ineffectiveness of temperature screenings

… These findings are consistent with mathematical models examining the effectiveness of airport screening for COVID-19, which suggest that most infected travelers would be undetected by symptom-based screening at airports.

…SARS-CoV-2 presents a formidable control challenge because asymptomatic (i.e., never symptomatic) and presymptomatic (i.e., contagious infections before symptom onset) infections can result in substantial transmission, …The proxy for infectiousness, viral shedding in the upper respiratory tract, is greatest early in the course of infection, before prominent symptoms are apparent, suggesting peak infectiousness at or before symptom onset.

…These findings demonstrate that temperature and symptom screening at airports detected few COVID-19 cases and required considerable resources. The observed yield was approximately one identified case per 85,000 travelers screened. Reasons for the low yield were likely multifactorial and might have included an overall low COVID-19 prevalence in travelers; the relatively long incubation period; an illness presentation with a wide range of severity, afebrile cases, and nonspecific symptoms common to other infections; asymptomatic infections; and travelers who might deny symptoms or take steps to avoid detection of illness (e.g., through use of antipyretic or cough suppressant medications).

…The hallmark of effective public health programs is reassessment of methods used for public health practice based on available evidence. Therefore, CDC recommended a shift from resource-intensive, low-yield, symptom-based screening of air traveler

air purifiers

Air cleaners and HVAC filters in Homes

PORTABLE AIR CLEANERS

To filter particles, choose a portable air cleaner that has a clean air delivery rate (CADR) that is large enough for the size of the room or area in which you will use it. The higher the CADR, the more particles the air cleaner can filter and the larger the area it can serve. Most air cleaner packaging will tell you the largest size area or room it should be used in. Portable air cleaners often achieve a high CADR by using a high-efficiency particulate air (HEPA) filter.

FURNACE AND HVAC SYSTEM FILTERS

Furnace and HVAC filters work to filter the air only when the system is operating. In most cases, HVAC systems run only when heating or cooling is needed (usually less than 25% of the time during heating and cooling seasons). In order to get more filtration, the system would have to run for longer periods. This may not be desirable or practical in many cases since longer run times increase electricity costs and may also result in less reliable humidity control during the cooling season.

https://health.ri.gov/covid/indooraircirculation/

Use a portable air purifier.
A portable air purifier with a HEPA filter can be used in rooms when you cannot open windows or use fans. If you use an air purifier, follow these recommendations:

• Get a purifier that is the right size for the room where you are going to use it. A typical classroom (30 feet by 30 feet) would need two purifiers that provide 300 cfm (510 m3/h) of HEPA-filtered air to get to 4 ACH. If there is already an HVAC system providing outdoor or filtered air to the room, one air purifier might be enough additional clean air in that room. The volume of these systems is measured with a clean air delivery rate (CADR). If the air purifier’s CADR is listed in cubic meters per hour, multiply the CADR by 0.589 to get the CADR in cfm.

• Follow the manufacturer’s directions for maintenance, including how often the machine’s filter should be replaced.

• Do not buy an air purifier with extra features, such as ozonation. There is no evidence that these extra features make the air purifier remove more particles, and they can produce gasses that can cause lung irritation.

• Put the air purifier as close to the center of the space as possible. Try to keep the sides and top of the machine at least two feet from furniture and other objects so the air flow is not blocked.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340613/

However, using air purifiers without considering the heating, ventilation, and air conditioning (HVAC) system of the facility may expose call center workers to new risks. The use of air purifiers is not an appropriate approach to control COVID-19 at call centers for the following reasons.

First, air purifiers use a dilution ventilation method, which reduces the concentration of harmful substances in the air, while diluting particulate matter (such as fine dust) or gaseous substances (such as volatile organic compounds). Diluted ventilation is widely used due to its low toxicity, low emission rate, and high effectiveness for gaseous substances, and it is used when the substances are produced uniformly over time or when the installation of a local exhaust ventilation system is difficult. The virus that causes COVID-19 is a highly contagious, small, and a biological hazard that is still not fully understood. Therefore, air purifiers employing dilution ventilation are unsuitable. Methods of controlling biological hazards such as COVID-19 are, from most to least effective, elimination, substitution, isolation, engineering control (ventilation), administrative measures, and the use of personal protective equipment (PPE). To prevent community infection, the most feasible option is to recommend the use of PPE, even though this is less effective than other methods; however, call centers can be adequately managed through the proper application of isolation and ventilation.

