Stock up on these 9 healthy foods to boost your immune system during coronavirus

When will it end?  By now we have been couped up (isolation) for many weeks as we wait for the Covid 19 curve to flatten out.  You are most likely tired of the routine diet you have been eating.  And because you are unemployed (unless you are an essential worker) your budget has been destroyed. For those of you who are working, exposure to Covid 19 means your immune system needs to be maximized.  Exercise and nutrition are key components to dealing with stress.

As cases of coronavirus continue to rise, taking daily precautions such as washing your hands, social distancing, exercising and getting enough sleep is key to lowering the risk of infection.

But maintaining a healthy diet to help boost your immune system may also give you an edge. It’s important to note that no research has been done on foods that help fight against COVID-19 specifically.

However, previous studies have found that eating certain foods can improve your health and strengthen your body’s ability to fight other invasive viruses.

Here are some recommendations. 

Here are nine expert-approved foods to stock up on during your next grocery store trip, along with creative ideas on how to add them to your diet:

1. Red bell peppers
Red bell peppers reign supreme when it comes to fruits and vegetables high in vitamin C. According to the U.S. Department of Agriculture, one cup of chopped red bell peppers contains about 211% of your daily value of vitamin C. That’s about twice more than an orange (106%).

A 2017 study published in the National Institutes of Health found that vitamin C contributes to immune defense by supporting a variety of cell functions and can lower the risk of respiratory infections. It can also help the growth and repair of tissues in your body.

“Daily intake of vitamin C is essential for good health because our bodies don’t produce it naturally,” Dr. Seema Sarin, an internal medicine physician at EHE Health, tells CNBC Make It.

She suggests slicing one up and eating it raw with hummus as a crunchy snack or mixing some into your salad. If you prefer them cooked, throw a handful in a pan for a quick stir-fry.

2. Broccoli
Broccoli is also rich in vitamin C. Just half a cup contains 43% of your daily value of vitamin C, according to the NIH.

“Broccoli is packed with phytochemicals and antioxidants that support our immune system,” says Sarin. It also contains vitamin E, an antioxidant that can help fight off bacteria and viruses.

According to the Dietary Guidelines for Americans, vitamin C is one nutrient Americans aren’t getting enough of in their diet, so finding simple ways to add it in is crucial.

“To get the most out of this powerhouse vegetable, eat it raw or just slightly cooked,” says Sarin. “I love sauteing broccoli with garlic and Parmesan, or stir-frying with bell peppers, ginger, garlic and mushrooms.”

3. Chickpeas
Chickpeas contain a lot of protein, an essential nutrient made of amino acids that help grow and repair the body’s tissues. It’s also involved in synthesizing and maintaining enzymes to keep our systems functioning properly, according to the Academy of Nutrition and Dietetics.

“Chickpeas are also packed with zinc, which helps the immune system control and regulate immune responses,” Emily Wunder, a dietitian and founder of the nutritious recipes site Healthier Taste, tells CNBC Make It.

Roasted chickpeas are great as a quick great snack or salad topper. Make sure they’re completely dry before roasting. Then add a few tablespoons of oil (vegetable, canola or grapeseed oil all work well) and bake at 400 degrees Fahrenheit, stirring halfway through until they’re crispy.

For a nice kick, Wunder suggests adding some salt and paprika. If you’re using canned chickpeas, she says you’ll want to rinse them thoroughly to cut down on sodium content.

4. Strawberries
Wunder enjoys half a cup of strawberries to get 50% of her vitamin C needs for the day.

“Vitamin C is great for strengthening your immune system,” she says because it can help protect cells from damage caused by free radicals that we’re often exposed to in the environment.

Wunder recommends adding chopped strawberries to yogurt, oatmeal or on top of whole-wheat toast with peanut butter. “Of course, they go well with smoothies, too,” she says.

5. Garlic
“Not only is garlic full of flavor, but it’s packed with health benefits such as lowering blood pressure and reducing the risk of heart disease,” according to Sarin. “Garlic’s immunity-boosting abilities come from its heavy concentration of sulfur-containing compounds, which can help fight off some infections.”

