Information For Nurses: COVID may be transmitted by Close Range Aerosol

This article is aimed primarily at nurses, health care workers, and policy managers everywhere.

My husband is a nurse and, as a veterinarian, I have some training in epidemiology and virology.  I have been following the situation since mid-February.

There is a lot of information out there and discerning good sources can be difficult.  I have been frustrated with the information found at the CDC and WHO.  I felt like droplet and fomite spread might not be the only modes of transmission for this virus, i.e. that just washing our hands well might not be enough.  Turns out the science is beginning to support that.

Recently I found a site I like much better for up to date news on the COVID outbreak: the Center for Infectious Disease Research and Policy’s ‘News and Perspective’ site.  I highly recommend this site. It gives unbiased, non-partisan information for the US and the World.  I now am limiting my COVID new consumption to this site and the John’s Hopkins reals time COVID map (links at bottom).

It promotes basing our responses on science (of course, I would like that!)

Here are some excerpts from articles at this excellent site.  Again – this is for nurses, healthcare workers, managers, and policymakers. Basically, it explains why we should be covering our healthcare personnel for aerosolized virus spread.  If you want more then my hand-selected excerpts, please go read the whole article.

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An often ignored, yet important mode of transmission for infectious respiratory diseases—close-range aerosol transmission—needs to be part of the equation….

The CDC admits some possibility that COVID-19 may be transferred by hands to mouth, nose, or eyes from contaminated surfaces, but notes that “this is not thought to be the main way the virus spreads.”11

the WHO states, “COVID-19 appears to spread most easily through close contact with an infected person. When someone who has COVID-19 coughs or sneezes, small droplets are released and, if you are too close, you can breathe in the virus

Underlying the CDC and WHO statements about transmission is this: Inhalation of particles near the source may be an important mode of transmission.

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The precautionary principle suggests we should approach this organism as we would any novel highly transmissible respiratory disease—as a contact, droplet and airborne disease, but with one important caveat: Short-range aerosol transmission is also a strong possibility….. the precautionary approach suggests that we focus on preventing short-range aerosol transmission in both public and healthcare settings.

For aerosol-generating procedures, the CDC should be recommending respirators with higher levels of protection than an N95 filtering facepiece respirator (eg, a powered air-purifying respirator), but at this point, it does not. In the face of supply shortages, the CDC last week changed its recommendations to allow the use of medical masks instead of respirators, saving the latter for aerosol-generating procedures.1 Healthcare organizations must return to using respirators for confirmed and suspected COVID-19 patients when supply chain problems are resolved. Requirements for airborne infection isolation rooms remain in place.

Organizations are encouraged to designate entire units for COVID-19 patient care and develop re-use procedures for personal protective equipment.

…. Healthcare organizations and public health agencies should consider the utility of reusable respirators, such as elastomeric respirators more commonly found in industrial settings. Such respirators may be in limited supply, but they offer some advantages, in that healthcare employees can be given an individual respirator for which they are responsible.

Healthcare organizations should also be considering source controls, such as cohorting suspected and confirmed patients, limiting the number of healthcare workers involved in care, using telemedicine, designating separate locations for triage and care, and deploying remote technologies, where possible.

Contrary to popular belief, the larger particles (5 to 15 micrometers [µm]) will not immediately drop to the ground but will remain airborne for several minutes. Smaller particles (less than 5 µm) will remain in the air for many minutes or even hours.

All particles will immediately begin to evaporate (mucus contains a lot of water), which means the range of particle sizes will decrease overall. Smaller particles are more affected by diffusion than gravity, thus making them more likely to remain airborne. In the absence of air currents, airborne particles will disperse slowly throughout a space (see the figures below).

China deployed a tiered hospital model very similar to that used for Ebola patients in the United States.21 Patients with critical or severe symptoms were moved into designated wards or hospitals while those with mild symptoms were cohorted in temporary hospitals in repurposed buildings. Healthcare workers wore full protection, including a gown, head-covering, N95 filtering facepiece respirators, eye protection, and gloves.22

…Different genotypes found in a paired throat swab and sputum sample from one patient suggest that replication may occur in the throat independently from the lung.

…The authors conclude that SARS-CoV-2 may be more efficient at transmitting than SARS-CoV through active shedding from the upper respiratory tract as symptoms are developing. Later on, COVID-19 is more like SARS, with replication in the lower respiratory tract. They conclude: “Our initial results suggest that measures to contain viral spread should aim at droplet-, rather than fomite-based transmission.”  (ref Woelfel et al, 2020).

