Follow the science. Trust the experts. But I’ve begun to wonder whether the experts are following the science or throwing darts at a board:
First, they told us that it was no problem, go on with your lives.
Next, they said, don’t worry we have the testing system and the capacity to handle any problem.
Then, they panicked and said stay home, close everything down, most of all arrest people who disobey us, and the very most important thing is to wash your hands and disinfect commonly touched surfaces because those surfaces are transmitting the virus.
They said only wear a mask if you have to get within six feet of other people,
Then they said wear a mask when you are outside.
They said don’t leave your house, then they said a high portion of the infections are occurring at home.
They said that the elderly were vulnerable, but provided no science based guidance to protect nursing homes.
To be fair, they started with a dearth of information, because the Chinese would not allow them to come into the country and observe, gather data, analyze the situation at ground zero. That being said, they should have had a plan, a backup plan, and a tertiary plan, and a criteria for switching between them as the data developed. But it doesn’t seem that they had that because they don’t seem to be shifting; they don’t seem to be teaching to the new data, and the authorities that are responsible for implementing the plan seem to be lost for direction and stuck at shelter in place.
They may be the experts, but they don’t seem to be good decision makers, planners or implementers. So unlike the politicians who seem to be a bunch of hens, clucking frantically while entangling their heads in the chicken wire, I will again offer rational suggestions for using science to move forward.
The latest declaration by the CDC is that COVID is not easily passed on through surface contamination, but is mostly spread by personal contact. Before we move with that, let’s be clear about surface contamination: The virus can be passed on that way, but just not as easily as originally thought and therefore it is not a primary method for passing the virus to others, however contaminated surfaces still can pass the virus to others, and if you are out in public places touching stuff others have been touching, or others have been sneezing on, it’s best to hedge your bets and clean those hands regularly.
So what does the CDC mean by “personal contact?” Yes, I know the Governor Cuomo claims that some huge percent, 30% or more got infected at home. That might be personal contact, but that is short sighted. Someone had to bring the infection home in the first place, which points to some public place outside of the home, i.e. community in origin, and if the commonly touched surfaces aren’t doing it, then what is?
It seems to be staring us right in the face. COVID19 is a respiratory disease; it inhabits lungs; lungs expel air up to 20 times a minute, and they expel bits and pieces of whatever is in them, which hangs in the air in a fine mist that slowly drops to the ground, where it forms contaminated surfaces, which the CDC says is no longer the primary candidate for spreading the disease. Am I missing something? If it is not the contaminated surfaces, then that seems to leave the air as a primary source for spreading the disease.
There are several articles which seem to indicate that the air can be and has been the culprit that first infected people, who then took it home to infect their families and friends. Some of these articles have been written by scientists and others are sufficiently math based to justify follow up investigations, if we could just get the authorities to do their jobs.
[Link to article: I don’t know if the linked article is legit, or if the author is who he says he is, but his statements are logic, and ring correctly to me, so I’m proceeding as if the article is valid]
According to the above article, if you are in an enclosed environment with an infected person, then you are at risk. Your degree of risk increases the longer you are in the enclosed space with the infected, and it can be increased by the actions of the infected. Should the infected only sit there and breath then your chances of becoming infected are less than if he talks, coughs, or sneezes, each of those being increasingly worse for your odds.
Jump to the article’s examples under restaurant and work space, where the author clearly says that air borne particles infected others. He specifically points out that those “down wind” were more likely to get infected. I summarize the writer’s contention to be: (number of people in your air space) times (how long you are in that space) times (level of activity of the inflected) divided (by space size) is your exposure factor. The more people in your air space, the more likely that one of them is a carrier.
While Mr. Bromage’s article helps gel the facts, it is not the only one that implies airborne transmission. The idea that the NYC subway system was a conduit for the virus has been proposed and shot at because it doesn’t stand up with sufficient cause and effect analysis (Link to article).But really, are we going to brush off an idea that has a logical basis just because the author does not have the resources and hasn’t had the time to build a bullet proof study? We need to consider all good ideas, particularly now that we are opening up (and probably even before we shut in). That virus had to get into the house somehow, and a crowded subway car sounds epidemiologically like a fairly reasonable bet (Link to another article). I call it the choke point: Where in the day of each person who came from a non-infected household and who became infected was she most likely to have come in contact with an infected person and share air with them for an extended length of time?
I’m betting the subway car, and it is a logical bet. How many people jammed themselves into those subway cars in the early days of the virus? How much more were they crammed in there after De Blasio shut down a great number of trains?
Premise: Some, possibly many, COVID19 hot spots begin with incidences of too many people in a confined space with poor ventilation. From these incidents, people become infected; they go home and infect their families and close friends, generating a hot spot, or flare up of infections.
If it is through the air then how do we mitigate against that?
First. the subway car. How many times an hour does a subway car replenish its air with fresh outside air? Are subway cars, or even buses designed to have adequate ventilation for the heavy passenger loads that they often carry? Of even a 75% full load? With some experience with HVAC systems and local governments, I can almost guarantee that: 1) The design ventilation is not adequate for heavy loads, i.e. full seating, let alone full seating and standing. 2) Even if the design is adequate, the systems are likely to have not been adequately maintained. HVAC systems are the last thing that any closed space operator fixes, usually only when odors or toxic fumes become unbearable. I’m suggesting that we if could look to the inordinate number of deaths and severe sicknesses among NYC bus drivers (Link) we would find that most of the buses they drove were not properly ventilated, and even if they were, then a higher ventilation standard, set in light of the COVID19 pandemic would have reduced the infection rate, and associated death rate. I also bet that the subway cars are have the same problems as the buses. I am proposing that a higher standard of ventilation for all interior public spaces, one designed to address COVID19, one that is implemented and well maintained, would reduce the number of infections and deaths.
