Dear reader,
the most important thing during an emerging crisis is to be prepared to act in a way to contain or control it first and to overcome the crisis completely at a later stage. The leadership must also be prepared for contingency plans in case their „plan A“ fails. A crisis like the current one can‘t be tackled by just one plan, it takes several layers of protection. "Plan A" seems to have been a vaccination scheme before a full blown public health crisis develops in a country. A race towards achieving "herd immunity" accompanied by some other measures, which were also not implemented the way Asian countries did.
Prof Chris Whitty says restrictions might need to be reintroduced next winter regardless of what happens with vaccine as that is the time the virus would most easily spread. Talks of an acceptable risk - like with winter flu - each year. There won't be a firm end.
— Kate McCann (@KateEMcCann) January 5, 2021
Fauci: Herd immunity against coronavirus could require 90 percent of country to be vaccinated https://t.co/yBaAbYSgLo pic.twitter.com/A3ZS05zUiF
— The Hill (@thehill) December 25, 2020
4. Mask up. Almost any mask greatly reduces spread from someone with the virus. But to protect ourselves better, we may need N95/KN95 when indoors near others. A more infectious strain requires stronger defenses. Masks all the time when around others not from your household. 15/
— Dr. Tom Frieden (@DrTomFrieden) January 10, 2021
The protection of the population can‘t rest on one pillar only and it should always be clear that humans can fail and therefore „backup plans“ are as necessary as a multi-layer approach (Swiss cheese concept) to contain the spread of a virus. Instead it seems that many countries fail(ed) in regard of TTI (test, trace and isolate), a fully working 'corona trace app' & have implemented several kinds of 'lockdowns' (shutting down public life) followed by opening-up public life, with varying success. (ECDC's EU infection map colored in red or dark red) Mask usage was introduced often very late and only first being ridiculed by some. By now wearing at least a simple mask covering nose & mouth has become mandatory in public transport, enclosed spaces used by the general public in many, if not all European countries. Although the 'keep you distance' rule was introduced quickly, there are still some governments not fully recognizing the importance of additional safety features than just keeping a certain distance (1,5 - 2 meters) or wearing a simple, neither airtight nor filtering mask. There isn't a 'war effort' of mass producing equipment which could massively curb the spread of the virus, except perhaps producing simple cloth or surgical masks. There seems to be almost unlimited financial resources for compensating financial losses due to several kinds of 'lockdowns', but only a fraction of those state funds is needed to mass produce all kind of protective hardware.
The Swiss Cheese Model of Pandemic Defense [New York Times, Dec 7 2020]
My plan for beating #covid19 after watching this pandemic for one year? Easy: Test like a Korean, track and trace like a Singaporean, sequence like a Brit, crush the curve like a New Zealander, vaccinate like an Israeli - and behave like a human being...
— Kai Kupferschmidt (@kakape) December 29, 2020
It was planned to release a detailed study¹ of several European country's approach and failures regarding pandemic countermeasures, but since the epidemic worsened considerably in several European countries, some articles have been published which look more forward than backward. It’s always most important to think about saving lives and not to discuss every little mistake that was made and to seek ‘culprits’.
Speaking of saving lives: It should be central to implement the most effective weapon against the virus besides high effective vaccines, which are currently not produced and inoculated in sufficient quantities and which would take at least another six months in most countries to cover 60% or more of the population. Vaccines are the ultimate ‘weapon’, but until reaching the point of vaccine induced ‘herd immunity’ (letting natural infection spread would result in so many dead people that the term ‘mass murder’ would be appropriate) there has to be mandatory use of filtration. Either for rooms in the form of air conditioning systems with so called ‘HEPA filters’ or by using filtering masks of the highest quality possible, since we don’t just have to tackle ‘droplets’ but aerosols.