… The effectiveness of hand hygiene in community settings is minimal.38

….In a temporary Wuhan hospital fashioned from an indoor sports stadium for cohorting and treating patients with mild symptoms, high RNA concentrations were found in rooms used for removal of protective clothing (18 to 42 copies/m3), with the highest concentrations found in 0.25- to 0.5-µm particles, thought to result from particle release from contaminated clothing.

High RNA concentrations (19 copies/m3) were measured in patient toilets in both hospitals. Toilet flushing is well-known as a source of aerosols.25

….A very recent study found that SARS-CoV-2 aerosols remain viable for up to 3 hours,32, which is similar to the viability of SARS-CoV in air33 and MERS-CoV.34,35 This is adequate time for exposure, inhalation, and infection to occur both near and far from a source.

… More than half of those contracting SARS during the 2003 pandemic were healthcare workers. As of early February 2020, more than 3,000 healthcare workers were believed to have contracted COVID-19 in China, and at least 6 died.37

Excerpted by Dr. Tama Cathers

LINKS:

CIDRP

http://www.cidrap.umn.edu/news-perspective/2020/03/commentary-covid-19-transmission-messages-should-hinge-science

JOHN HOPKINS MAP

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

Photo Credit:

Photo by JESHOOTS.COM on Unsplash

 

I am beautiful because…

My partner and I have been playing with some aspects of Power and Privilege.  We decided to play with the experience of being in control.  We agreed to both have a weekend where one of us got to ‘be in control,’  to order the other around, and have them do tasks we wished to have done.  We have found it very rich.  I wrote a previous blog about how my experience of being in control informed me of my current experience of place in the world, and with alternatives to the powerlessness I experience in general society, as a woman.  The weekend I am discussing now, he was to be the person in control.  I was to do the tasks he requested: work out, write, eat breakfast, make coffee.  The most challenging one was…. here it comes….. yes, it’s true, I actually volunteered to do things for him… Wait for it….. the most challenging task was to Shave his Face.

 

Yes – my hardest task was to shave his face.  I did it too lightly.  I did it too deeply. There are all these icky curves I usually love about his face, but I was afraid of cutting him.  To be honest, it made a sound that felt like rubbing shark skin.  I was just no good at it.  To be honest, it made me want to vomit. It completely stressed me out. I had no idea it would be that difficult or emotional!  At some point, I decided I did not care what the ‘consequences’ were – I was going to give up.

 

It was a beautiful moment.  Tears filled my eyes and I realized how many things I have given up – because I was not good at them  – the first couple times I ever did them.  I told him so, at the same time I told him I quit, a I wasn’t going to shave his face – consequences be damned!

 

He listened and then gave me my next task; a consequence to my experience.  He told me to write down 5 things I had quit …. and 15 ways I was beautiful.

 

This was also a awful and profound experience.  I sat down and wrote down 111 things I had quit, using up most of my allotted time.  Then I struggled to pull out ‘ways I am beautiful.’  I could only come up with 8. I did not accomplish my task!   My punishment was to ……this is exciting, don’t hold your breath….To correct my list; 5 things I’d quit and 15 ways I was beautiful, then standing like an orator, stand on top of the fireplace hearth and read them out loud.  I think I might have cried.  Shit!  I’d better straighten up and get this right!

 

I corrected my list, the 15 ways I was beautiful. It took a long long time, so I hurriedly wrote down the first 5 things I’d quit. I might have cried.  My consequence for that transgression, for not speaking with pride about how beautiful I really am, was….. to say out loud, into the mirror, the 15 ways I was beautiful.

 

This felt really stupid!! But I was excited! I would NEVER do this on my own.  Oh the hippie-dippie-ness of it all.  Sure, respected authors and self-help people said to do it… but no way.

 

I leaned over the sink and looked myself in the eye and told myself why I was beautiful.  A few lines in, I realized the reflection of my eye was….not my own.  I have dark brown eyes and, get this, round pupils!  It was amazing, one of the eyes staring back at me was clearly blue, and the pupil was ….odd.  I looked some more – and the eye smiled back at me.  The iris was deeper than my iris, ancient blue with flecks of green color, and brown that was not my own color.  It had a square pupil.  Was that possible?  That eye looked – tired, and wise.  It looked like an Ancient Mother’s eye.  She was looking at me out of one of my own eyes.  And smiling. I cried some more: Tears not of sorrow. Tears of surprise and welcoming after a long time not seeing this friend.