Garlic has been shown in the past to help ward off the common cold. In a 2001 study published in Advances in Therapy, participants who took garlic supplements were less likely to catch a cold. And those who did get infected recovered faster than participants in the placebo group.

It’s an easy vegetable to work into your diet, says Sarin. You can add to it anything — from pasta sauce and salad dressings to soups and stir-fry dishes. She suggests aiming to consume two to three cloves per day.

6. Mushrooms
“While sun exposure is the best source of vitamin D, it can also be provided by some foods, including mushrooms,” says Wunder.

A 2018 review of mushrooms as a vitamin D source found that the “sunshine vitamin” can help enhance the absorption of calcium, which is good for bone health and may also protect against some cancers and respiratory diseases.

Mushrooms are great as a side dish or appetizer. Wunder recommends roasting them at about 350 degrees Fahrenheit, using one to two tablespoons of oil, minced garlic and a dash of salt and pepper. For something more flavorful, bake button mushrooms stuffed with cheese, onion and artichoke hearts.

7. Spinach
“Spinach is rich in vitamin C and full of antioxidants that help shield our immune cells from environmental damage,” says Sarin. “Plus, it has beta carotene, which is the main dietary source of vitamin A — an essential component of proper immune function.”

Like broccoli, it’s best to consume spinach raw or slightly cooked. To incorporate more spinach into your diet, Sarin suggests blending it in a smoothie, cooking it with your morning eggs or, as an easy side dish, lightly sauteing with garlic.

8. Yogurt
“Yogurt is a great source of probiotics, which are good bacteria that can help promote a healthy gut and immune system,” says Sarin. Recent studies have also found probiotics to be effective for fighting the common cold and influenza-like respiratory infections.

Sarin recommends choosing plain yogurt — rather than anything too flavored or sweetened — and topping it with fruit and honey. “Or, you can add it to your favorite post-workout smoothie,” she says.

Those on a dairy-free diet can still benefit from almond-milk and coconut-milk yogurt options.

9. Sunflower seeds
“Sunflower seeds are high in vitamin E, which works as an antioxidant and helps boosts the immune system,” says Wunder.

Small but mighty, just one ounce of dry-roasted sunflower seeds can give you 49% of your daily value of vitamin E, according to the NIH.

Line a baking pan with parchment paper and roast unshelled sunflower seeds at 300 degrees Fahrenheit until they’re lightly browned. Then add the seeds to your salad or toss them with roasted vegetables. You can also use raw seeds in place of pine nuts for some homemade pesto.

Brittany Anas is a health and nutrition reporter. She has written for HealthDay, Women’s Health and The Denver Post. Follow her on Twitter @BrittanyAnas.




Stock up on these 9 healthy foods to boost your immune system during coronavirus

The COVID-19 vaccine development landscape-The Perfect Storm

Covid Viral Particles

Discover the world’s best science and medicine

COVID 19 provided the fertile ground for a singularity of events and technology.  Covid19 will have a long-lasting effect on the world. Considering it is one of the simplest forms of life it's impact is as great as a world war, and it will require a worldwide "Marshall Plan"

The effects of the pandemic have resulted in less pollution, due to decreased carbon emissions from motor vehicles. Airplane travel has decreased by over 90%, non-essential businesses have closed. Unemployment has soared suddenly within a two week period.  

This is the first pandemic of a global nature, far exceeding that of SARS, MERS, and H1N1 during the last two decades.  It comes at a time where the internet and health information technology has matured.  Telehealth has increased accessibility and allowed social distancing to occur, removing another infectious route in the clinic and/or hospitals.

There is no industry untouched by this pandemic.  It has catalyzed the use of modern technology, modeling, and algorithms, to follow and predict outbreaks.  The world has never been so connected, allowing an almost synchronous exchange of information around the world. An epidemic of infectious disease at far distant points on Earth are instantaneously announced, not only by official sources such as the World Health Organization and Social media platforms such as Facebook, Twitter, and Instagram. We have discovered public health organizations have become outmoded during the last decade.  The learning curve is steep and necessity is the mother of invention.