The second challenge is posed by the air dispersion methods of such air purifiers. Most air purifiers function by directing pollutant-containing air downwards to capture it, passing the air through a filter, and discharging the purified air back into the surroundings. Since the purified air must be discharged at a greater distance from the purifier than its intake, the wind speed is stronger at the outlet than at the inlet. Therefore, since relatively strong air flow is present at the outlet, the pressure difference causes the air to rise and disperse into the surroundings at a location farther away or positioned higher than the inlet.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424318/

This paper describes an innovative temporary anteroom in addition to a portable air purifier unit to turn a general patient room into an isolation space. Using an aerosolization system with a surrogate oil-based substance, we evaluated the effectiveness of the temporary plastic anteroom and the portable air purifier unit. Moreover, the optimal location of the portable unit, as well as the effect of negative pressurization and door opening on the containment of surrogate aerosols were assessed. Results suggested that the temporary anteroom alone could prevent the migration of nearly 98% of the surrogate aerosols into the adjacent corridor. Also, it was shown that the best location of a single portable air purifier unit is inside the isolation room and near the patient's bed. The outcome of this paper can be widely used by hospital facilities managers when attempting to retrofit a general patient room into an airborne infection isolation room.

Thanksgiving Guidelines

https://www.bonappetit.com/entertaining-style/holidays/article/thanksgiving-etiquette-guide

➤ The highest form of conversation is when, for a time, the entire table discusses one topic. Hostsshould gently encourage and orchestrate general conversation; guests should participate, resisting the urge just to turn and gossip with their neighbor.

➤ If you notice someone stranded outside the conversation, invite him into your circle: “We were just talking about...”

➤ If you’re sat next to a conversational void, try one of the following gambits:

How has the last year been for you?
How did you celebrate Thanksgiving when you were a child?

➤ Argument is not conversation, and rudeness is never wit. Keep jokes short and stories shorter. Listen and laugh.

➤ Let kids be kids. It’s a long day—give them space to watch a movie or play outside.

➤ If you have time and energy, get kids to help prepare a simple dish. This will acclimate them to cooking and bestow a sense of pride when “their” dish is served.

➤ Thanksgiving is a great opportunity to intermix the generations—especially if grandparents live far from their offspring.

➤ Thanksgiving deserves a little pomp and ceremony. Hosts should prepare something to say at the start of the meal: grace for the religious, a toast for the secular. This moment of reflectionallows those of all faiths, and none, to express their thanks for the food, family, and friends before them.

➤ If you’re not a confident speaker, your toast need only be brief and heartfelt.

➤ Separate toasts should be raised to the hosts, cooks, and absent friends.

➤ After the toasts, guests may be asked to share what they are especially thankful for. This is a charming way to learn something significant about everyone present.

https://www.usatoday.com/story/news/nation-now/2017/11/16/thanksgiving-dinner-etiquette-20-tips-help-guests-mind-their-manners/871757001/

1. RSVP. Let your host know right away if you can come or not. If you received a “family” invitation, let your host or hostess know how many of you can come.

2. Offer to contribute to the meal — but don’t dictate the menu. Your best bet is to make your offer open-ended and follow your host’s direction. If you or your “party” have special dietary needs, it’s very gracious to offer to bring a dish that meets those needs. “Jen is a vegetarian — I’d love to bring a dish for her if that’s okay with you.”

3. Dress appropriately. At the very least, make sure your clothes are clean and pressed. As a true sign of consideration, dress one notch up. Your hosts are probably going all out, and your attire can either say, “I appreciate the effort you are making for all of us,” or “I thought you were ordering takeout.”

4. Arrive on time. Yes, it is a day of feasting, but that turkey is going to be done at some point and your hosts are trying to plan around that magic moment. If you arrive late, don’t expect anyone to wait for you.

5. Don’t show up with uninvited guests. There is usually room for one more at Thanksgiving, but this is something you must discuss with your host ahead of time.

How to say Thanksgiving grace: Expert advice on finding the words to give thanks

6. Never have more than one cocktail before dinner. There’s absolutely no excuse for being tipsy — or drunk — during dinner.

7. Wait for the eldest adult to take their seat at the table first.

8. After being seated, simply unfold your napkin discreetly under the table and place it in your lap. Do not open your napkin by shaking it, and never tuck your napkin into your shirt.

9. Sit up straight — avoid slouching, leaning or putting your elbows on the table.

10. Put your cell phone away at the dinner table. You can check texts and Facebook and scores after the meal.

11. Wait. Do not begin the meal until everyone at the table has been served theirs, and until the host or hostess has taken his or her their first bite.

12. The cutlery that is furthest from the center of your plate is the cutlery you use first. For instance, if your meal begins with soup or salad, the soup spoon or salad fork will be furthest to the right or left of the plate. Following this, you work your way towards the center. The dessert fork and spoon are generally found above the plate or served with dessert.

13. Never blow on your food — just wait until it cools. Also shake your salt and pepper on to your food, and never into the palm of your hand.

14. Pass food to the right, and always pass the salt and pepper together. (They should stay on the table together throughout the meal.)

