Coronavirus pandemic non-socio-political discussions

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UrbanCowboy1

Some cowboys gots smarts real good like me.
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I feel like I need to be clear on my post, I definitely don't want to make a political statement. I only wish for everyone to take a deep breath and try to find some happiness during this trying time.
 

RxCowboy

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I like these updates, I honestly do. But I have a small problem with point one and two. Point one is anecdotal as I'm just one person, but I live in Phoenix, which apparently is the center of Satan's butthole. My son had a COVID test two weeks ago. We were told the results would be available in 48 hours...that's how long it was taking them to turn these around. We got it back in 36 hours. Not sure where your friend is getting 2 weeks from.
If she said that it is because those are reports she's getting from contact tracers on the ground in Phoenix. YMMV.
Point two is market experience as I work in the medical supply field. We can't get people to take our PPE. We even went through an EAU to make sure we could be 'part of the solution' as these things aren't in our normal mix of products. It's the hospitals themselves that aren't providing it to their staff. We're offering this stuff for almost free and the same hospitals that are being portrayed as being overrun and under supplied aren't interested or say they are good. And to give a clue, I'm talking about equipment that is measured in cents, not dollars. This isn't price gouging; we'll lose money from a total margin perspective.
steross made this point in another thread. Hospitals are cutting costs. They've taken hard by having to cancel elective procedures. Contrary to popular belief, COVID has not made hospitals rich.
Lastly, I'll give a note of hope from me. Phoenix is ground zero right now. There's no where else that's had a rise of cases like us and we'll explode past New York soon on cases per million basis. Based on my current projections we won't peak until sometime past 35K/million which puts us in either first or second place in the world for cases per million. And while all that is terrible and it's putting an enormous strain on people mentally and physically... it's not that bad. No one is eating their dogs. No social services have broken down. It's not chaos in the streets. People are still generally polite, maybe even moreso than before. We call our friends and family on the phone, we have food and water (which is good because it was like 117 over the weekend). I guess the point that I'm trying to make is that the reality of life out there is much different than the social media version of it that you're reading through whatever device you happen to have handy. Try to remember you're viewing humanity through a lens when you read things here as opposed to experiencing them in the real world. I'm not saying it's all peas and carrots, there's a lot of heartbreak. But please repeat to yourself: "The world is not ending. The world is not ending. The world is not ending." Thanks.
That's all good news. If you don't mind, I'll pass this along to her. She'll be encouraged by it.
 

RxCowboy

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Are they heating the air or the filter to nearly 400 F?
I don't have access to the whole article from here at home (not sure if I will at work either). I'll check next time I'm in the office. But, yeah, it looks like that's what the filter does. Might be useful in a hospital COVID ward, but not practical for home use. Might also be useful for, say, I don't know... schools.
 

RxCowboy

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July 15

COVID-19 Update, Wednesday, July 15, 2020
Blood clotting and long-term issues, a global snapshot, a change in reporting, COVID and pregnancy and the MMR vaccine.

1. Autopsies (published in The Scientist) conducted on those who did not survive COVID-19 indicate blood clots are a significant issue. Blood clots were found in organs throughout the body as was damage to the heart and lungs. There have been reports that even mild cases of COVID can cause the onset of heart disease, similar to prior findings that it could cause the onset of diabetes. Potential long-term health effects appear to be a real concern from having COVID even in mild cases.

2. Here’s a look at what is happening globally: Hong Kong is on their third wave which they believe is linked to restaurants. Spain has cluster outbreaks springing up in Catalonia they are working to control, The Philippines loosened restrictions on June 1, and have seen cases triple since they did. Mexico’s death toll is on the rise, South Africa is struggling to manage hospitalizations in some part of the country and has tightened mask requirements and implemented curfews. But in good news, Belgium has reported 0 COVID deaths for the first time since March! That is excellent news and was accomplished through social distancing, and mandatory masks. On a slightly related note, a study out of Belgium published in JAMA found that household exposure is a greater risk than community exposure. Meaning, if someone in your home gets it, you have a much higher chance of getting it than from other sources.

3. COVID data will now be reported to the US Department of Health and Human Services database instead of the CDC National Healthcare database. This is pretty unprecedented. Depending on how this transition is managed it could cause some disruption in official reporting as people change over so don’t be surprised if it gets a little bumpy for a minute. The reported reason for the change is to streamline information and help with allocation of PPE and Remdesivir.

4. New information has come out regarding COVID and pregnancy. You may recall early indicators were that there was no increased risk and we did not believe there was mother to child transmission. Primarily because we hadn’t seen any. That has now changed, and we have seen a few cases of transmission from mother to fetus. In addition, pregnant women are more likely to have negative outcomes from COVID. You can read a case study on one such baby in France from Nature Communications. The good news is that while the mothers tend to have negative outcomes, the babies seem to recover well. Much more research is needed here.

5. More news and research emerge regarding the possible benefits of the MMR vaccine against COVID. A study published in mBio suggests that MMR re-purposing may be a good option for a vaccine against COVID. I know I mentioned this last week too but this is looking good (hopefully it continues to) and is a nice option for people who are concerned about the fast pace of the vaccine development given this is an existing and known vaccine. This is particularly good news as new deaths doubled from Monday to Tuesday in the US.

FINAL THOUGHTS: Sometimes life throws you curve-balls. Sometimes FB bans you for no apparent reason. Sometimes your power goes out in the middle of the night, so you have no AC, no internet and no alarm clock and no coffee to wake you up. Sometimes you are asked to wear a mask which is hot, uncomfortable (until you find one that fits well) and steams up your glasses. Sometimes you are cruising down the vegetable aisle and realize you are headed against the arrows. Sometimes all of those things happen at once. We call those times 2020. But seriously. sometimes you are faced with the unexpected and you must decide how to respond. Today, as the unexpected jumps out from behind bushes, slithers across your computer screen or flashes up on your phone, decide to respond with grace, dignity and poise. Chose to hold your head high even when you feel like a wild, hot mess. What is done is done. We cannot change it; we can only move forward. So, let’s link arms and walk forward together. Let’s hold each other up and fight for those who cannot fight for themselves. Today we slo-mo walk with confidence, boldness, kindness, compassion and strength; unrattled by the unexpected.
 