We see how important supply logistics and communication are essential ingredients for dealing with shortages of critical medical equipment such as facial masks, gowns, gloves, ventilators, sanitizers, and ordinary hospital supplies.

Makeshift Ventilator for Shortages of Ventilators

1. 
   

The COVID-19 vaccine development landscape:

Free AI software helps find COVID-19 in chest X-rays

Dutch companies are using a free AI tool to help hospitals generate heatmaps of COVID-19 seen in X-rays. (Delft Imaging)

Two Dutch companies are providing artificial intelligence (AI) software free of charge to hospitals to help triage COVID-19 cases by highlighting affected lung tissue in chest X-ray images.

The companies see the tool as especially helpful in places where healthcare resources are limited and where X-rays are available, but CT scans are not.

The software tool, called CAD4COVID, builds on an existing tool certified by the Dutch Ministry of Health called CAD4TB that has been used in more than 40 countries with 6 million people to screen for tuberculosis, according to the joint companies involved, Thirona and Delft Imaging.

Normally, COVID-19 has been detected with a CT scan and an RT-PCR test, but since resources are limited in many areas, X-rays can be a useful tool to provide first-line triage before further testing, the companies said.

Hospitals can register on a Delft-sponsored website to learn more about CAD4COVID and gain access to the tool. The website includes a liability clause and notes that CAD4COVID is not yet certified but has been submitted to the Dutch Ministry of Health. CAD4COVID has been developed to support the COVID-19 crisis and is not intended as a commercial product, according to a company FAQ.

The companies noted that CAD4COVID will be continuously improved and optimized.

CAD4COVID works by generating a score of between 1 to 100 to indicate the extent of COVID-19-related abnormalities found in an X-ray and then displaying the abnormalities through a heatmap and quantifying the percentage of the lung that is affected. 

The FAQ says that the tool processes chest X-ray images both from CR and DR X-ray in DICOM format.

In the first phase, CAD4COVID is available as a cloud-based solution and users will receive a unique account for their facility which provides access to a CAD4COVID viewer. The companies said that they will not use a hospital’s data for product development purposes without further permission.

Guido Geerts, the CEO of both Delft Imaging and Thirona, said that CAD4COVID will be especially useful in areas where the virus is active and care resources are low. “Our breadth of experience in such settings has made us very concerned about the implications that COVID-19 can have on countries where the healthcare infrastructure is already under pressure,” he said in a statement. “Many of the measures implemented across Europe and the U.S. will be difficult to replicate in Africa.”  CAD4COVID is available for free “to have a big impact, quickly,” he added.




Free AI software helps find COVID-19 in chest X-rays | FierceElectronics:

Covid 19 and Technology

Bare Bones Bag-Mask Ventilator

While government orders for social distancing and travel restrictions are in place to mitigate the spread of coronavirus, the development and implementation of technology to produce critical medical supplies is becoming crucial as overcrowded hospitals face shortages of ventilators and masks. In addition, technology is driving efforts to detect the presence of COVID-19 in patients and in biomarkers that could signal the presence of the disease in specific geographic regions.

But more than technology is needed. Making sure the ventilators work properly is important, and so is the presence of a strong supply chain to ensure supplies get to critical locations in a timely manner.

Because ventilators serve a critical patient need, ensuring they work properly is of utmost importance. One company playing a role is National Instruments, which makes automated testing and measurement systems to measure an array of devices. As no two ventilator models are alike, National faces the daunting challenge of testing ventilators with different shapes, features, etc. National is partnering with a number of companies in their testing efforts.

The urgency of producing ventilators has received a strong response from crowdsourced efforts and universities. Some of the current university efforts involve researchers from MIT, the University of Minnesota, and Vanderbilt University. All are based on advancing the manually bag-operated valve mask, known as a BVM or Ambu-bag.

Advanced technology, such as robots, is also being used to expedite COVID-19 testing. At the University of California at Berkeley, a pop-up diagnostic lab has been set up that uses a liquid handling robot able to process more than 1,000 patient samples daily. The lab is initially handling the UC Berkeley community but could expand its efforts to the greater East Bay area.