A list of available equipment and also some studies regarding their ability to provide (virus free) clean air can be found here: technical solutions against Covid-19 [EZRsecurity compilation, various languages]
It is absolutely unnecessary to have discussions among scientists or between between scientists and members of the public how to name smallest particles emitted from humans through their nose or their mouth. Whether to call a virus ‘airborne’ or using the definition of ‘aerosols’ instead or as addition to droplets does not help a single person trying to not catch the virus and develop Covid-19 days later. It should be crucial to concentrate on the mass production of not only ventilators for use in hospital ICUs once too many got infected and develop the most serious form of Covid-19 resulting in lung damage, which needs to be treated with ventilators or the patient dies of ‘suffocation’. It’s much better and also way cheaper (100€ instead of 20-30 thousand euro per ventilator unit) to mass produce relatively simple filtering masks, which combine maximum virus protection with comfortable use during many hours of the day. The single use filtering masks have some known disadvantages and especially since the infections via ‘fomites’ on surfaces have been almost ruled out makes it desirable to call for mass use of respirators made of materials like soft silicone (or a combination of clear plastic with silicone for sealing purposes) which can be used all the time and just the filtering units have to get replaced once in a while. It was noted by some experts that a traditional (e.g. military) CBRN mask would not be helpful during a pandemic due to its lack of filtering the ‘used’ air of its user. That would be correct if not all occupants of a room wore such a ‘single side mask’, those who would not have ‘full protection’ could inhale the aerosols emitted by those enjoying ‘full protection’, but who got infected somehow nevertheless.
A.) The risk of getting infected despite using a CBRN Mask all the time is very small and thus spreading the virus by using a ‘filtered intake mask only’
B.) In room where 100% of all people wear such a ‘single side respirator’ the air could be completely polluted and still would all filters on the ‘air input side’ of their respirators would prevent them getting infected.
A military style CBRN respirator is designed also to protect against e.g. chemical aggressive agents or nerve agents, so the full face including the eyes are covered either by some kind of ‘glass’. Such a mask would be perhaps only useful in highly contaminated environments like ICUs where patients have to be intubated by doctors and/or nurses, or dentists who are forced to operate safely just in front of the patient’s opened mouth. For most daily routines a half-mask covering ‘just’ mouth and nose should be sufficient, and where it’s not sufficient it’s always possible to wear additional goggles or a visor.
Such masks made of soft rubber like materials such as silicone usually have also just one filter for ‘incoming air’, but should have two for ‘incoming and used air’. There should be one additional feature which is: a microphone which can connect to either a small amplifier/speaker system on the person or to a cell phone / tablet. Without a microphone it’s very hard to hard to understand the muffled voice behind an airtight sealed mask and two connectors would be ideal: one conventional 3.5mm jack designed to plug-in a cable and one wireless Bluetooth capability to connect the mask via ‘pairing’ to other devices like phones, tablets, PA systems, etc. When shopping a single filter mask ‘conventional’ mask for e.g. for DYI use or to be used in professional construction work, the price of all individual components would be in the range of 70-100 Euros. A two filter system for inhaling and exhaling would look rather clumsy if those filters would be attached to the mask in front of the mouth. A better design would be a transparent mask with two 1 inch flexible tubes which would would connect the flat mask to the filter unit behind the skull or in the neck or back of the person. For persons which have breathing difficulties or persons who perform exhausting tasks with increased needs of oxygen intake it’s possible to attach a battery powered active ‘air pump’ to the filter unit.
All those components mentioned above are already on the market, just not as a ‘package’. There needs to be some modification in the production process and to develop such kind of new end product would not need too much time and the components are cheap to produce and of much more use for the end user and his/her protection. Those masks when made of the right materials and with the right design can have better acceptance with people who are now reluctant to wear a mask since it covers half of its users face and make him/her unrecognizable and they are often very warm and humid and unpleasant to wear. Especially annoying when used by persons who also have to use glasses and those masks made of fabric will reduce the vision of a user to ‘heavy fog’. Making them not only uncomfortable to wear, but also dangerous because of the reduced vision. Such a mask could also be used with a oxygen tank instead of the 'intake filter' on the back for use in heavily polluted environments or for patients with existing reduced blood oxygen levels like those who have COPD. Those masks can last much longer than the single use masks made of fabric and could be stored in households for any kind of future local or widespread dangers from 'house on fire' to dangerous chemicals released accidentally into the environment (once a set a suitable filters is also at hand) and could therefore play a role in protecting the general public from various hazards which now cost several lives every year. Why not provide the general public with a similar kind of protection level the members of the local fire department already have ?