RxCowboy

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Editorial
July 14, 2020

Universal Masking to Prevent SARS-CoV-2 Transmission—The Time Is Now
John T. Brooks, MD; Jay C. Butler, MD; Robert R. Redfield, MD
JAMA. Published online July 14, 2020. doi:10.1001/jama.2020.13107

In this issue of JAMA, Wang et al present evidence that universal masking of health care workers (HCWs) and patients can help reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections.1 In the largest health care system in Massachusetts with more than 75?000 employees, in tandem with routine symptom screening and diagnostic testing of symptomatic HCWs for SARS-CoV-2 infection, leadership mandated a policy of universal masking for all HCWs as well as for all patients. The authors present data that prior to implementation of universal masking in late March 2020, new infections among HCWs with direct or indirect patient contact were increasing exponentially, from 0% to 21.3% (a mean increase of 1.16% per day). However, after the universal masking policy was in place, the proportion of symptomatic HCWs with positive test results steadily declined, from 14.7% to 11.5% (a mean decrease of 0.49% per day). Although not a randomized clinical trial, this study provides critically important data to emphasize that masking helps prevent transmission of SARS-CoV-2.

This change and its association with universal masking is unlikely to be artifactual; throughout the intervention, the number of symptomatic HCWs tested per day appears to have remained steady, while at the same time the daily number of new SARS-CoV-2 infections in the greater Massachusetts community was continuing to increase or had plateaued.2 An artifactual flattening or decline in the rate of newly diagnosed SARS-CoV-2 infections when the rates were actually unchanged by the intervention could have occurred if, during the intervention period, a competing etiology for the symptoms that prompted SARS-CoV-2 testing among HCWs, such as influenza, had been trending more rapidly upward; however, weekly rates of diagnosed influenza in Massachusetts were low and approaching zero during this time.3

The authors rightly note that other community-wide and hospital-specific interventions may have contributed to their observation, including the statewide declaration of emergency (March 10), new hospital policies to restrict visitors (March 12) and elective procedures (March 14), statewide school closures and hospital restrictions on business travel and on-site working (March 16), local public transportation reductions (March 17), issuance of statewide stay-at-home orders (March 24), and automation of screening and testing (March 30).4 Nonetheless, it was only after the universal masking policy had been in operation for approximately a week that the temporal trend in positivity of SARS-CoV-2 testing among HCWs declined (as shown in the Figure in the report by Wang et al).

Covering mouths and noses with filtering materials serves 2 purposes: personal protection against inhalation of harmful pathogens and particulates, and source control to prevent exposing others to infectious microbes that may be expelled during respiration. When asked to wear face coverings, many people think in terms of personal protection. But face coverings are also widely and routinely used as source control. For instance, if given the choice between having surgery performed by a team not wearing some covering over their mouths and noses vs a team that does, almost all patients would reject the former. This option seems absurd because it is known that use of face coverings under these circumstances reduces the risk of surgical site infection caused by microbes generated during the surgical team’s conversations or breathing. Face coverings do the same in blocking transmission of SARS-CoV-2.

Early in the pandemic, the Centers for Disease Control and Prevention (CDC) recommended that anyone symptomatic for suspected coronavirus disease 2019 (COVID-19) should wear a face covering during transport to medical care and prior to isolation to reduce the spread of respiratory droplets.5 After emerging data documented transmission of SARS-CoV-2 from persons without symptoms, the recommendation was expanded to the general community, with an emphasis on cloth face coverings that could be made more widely available in the community than surgical masks and to preserve personal protective equipment such as N95 respirators to the highest-risk exposures in health care settings. Now, there is ample evidence that persons without symptoms spread infection6 and may be the critical driver needed to maintain epidemic momentum.7

While community use of face coverings has increased substantially, particularly in jurisdictions with mandatory orders, resistance continues. Some have raised concerns that homemade face coverings made from household fabrics may be inferior compared with commercially manufactured products. Cloth face coverings can substantially limit forward dispersion of exhaled respirations that contain potentially infectious respiratory particles in the 1- to 10-µm range that includes aerosol-sized particles,8 and recent research of household textiles’ performance when used as source control suggests cloth face coverings may be able to do so with acceptable efficiency and breathability.9,10 Others may think it is premature to promote community masking until research has been completed that measures the effectiveness of cloth face coverings to prevent exposure specifically to SARS-CoV-2. Laboratory studies will be difficult and costly because they require capacity to safely manage this biosafety level 3 pathogen. Any type of community-based randomized trial will be complex to deploy in the right setting (a community with active infection) at the right time (when infections are increasing) to produce actionable results quickly. In the absence of such data, it has been persuasively argued the precautionary principle be applied to promote community masking because there is little to lose and potentially much to be gained.11 In this regard, the report by Wang et al provides practical, timely, and compelling evidence that community-wide face covering is another means to help control the national COVID-19 crisis.

Data from a large health care system may be generalizable to the greater community insofar as the findings represent the contribution of masking when individuals are physically close to one another and social distancing is not possible. Like herd immunity with vaccines, the more individuals wear cloth face coverings in public places where they may be close together, the more the entire community is protected. Community-level protection afforded by use of cloth face coverings can reduce the number of new infections and facilitate cautious easing of more societally disruptive community interventions such as stay-at-home orders and business closings.

