Triathlon and Team Oaxaca Coronavirus Guidelines

We started learning since the beginning of the pandemic about the virus, to face the situation.  We have learned the following:

1)   The virus is transmitted via aerosol in addition to saliva drops.  Why?  We have the story about the chorus rehearsing and apparently keeping the distance between two people.  They said: “No one sneezed or coughed.”  One-day rehearsal, 60 people practicing, 45 sick, two deaths. https://edition.cnn.com/2020/04/01/us/washington-choir-practice-coronavirus-deaths/index.html  This is more anecdotal, if you wish, but we have other sources of information.

We have the studies mentioned in the New England Journal of Medicine:

https://www.jwatch.org/

Surgical Masks Provide Source Control of Respiratory Viruses

Richard T. Ellison III, MD reviewing Leung NHL et al. Nat Med 2020 Apr 2 Bae S et al. Ann Intern Med 2020 Apr 6

Surgical face masks were found to reduce presence of influenza and coronavirus RNA in respiratory droplets and aerosols from infected individuals.

The CDC has just recommended that the general U.S. population begin wearing cloth face coverings to decrease the community-based transmission of the SARS-CoV-2 virus. Two new studies provide some support for the CDC guidelines.

In the first, researchers at a Hong Kong hospital obtained nasal and throat swabs and respiratory droplet and aerosol samples from 246 individuals with presumed symptomatic acute respiratory viral infection seen year-round between March 2013 and May 2016. During a 30-minute collection of exhaled breaths when patients were breathing and coughing normally, 124 individuals were wearing a face mask and 122 were not; 49 provided second 30-minute samples of the alternate type.

By reverse transcriptase polymerase chain reaction (RT-PCR) there were 54 individuals with rhinovirus infection, 43 with influenza infection, and 17 with human seasonal coronavirus infection. For all three viruses, the viral load was higher in nasal than in oral secretions, and all three viruses were detectable in both respiratory droplet (particles >5 μm) and aerosol (particles <5 μm) fractions of the exhaled breath. Masks led to a notable reduction in the number of RT-PCR–positive respiratory droplet and aerosol samples for patients with either coronavirus (in respiratory droplets, from 30% to 0%; aerosols, 40% to 0%) or influenza infection (respiratory droplets, 26% to 4%; aerosols, 35% to 22%); there was no meaningful reduction seen with rhinovirus infections. Influenza virus was able to be grown from 4 of 5 studied RT-PCR–positive aerosol samples from individuals not wearing masks.

The second study, by Bae and colleagues, recruited 4 patients with SARS-CoV-2 infection to cough five times onto petri dishes containing viral transport media approximately 20 cm from their face while wearing either no mask, a surgical face mask, or a two-ply cotton mask. The median nasopharyngeal viral load was 5.66 log copies/mL, and the cough samples found viral loads of 1.4 to 3.5 logs/mL whether or not a mask was present for three of the four patients. Swabs of the outer surfaces of both types of masks were positive for all four patients.

COMMENT

The work by Leung raises the theoretical concern of viral transmission through aerosols as well as respiratory droplets although, as the authors note, there was no attempt to grow either coronavirus or rhinovirus from the RT-PCR respiratory samples to confirm the presence of viable virus. Still, this novel study provides strong evidence that the use of surgical masks can provide source control for both human coronavirus and influenza virus infections when individuals are sitting for 30 minutes. In contrast, the very small study by Bae shows that neither surgical nor cotton face masks will prevent the spread of virus from a coughing individual — at least at a distance of only 20 cm. While both studies have clear limitations, together they suggest that the use of a surgical face mask can provide some source control in individuals infected with coronavirus or influenza, although the efficacy is likely diminished in coughing individuals (and we can't extrapolate the findings to other types of masks). Still, in my mind these limited data do support the broad use of face masks until this pandemic is brought under control.

2)   The German expert who instituted the program in Germany challenged the notion that the virus is primarily acquired touching infected material.  The assumption was that the coronavirus is transmitted via air and not so much by contact.

Researchers have so far come to different conclusions on how long the virus can survive on surfaces. But now a team of scientists in Germany are trying to find answers.

"So far, no transmission of the virus in supermarkets, restaurants or hairdressers has been proven," explained Bonn virologist Hendrik Streeck on the ZDF Markus Lanz talk show.

Instead, the major outbreaks have been the result of close get-togethers over a longer period of time, he said.

That's demonstrated in, for example, outbreaks that have stemmed from après-ski parties in Ischgl, at football matches in Bergamo or at carnival celebrations in the municipality of Gangelt in the Heinsberg district of North Rhine-Westphalia.

https://www.thelocal.de/20200402/how-german-scientists-hope-to-find-answers-on-coronavirus-in-countrys-worst-hit-spot

3)   The lakes, ocean are not infected to the degree of being a source of infection.  The problem is that we still get aerosol from infected people because those places are crowded most of the time.  The infection is not in the water.

https://www.unwater.org/coronavirus-global-health-emergency/

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases. According to WHO, while persistence in drinking-water is possible, there is no current evidence that coronaviruses are present in surface or groundwater sources or transmitted through contaminated drinking-water.