Artificial intelligence, not surprisingly, is also getting into the act. Two Dutch companies are providing artificial intelligence (AI) software free of charge to hospitals to help triage COVID-19 cases by highlighting affected lung tissue in chest X-ray images. The software tool, called CAD4COVID, builds on an existing tool certified by the Dutch Ministry of Health called CAD4TB that has been used in more than 40 countries with 6 million people to screen for tuberculosis, according to the joint companies involved, Thirona and Delft Imaging.

Detecting signs of coronavirus before it can spread will be the key to controlling future outbreaks. Researchers from Cranfield University in the UK are using paper-based kits to test wastewater for the presence of biomarkers in urine and feces samples, that could determine if there are carriers for COVID-19 present.

A team at the University of Minnesota is pursuing a design, called the Coventor, based on a bag-valve-mask that uses an electric motor that turns a crank that pushes a piston up and down. Two weeks ago, a prototype proved successful in a trial run.

Vanderbilt University’s design similarly involves an Ambu-bag, retrofitted with a mechanism to apply the necessary squeezing action. The first prototype consisted of nylon webbing wrapped around an Ambu-bag attached to the crank arm of a windshield wiper motor to apply the repetitive squeezing force

In all three cases, the basic engineering challenge is to take a low-cost design and figure out an economical way to eliminate the need for an operator.

But that’s not the end of the story: A low-cost ventilator will ultimately need specific performance characteristics and features—the very blueprint of any product design—to be safely used in a clinical setting. And determining what those are will require the practical, real-world experience and medical know-how of doctors.

To that end, the three teams consist of a mix of engineers and doctors, bringing together the best technical and medical expertise to bear on the issue.  

MIT Mechanical Engineering Professor Alexander Slocum, one of the authors of the MIT paper on a low-cost mechanical ventilator, stressed that no engineering team can come up with a low-cost ventilator design without specific performance requirements (other than cost) and be effective. “Which is why we work with doctors on the problem and where we post [to the website MIT E-Vent] as we learn,” he noted in an email response.

From that learning is emerging a more detailed set of specifications, which the team is sharing with others who may be seeking to manufacture a low-cost emergency ventilator.

For example, the website states that, “Any low-cost ventilator system must take great care regarding providing clinicians with the ability to closely control and monitor tidal volume, inspiratory pressure, bpm (breaths per minute), and I/E ratio, and be able to provide additional support in the form of PEEP, PIP monitoring, filtration, and adaptation to individual patient parameters. We recognize and would like to highlight for anyone seeking to manufacture a low-cost emergency ventilator, that failing to properly consider these factors can result in serious long-term injury or death.”

In a press release on Vanderbilt University’s website, Robert Webster, Professor of Mechanical Engineering, described why his colleagues added sensors and controls to the design. “This was the result of a lot of conversations with doctors where it became clear that a pressure sensor with an alarm on it for too-high or too-low pressure was essential to the design,” noted Webster. “This is something we would not have known without having many Vanderbilt physicians involved in the project.”

The teams anticipate it will be an iterative process and the concepts will evolve, as doctor’s feedback from early tests is incorporated into the designs.

Many engineers with specific areas of expertise may be interested and wondering how they can contribute to these efforts. Slocumb offered some very good advice: “Stay isolated and do not spread it. And when you see a design on-line, offer constructive peer review.“

What trade-offs to make in a low-cost ventilator design?

In the wake of a growing number of COVID-19 hospitalizations, health care facilities will be facing a critical shortage of ventilators. In response, some of the world’s most gifted, competent engineers at MIT, the University of Minnesota, and Vanderbilt University are pursuing the development of open-source, low-cost ventilators that can be brought to market quickly. The idea is to make the designs available to the public so that anyone can build them.

In essence, the concept for the designs came from a common starting point: Take a simple design—a manually-operated bag-valve-mask (known as a BVM or Ambu-bag) and figure out a way to automate it.

MIT’s team, called MIT E-Vent, is using as its reference a design detailed in a 2010 paper, presented at the Design of Medical Devices Conference, titled “Design and Prototyping of a Low-cost Portable Mechanical Ventilator.” The low-cost design is based on a conventional bag-valve-mask, employing a mechanical cam arm to eliminate the need for a manual operator.