Two reports published this week in Morbidity and Mortality Weekly Report provide additional new data about face coverings. One report indicates that use of face coverings increased following the April 3, 2020, announcement by the White House Coronavirus Task Force and the CDC that recommended their adoption in public to slow the spread of COVID-19. In an internet-based survey among 503 adults during April 7-9, 2020, and a similar survey among another sample of 502 adults during May 11-13, 2020, the self-reported prevalence of use of cloth face coverings among those who reported leaving their homes within the previous week increased from 61.9% to 76.4%.12 Another report from investigators in Missouri found that adherence to universal masking for source control as mandated by city ordinance and company policy helped prevent transmission of SARS-CoV-2 from 2 symptomatically infected stylists at a hair salon in Springfield, Missouri. Before they were diagnosed as having COVID-19, the hair stylists had served 139 clients but had been required to wear masks at all times while working with them. After public health contact tracing with the hair salon clients and after 2 weeks of follow-up, no symptoms of COVID-19 were identified among the exposed clients or their secondary contacts. Among 104 interviewed clients, 102 (98%) reported wearing face coverings for their entire appointment.13 In addition, another analysis published by Goldman Sachs Research suggests that expanding community masking by 15% could prevent the need to bring back stay-at-home orders that would otherwise cost an estimated 5% of gross domestic product, or a projected cost of $1 trillion.14

For the person assessing personal exposure risk when going out in public, minimizing the number of nonhousehold contacts, maintaining a physical distance of at least 6 ft, and limiting the amount of time around others, especially while indoors and in poorly ventilated areas, are all important considerations. An additional factor in this calculus is the extent that individuals and communities will also be practicing source control by wearing masks. Several state and local governments have issued temporary mandates for face coverings in public places and some business are requiring mask wear by customers and employees. However, face covering is not needed all the time. It is probably safe for individuals and safe for others to drive alone or to walk or jog alone on an uncrowded route without a face covering. But when individuals choose to go out or must be close to others in public, a cloth face covering can help reduce the spread of COVID-19 from asymptomatic individuals or others. With cloth face coverings, personal protection is derived from their use by all members of the community.

How then can individuals make the most of this intervention? First, public health officials and leaders need to ensure that the public understands clearly when and how to wear cloth face coverings properly and continue building the evidence base for their effectiveness. Second, although cloth face coverings are generally well tolerated for short periods, with prolonged use they can be irritating or difficult for some people to breathe through, especially in hot or humid environments. Innovation is needed to extend their physical comfort and ease of use. Third, the public needs consistent, clear, and appealing messaging that normalizes community masking. At this critical juncture when COVID-19 is resurging, broad adoption of cloth face coverings is a civic duty, a small sacrifice reliant on a highly effective low-tech solution that can help turn the tide favorably in national and global efforts against COVID-19.

Back to topArticle Information
Corresponding Author: John T. Brooks, MD, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mail Stop D-21, Atlanta, GA 30329 (zud4@cdc.gov).

Published Online: July 14, 2020. doi:10.1001/jama.2020.13107

Conflict of Interest Disclosures: None reported.

References
  1. Wang X, Ferro EG, Zhou G, Hashimoto D, Bhatt DL. Association between universal masking in a health care system and SARS-CoV-2 positivity among health care workers. JAMA. Published online July 14, 2020. doi:10.1001/jama.2020.12897
  2. Massachusetts Department of Public Health COVID-19 dashboard—April 30, 2020. Accessed July 8, 2020. https://www.mass.gov/doc/covid-19-dashboard-april-30-2020/download
  3. Massachusetts Department of Public Health (MDPH) weekly influenza update May 22, 2020: estimated weekly severity of influenza. Accessed July 8, 2020. https://www.mass.gov/doc/weekly-flu-report-may-22-2020/download
  4. Zhang H, Dimitrov D, Simpson L, et al. A web-based, mobile responsive application to screen healthcare workers for COVID symptoms: descriptive study. medRxiv. Preprint posted April 22, 2020. doi:10.1101/2020.04.17.20069211
  5. Patel A, Jernigan DB; 2019-nCoV CDC Response Team. Initial public health response and interim clinical guidance for the 2019 novel coronavirus outbreak—United States, December 31, 2019–February 4, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(5):140-146. doi:10.15585/mmwr.mm6905e1
  6. Furukawa NW, Brooks JT, Sobel J. Evidence supporting transmission of severe acute respiratory syndrome coronavirus 2 while presymptomatic or asymptomatic. Emerg Infect Dis. 2020;26(7). doi:10.3201/eid2607.201595
  7. Li R, Pei S, Chen B, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science. 2020;368(6490):489-493. doi:10.1126/science.abb3221
  8. Verma S, Dhanak M, Frankenfield J. Visualizing the effectiveness of face masks in obstructing respiratory jets. Phys Fluids (1994). 2020;32(6):061708. doi:10.1063/5.0016018
  9. Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S. Aerosol filtration efficiency of common fabrics used in respiratory cloth masks. ACS Nano. 2020;14(5):6339-6347. doi:10.1021/acsnano.0c03252
  10. Ma QX, Shan H, Zhang HL, Li GM, Yang RM, Chen JM. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol. 2020;31:31. doi:10.1002/jmv.25805
  11. Greenhalgh T. Face coverings for the public: laying straw men to rest. J Eval Clin Pract. 2020;e13415. doi:10.1111/jep.13415
  12. Fisher KA, Barile JP, Guerin R, et al. Factors associated with cloth face covering use among adults during the COVID-19 pandemic—United States, April and May 2020. MMWR Morb Mortal Wkly Rep. Published online July 14, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6928e3.htms_cid=mm6928e3_w
  13. Hendrix MJ, Wade C, Findley K, Trotman R. Absence of transmission of SARS-CoV-2 after exposure at a hair salon with a universal face mask policy—Springfield, Missouri, May 2020. MMWR Morb Mortal Wkly Rep. Published online July 14, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6928e2.htms_cid=mm6928e2_w
  14. Hatzius J, Struyven D, Rosenberg I. Face Masks and GDP. Goldman Sachs Research. Published June 29, 2020. Accessed July 8, 2020. https://www.goldmansachs.com/insights/pages/face-masks-and-gdp.html
 

UrbanCowboy1

Some cowboys gots smarts real good like me.
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If she said that it is because those are reports she's getting from contact tracers on the ground in Phoenix. YMMV.

steross made this point in another thread. Hospitals are cutting costs. They've taken hard by having to cancel elective procedures. Contrary to popular belief, COVID has not made hospitals rich.

That's all good news. If you don't mind, I'll pass this along to her. She'll be encouraged by it.
For sure, she's doing a real service by writing that. it's keeping everyone level-headed.