 

I go to the mirror now daily to say my list.  My lists keeps growing now.  I don’t cry.

Really, I go to the mirror just to see the other woman.

To feel her welcoming acceptance.

To hear her say,

“And I made you that way.”

“You are just the way you should be.”

 

Today’s List:

I am beautiful because I am curious.

I am beautiful because I am adventurous.

I am beautiful because I am intelligent.

I am beautiful because I am introspective.

I am beautiful because I like to smile and laugh.

I am beautiful because I sing!

I am beautiful because I dance spontaneously.

I am beautiful because I am a good mother.

I am beautiful because I protect those I love…. (the older woman added this,)  …. including myself.

I am beautiful because I ask hard questions.

I am beautiful because I help others grow.

I am beautiful because I love animals, plants and the earth.

I am beautiful because I enjoy the  senses.

I am beautiful because I am eager to participate.

I am beautiful because I am working and growing.

I am beautiful because I try to do no harm.

Quilts and Handshakes

My usually wonderful, sensitive, trying to unpack his privilege partner, who is a male, said one of the rudest things he’s ever unwittingly said to me. I had been talking about having a women’s group meeting. He said “You all can get out your mirrors and look at your vagina’s…or what ever it is you women do at your women’s meetings.” I looked at him aghast. I just stared at him with my mouth open.

First – he goes to a bi-monthly men’s’ meeting. Never have I thought to ask him if he and his friends measure each other’s penises, or get out mirrors and look at their assholes! Assholes. Secondly, I have told him – at least 3 to 4 times that that is not what we do, that I have never done that at a women’s meeting.

He said “Well! I really don’t know what you do, you know, umm…”

I looked him in the eye and said ”That is one of the most demeaning things you have ever said to me!”

“I’m sorry….”

“Oh yeah? Well the only way you can make it up to me is to buy that vulva/yoni quilt we saw on Pinterest! No – I mean it. You buy it and we are going to put in on our bed for months!”

WTF!?!

(I guess I am still pissed., eh?)

 

Days later, I was at work. In a spare moment, I looked at the news headlines: Trump refuses to shake hands with Chancellor Merkel. I read the article written by Jessica Valenti in the Guardian.   This behavior was not surprising to her, or many other women. She wrote about an experience of her husband and she, meeting a shared male aquaintance, .

“…..he wouldn’t even look at me when I asked a direct question.”

So familiar!!!!   Other parts of her article were more to the point. These sentences about Trump behavior, about men’s behavor, changed my life in a day.

“While it would be tempting to write off the exchange as simple rudeness, this brand of slight is familiar to most women.”

“The assumption, of course, is that the women in the room simply aren’t important enough to warrant attention or conversation. It’s a phenomenon I’ve noticed increases as women get older, and ever more invisible.”

I read the article on a busy day at work, and did not have time to process it. When I came home and shared my day with my mate, however, the impact came out. We started talking about how this is my experience; across the board. In fact it is so common, that we don’t even mention it. It is ‘just part of everyday life.’ Women go somewhere…. anywhere, everywhere…. and women are ignored by men, treated as if they are there or aren’t relevant. What a shock to see it written out loud. A relief, really.

I realized, it is one of the ways that women are continuously shown by society, that we are still owned, that we are basically chattel, and below notice from those who count – the men! We are all, on some level, still ‘just pusses’ to men. It is not even the ‘bad guys.’ Good guys, even my loving caring partner, even sometimes women put women ‘in their place.’ These actions are meant to tell us who and what we are. The informa women that we are things. As things we are owned, and as such can ‘rightly’ be controlled. No one should ever say what he said to me. It reduces me to a thing – a pussy specifically.

In a way, it is not directly his fault. If he could have seen it, he wouldn’t have said the things he did. But he is a product of our shared culture, as am I. Such a statement could almost slip past unnoticed, by both of us. Thank goodness for ole’ orange Donald, pointing these injustices out to us once again. No one should ever ignore another person due to gender, color or socioeconomic status, religion or sexual orientation.

In some basic ways, our society actively promotes the invisibility of women, minorities, people of color, and children…basically any group that is not male and/or white. It promotes even caring members of society, men, and sometimes even women, putting us in our place. They do it without even knowing they are doing it. They are unwitting drones for the status quo.