FORD and General Motors are also converting production to building ventilators to assist patients with acute respiratory distress resulting from COVID19 infection.

Workers are beginning to produce life-saving ventilators at Michigan plants that normally make cars and trucks. This will take several weeks to design and manufacture them in volume.

While full production won’t begin until May, the many thousands of ventilators they make will be useful then and in later months should a COVID-19 resurgence occur in the fall or later in 2021 before a vaccine is ready and widely used.

 “We’re used to building big automotive products but scaling to produce a small ventilator requires different sourcing of components and capabilities,” Adrian Price, Ford’s director of global core engineering, said in an interview with CBS This Morning. 

“There’s quite a bit that goes into making a design that is currently produced at the rate of two a day and scaling that to over 7,000 a week,” he added.

GM is bringing back hundreds of workers to produce ventilators next week and will be imposing safety guidelines that include distancing between workers, the periodic taking of temperature and scrubbing down work areas between shifts, according to the CBS report.

The two companies together are enlisting up to 1,500 workers to make ventilators, while Ford wants to produce 50,000 by July 4 and GM wants to build 200,000 overall, according to The Washington Post.

Getting fully functioning machines ready for use that are tested and reliable will be part of the process.  Some ventilators are built to operate only for short periods of time, pumping air or oxygen into a patient’s lungs, while others must pump for days.  There can be an array of electronics for controlling alarms and fail-safes, as well as redundancy.  Testing of the machines will typically take a few minutes, looking at plastic and metal parts but also assessing how well a machine responds when in use, even when a patient coughs into a tube that is connected to the device, according to engineers.  The engineering feat of converting from making vehicles to ventilators is complex, not only because of the technology involved. Both cars and ventilators share electronics and metal and plastic parts that need to be assembled, but there are the added challenges of building thousands of medical devices rapidly with high accuracy and of keeping workers safe while they maintain personal distancing on an assembly line. Some ventilators are elegantly designed and will take more time to produce in large numbers, and they may not meet the peak demand. Others are simple, not complex and designed to work in a third world country where there is no electricity. 

Bag-Mask Ventilator with Enclosure and Intubation

Simple Bag-Mask Ventilator

The researchers noted that live SARS-CoV-2 can be isolated from the feces and urine of infected people, and the virus can typically survive for up to several days in an appropriate environment after exiting the human body. 

 

https://tinyurl.com/u7xjequ

States Get Creative To Find And Deploy More Health Workers In COVID-19 Fight - capradio.org

To stop COVID-19, retired doctors are signing up to take clinical shifts. Specialists, including dentists, could move to front line care. And med students are fielding calls in overwhelmed clinics.

 

When Dr. Judy Salerno, who is in her 60s, got word that the New York State health department was looking for retired physicians to volunteer in the coronavirus crisis, she didn't hesitate.

"As I look to what's ahead for New York City, where I live, I'm thinking that if I can use my skills in some way that I will be helpful, I will step up," she says.

Salerno says she doesn't think of herself as a retiree — she's president of The New York Academy of Medicine, which does public health advocacy. But she is essentially retired from clinical practice.


Because of her age, Salerno is among those at higher risk of serious illness if they contract COVID-19. "But I feel that I'm healthy," she says. "I'm working full time, I have no other risk factors, so I do need to be there if needed — it's important for me."

Public health experts say the United States is in for a shortage of health care workers in many places soon, as cases of COVID-19 escalate. First, the ranks of front-line health workers will be stretched thin, as hospitals fill. And if health care workers have to scramble to care for sick patients without enough protective gear, they will get infected with the virus and fall ill, too.

"The reality is that we're facing the inevitable shortage of health care providers," says Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University. "The people that are coming into close contact — and therefore in greatest danger — are the doctors and nurses and people directly examining patients who possibly have coronavirus."

Wishful thinking and harsh realities. 

"The reality is that we're facing the inevitable shortage of health care providers," says Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University. "The people that are coming into close contact — and therefore in the greatest danger — are the doctors and nurses and people directly examining patients who possibly have coronavirus."