As for the delay in results, I've gotta figure there are different turnaround times for different labs. Saw an article this morning that if you use Sonoran Labs that its at least a week. Hopefully they can speed it up in the upcoming weeks.
 

RxCowboy

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For sure, she's doing a real service by writing that. it's keeping everyone level-headed.

As for the delay in results, I've gotta figure there are different turnaround times for different labs. Saw an article this morning that if you use Sonoran Labs that its at least a week. Hopefully they can speed it up in the upcoming weeks.
It may be the actual tests, too, deep swabs versus nasal swabs. The one thing I can tell you is that she most likely heard that from boots on the ground.
 

RxCowboy

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Multisystem Inflammatory Syndrome in U.S. Children and Adolescents
June 29, 2020
DOI: 10.1056/NEJMoa2021680
Leora R. Feldstein, Ph.D., Erica B. Rose, Ph.D., Steven M. Horwitz, M.D., Jennifer P. Collins, M.D., Margaret M. Newhams, M.P.H., Mary Beth F. Son, M.D., Jane W. Newburger, M.D., M.P.H., Lawrence C. Kleinman, M.D., M.P.H., Sabrina M. Heidemann, M.D., Amarilis A. Martin, M.D., Aalok R. Singh, M.D., Simon Li, M.D., M.P.H., et al., for the Overcoming COVID-19 Investigators, and the CDC COVID-19

Abstract
BACKGROUND
Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome.

METHODS
We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms.

RESULTS
We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores =2.5) were documented in 15 patients (8%), and Kawasaki’s disease–like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%).

CONCLUSIONS
Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.)
 

RxCowboy

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COVID-19 Update: Thursday, July 16, 2020
Increasing numbers, the latest mutation, long term neurological effects, testicles, the GDP and gyms.

NOTE: there was a lot of news this week, so I haven’t been able to discuss colleges and universities but I haven’t forgotten, we will get there early next week.

1. We ended yesterday with another day of very high numbers. Over 71k new cases and over 1,000 deaths. Deaths have seen a steady incline this week as predicted by many of the models. You may recall the CDC model predicted 148k deaths by the end of July. We are now at 140k. Texas led yesterday with 12k new cases, followed by Florida with 10k and then California with 9.6k.

2. Additional research has confirmed that the latest mutation does make the virus more infectious, but it does not make it more lethal. So some of the increase in spread/cases may be that it is simply easier to spread.

3. A study published in the Journal of Neurology suggests that COVID can cause neurological issues some of which may become chronic or at least long term due to the overall impact on the Central Nervous System (brain, and spinal cord). Another study published in Laryngoscope suggests some of those issues may include depression and anxiety which has been seen in people with COVID and those who have recovered. This is early research so we can’t know this for sure but further research is warranted.

4. You may recall that we previously discussed how viruses work and that they enter your cells by finding just the right “door” to get into the cell. Each virus looks for the “door” or receptor that it needs. This virus looks for a receptor called ACE2 which is a spike protein found in multiple places in the body including the lungs, heart and testes. We have found damage in both the lungs and heart both during active disease and after recovery. There has been conflicting research regarding virus in the semen, studies continue in that area to determine if enough active virus is present to suggest sperm as a means of transmission (currently there does not seem to be enough viral load for it to spread). However, Medical News Today, a study in preprint, a study from the NIH and a report from NCIB, all suggest that COVID could cause damage to the testicles including possible damage to the area responsible for producing sperm and 1/5 of patients in the studies complained of scrotal pain associated with COVID. All of these studies were small so further research is needed and we don’t know the extent to which the virus causes damage or if it will cause reproductive issues later. We do know men tend to die from the virus at a higher rate than women and women recover, on average, 2 days faster than men. We have detected several genetic factors associated with that and this could be another one.

5. A Goldman Sachs report estimates that expanding community mask use by 15% could prevent a second shut-down. A second shutdown would cost the nation 5% of GDP (estimate) which is the equivalent of $1 trillion. In related news, the CDC reports that mask usage is up in many places. They also acknowledge that better fitting masks are more comfortable and more effective and additional education is needed in that area along with more comfortable designs, increased ease of use and more education on proper handling. But mask wearing is a minimal sacrifice, low tech option with high positive impact.

6. There is a preprint study going around that says gyms are low risk environments – which is in direct contrast with what experts are saying. When reviewing the study there were significant issues with it – namely, it was conducted in areas with very low numbers, virtually 0% which renders the findings of little to no value. So if you see that headline you can ignore it.

FINAL THOUGHTS: As I chat with people throughout the day and week, the one thing I hear the most these days is that people are really struggling to find their motivation. They just don’t want to “do” anything so they have to force themselves to do what they must. Motivation seems to be in short supply. If that is you, you should know you are in the majority. We have reached that point. We have been digging deep and our proverbial buckets are low. Even on days when motivation may be high – or at least good, production is often low. This too is pretty normal right now. For those who aren’t or can’t take breaks it can be even worse. Listen to your body and know when to push yourself and when to give in. A day of rest, relaxation and recovery time are not luxuries, they don’t make you lazy, and they aren’t doing “nothing” they are you, actively recovering. They are necessary. It’s ok to say no to things, to be at maximum capacity and to say so, and to just Netflix and chill sometimes. Start planning now for how you will give yourself a break so that you can renter the fray fresh and ready. In the meantime, cut yourself some slack.
 

Boomer.....

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6. There is a preprint study going around that says gyms are low risk environments – which is in direct contrast with what experts are saying. When reviewing the study there were significant issues with it – namely, it was conducted in areas with very low numbers, virtually 0% which renders the findings of little to no value. So if you see that headline you can ignore it.
Gyms are always listed as one of the top 5/7 hot spots for spread. Our gym has been open for a couple months after the lock down and, in my opinion, it is cleaner than ever. There is hand sanitizer, spray and sanitizing wipes all over the gym and most, if not all people wiped down the equipment after every use. On top of this, they are strict on the distancing and the masked employees are consistently going around the gym wiping down equipment as well. Our gym is large and open, so distancing is never an issue especially at lunch when I go and many of the close quartered areas remain closed such as locker rooms, basketball court, hot tub, and sauna. Overall, I feel the overall cleanliness of the gym is much improved over pre-Covid and I feel comfortable in going.