The spread of the virus is closely related to water and sanitation.Cleaning hands can reduce the transmission and help people stay healthy but today billions of people lack safe water, sanitation and handwashing and funding is inadequate.

Based on the above:

1)   Keep your distance, two meters from other human being.

2)   Wear a face mask according to what you do.  Driving a car with other triathletes, wear a N95 mask; use a surgical mask when riding or running with other mates, keeping most of the time the two meters of separation.

3)   Swim in an empty swimming pool, one member per lane or in a lake (keeping distance).

4)   Wash your hand as frequently as you can or use gel (alcohol above 60%).

5)   Avoid public places or wear your N95 if you need to be in a close room, even if you keep the two meters distance (remember the chorus rehearsal).

6)   Train with responsible people that is concerned about his/her health and the health of others.  This is the moment to define your friends.

7)   This should be in place until we obtain the vaccine or we get 70% infected people.  I hope the vaccine comes first.

Addendum:
Regarding your eyes.  Wear your glasses like Fauci, but the eyes are not a problem unless you are in very close contact with people:
https://www.researchgate.net/publication/340011892_Role_of_the_Eye_in_Transmitting_Human_Coronavirus_What_We_Know_and_What_We_Do_Not_Know

Triathlon and Coronavirus III

Eric Topol speaks of betrayal to the medical establishment on the part of the government but I would say that they betrayal the whole country.  The same phenomenon is happening in Mexico.  The bozos directing the frontline of the pandemic (who are not on the frontline) are lying; the same for the ones directing at the WHO:

The year 2020 started with American physicians, nurses, and the whole healthcare workforce dispirited, in a deep state of burnout, with the worst rates of clinical depression and suicides that have been recorded. Indeed, this was not confined to the United States; a global epidemic of burnout had been diagnosed. But things were about to get considerably worse for the healthcare workforce.

In December 2019 an epidemic of pneumonia, with many fatalities, erupted in Wuhan, China. The pathogen was sequenced and determined to be a novel coronavirus on January 5, 2020, and was subsequently named SARS-CoV-2. The first patient in the United States with COVID-19, the disease caused by SARS-CoV-2, was diagnosed in Seattle on January 21, which was within 24 hours of the first patient diagnosed in South Korea, a key country for comparison.

The First Phase: "Silent" US Spread

Unlike South Korea, which quickly started testing for COVID-19 using the World Health Organization (WHO) test, the United States refused the WHO test, opting to develop its own through the Centers for Disease Control and Prevention (CDC). But the CDC test was ultimately found to be flawed and represents one of many government stumbles. Without an adequate test, there were nearly 50 days from the first patients in both countries before the United States started to ramp up testing. Why was this so critically important?

During this extended phase in the United States, there were countless numbers of patients presenting with pneumonia and respiratory tract symptoms to emergency rooms, urgent care centers, and doctors' offices. Without the ability to make the diagnosis of COVID-19 or even suspect it, these patients unwittingly spread their infections to healthcare workers. Also, during this first phase of spread, there was likely — albeit still not yet validated — a high rate (approximately 30%) of asymptomatic carriers for COVID-19, which further amplified the chances for doctors and health professionals to be infected.

For the sake of comparison, during the month of February, South Korea performed more than 75,000 tests (versus just 352 in the United States) and adopted all of the WHO best practices, which includes massive testing, tracing every contact of a person infected and testing that person, quarantine of all known cases, and social distancing.

The United States did none of these. Instead, officials repeatedly made bad choices that put public health in jeopardy, along with the healthcare workers charged with caring for the public.

South Korea, meanwhile, got ahead of its outbreak and became a model in the world for how that was achieved. But it wasn't just South Korea that reacted well. As Atul Gawande summarized, Singapore and Hong Kong also adopted all of the WHO practices, including providing protection for their healthcare workers. In both places, healthcare professionals were expected to wear surgical masks for all patient interactions. That practice turns out to foreshadow the second phase of failure in the United States.

The Second Phase: The War Without Ammo

Although Seattle is where the first cluster of cases occurred, it was the unchecked number of patients diagnosed in New York City in early March that led to the full realization of how ill-equipped the country is in terms of personal protective equipment (PPE), intensive care unit beds, and mechanical ventilators.

The dire, inexplicable lack of masks is well recapitulated by Farhad Manjoo in "How the World's Richest Country Ran Out of a 75-Cent Face Mask", and Megan Ranney, MD, MPH, and colleagues similarly describe the profound deficits in PPE and ventilators in a perspective published in the New England Journal of Medicine.