To address the coming shortage, states from Hawaii to New Hampshire are loosening their licensing rules to give those with clinical skills the ability to pitch in, such as allowing out-of-state physicians to practice right away, asking retired physicians to volunteer, and more. Most states are making these kinds of regulatory changes, according to a tracker maintained by the Federation of State Medical Boards.

Changes in state rules are just the first step. Volunteer doctors can't simply show up at a hospital ready to work, FSMB President Dr. Humayan Chaudhry explains. Hospitals and health systems need to verify that physicians have the training and licenses they claim to have. "Sometimes that's a laborious process," he says. "Sometimes it takes weeks to complete."

To help speed the process along, Chaudhry says, the Federation of State Medical Boards is offering free access to its physician database, which allows hospitals to quickly verify "where the physicians went to medical school, where they trained, whether or not they've been licensed in one or more jurisdictions, whether they've ever been disciplined, or whether or not they are specially certified by either the American Medical Specialties or the American Osteopathic Association."

In California, for instance, if a physician has been retired and their license is expired, doctors must verify their CME credits are up to date. If it has been more than five years the process is arduous, time-consuming and expensive.  California requires a five-day course at an approved University which costs $20,000.

The downside of including retirees

Although the idea of recruiting retired physicians and nurses has been a fairly popular move among states so far, Redlener thinks it's a bad idea for the front lines of medical care.

"If you start calling in retired doctors, nurses, whatever — these are de facto people at high risk," he says. "They're older — that's why they're retired. Many of them will have serious medical risks on top of that. And if we're going to put them anywhere near the front lines of this particular pandemic crisis, we are endangering some very high-risk people."

In his conversations with public health officials exploring these options, Redlener says, "all avenues are being explored." Nurse practitioners and physician assistants can also work on the front lines if they're willing, he says. And public health officials are also talking about retraining specialists like plastic surgeons and dermatologists so that they could help care for COVID-19 patients. Dentists might be recruited and retrained, too, he adds.

One idea Redlener favors is revisiting the rules about internationally trained physicians who are living in the U.S. "One of the things that I have been thinking and talking about is eliminating — for now — the regulation that you have to repeat your residency in order to practice in the U.S.," he says. "These people are ready to go, and my experience with them is they're very talented, very well-trained and coming from all different countries. That's a pool we should tap."

He adds, "Whatever it is that we do, we should [recognize] that we're putting people in very high risk situations with respect to the coronavirus."


How medical students can help

There's another pool of people at the very start of their medical careers who would like to help out: medical students.

"They're obviously in the process of learning how to be practicing physicians, but there's no reason why they can't also be helpful in the current situation," says Chaudhry of FSMB. He says most third- and fourth-year medical students were recently pulled from hospital rotations because of the dearth of personal protective equipment and the risk of exposure.

"We're working with the national organizations that oversee medical students — both the Association of American Medical Colleges and the American Association of Colleges of Osteopathic Medicine — to make sure that our next generation of physicians who are currently in training are able to come back to the hospitals soon to help out in any way that they can."

Chaudhry says some schools, at least, are considering graduating senior medical students early. "We are beginning to have some early conversations about the current duration of medical school training, the current duration of specialty training for physicians — that's something that we may need to look at at some point, " he says. "We are beginning to have those conversations because nobody knows what the future may hold."

With most med students now sidelined from the hospital, many have been brainstorming ways they can help immediately. Some med students at Harvard, for example, are making infographics and explanatory videos for the general public, which they share on Instagram. And at the University of California, San Francisco, students have held mask drives for local hospitals.

Palak Patel is a fourth-year medical student at Midwestern University. Inspired by medical students at the University of Minnesota, Patel organized, via google-forms, a med student volunteer sign-up program in Chicago and its suburbs.



Some of the things Patel and her peers are volunteering to do make use of their medical training — like fielding calls from patients at several clinics that have been completely inundated, and taking basic medical histories from patients over the phone. But Patel says some med students are also babysitting for hospital workers whose kids are now out of school or doing their grocery shopping.

Patel says she's been delighted with the response from her fellow students. "I've been actually overwhelmed. We've had more than 100 volunteers sign up in 72 hours — my email was just blowing up," she says, and laughs.