I also read a study saying gym goers were less likely to catch Covid-19 or at least show severe symptoms from it. I think this more likely has to do with the fact that gym goers are typically healthier and less likely to have pre-existing conditions which the disease attacks.
 

RxCowboy

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Gyms are always listed as one of the top 5/7 hot spots for spread. Our gym has been open for a couple months after the lock down and, in my opinion, it is cleaner than ever. There is hand sanitizer, spray and sanitizing wipes all over the gym and most, if not all people wiped down the equipment after every use. On top of this, they are strict on the distancing and the masked employees are consistently going around the gym wiping down equipment as well. Our gym is large and open, so distancing is never an issue especially at lunch when I go and many of the close quartered areas remain closed such as locker rooms, basketball court, hot tub, and sauna. Overall, I feel the overall cleanliness of the gym is much improved over pre-Covid and I feel comfortable in going.

I also read a study saying gym goers were less likely to catch Covid-19 or at least show severe symptoms from it. I think this more likely has to do with the fact that gym goers are typically healthier and less likely to have pre-existing conditions which the disease attacks.
Wiping down everything is necessary, but there's little evidence of fomite transmission (from surfaces). The most important transmission is respiratory airborne particles (droplets <most common> and aerosols <smaller and less common>). I imagine that while working out in a relatively confined space people are emitting plenty of respiratory droplets, which would make gyms high risk. Wearing masks would lower the risk.

It isn't about the gym-goers themselves, it is who they spread it to. R0>1.
 

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Wiping down everything is necessary, but there's little evidence of fomite transmission (from surfaces). The most important transmission is respiratory airborne particles (droplets <most common> and aerosols <smaller and less common>). I imagine that while working out in a relatively confined space people are emitting plenty of respiratory droplets, which would make gyms high risk. Wearing masks would lower the risk.

It isn't about the gym-goers themselves, it is who they spread it to. R0>1.
So the claim that the disease can live on the surface of objects for hours up to a week and be transmitted by touching your face/mouth isn't plausible?

I was just reading some of what you were saying and was stunned that the aerosol droplets can remain suspended in air for hours. We're all doomed!
 

RxCowboy

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So the claim that the disease can live on the surface of objects for hours up to a week and be transmitted by touching your face/mouth isn't plausible?

I was just reading some of what you were saying and was stunned that the aerosol droplets can remain suspended in air for hours. We're all doomed!
No, it's plausible, we just don't have much evidence of it... yet.

Fortunately, droplets are more common than aerosols.
 

RxCowboy

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COVID-19 Update: Friday, July 17
Friday=Numbers, masks, increases among children, serology, prisons, recommendations – there is a lot here today, plus a few charts/graphs for good measure. I got a bit lengthy.

NOTE: I added two charts today. One that visualizes excess deaths and one that allows you to see how your state is doing compared to others this week. I also put in a link to an interactive map/chart that will show you how your specific county is doing compared to others in your state.

1. Globally we hit 13.97 million cases. We will surpass 14 million today. Total deaths globally is 593k with a case fatality rate of 4.25 (higher than the US average of 3.82).

2. In the US we set another record yesterday with 73k new cases in a single day. Some trackers report 77k – the discrepancy is entirely due to which time zone they are operating on so don’t let that throw you. The US added an additional 475k cases over the week and 5,297 deaths. While these numbers are large and significant, our case fatality rate dropped significantly from 4.22 to 3.82 which is great news. That puts us well below the global average. We are doing much better keeping people alive. However, as our system becomes overwhelmed this may change. You may also recall that the CDC predicted 148k deaths by the end of July at a time when that number seemed highly unlikely. But we are mid-July with 141,125 total deaths in the US. There model appears to be accurate and we seem to be slightly ahead of schedule. Over 100k medical professionals in the US have or have had COVID. And just as a reminder, the flu kills, on average, 31k people a year – COVID has killed 141K in under 7 months. Here is the link to a great map that shows the breakdown by county so you can see how your county is doing for those who are interested. https://www.cdc.gov/covid-data-tracker/index.html#county-map

The University of Washington’s Institute for Health Metrics and Evaluation is now predicting 224k deaths by election day. However, they report universal mask usage could reduce that by 40k deaths.

*The weekly summary of % Cause of Death (COD) and other pertinent data (that I normally use for analysis to share) which is published each Friday by the CDC has not yet been updated this week. This includes hospitalization rates, % COD, virology data etc. I will update this once if is available. (it isn't late until noon).

3. Cases among children have increased from 2% to 6.4% of total cases although they still only represent 0.3% of deaths – which is good. Individual state counts vary with states like California, Mississippi, and Florida reporting higher cases among children than the national average. Many of these cases remain mild to moderate. A reminder that symptoms among children can include: cough, fever, shortness of breath, sore throat, diarrhea, muscle aches, fatigue, runny nose, vomiting, stomach pain, conjunctivitis, and/or rash. However, a study out of Italy suggests that up to 80% of children with COVID may be mild or asymptomatic.

4. More than 300 workers in at Los Angeles Apparel (a garment manufacturing company) have tested positive.

5. A study published in JAMA looked at cases pre-masking requirement compared to post universal masking requirement among healthcare workers and found a 0.49% decline per day after universal masking was required. The infection rate went from 21% pre-intervention to 11% post intervention/end of the study.

6. In a study (published July 9th in JAMA) of previously hospitalized COVID patients, 90% of them still had 1 or more systems 2 months or longer after onset and more than a month after hospital discharge. Some physicians anticipate patients may require follow-up for a year, depending on case severity. Fatality rates should not be the only measure of severity. Based on the collective research available, it is becoming evident that long-term effects are likely and illness duration can be significant. Important to note this was a small study so further research is needed.

7. The CDC is no longer going to recommend doing 2 post tests for those who have recovered due to test shortages and back-logged tests.

8. Due to the inaccuracy of serology tests (the tests designed to identify if you had COVID in the past) are losing credibility among healthcare workers and researchers.