15. Hold your glass properly. Tumbler glasses are held near the bottom, stem glasses are held by the stem, and a goblet is held by the bottom of the bowl.

16. Avoid discussing controversial or painful family subjects. This is a day to be together in a spirit of generosity and thankfulness for all you do have. Let it be so. Likewise, do not talk about your health — good or bad.

17. Stay at the table. When you have finished your meal, don’t push your plate or chair away from the table. Be patient.

18. Offer to help with the clean-up. Family or non-family, this is one day where it is a great idea to pitch in.

19. Don’t overstay your welcome. Pay attention to cues and hints about when it’s time to leave (but never depart without offering to help, and without thanking your host and/or hostess).

20. Say thank you. A phone call or, better yet, a handwritten note of thanks to your hosts shows your appreciation for all their hard work.

“Showing grace is just as important as saying grace at your Thanksgiving meal,” says Deborah Ritch. “Knowing the proper mealtime etiquette makes the right impression on family and friends at your traditional gathering. Good manners are also expected of children and young adults. Give them a few lessons in the days and weeks leading up to the gathering. Correcting them at the table is too little too late, and will only disturb the other guests.”

https://www.marthastewart.com/1523159/thanksgiving-etiquette-for-hosts-guests

Make Your Guests Feel Comfortable

Dining with your immediate family members is comfortable, but Thanksgiving dinner is often about coming together with those in your larger community. "If you're throwing a true dinner party, you'll invite many different kinds of people and try to include new members in your party that your family and other friends may not know—that's the beauty of a dinner party, after all. It's an opportunity to meet new people and have more fun," Fitzpatrick says. While it's important to let your family know in advance who you'll be extending an invitation to, don't feel that you have to keep it just to family for Thanksgiving—they should be gracious and help you welcome anyone to your home.

https://www.cookinglight.com/entertaining/holidays-occasions/thanksgiving-host-guest-etiquette

Chill Out

The most important role of a good host is to make the guests comfortable. If you're uptight and stressed, guests feel it. If you want to be relaxed, you need to plan your Thanksgiving menu ahead of time. Don't hesitate to delegate tasks — have someone chop onions while you mash potatoes — and don't forget a great Thanksgiving playlist to dance along to! 

Be a Polite Guest

We all need to sing for our supper. A good guest makes hosts glad they invited you. Arrive on time, with a gift, and make pleasant, interesting conversation with other guests. Stuck on what to get your host? It doesn't have to be anything expensive or elaborate, and we put together a host gift guide to help you find the perfect token of appreciation.

Keep Special Requests in Mind

A good host will accommodate guests' food needs within reason: There's a difference between an allergy and watching calories. A guest with a self-imposed restriction should bring a dish of their own, with enough to share. However, if you're working around special diets or food restrictions, we have dairy-free Thanksgiving recipes, gluten-free Thanksgiving recipes, vegetarian Thanksgiving recipes, vegan Thanksgiving recipes, diabetic Thanksgiving recipes, and even more delicious meal ideas to help you navigate.

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays/thanksgiving.html

Traditional Thanksgiving gatherings with family and friends are fun…

Alcohol Concentration Levels for Hand Sanitizers

Ethanol concentrations of 60% to 95% (v/v) are deemed safe and effective for disinfection by the United States Food and Drug Administration (US FDA), CDC and the WHO (Boyce et al., 2009, CDC, 2019a, FDA, U.S., 2020, FDA, U.S., 1994), including for use against SARS-CoV-2. Interestingly, Edmonds et al. suggested that the antimicrobial activity of the ABHRs is highly dependent on the choice of formulation (i.e., excipient) rather than on the concentration of alcohol. They also suggested that the liquid, gel and foam-based products can all be equally effective if the ethanol content used was within the 60–95% standard range (Edmonds et al., 2012). However, increasing ethanolic concentrations of hand rubs from 80% to 85% (v/v) can reduce the contact time necessary to achieve an efficient bactericidal activity (Suchomel et al., 2012; Eggerstedt, 2013; Wilkinson et al., 2017). Despite this, the WHO, US FDA and CDC still maintain their recommendations of 60–95% ethanol content in ABHRs. …It is worth highlighting that ethanol, unlike water, has a density < 1 g/cm3, which means that percentages of ethanol in water by weight (w/w) and by volume (v/v) can be significantly different and must be specified on the label. A useful comparison between percentages by weight and by volume of ethanol in ABHRs is reported in a recently published document (BDC, 2020). Although this concept might seem trivial, there are cases of published works, where the concentration expression (either w/w or v/v) was not specified, as indicated by Kampf (Kampf, 2018), ultimately presenting ambiguous information. In research work, compounding and manufacturing, it is recommended to clearly specify the concentration units of alcohol used in ABHRs.

https://www.bode-science-center.com/center/hand-hygiene/hand-disinfection/detail-hand-disinfection/article/ethanol-concentration-table-what-is-the-percentage-by-volume-or-weight.html

According to the US FDA's Tentative Final Monograph (TFM) for health care antiseptics, isopropanol should be used as an antiseptic alcohol at concentrations between 70 and 91.3% (v/v) (FDA, 1994). This range of concentration has also been re-endorsed by the US FDA for the preparation of ABHR during the CoViD-19 health emergency (FDA, 2020).