Together, a situation was set up for healthcare workers to not have masks — or to reuse them for days on end — and lack other protective gear. And this is about plain 75 cent masks, not the N95s that are better for blocking aerosol droplets.

But the required sharing of equipment is not just among doctors and nurses; it even extends to patients sharing a ventilator in some intensive care units. To put some numbers on ventilators, we will need several hundred thousand to a million but have fewer than 160,000 throughout the country.

It's bad enough that the United States was totally unprepared for a pandemic and has such an unimaginable shortage of requisite resources. But the situation still gets worse. On a widespread basis, doctors and nurses are being gagged and muzzled by administrators for expressing their concerns, and penalized or even fired when they do speak out.

Meanwhile, the unconscionable lack of COVID-19 testing has continued in this second phase. And with that, systematic testing of the workforce has yet to start, despite being desperately needed.

The Third Phase: Healthcare Professionals Broadly Infected and Dying

Back in Wuhan, Li Wenliang, a 33-year-old ophthalmologist, was one, if not the first, doctor to alert people in China of the outbreak. He died on February 7, 2020. But he certainly wasn't the youngest doctor to die in China. Xia Sisi, a 29-year-old gastroenterologist, also died after a 35-day hospitalization.

Yet on March 11, from the Oval Office, President Trump stated, "Young and healthy people can expect to recover fully and quickly."

By late March more than 54 doctors in Italy had already died, and in the Lombardy region of northern Italy, one of the worst hit regions in the world, 20% of the healthcare workforce have become confirmed cases. Now, in the United States, as large numbers of healthcare professionals are getting diagnosed with COVID-19 in Boston, New York, and other hotspot cities, young doctors are writing their wills and making provisional funeral plans.

COVID-19 was not supposed to kill young people, but young nurses and doctors are dying in the United States. There are many theories as to why this is happening, perhaps the best one is the viral load — the mass of COVID-19 inoculum.

Because healthcare workers are exposed to the sickest patients — often without access to the proper protective equipment — the heavy viral load may be overwhelming even young clinicians' ability to mount a sufficient immune response to counter the infection.

That doctors and clinicians are succumbing to the virus is beyond a tragedy, as many of these dedicated individuals are dying unnecessarily, as a result of the no-testing and no-PPE fiascos.

Yet a far greater toll in numbers is the temporary loss of clinicians to infections and sickness. This is the other poorly recognized exponential growth curve: As each doctor, nurse, respiratory therapist, paramedic, and patient-care person takes care of tens to hundreds of patients at any given time, the loss of even one of these individuals has a dramatic ripple effect on the shortage of professionals trained to care for affected patients, no less the non-COVID-19 usual patient mix. No number of accelerated medical school graduations (which are being announced) can compensate for these losses, not just by numbers but also by experience.

The handling of the COVID-19 pandemic in the United States will go down as the worst public health disaster in the history of the country. The loss of lives will make 9/11 and so many other catastrophes appear much smaller in their scale of devastation. Perhaps what we in the medical community will remember most is how our country betrayed us at the moment when our efforts were needed most.

https://www.medscape.com/viewarticle/927811

One of my patients told me that at the hospital she works eight people died, and they went without being reported because they were not tested.  The diagnosis was pneumonia.  The number of deaths in my State (Oaxaca) is just one digit because they stopped testing.  The bozo that directs the policies regarding the pandemic says that face masks are not necessary because the WHO said so, and we do not have a valid research to say that face masks protect us.  We can see the professional liars when it comes to see our present reality.

https://www.yahoo.com/news/noble-lie-masks-coronavirus-never-104001181.html

As would more of I will bluntly call adult behavior. We must put an end to the idea that the best way to get through this crisis is to say things we know are not true in the hope of getting people to behave a certain way. This means not saying masks are useless when what you really mean is, "Masks are in short supply, please consider before you start hoarding them whether you really need them at present and if so how many." Ditto the painfully relentless attempts to give young people the impression that they are horribly likely to die from the new virus. Even in Italy, the country with the worst measured fatality rate so far, around 86 percent of all the deceased have been aged 70 or older, and 50 percent were at least 80. We do not need to zero in on statistical anomalies or otherwise engage in scaremongering. It should be enough to say, "Even though you are very unlikely to die from coronavirus, remember that you could contract the disease and spread it to more vulnerable people without even experiencing symptoms, so please don't revel with 5000 strangers at the beach and then run home to give Grandma a hug."

We depend on the viral load and our immune system to survive this virus.  We know what we should do as triathletes, rest, eat well and follow a training plan according to our ability to tolerate it (time training); our immune system will respond accordingly.  The “but” would be the viral load.  What can we do to decrease the viral load?  Distance yourself and wear a face mask; the one that is denied by the criminal authorities.  If for some reason you got infected, because you did not wash your hand sufficiently and on time, the viral load must be low and your chances of dying lower.  Wearing a mask prevent you from infecting others.