9. Case rates among prisoners are 5.5 times higher than the general population.

FINAL THOUGHTS: We have survived another week and most of us are heading into record heat waves for the weekend, so that should be fun. Seems like a great time for a water-balloon fight, a dip in the pool, a trip to the lake, or a few hours with the sprinkler. Take a break from COVID this weekend, take a break from social media, take a break from the news. Instead, make homemade Popsicles, eat a pint of ice cream, just sit in the sun with your feet soaking in a bucket of cold water, or lay on the couch in the AC and pretend nothing else exists. It doesn’t really matter what you choose to do as long as it is stress-relieving and fun. Dare I even suggest decadent. You need a break; you deserve a break. We can only push ourselves so hard and so far. You have done great this week. Now rest, recover, and renew because Monday is coming.
 

RxCowboy

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COVID-19 Update: Monday, July 20
Colleges and Universities edition.

NOTE: most of today’s post is general recommendations for colleges and universities with a focus on faculty and staff. These are general recommendations that will need to be tailored to your individual situation or campus situation (I could not possible put everything in a post) but hopefully what is here will help get you thinking about ways you can reduce your personal risk.

1. 6.7% of all deaths in the US were attributed to COVID during the week of July 6th – 11th. This is from formal death certificate data which is on a lag so this number will change. Hospitalizations are on the rise.

2. The CDC has released guidance for colleges and universities as they prepare to resume face to face classes (F2F). Below is a link to that guidance, at the same link you can find a list on the left side for other organizations such as churches, K-12 schools, and an assortment of other businesses. But today I want to focus on colleges and universities. As we get started, I want to remind you of a couple of things: a) the situation is about risk mitigation. Understanding what our risk is then working to reduce that risk. It is not about fear or living in fear but about having the information you need to make the best decisions for you and your family. Each of us will have a different risk level and a different risk tolerance. You must assess the risk, review the ways to reduce risk, and then make the decisions that are right for you and your family. B) when schools resume there will be an increase in cases and there will be a loss of life. The question is not “if” that will happen but how many and how well we will be able to manage it.

Colleges and universities are at higher risk for disease than K-12 schools for multiple reasons among which are: a) people come there from all over the world, not just local, b) they do not have the same protective mechanisms that K-12 students have physiologically, c) they are together more and inter-mix more than K-12 students and d) class sizes tend to be larger and longer in duration.

Colleges and universities also have considerably more control and flexibility over how they operate and manage the issue and like K-12 schools the situation by institution will vary considerably. For example, small institutions or small classes will have less risk than large ones. Think of it this way, if 1 out of every 10 people has COVID (this is not true, just an example) and you put 10 people in the room, while you may not know who the one person is, you can space out pretty well and attempt to avoid the other people. For each person you add to that room your risk goes up and your ability to avoid the people goes down. In a large auditorium size class with 100+ people, at least 10 would have COVID (still just a random number for example purposes) and they would be scattered about the room. Avoiding them becomes much more difficult. The more times you put yourself in that situation, the higher your chances of getting COVID. College campuses are notorious for infectious diseases, they are not notorious for social distancing.

High-risk times/locations for colleges and universities include Tuesday/Thursday classes, large classes, classes where spacing isn’t possible, social events such as frat parties and mixers, dining halls, student unions, chapel (for religious schools), labs that don’t have specialized ventilation, sporting events (particularly indoor events), theater performances, dorms, libraries, the gym – etc. Basically, places where there are large numbers of people and limited space.

So what can you do? As an administrator there is a lot that you can do – including mitigating each of these venues, and working with a public health professional or epidemiologist to develop the best possible risk mitigation plan. While including people from your institution in the planning is an absolute requirement, bringing in someone who specializes in this is essential. There are apps and software to help administrators track, monitor and reduce risk. Invest in a tracking mechanism, appoint someone on your campus to be the POC for all things COVID, preferably someone who has public health, epidemiology, infectious disease, emergency management etc. credentials. I recommend asking all students, staff, and faculty to quarantine for 2 weeks prior to coming on campus.

A strong plan for risk mitigation and hazard response is crucial. Communicate the plan and enforce it but also be flexible. A good plan will have contingencies and will recognize that one size does not fit all. Faculty, staff and students need options that will best accommodate their risk levels, provide those options. Hold faculty meetings via Zoom (or some other similar system), require masks when F2F meetings are necessary. Keep meetings short and hold them in rooms where spacing is possible. If what you need to communicate is one way (i.e. you are providing info not asking for input) send the information out via email. Have a plan for if you have an outbreak.

Having worked at a variety of Universities I understand that Faculty have differing levels of control in different environments. But there are some things that most faculty at most institutions have control over. Ask questions of the administration and be familiar with the plan for the campus. Assess your personal risk level and make decisions from there. Reduce F2F time as much as is reasonable. Include online options when feasible, for example, lectures can be done online – either live or pre-recorded. Labs, not so much. If you aren’t comfortable with on-line, consider doing some lectures as pre-recorded content and some in person to reduce in person time. Require masks to be worn in your class. Put this requirement in your syllabus and stick to it. Reduce your class sizes if you work in an institution that gives you that option, require students to space out when you can. Hold class outside when possible – outdoor classes have less risk than indoor ones.

Invest in a face shield that has a nice fit against your forehead. Get several and wear them to class (just one at a time of course). Students will be able to see your face and hear you and you will have a nice level of protection. Face shields are easy to clean/disinfect and generally speaking will reduce the number of times you touch your face. Stay distanced from the students as much as possible and when not possible try to limit the amount of time you are within 6 feet of them to 10 minutes or less. Buy masks and have one for each day of the week. Do not take your campus masks home – let them be designated for campus only. Once you wear one, let it hang in your office for the rest of the week – don’t re-wear the same one again that week. Require masks be worn in your office – put a sign on the door. Don’t eat in the cafeteria. Don’t attend large social gatherings, wear a mask when you can’t avoid these things. Keep hand sanitizers in your classes and require all students to use it when they come in. Arrive early to class and clean common surfaces such as computer equipment, the mic, the podium, lab equipment, etc. Take your own dry erase marker/eraser if applicable. If you are high risk – opt for online.