"We hope that the situation doesn't worsen," Patel says. "But if it does, we're hoping that we can get more and more involved."

Careful consideration must be given to the exact role in which medical students would function.  They might be useful in triage areas or filling in for licensed physicians in family practice or primary care.

Retired physicians are adept at recognizing illnesses, severity and make rapid decisions based upon decades of experience.  State regulation is a poor indicator for physician competency 

States Get Creative To Find And Deploy More Health Workers In COVID-19 Fight - capradio.org:

6 Feet is not Enough: Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19 | Infectious Diseases | JAMA | JAMA Network

This JAMA Insights Clinical Update discusses the need to better understand the dynamics of respiratory disease transmission by better characterizing transmission routes, the role of patient physiology in shaping them, and best approaches for source control in the context of the COVID-19 outbreak.

Respiratory spray from a cough at 24 feet

The image above is a still photograph from a video examining the spray pattern from a typical sneeze or cough when not wearing a mask or covering your nose with your elbow.

The numbers are given by officials, at first 3 feet, then 6 feet are inaccurate.

Owing to the forward momentum of the cloud, pathogen-bearing droplets are propelled much farther than if they were emitted in isolation without a turbulent puff cloud trapping and carrying them forward. Given various combinations of an individual patient’s physiology and environmental conditions, such as humidity and temperature, the gas cloud and its payload of pathogen-bearing droplets of all sizes can travel 23 to 27 feet (7-8 m).3,4 Importantly, the range of all droplets, large and small, is extended through their interaction with and trapping within the turbulent gas cloud, compared with the commonly accepted dichotomized droplet model that does not account for the possibility of a hot and moist gas cloud. Moreover, throughout the trajectory, droplets of all sizes settle out or evaporate at rates that depend not only on their size, but also on the degree of turbulence and speed of the gas cloud, coupled with the properties of the ambient environment (temperature, humidity, and airflow).

Turbulent gas cloud dynamics should influence the design and recommended use of surgical and other masks. These masks can be used both for source control (ie, reducing spread from an infected person) and for protection of the wearer (ie, preventing spread to an unaffected person). The protective efficacy of N95 masks depends on their ability to filter incoming air from aerosolized droplet nuclei. However, these masks are only designed for a certain range of environmental and local conditions and a limited duration of usage.9 Mask efficacy as source control depends on the ability of the mask to trap or alter the high-momentum gas cloud emission with its pathogenic payload. Peak exhalation speeds can reach up to 33 to 100 feet per second (10-30 m/s), creating a cloud that can span approximately 23 to 27 feet (7-8 m). Protective and source control masks, as well as other protective equipment, should have the ability to repeatedly withstand the kind of high-momentum multiphase turbulent gas cloud that may be ejected during a sneeze or a cough and the exposure from them. Currently used surgical and N95 masks are not tested for these potential characteristics of respiratory emissions.

Ref:

Scharfman  BE, Techet  AH, Bush  JWM, , Bourouiba  L.  Visualization of sneeze ejecta: steps of fluid fragmentation leading to respiratory droplets.  Exp Fluids. 2016;57:24.Google ScholarCrossref

Ong  SWX, Tan  YK, Chia  PY,  et al.  Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient.  JAMA. Published online March 4, 2020. doi:10.1001/jama.2020.3227
ArticlePubMedGoogle Scholar


Management of ill travelers at points of entry—international airports, seaports and ground crossings—in the context of COVID-19 outbreak. World Health Organization website. Published on February 16, 2020. Accessed March 13, 2020. https://www.who.int/publications-detail/management-of-ill-travellers-at-points-of-entry-international-airports-seaports-and-ground-crossings-in-the-context-of-covid--19-outbreak








Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19 | Infectious Diseases | JAMA | JAMA Network:

The Science Behind the Coronavirus, the complete series

There is much information on the internet. Who do you trust?

Patrick_Soon-Shiong

It's Time to Face Facts, America: Masks Work | WIRED

Official advice has been confusing, but the science isn't hard to grok. Everyone should cover-up.

