human behavior—for instance, when a person who is infected decides to go to a beach. De Kai’s team have also added some original programming that takes into account mask-specific criteria, such as how effective certain masks are at blocking the invisible micro-droplets of moisture that spray out of our mouths when we exhale or speak, or our noses when we sneeze, which scientists believe are significant vectors for spreading the coronavirus.

Along with the masksim site, the team is also releasing a study that describes their model in detail as well as their contention that masksim’s forecasts support a growing body of pro-mask evidence. “What’s most important about wearing masks right now,” said Guy-Philippe Goldstein, an economist, cybersecurity expert, and lecturer at the Ecole de Guerre Economique in Paris—and a masksim collaborator, “is that it works, along with social distancing, to flatten the curve of infections as we wait for treatments and vaccines to be developed—while also allowing people to go out and some businesses to reopen.”

While all models have limitations and are only as good as their assumptions, this one is “a very thorough model and well done,” said William Schaffner, an infectious disease specialist at Vanderbilt University, who reviewed the De Kai team’s paper. “It supports a notion that I advocate along with most other infectious disease experts: that masks are very, very important.” Jeremy Howard, founding researcher at fast.ai and a distinguished research scientist at the University of San Francisco, also assessed the paper. “It’s almost overkill how careful they were with this modeling,” said Howard, who also coauthored and spearheaded a study last month (recently submitted to the journal PNAS) that reviewed dozens of papers assessing the effectiveness of masks.

Respiratory Droplets from Infected Individuals are a Major Mode of Transmission

This is the conclusion of DELVE who state that It is currently believed that droplets are the main route of transmission. Whilst there is indirect evidence that supports this, the relative contribution of droplet/aerosol transmission has not been estimated.

Aerosols refer to suspensions in gas of small particles (typically < 5-10 µm) and can travel relatively long distances. Droplets refer to large particles (> 20 µm) and can only travel short distances as they will fall to ground due to gravity. While the possibility of aerosol transmission of COVID-19 has been clearly demonstrated through experiments and outbreak reports (e.g., Washington state choir), it remains unclear what proportion of infection can be attributed to aerosol transmission. Some studies provide indirect evidence that droplets may be the main routes of transmission. For example, a recent report by Lu et al describes an outbreak in a restaurant in Guanzhou, China, in which customers were likely to have been infected through droplets that travelled through air conditioning airflow; they conclude that the patterns of outbreak is consistent with droplet transmission, rather than aerosol transmission. Anfinrud et al demonstrates that droplets, smaller than those generated through coughing or sneezing, can be generated via speech, providing further evidence that droplet transmission may play important roles. Public Health England also suggests that droplets and contacts are main routes of transmission. It is currently unknown what proportion of infected cases can be attributed to aerosol vs droplet transmission.

DELVE – Data Evaluation and Learning for Viral Epidemics – is a multi-disciplinary group, convened by the Royal Society, to support a data-driven approach to learning from the different approaches countries are taking to managing the covid-19 pandemic. More information about the project and its work are available on the about and people pages.

The computerized model referenced in the preceding article shows substantial impact from mask wearing in the UK. Deaths over 500 days are 60,000 vs 1.1 million just with social distancing.

Comparing different mask materials, medical masks have been found to be up to three times more effective in blocking transmission compared to homemade masks (Davies et al., 2013). Surgical masks most efficaciously reduce the emission of influenza virus particles into the environment in respiratory droplets. Still, although masks vary greatly in their ability to protect, using any type of face mask (without an exploratory valve) can help decrease viral transmission (Sande et al., 2008). However, the effect of universal masking does not require full protection from disease to be effective in lowering infection rates of COVID-19. Masks may be especially crucial for containing the COVID-19 pandemic, since many infections appear to come from people with no signs of illness. For instance, around 48% of COVID19 transmissions were pre-symptomatic in Singapore and 62% in Tianjin, China (Ganyani et al., 2020). This suggests that masking needs to be universal and not restricted to individuals who think they may be infected. Furthermore, the SARS-CoV-2 virus is known to spread through airborne particles (Leung et al., 2020) and quite possibly via aerosolized droplets as well according to Service (2020), van Doremalen et al. (2020), Santarpia et al. (2020), and Liu et al. (2020). It may linger in the air for and travel several meters, which is why social distancing rules require at least 2 meters between individuals to be effective.

The number of Americans in nursing facilities is expected to increase to 27 million in 2050. Respiratory issues are the fourth-largest health concern for seniors and the third-largest cause of death among the elderly. Studies have shown that those in nursing homes are sensitive to air pollutants which cause asthma. So providing cleaner air could be justified even without the virus.

Over 27,000 deaths from COVID have occurred at U.S. nursing homes. This represents more than one third of the total U.S. COVID deaths. There are 15,000 nursing homes which should be equipped with air filtration and large numbers of workers who need the best PPE. Advice for these homes is provided by the American Healthcare Association

Identifying reliable personal protective equipment (PPE) suppliers during the COVID-19 pandemic has been extremely challenging for providers. AHCA/NCAL has vetted countless vendors and concluded that the best indicator of potential suppliers is members’ experiences ordering and receiving supplies in this uncertain time. AHCA/NCAL has compiled a list of vendors that have successfully delivered PPE to members during the pandemic.

AllerAir's 5000 Exec UV is strategically placed in the Fayetteville Nursing Home in Fayetteville, North Carolina

There is one particular room where the residents of the home spent most of their time. The senior citizens that live in the home are also very sensitive to any dust or pollen that was present in the indoor air. Older people generally have weaker immune systems than younger people and react to certain contaminants more severely. If one resident of the home was sick, it was certain that after spending a day cooped up in the same room as the other residents, the other residents would also catch the sickness. The bacteria and dust particles in the room of the nursing home were causing problems for the senior citizens. The only way for them to be healthier and able to enjoy their day in the room together is if the indoor air was of higher quality.

The home invested in the 5000 Exec UV for its effectiveness and efficiency. The air purifier is able to clean a room that is 1500 square feet in size. The air purifier was placed in the main room, and it can easily clean the large room in no time. The 5000 Exec UV contains the same filters as other effective air purifiers, able to remove particles, pollen, and dust from the air inside a room. The HEPA filter and pre-filter inside the air purifier absorbs and eliminates mold spores, particles, and odors from the air. Once the air has moved through these efficient filters, it is then moved to a UV lamp. The 10-watt UV lamp is able to eliminate the bacteria and viruses from the air that passes through it. The lamp is also able to trap and eliminate mold spores in the air and any other toxins that may have been missed by the pre-filter. With the technologies of the filters and the UV lamp combined, AllerAir's 5000 Exec UV air purifier is able to eliminate most harmful contaminants from the air.

After running the 5000 Exec UV, the home has found that the residents of the nursing home do not get sick as often. When one resident suffers from a cold or virus, there is no longer a fear that other residents will subsequently catch the virus. The air inside the main room of the nursing home is more fresh and clean smelling. Since the unit only uses 95 watts of power when placed on the high setting, the home is able to run the unit overnight in the main room.