Consider the high-risk areas of campus and ways to reduce your and your student’s times in those areas. For example, don’t hold class in the library unless you are able to do in a way that allows them to be socially distanced.

Develop a plan for how to manage high-risk students, give them options for how to participate in your class. Put these in your syllabus. Develop a plan for how to manage students who develop COVID and therefore have to be out. Consider your attendance policy and how you want someone with a cough to respond. What adjustments do you need to make? What about someone with a known exposure? (this is also where your university having one of those apps I mentioned earlier come in handy). How will you handle class once someone in the class has been exposed? Make a plan for if you get sick. Create a COVID section in your syllabus and include all these things. Be flexible.

Link to the CDC guidance: https://www.cdc.gov/coronavirus/2019-ncov/community/colleges-universities/considerations.html



FINAL THOUGHTS: Let’s walk into this week strong, and bold, and confident. This week resolve to be in control, to be calm, to be focused. This week, this isn’t something that is happening to you, it is something you are managing. Let this be the week you embrace the crazy, the week you go on an online shopping spree to stock up on masks you love. Because if you are going to have to wear them, you may as well have cute ones – and plenty of them. Let this be the week we stop fighting against it and just embrace that this is happening, and we can win. This week, be a COVID warrior, informed, prepared, and unafraid. Because you are informed. You are prepared. And you are cautious but not afraid. Know that you are doing what you can, and that is all you can do. So be ok with that. Put a little whipped cream in your coffee and step into the fray because you are strong, and you are ready. And let’s agree to have ice cream for dinner.
 

RxCowboy

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COVID-19: Tuesday July 21 Update
Zinc, 4 Million, Testing Changes, Fake Headlines and MIS-C

NOTE: For the foreseeable future I will be using pictures from the Spanish Flu outbreak of 1918 to accompany my posts. I hope seeing them will remind you that people haven’t changed that much and that many of the things we are being asked to do are not new – they are things we were asked to do then too. People resisted then too, hopefully that will encourage you. But we made it through, just as we will now.

1. The US will hit 4 million cases either today or tomorrow at the latest. That will mean we added a million cases in 6 or 7 days – depending on if we hit today or tomorrow. Either way, it means we continue to cut our time roughly in 1/2 for each additional million. If that trend continues, we could hit 5 million as quickly as this weekend. Hopefully, the trend will not continue.

2. The International Journal of Molecular Medicine published a study suggesting the anti-inflammatory effects of Zinc may help reduce risk and severity of COVID. Zinc can be found naturally in meat, shellfish, chicken, fortified cereal, nuts, seeds and beans. Vegans and vegetarians may need to add 50% more zinc to their diet according to the study. While additional research is needed, it is never a bad idea to get enough vitamins and minerals.

3. The CDC will no longer be recommending repeat testing for those who have been infected and gotten better. The current recommendation was for 2 tests post recovery to assure accuracy of testing and that the person really was free of COVID. But some people are being tested up to 6 times. Three days after you are free of symptoms you are considered no longer contagious. So the change is expected to recommend only one post-test. This deviates from WHO recommendations but is being done because test shortages are becoming an issue. Repeat testing will still be recommended for those who are critically ill, those with immune deficiencies and those with immunosuppression. Repeat tests are not recorded as “tests” (or at least they shouldn’t be, mistakes happen occasionally). But even if they were mistakenly counted, they would be included in the negative column as these are tests being done on those who have recovered.

4. Fake headlines: there are two fake headlines you should be aware of. One is proclaiming that people who practice social distancing are more intelligent – that isn’t true and is a stretch of what their data found. The second is about Bubonic plaque in a squirrel, that is true but is hype. We have cases of Bubonic plaque in the United States every year. Typically, around 5 if memory serves me correctly. Most commonly in CA. This is nothing to be alarmed about, it normal and in today's world Bubonic plaque is treatable.

5. According to a report in the Lancet medical journal on Saturday, doctors in NY have identified MIS-C in two adults, a 45-year-old man and a 36-year-old woman. These are two isolated cases, so we don’t want to draw too many conclusions, but they are worth knowing and it is something to watch and be aware of. You may recall MIS-C is typically seen in children and is considered a “side effect” of COVID exposure in children. Over 6 weeks a PICU (pediatric ICU) in the UK admitted an average of 14 children a week with MIS-c reaching a peak of 32 admissions one week. Nearly all children recovered. MIS-C is still considered rare – as of July 14th the US had seen 342 cases across 37 states. The children ranged in age from 0-20 with most being between 1-14. The US has seen 6 deaths. Most of them were exposed to COVID and developed MIS-C 2 weeks post exposure. You can learn more here: https://www.cdc.gov/mis-c/cases/index.html

FINAL THOUGHTS: This experience has certainly tested our patience, our resolve and our resilience. Now, many are facing another tremendous decision regarding sending their children back to school, sending their college students off to the dorms or returning to teach in those classrooms. Those decisions are difficult, scary and in some cases, not a decision at all – simply something you know is coming without knowing what to expect. Some people aren’t concerned at all. Others are quite concerned and still others fall somewhere in the middle. Let’s not forget that we are all entitled to our own thoughts, feelings and opinions. Opinions are just that, opinion. Give yourself permission to feel what you are feeling about this entire situation and let others do the same. You don’t have to agree with them, you don’t have to convince them, and you don’t have to argue – it is, after all just their opinion. Opinion should not be confused with truth but should be identified as perception. While perception affects our views and behaviors it is not the same as truth. Either way, isn’t right now stressful enough without arguing? Today, do what is hardest, let go. Let people deal with this their own way while you do the same. Let’s hold each other up and love each other, we’ll sort out who was right later.
 

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As you friend mentions sharing photos from the Spanish Flu epidemic, I just read the following article related to the mask mandates during that pandemic...not much has changed, a few article excerpts below.

