I am still not seeing as much as I would like about ventilation. One of main things we have learned about the virus is that indoor air exchange is the A-1 vector for transmission. I think of this at work when I go down to the cafeteria and a young woman with gloves has to pick up a sugar packet, a coffee stirrer, and a coffee cover and hand it to me. Then I go back to an isolated office for phone and online meetings while all the air in the building is pumped directly onto me.
This is significant for nursing homes. No everyone is there for the comorbidities we are so attentive to these days. For some, it is dementia, or mobility and balance issues, or Parkinson's symptoms that prevent independent living. But there they are, now stuck in close quarters with a lot of people with C-Pap machines aerosolising everything. I have an ugly suspicion that it goes less-noticed because it is not easily weaponised by either camp in the national debate. If a governor had said early on that businesses like restaurants could stay open with a few restrictions, so long as they had ventilation systems that met a certain standard - particularly in areas outside of the Northeast cities that were so heavily affected - it would be hard to gin up anger either way. Dan from Madison (over at Chicago Boyz) raised the caution flag that a lot of these systems are now so far back-ordered that no one is getting delivery in months. I'm betting that stuff is harder to switch production to than individual ventilators. So who can capitalise on that one at the Conventions?
I have also not heard much about viral load, which I suggested early on would be important. Next-most-affected after older people are those taking care of them. It can't be a non-factor, but whether it large or merely worth noting as a possibility would seem of some interest. If I were to guess, the importance of superspreader events would suggest that crowds indoors are an enormous risk.
Bsking just mentioned in the Apples to Apples comments that America's high obesity rate as a factor is also neglected. That matters at a couple of levels. Median age has also been mentioned WRT Laos in specific and SE Asia in general. It likely matters.
The advance notice for the Apples to Apples II post is that the regional approach within countries does look like the best way to look at this, and whatever lessons we might extract across countries are often going to come from this.
"I have also not heard much about viral load, which I suggested early on would be important."
ReplyDeleteIts almost as if you know very little about this virus. Have you not kept up with ongoing discoveries we have made over the course of this pandemic? I have.
The actual viral load is very important and is often the difference between a mild infection and a serious one. This is one reason masks are a useful thing in any crowded space. An infected person will put about 80% less viral particles into the environment with one on. This is of course a ballpark figure.
Unfortunately, there has been a lot of really poor fluid dynamics stuff (for and against masks for example) floating around to muddy the waters. If you look at big picture impacts the ventilation issue jumps out at you. Think of March in NYC with most people living in hot water or steam heated apartment buildings in the Bronx and Brooklyn. There is virtually no significant air exchange so everyone in the family in an apartment is highly likely to be infected. the same for a larger cruise ship with most cabins and spaces with air conditioning but little outside air exchange. There is almost no evidence of infection in airliners with continuous air exchange and HEPA filters.
ReplyDeleteFrom my mom’s experience in a nursing home, I agree entirely. Closed up pretty much except for outdoor excursions.
These are the same conclusions reached by the Army Sanitary Commission after the 1918 Flu!
We know a lot about the C19 virus and its effects on people. As you seem to be mostly ignorant I will help with that a bit.
ReplyDeleteObesity has been one of the major comorbidities since we started collecting data. Males are substantially more affected by the virus, than women. With some notable exceptions we are just finding out about, the darker your skin, the worse you will suffer. We are putting extra effort where I live, to keep native people well isolated as they suffer a lot more.
The brand new plasma treatment Trump is excited about has been around for a long time. We have Chinese and European data, that shows some improvement in patient comfort but little improvement in death rate.
Most infection will be droplet and although we know, and have known since the Chinese published data on it, it can become an aerosol, this is not the main transmission mechanism and although I don't know of hard numbers, quite rare.
If I may suggest something, as I intuit that you are attempting identify locations X and Y that are otherwise comparable but X or Y had some special sauce that caused better COVID results. I think you are going to be stymied in finding comparable areas as well as the myriad of factors that might interrupt COVID transmission that aren't really reproducible from lack of comorbidity to low population density to geographic isolation. Try doing it the other way around. Look at the places that had high mortality and identify what they did (or didn't) do as a guide to what practices to avoid.
ReplyDeleteI still read "PenGun" as "Penguin" and can't shake the image of a particularly contentious young penguin typing away on his keyboard, and it cracks me up.
ReplyDelete@Christopher B, I think that's a solid idea to look where things are bad and see what they are doing wrong. It also does tie into my general pessimism that we can know much about the "right approach" this year. I think we can kind of guess at works doesn't work and why, but getting a solid handle on why certain areas, people, countries, etc aren't as susceptible seems like a fools errand at this point. We don't even know true death counts so until we're a year or two out, we're a bit hamstrung.
ReplyDelete"I still read "PenGun" as "Penguin" and can't shake the image of a particularly contentious young penguin typing away on his keyboard, and it cracks me up."
ReplyDeleteYou are not far off. The name comes from a web site I ran in the 90s. It was concerned with Linux, Games and the peccadilloes of Windose. As I had a bit of a Quake deathmatch obsession, I created the character PenGun for that game. Its a combination of Penguin from my long time use of Linux for my servers, and of course a gun.
We were the first to play multiplayer deathmatch online and it was a wonderful time. There were only a few thousand in the world at that time, playing Quake online and we got to know each other. That's where our motto came from. 'Make new friends and kill them'. ;)
I am doing that till this day, now playing Eve Online. I have to somehow get through a set of gate camps to do my next set of missions and it has cost me rather too many ships. TEST is recruiting:
TEST
EVE Online is one of those games I always wish I’d gotten into a while back. I love reading the stories of deception and intrigue that come out of the various wars and conflicts. And the developer’s focus on including the community is a great model that I wish more studios would/could emulate.
ReplyDeleteNever too late to play Eve. I'll be 74 in a couple of weeks and I'm having a great time. You can play for free as an Alpha and we have some bonuses available.
ReplyDeleteAlpha Skill Bonus
@ Christopher B - I am trying to do both. I am certainly not advocating hard conclusions at this point, but I am trying to eliminate some lines of speculation as unlikely while trying to draw outlines of what is emerging from the mist.
ReplyDeleteThat might be clearer after my next post which is a summary/nonsummary.
Re: HVAC and better filtration. Just because its not in the news, I woudn't assume that its not happening.
ReplyDeleteHVAC, filtration, environmental controls and that sort of thing is a huge business that is about as interesting as drying paint to most people. But it is actually a very innovative business and as I am in a closely related and equally boring business, I know that there is a lot going on in new filtering systems and even virus killing ventilation systems:
https://www.enr.com/articles/49800-air-purifiers-with-filters-that-kill-coronavirus-are-in-production
When things get a little more back to normal, commercial building managers are going to be front and center touting new air purification abilities to help lure back their lost tenants.