We know that encounters with people outside are less dangerous than inside, and that is because the virus quickly dissipates in open spaces. This is why it is moronic to fine people for hiking, walking on a beach, riding a bike, etc. Indeed, people should be encouraged to go outside, and if they encounter someone, even fairly closely, they are unlikely to be infected, unless they are so unlucky as to be sneezed on.
We have many instances where ventilation could be a contributing factor in an infection flare up. They need to be investigated and recommendations are in order if these systems are found to be inadequate. Public areas, e.g. eating areas, of nursing homes and elder centers which had high infection rates needs to be assessed with regard to 1) adequacy of design, 2) adequacy of maintenance, 3) necessity of a higher standard for elder care centers. How do HVAC systems in nursing homes which had high infection rates compare to those which had low infection rates? This is a place where the government could throw money and possibly accomplish some good and produce guidelines which would help during the restart of our economy and would reduce the virus spread if another flare up occurs.
While various functional public spaces may have adequate ventilation based on ASHRAE standards, those standards likely need to be ungraded in response to the pandemic. For those of you who don’t know, ASHRAE is the engineering society that sets the standards for heating, a/c, and ventilation, among other things. The air handling system in every structure of any importance in the world was built based on these standards, and that probably includes the ventilation system in your automobile. These standards have been tested and proven to be healthy, safe, and efficient-prior to the COVID pandemic.
Relying on Bromage’s observations and arguments presented in his blog, I am offering recommendations regarding ventilation, etc. in public space, which SHOULD and MAY help decrease infection rates in the future.
- ASHRAE should begin, if they have not already, to investigate the impact of ventilation (HVAC) on the spread of COVID19, and determine a) whether suspect public spaces, e.g. impacted nursing homes or subway cars, were operating at the designed ventilation rates, whether the designs were appropriate to the use, etc. etc. Then they should make recommendations with regard to ventilation in the public areas of nursing homes, elder care centers, mass transit cars, etc. to reduce or eliminate the spread of COVID19 through better air circulation.
- Until new science based standards are developed, all public spaces, particularly in nursing homes should: a) test and maintain HVAC systems on a required schedule, b) bring all HVAC systems up to the designed volume of ventilation, and require 100% outside air intake for public areas. These rules should apply to all public spaces, but nursing homes have been identified as centers of COVID19 and their populations are particularly susceptible to severe illness and death so they should be the first target for upgrade. Early emphasis should also be placed on improved air circulation in mass transit cars, etc.
- The above will place a high demand on existing HVAC maintenance and service agencies. To minimize the spread of COVID while providing service, public space operators should operate under the social distancing standards for all of their indoor functions. Outdoor spaces with adequate natural or forced air circulation can have greater population density, which probably can be determined from CDC standards.
- If the federal and state governments wish to stimulate the economy over the long haul, they should: a) fund the ASHRAE studies, assist and provide funding to recruit additional professional engineers, scientists, and other staff to engage immediate commencement of the required studies on a grand scale such that these can be completed in a short time frame. Studies and recommendations should be scheduled in a sequence designed to provide American businesses with functioning guidelines to resume activities and employment as quickly as possible; b) provide tax credits, stimulus dollars to businesses to assist them in implementing the air circulation guidelines; c) recruit and fund engineers, engineering students, and necessary equipment to expedite the testing and installation of necessary modifications.
Choke Point Analysis:
I’m going to introduce another idea, which may already be a standard practice but if not, here it is: Every activity which we seek to “open up” should be examined for its weak points with regard to spreading the virus. These weak points may be minor, i.e. so insignificant as to be negligible, or some may be so great as to be game stoppers. I would suggest that each business engage in an analysis of their activities which assesses these weak points, which I term as choke points, and if the choke point requires remediation, then the business should explain how they are going to do that.
I realize that this opens the door on a huge government bureaucracy, which would become a choke point for opening up, and that is something which we cannot afford. Perhaps the business choke points and resolutions can be reviewed by a professional engineer, or just someone with an engineering degree, and their signature without public official review could be sufficient for the business to go. Whatever is decided, it must not slow down reopening in a significant way- let’s say not more than a two week delay. If the government really wants to throw money at stimulating the economy, this is another way to actually mitigate against future outbreaks while allowing businesses to begin business.
Quick superficial example: On cursory review, the airline business seems to have several choke points: Check in of luggage and security check points will create longer lines when social distancing is involved. Airlines and airports could investigate how this could be alleviated with prescreening, at home printing of baggage tags that are generated during at home check in. An overriding mitigation could be that a COVID19 test is required within one week of the trip with the report being sent directly to the airline; similarly for airport workers. Perhaps all choke point businesses, e.g. restaurants, would be required to have frequent testing of employees. Again if the government really wants to help, then funding these tests and test centers, might be a better use of money than perpetual unemployment compensation.
Restrooms in airport: Full time monitoring where the government could assist with the costs, or customer could pay with a use fee, or an added fee to the ticket, or a combination of all those. Sanitation wipes could be provided on entry. And certainly, increased ventilation with outside air intake.
It has been stated that airplanes already have excellent air filtering and outside air ventilation. But the on plane restroom could be a choke point. If the stewardess must clean between each user, lines will form, passengers will panic as their urge grows. It might be better to provide sanitary wipes so that each user can be satisfied that he/she has made the space safe to use. Perhaps after each user there could be a 30 second accelerated venting of the space to remove all airborne contaminates.
Anyway, again those are ideas which I came up with in a short period of time. They, or course, have their difficulties, but so has everything that man has achieved. It has always been necessary to tinker and pry and bend and hammer until the right form has been achieved. It would be the same with this. But someone in charge needs to step up, line up the workers, and give the order.