It was very helpful to me to see these two things, highlighted as they were, and side by side. How much of my self-esteem issues, or childhood trauma is just culturally induced prejudice and systematic repression. Quite a lot, I would say. One of my largest internal issues is dealing with ‘some childhood incident’ that lead me to believe I was not important, significant, or worth listening to. I have searched for this event for years. Now I am realizing why my search for this one childhood event has been fruitless. It is not that my father did not do this to me, he did. However, more importantly, he was not the only one; there was no one perpetrator. There was no single event. It was an endless onslaught of culture saying, “We don’t see you. We don’t hear you – you have nothing worth listening too. You are not of any interest.”

So – okay Dad. You are off the hook. But you and all you other men- you are still on the hook! Now that you men can see the hook – I will be expecting different behavior from you. Starting right now!

And I want my yoni quilt! The one with the psychedelic colors and the large lips and the round enfolded clitoris. If you are sleeping in my bed, you are sleeping under the auspices of all the yoni, vulva’s, vaginas, and pussies that brought you into to this world and fostered you and your growth. Bring on the pussy quilts!

 

See Art by MarDee Hansen – Yoni Quilts

Power and Privilege, Hugs and Sex

My partner and I explore ways of being together. We are still working out how power moves in our living together, and being together. It has been revealing, helping me to understand privilege, racism, and sexuality. If you are squeamish about sex, you should probably move on, because I am going to try to tie together some concepts from vastly different spaces. Those include politics, sexism, the body ….and sex, as this is one of the ways I express and explore the world and my reality.

I think it all started with me complaining that I always ‘had to’ conform my body to his when we hugged. He is sensitive and pro-active….He started conforming his body to mine. Wow! That was amazing! It was so……different. It felt…..different! It felt odd, because I was so used to our bodies coming together differently.

He started bending his knees to kiss me, so that I wasn’t cranking my head up and he wasn’t looking down on me. I didn’t have to hold the back of my own neck to support my head when we kissed! WaLa! No neck pain. I liked this – this lack of discomfort and started to pay attention.

As I did so, I started to notice things: When we sit on the bed to talk, he leans back against the head board, looking out. I sit cross-legged facing him, or crane my neck around to see him, or lay propped up on a pillow for long conversations. One day, I suddenly noticed: I was going through all sorts of uncomfortable contortions to fit his position…..AND I ALWAYS HAD.

My WHOLE life. I always had done this, not even noticing.

Then one day, I took my life frustrations out on him, in a fun sexual way; I played at telling him what to do, and focused on being there only for my pleasure. Selfish and Lovely. That was fine and silly, but what happened afterwards was the most important.

Afterwards, when we both laid back on the bed, he opened his arms to invite me in. I frown at him and said “Nooo!” Then I said, “You come lay in MY arms.” Everything changed. He put his head on my shoulder, and I put my arms around him….but this time, he had to conform to MY body. As I held him, I felt a sense of power, calm, control, protectiveness. It was as if by changing our positions, my view of life had changed. I’ve tried changing back and forth a few times since then, and it is consistent. There is power in the ‘how’ of how you hold someone. Every time, he conforms his world to mine, it FEELS different. Vastly – Powerfully – Different.

So, without any details, I played the person in charge again. No, that is not true. I WAS the person in charge. That being said, it was expected that I should order the world so that it suited ME. It was meet and right that I do so. It was just ‘how it is.” You get the picture here, right.

It was viscerally different experience. To really have the power to have everything the way you prefer it, just BECAUSE you prefer it that way – that is different. I realize that now, in a way I never had before. That is why I call it visceral; there is a body sense that changes when you don’t have to conform.

I have thought about being powerful. I have worked on being powerful. I’ve trained, and read, and discussed. But I feel like I make little to no headway in actually being more powerful. THESE experiences of power are the times I can clearly recall an experience what it is like to BE powerful, if only on a teeny scale: YOU mold yourself to my body. You mold yourself to My desires. You mold yourself to MY life. That is vastly different. it opens my eyes. It is changing me and how I feel I can show up in the world. It is allowing me to BE more powerful.