Just a relatively short text this time pleading for ‘filtered air’ either by constant cleaning of a whole room or by providing individuals a ‘pandemic respirator’ device which combines safety with modern design and which doesn't look like those rather creepy looking Soviet era gas masks or like those white ‘coffee filters’(N95 or FFP masks) covering people’s mouths and noses. It’s irrelevant whether we call those ‘anti-airborne’ masks or ‘anti-aerosol’ masks, just call them ‘overcoming pandemic masks’ - the most important thing is that they protect individuals and society alike and are available in various sizes, so that also women and children can wear really airtight masks. (often observed footage of 'leaking' N95 masks during talk or work by e.g. female nurses). Clear, but airtight masks also enable 'lipreading' by people with e.g. hearing loss. People wearing conventional face masks often take them off (often for minutes) on public transport before drinking beverages, so the 'future mask' should have an airtight opening for a drinking straw, too. For immediate mass use only connector norms like RD 40, already available on the market, for attaching the filter units should be used ²
It's much easier to provide people with the right kind of protection than trying to control their behavior like keeping distance or not meeting more than X,Y persons for a long period of time. Socializing is human & (see: numbers published in technical solutions against SARS-CoV2) last, but not least there is the 'refusal factor' where a small minority of society simply refuses to cooperate and will thus keep emitting the virus, when infected. So the 'rest' has to wear highly protective masks. A 90% participation in containment measures by 'controlled behavior' isn't enough, especially when new,more transmissible ("UK" or "South Africa") variants have been detected in several countries.³
Such a mask is ideal for gatherings in rooms without proper ventilation in order to prevent this:Portugal's finance minister tests positive for coronavirus after meeting top EU officials [Straitstimes, Jan 16 2021]
related articles, research papers:
In case you are wondering about masks after hearing me on @BBCRadio4, they are not a magic bullet but benefits are very likely to outweigh any risks. Wearing a good quality mask well can make a difference. Evidence for some of the myths in here https://t.co/DuLwPlTBYj
— Prof Cath Noakes 😷 (@CathNoakes) January 1, 2021
Government delivers 250,000 clear face masks to support people with hearing loss [UK government, Sep 5 2020]
Where and how these risk groups in Germany can get free FFP2 masks [The Local Germany, Dec 17 2020]
Expiratory aerosol particle escape from surgical masks due to imperfect sealing
[Christopher Cappa, Sima Asadi, Santiago Barreda, Anthony Wexler, Nicole Bouvier, William Ristenpart, Researchsquare, Jan 12 2021]
On average, the N95 respirator blocked 99% of the total mass of test aerosol from being released into the environment, while the medical procedure mask blocked 59%, the cloth face mask blocked 51%, the single-layer gaiter blocked 47%, the double-layer gaiter blocked 60%, and the face shield blocked 2% of the total aerosol ....For example, a 100 µm aerosol particle takes 4 s to fall 1 m in still air, while a 10 µm aerosol particle takes 5.4 min and a 1 µm aerosol particle takes 8 h to settle the same distance (Hinds 1999)....The presence of small aerosol particles containing infectious SARS-CoV-2 detected in these studies suggests that in addition to large aerosols, these small aerosols might play a role in SARS-CoV-2 transmission (Anderson et al. 2020; Bahl et al. 2020; Ma et al. 2020; Morawska and Milton 2020).