WHEN YOU LOOK at photos of Americans during the 1918 influenza pandemic, one feature stands out above all else: masks. Fabric, usually white gauze, covers nearly every face. Across the country, public health experts recommended universal mask-wearing, and some cities ordered residents to wear them under penalty of fine or imprisonment. The Red Cross made thousands of cloth masks and distributed them for free. Newspapers published instructions for sewing masks at home. “Make any kind of a mask … and use it immediately and at all times,” the Boston commissioner of health pleaded. “Even a handkerchief held in place over the face is better than nothing.”

After the 1918 pandemic, the prophylactic use of masks among the general public largely fell out of favor in America and much of the West. The US Centers for Disease Control and Prevention has almost never advised healthy people to wear masks in public to prevent influenza or other respiratory diseases. 

In the past few months, with medical supplies dangerously diminished, the CDC, US surgeon general Jerome Adams, and the World Health Organization have urged people not to buy masks, paradoxically claiming that masks are both essential for the safety of health care workers and incapable of protecting the public from COVID-19. (WIRED's editorial staff, like the CDC, suggests that healthy people not wear masks.)

Recently, some experts have disputed this contradictory advice. They propose that widespread use of masks is one of the many reasons why China, Japan, South Korea, and Taiwan have controlled outbreaks of coronavirus much more effectively than the US and Europe. “Of course masks work,” sociologist Zeynep Tufekci wrote in a New York Times editorial. “Their use has always been advised as part of the standard response to being around infected people.” Public health expert Shan Soe-Lin and epidemiologist Robert Hecht made a similar argument in the Boston Globe: “We need to change our perception that masks are only for sick people and that it’s weird or shameful to wear one … If more people donned masks it would become a social norm as well as a public health good.” Last week, George Gao, director-general of the Chinese Center for Disease Control and Prevention, said that America and Europe are making a "big mistake" by not telling the public to wear masks during the ongoing pandemic.

It is unequivocally true that masks must be prioritized for health care workers in any country suffering from a shortage of personal protective equipment. But the conflicting claims and guidelines regarding their use raise three questions of the utmost urgency: Do masks work? Should everyone wear them? And if there aren’t enough medical-grade masks for the general public, is it possible to make a viable substitute at home? Decades of scientific research, lessons from past pandemics, and common sense suggest the answer to all of these questions is yes.

Considering how badly the US government has botched its response to the ongoing pandemic, and how much better most Asian countries have fared so far, it’s difficult to believe that Japan once regarded America’s management of a viral outbreak as progressive. Had the US federal government listened to expert warnings about an inevitable pandemic and taken the necessary precautions years ago—by investing in domestic mask production, for instance—we would not be faced with such a dire shortage of basic medical equipment today. Mask manufacturers around the world are working overtime and expanding their operations, but it remains uncertain whether they will meet the surging demand; some of the necessary machines cost millions of dollars and take months to construct.

3M ramps up N95 respirator production as demand surges from global coronavirus outbreak

To fill the surge in demand for the devices, particularly the N95 respirator, 3M is ramping up production, which means hosting job fairs, making offers on the spot and expanding its assembly line with robots.

In Aberdeen, South Dakota, more than 650 employees at one of 3M’s largest manufacturing facilities are working overtime to increase face mask production.

The N95 respirator filters 95% of airborne particles, and can even filter out bacteria and viruses, according to the Centers for Disease Control. Many face masks on the market, including surgical masks, do not effectively filter out particles in the air.

Health-care professionals are concerned that 3M and other respirator manufacturers like Honeywell and Kimberly-Clark won’t be able to fulfill all the orders flooding in.

To overcome the present crisis we must summon more than ingenuity and industry, however. We need solidarity. As we move closer to a phase of the pandemic in which people are allowed to mingle again but there is still no vaccine—and therefore still a chance of new outbreaks—universal masking may become even more imperative. The US desperately needs to revive the ethic embodied by the legions of gauze-wrapped faces in photos from 1918. “You must wear a mask not only to protect yourself but your children and your neighbor,” the Red Cross implored a century ago. “The man or woman or child who will not wear a mask now is a dangerous slacker.”







It's Time to Face Facts, America: Masks Work | WIRED:

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