COVID infections and mask use

is infection rate
a function of honesty
or mask adherence

Reported use of cloth face covering or mask 14 days before illness onset

Never 6 (3.9%) 5 (3.1%)
Rarely 6 (3.9%) 6 (3.8%)
Sometimes 11 (7.2%) 7 (4.4%)
Often 22 (14.4%) 23 (14.5%)
Always 108 (70.6%) 118 (74.2%)

A Primer for the Media on Viruses, Vaccines, and Covid-19

…No vaccine “wipes” out a virus. Vaccines are not cures. Vaccines are not preventatives. Vaccines do not seek out and destroy. As an example, we have had vaccines for influenza for decades (since the 1940s) and each year influenza exacts a toll on humans, including sometimes those who have been vaccinated. Influenza is not even close to being “wiped out.” We manage it at best.

Here is a short list of infectious diseases that are a part of our natural existence and any of these have the potential to cause death in any given individual..

1.          Bacterial Infections. (Cocci) Pneumonia, Staphylococcal, Streptococcal, Enterococcal, Toxic Shock; (Gram Positive Bacilli) Diphtheria, Anthrax, Listeriosis; (Gram Negative Bacilli) Cholera, Trench Fever, E. Coli, Plague, Salmonella

2.          Spirochetes Infections. Lyme disease, Yaws, Leptospirosis

3.          Anaerobic Bacterial Infections. Botulism, Tetanus, Clostridium

4.          Rickettsiae Infections. Murine Typhus, Rocky Mountain Spotted Fever

5.          Mycobacteria. Tuberculosis, Leprosy

6.          Fungal Diseases. Aspergillosis, Candidiasis, Histoplasmosis

7.          Parasitic Infections. Nematodes (roundworms), Trematodes (flukes), Cestodes (tapeworms)

8.          Protozoan Infections. Amebiasis, Giardiasis, Malaria, Encephalitis, Toxoplasmosis

9.          Respiratory Viruses. Influenza/Parainfluenza, Adenovirus, Rhinovirus, Coronavirus

10.       Herpes Viruses. Chickenpox, Mononucleosis, Cytomegalovirus, Herpes Zoster

11.       Enteroviruses. Polio, Hand-Foot-Mouth Disease (not the same as the politician’s “foot-in-mouth” disease)

12.       Various Viradae Viruses. Dengue, Hanta, Lassa, Ebola, Marburg, Yellow Fever

13.       Immunodeficiency Virus. HIV

14.       Misc. Viruses. Measles, Mumps, Rubella, Smallpox

15.       Sexually Transmitted Diseases. Syphilis, Gonorrhea

16.       Mycoplasma

Many of these diseases have vaccines available, many do not. Some vaccines are more effective than others. But there has been only one that we have eradicated naturally, i.e. “wiped out,” and that is smallpox. 

…So, is coronavirus deadly? Not really; in fact, most viruses are not truly deadly. The outcome may be death, but that is different than actually being deadly. A bite from a black mamba snake is deadly due to the potent venom. Viruses are parasites, unlike bacteria. Viruses depend on the support of their host. If a virus is to survive, it needs the host to survive. What kills most people with viruses is their own immune system weakness, but sometimes the immune overreaction can kill. That weakness is taken advantage of by bacterial infections. Also, generally poor health conditions can lead to organ failure. 

1.    The coronavirus, SARS-COV-2, is not “deadly.” It can lead to death in very well-identified segments of the population, e.g. the infirmed elderly or poor, but it is very rarely death by the virus. It may be death by bacteria or other causes, yes, but very rarely, if ever, by virus. This is exactly the same as other URI and many other infectious diseases.

2.    The mortality that is associated with Covid has little impact on the expected mortality rate since the population that was most at risk also had a very low life expectancy. 

3.    Increases in mortality in the US are more likely associated with increases in drug OD and suicides, which are collateral damage due to the policies imposed during 2020.

4.    Any vaccine that may be developed and approved for coronavirus is at best a boost to the immune system. It will not prevent infection or wipe out the virus. The degree of effectiveness will only be determined over time.

5.    People who have experienced Covid or are otherwise healthy do not need a vaccine. But it should be their choice, as it should be for all.