Advocates for the use of reusable elastomeric respirators have pointed to anecdotal evidence from users across industries, including health care, that reusable elastomeric respirators provide a more fault-tolerant fit—that is, a secure face seal is more easily achieved and less prone to human error than when donning and using a disposable filtering facepiece respirator (Chang, 2018). While the fault tolerance of the reusable elastomeric respirator face seal has not been quantitatively tested in a real-world setting, Lawrence and colleagues captured data on SWPF for both reusable and disposable respirators prior to and after fit testing (see Table 2-2). Their data show that prior to fit testing, the 15 reusable elastomeric respirators, as a class, obtained significantly higher levels of protection than the 15 disposable filtering facepiece respirators...
source:Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use. [NCBI/NIH]
As always, @zeynep clearly summarizes practical info on masks. Material in N95s and surgical masks is good for many reuses; straps will go first. We tested filter cartridges from elastomeric respirators after months of use; they were still >90% efficient. https://t.co/TbEoTFpDK4
— Linsey Marr (@linseymarr) February 4, 2021
If we wanted to get serious vs B.1.1.7
— Eric Topol (@EricTopol) January 5, 2021
—get N95/K95 masks to all and enforce their use
—get rapid home testing big supply to each household for daily use
—amp up digital, mobility, genomic and wastewater surveillance 100X
—vaccinate 24/7 like it's an emergency. Because it is.
South Korea has mounted one of the best responses to Covid. Here's an example of the action the country takes to keep the virus out. https://t.co/FZz04gyb5R
— Dr. Tom Frieden (@DrTomFrieden) January 5, 2021
Study showing probable SARS-CoV-2 transmission on Dubai to New Zealand flight, despite index case(s) testing negative beforehand. Sequencing suggests case A (& maybe B) infected C-G, despite mask use by most (but unclear if masks were removed for meals).https://t.co/9VY6s3Dlmb pic.twitter.com/Aug9Bl3zIH
— Dr Zoë Hyde (@DrZoeHyde) January 6, 2021
The 7 passengers had begun their journeys from 5 different countries before a layover in Dubai; predeparture SARS-CoV-2 test results were negative for 5 (Figure 1). ... No passengers entered or exited the aircraft during the 2-hour refueling period in Kuala Lumpur.... The first 3 passengers to receive positive SARS-CoV-2 test results (passengers A, B, and C) were identified through routine surveillance testing on the third day of the quarantine period in New Zealand (Figure 2). Passengers A and B traveled together from Switzerland; both reported having had negative test results in their country of origin, <72 hours before boarding the flight ... Evidence of in-flight transmission on a flight from the United Arab Emirates to New Zealand is strongly supported by the epidemiologic data, in-flight seating plan, symptom onset dates, and genomic data for this group of travelers who tested positive for SARS-CoV-2 .... It must also be noted that the auxiliary power unit of the flight EK448 aircraft was reported as having been inoperative for ≈30 minutes during the 2-hour refueling stop in Kuala Lumpur, such that the environmental control system would not have been working during this period.
source: Genomic Evidence of In-Flight Transmission of SARS-CoV-2 Despite Predeparture Testing [CDC, released Jan 6 2020]
Why it's hard to change unhealthy behavior - and why you should keep trying
[Havard,Published: January, 2007]
³
For a while, the strategy in England appeared to have worked, with many areas that previously had high case incidence seeing rates drop sharply in November, including northwest England and Yorkshire, areas which had previously seen some of the highest incidence rates in the UK. However, it soon became apparent that the English lockdown had not had the same effect in every region. In Kent, a large county in the southeast, cases actually continued to increase during the lockdown, despite having the same restrictions as other regions.