What did people say about wearing masks in the 1918 pandemic? It sounds familiar

About 2,000 members of the so-called Anti-Mask League gathered in San Francisco in 1919 “for a rally denouncing the mask ordinance and proposing ways to defeat it,” Navarro wrote

During the flu pandemic, which killed 675,000 Americans in 1918 and 1919, “noncompliance and outright defiance quickly became a problem,” Navarro wrote of face-mask mandates. “Many businesses, unwilling to turn away shoppers, wouldn’t bar unmasked customers from their stores. Workers complained that masks were too uncomfortable to wear all day.”

Much like today, some people pleaded for compliance. Headlines from Chicago newspapers in 1919 declared, “Open-face sneezers to be arrested.” “Police raid saloons in war on influenza; Keep church windows open.” “’Nonessential’ crowds barred in epidemic war.”

Read more here: https://www.charlotteobserver.com/news/coronavirus/article244267462.html#storylink=cpy
 

RxCowboy

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COVID-19 Update: Wednesday, July 22
Zinc, hydroxychloroquine, 3M, vaccines, long-term effects, and kids&COVID

1. More on Zinc, the NIH has issued a statement about Zinc – it should not be used above the daily recommended allowance and should not be considered a treatment. It is important to note that Zinc is recognized as beneficial for possibly reducing severity of disease but will not prevent disease and can be toxic in large amounts. Diet is the best source.

2. Several studies have come out recently that show that hydroxychloroquine does not have any benefit. One randomized control trial (available through Medscape-dated July 17th) was done on non-hospitalized patients with mild symptoms found it did not have any statistically significant benefits in recovery. Another randomized control trial out of Spain (300 patients –) also found no benefit and a third study (RECOVERY – a partnership of the NIH and the UK on 4500 hospitalized patients found it did not reduce mortality and was associated with increased hospitalization time, increased risk of dying and increased risk of needing a ventilator.

3. 3M and MIT have partnered to develop an antigen test that would work similar to a pregnancy test and provide results in minutes. They are hoping to have the test ready by late summer.

4. More than 100 potential COVID-19 vaccines are in development right now with at least 20 in human clinical trials.

5. Some people who have recovered from COVID are experiencing “long-term” effects. (note the quotes there – we haven’t have long enough to have truly long term effects, but long term as far as what we have seen so far) Brain fog, reduced endurance (meaning they tire easily), short term memory problems, trouble reading, speaking and writing, breathlessness and muscle pain, and damage to the testicles are some of the complaints. These are making returning to work a challenge. It is worth noting here that this is by no means everyone – just something that we are seeing. Some people will get COVID and not get that sick. They will recover quickly and move on. Others will be moderately ill and it will seem to linger for weeks, perhaps even a month. And of course, some will have severe cases. Despite which form one gets, there are concerns regarding what level of damage their tissues may have experienced that we don’t know about – (consider Sept. 11th and how it was years until we began to see the long term health effects experienced) -this can be true even for those who experience mild or no symptoms. We need to assess the disease based on more than mortality alone.

6. A study conducted in South Korea and published in the CDC-journal Emerging Infectious Diseases reports that children ages 10-19 can transmit COVID as easily as adults. Suggesting the limited transmission suspected among children is only in those under 10. More research is needed to know for sure, but we don’t want to assume that children cannot spread it. In related news, Texas is reporting an increase of cases among infants (those under 1) with reports that one county has had 85 cases in infants (I have not been able to independently verified this). The CDC is reporting that 4.4% of total cases are now children and the first case of COVID related development of Guillain-Barre syndrome has been reported in a child (published in the Journal of Pediatric Infectious Disease and available pre-print via the NIH). Post-COVID development of Guillain-Barre had been seen previously in adults but not children.

FINAL THOUGHTS: We have reached the middle of the week and you have tried to be kind, hold your tongue and to respect other people’s opinions, even if you weren’t always successful. And is it me, or does it seem like the harder you try the more challenging it becomes? Like ridiculous, frustrating things just creep out of the woodwork determined to sabotage your efforts? It can be exhausting. You can feel drained, emotionally fragile, and exhausted from the effort. Combine that with the stress so many are facing regarding sending their children to school and/or returning themselves, increased cases around the country, plenty of bad news everywhere and general life – and you have a great mix for burnout. So today I want to encourage you to take a day of active recovery. Keep being kind, keep respecting others rights to their opinions (you don’t have to agree with them – or validate wrong information, just respect their right to have that opinion) and keep moving forward, but cut yourself some slack today. Give yourself the same kindness you have been showing others. Look at that “to do” list and see what you can remove. Take a break in the middle of the day and do something relaxing for just a bit. Go for ice-cream at lunch, get the flavored coffee, blast music a little too loud, something, anything that will give you that extra little support you need to keep fighting the good fight. Don’t be so hard on yourself, reduce your expectations for productivity, let yourself off the hook a bit, say no when you need to. Because you cannot love others properly if you haven’t loved yourself first. So today, show yourself some love whatever that may look like for you and know that you are doing the best you can in the situation where you are.
 

RxCowboy

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As you friend mentions sharing photos from the Spanish Flu epidemic, I just read the following article related to the mask mandates during that pandemic...not much has changed, a few article excerpts below.

What did people say about wearing masks in the 1918 pandemic? It sounds familiar

About 2,000 members of the so-called Anti-Mask League gathered in San Francisco in 1919 “for a rally denouncing the mask ordinance and proposing ways to defeat it,” Navarro wrote

During the flu pandemic, which killed 675,000 Americans in 1918 and 1919, “noncompliance and outright defiance quickly became a problem,” Navarro wrote of face-mask mandates. “Many businesses, unwilling to turn away shoppers, wouldn’t bar unmasked customers from their stores. Workers complained that masks were too uncomfortable to wear all day.”

Much like today, some people pleaded for compliance. Headlines from Chicago newspapers in 1919 declared, “Open-face sneezers to be arrested.” “Police raid saloons in war on influenza; Keep church windows open.” “’Nonessential’ crowds barred in epidemic war.”

Read more here: https://www.charlotteobserver.com/news/coronavirus/article244267462.html#storylink=cpy
Proof that in 100 years people haven't gotten any smarter.