source: New variant of SARS-CoV-2 in UK causes surge of COVID-19 [Jan 5 2020]
Dismantling myths on the airborne transmission of severe acute respiratory syndrome coronavirus (SARS-CoV-2) [The Journal of Hospital Infection, Jan 12 2020, J W Tang, W P Bahnfleth, P M Bluyssen, R Tellier, et al]
Here's a great article by @zeynep and @jeremyphoward about improving our masks. Last year, it was important to get as many people to wear masks as possible; something was better than nothing. Now, it's time to improve our masks because of B.1.1.7, etc.https://t.co/Fv8UjBCTuA
— Linsey Marr (@linseymarr) January 13, 2021
Bavaria orders compulsory FFP2 masks on public transport and in shops [The Local Germany, Jan 12 2021]
UK:
We can adjust by population to get crude excess death rates
— Nick Stripe (@NickStripe_ONS) January 6, 2021
2020 will also be the highest since 1940
Even with measures taken to limit COVID spread, 2020 will still top 1951, the year of a major flu epidemic
Without all our efforts, 2020 could have been much worse
9/11 pic.twitter.com/RrHghNcRBm
Hardware
(just to give a 'visual example' of already existing hardware, not necessarily to be used in future end product made of components like there)
source: CNBC/MIT
² = source: stofmasker_shop
source: Indiamart.com
Bluetooth Mono Headsets [Jabra, commercial] (just an example for the concept, based on readily available products, microphone integrated in mask with or without separate earpiece)
Razer has created a concept N95 mask with RGB and voice projection [The Verge, Jan 12 2021]
lockdowns & new virus variants
NEW: Saturday update of latest UK Covid data
— John Burn-Murdoch (@jburnmurdoch) January 2, 2021
The trend in test positivity since Christmas is genuinely scary, with lines climbing almost vertically in all English regions.
On Christmas eve 17% of tests in London came back positive. Four days later that was 24% and accelerating pic.twitter.com/N70QHlhxHM
Counterfeit masks
Lots of questions about KN95s. Their filtration efficiency is supposed to be similar to that of N95s, but (1) actual performance depends on fit (ensure no gaps), (2) fakes are a problem. I have seen test data for some that are <25% efficient. https://t.co/BZSmH4KPHn
— Linsey Marr (@linseymarr) January 7, 2021
logistics problems with disposable masks
Inside the Chaotic, Cutthroat Gray Market for N95 Masks [NYTimes, Nov 17 2020]
COVID MASK WARS [Hamish de Bretton-Gordon, The what and the why, Apr 18 2020]
environmental hazards re disposable masks
Verheddert. Erstickt. Vergiftet. Falsch entsorgte Corona-Masken haben verheerende Auswirkungen auf die Umwelt und die Tierwelt, warnen Naturschützer. https://t.co/0lkZyQXtfU
— Die Nachrichten (@DLFNachrichten) January 23, 2021
Coronavirus: Disposable masks 'causing enormous plastic waste' (BBC, Sep 13 2020)
The energy and environmental footprints of COVID-19 fighting measures – PPE, disinfection, supply chains [NCBI, Aug 27 2020, Jiří Jaromír Klemeš, Yee Van Fan,and Peng Jiang ]
¹ = just a few commonly 'incidents' during the last 10 months and in several countries, where high performing filtering masks would have made a difference: (talking to people behind windows/without inhaling aerosols/droplets isn't a problem)
mass infections & numerous deaths in some care homes
hospital staff getting Covid-19 and some of them died
medical/cleaning staff with insufficient/no masks infecting elderly persons in their home
bus drivers getting infected & some killed
children / teachers getting infected , virus spreads in schools/universities
virus spreads massively in some meat/vegetable production facilities
people demonstrating, without mask and without sufficient distance, against containment measures such as lockdowns & mandatory mask use
superspreader events during singing, praying, shouting during rehearsals, concerts, religious & political gatherings
Christmas gathering of care home staff (as usual)
Mass infections in prisons
please note: this document is based on the compilation 'technical solutions against SARS-CoV2' and a concept document sent to several European defense departments as well as to the European Commission March/April 2020. Latter document also making use of 'additional' knowledge of previous failed national projects pushed by various politicians. A kind of 'doomsday solution' anticipating that many politicians just can't solve very complex problems based on their limited knowledge of data, time for thorough analysis and also often the motivation to pursue the easiest path. A solution also based on the principle of 'distributed (non!) responsibility'...
Updated: Jan 22 2021
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