The other day, we were eating at a restaurant. Our waitress was a lovely young woman, working on a holiday, dealing with grumpy people – like me. She was chatting with us about grumpy people. We were laughing and having a good time. A bus boy, man in his late 20’s to early 30’s, came out pushing his cart to clean the table behind us. I knew he was going to do it when he was 30 feet and two turns away from her! As he passed, he bumped into her with his cart on the way to a table. She apologized. When he was done cleaning the table, he came back the same rout, though another was available to him. She moved out of the way – WITHOUT EVEN THINKING. Not only that, but as I went to look for the restroom, I noticed the men’s door had a large “M” on it. The women’s door? I had an upside down “M,” which was clearly, let me say it again, clearly not a “W.” I found it surprisingly offensive. What – we can’t even have our own letter?!

THAT is privilege. I am privileged, I know. I am white. However, I am not a male. I realize that I routinely conform my body, my life and my world to the masculine. These experiences have given me a way to intimately understand the experience of privilege……and lack of privilege. I am working on understanding and changing.

The bus-boy incident reminded me of an article, I am not sure I even posted, about what happens when we DON’T move from the bullies path. Well that is the experience of Women. When you don’t move out of the path of the male – you are corrected. We don’t get our own letter, only a lesser subset of the male world. Unless you meet a male who is willing to give you equality. To take the longer path. To bend down, so you don’t hurt your neck. To make a W for our doors, because they know we deserve our own letter.

This is what we have to do. First, we have to be able to see. To even know to see! I thank all those who have spoken up and brought these subjects to light. Second, we have to seek to partner with forces that are willing to change, to BE different, to make a new world. If we do that, it will change our world. Even if we start by making these changes on a small level. Even if it starts in the bedroom or in a hug.

So go out and kiss your partner, sit on the bed to talk, hug, but take a different power stance from your normal one. Explain what you are doing. Let the other person experience what it is to be Powerful. Or to be Conforming. Try it on for size. It may change you world.

 Note: In the photo, note the more natural position of the male vs the woman’s position.  If you took one person or the other away, who would look comfortable or stable?

When the Locker Room Comes Home

I am grateful for Donald Trump; for bringing the darkness into the light. We are seeing the wider society is now engaged in conversation about what is appropriate, what is harassment, and what is assault. These are all good things that come from his run for the White House.

I wonder, though, how do these things show up at home? In your home? In my home? How do we engage our sensitive (uninterested) teens in conversation? In the moment – as the moments arise?

It is really a hard thin line to walk. What was okay in 2001, is not okay now. I support that. But – How do we address that with our kids. With our partner’s kids. With our neighbor’s kids? Perhaps while we are at someone else’s house – as their guest, etc.

This was brought home to me last night, when we sat down to watch a movie with my male partner, and his teenage son. The son will often forgo watching movies, so when my partner suggested Zoolander, and son okayed it, I thought I was happy. I remembered it being dumb and zany. Really, all I remembered was the gasoline dance scene!

Turns out, I forgot how much of Zoolander is not only inappropriate – and funny in part due to some of the inappropriateness, but also offensive. I know – that was the main point of the movie. But even for a movie about superficiality and sexism…. it’s really sexist.

I squirmed on my seat at the focus on looks. Not the ‘male model” part, which is how the movie points out the ridiculousness of this, but how the female characters still were DEFINED by how they looked, not who they were, or what they did. SUCH focus! God forbid, you had been fat – ever.

The blatant sexual harassment and assault was much harder to take. It was just not right, and I wanted to stop and talk about this. Instead, I started pointing these out, however. Maury is the old geezer that does all the things boys know they shouldn’t do any more – grabbing women’s bodies as they walk by, etc. Okay, maybe I’m supposed to let that slip as a “character exaggeration,” i.e. an reminder of what not to do.

But there are so many other things in this movie. There is a scene where the ‘Nasty Woman’ gets smacked in the mouth, during a fist fight, drawing blood. She licks the blood, tasting it, her eyes widen, and she give a distinct sexual look to the antagonist, while softening and stretching like a cat. While there are fetishes that could possibly incorporate these behaviors, they are all arranged with prior mutual consent. This gives the message, with clear sexual innuendo, “Hey! Smacking a woman may turn out well for you!”

It went from bad to worse. There is a clear date rape drug scene, that I can’t believe I had not seen it before. Now I have argued over this with my sensitive, male, partner. However, when you take a woman who hasn’t had sex in “a couple years”, give her a
“special tea,” complete with white witches steam rolling off the top of it and in minutes go to “Let’s get naked and having an orgy,” that is NOT CONSENT! The tea is a clear metaphor for alcohol and drugs, specifically the date rape drug = it makes women complient, and they do what ever their antagonists asks them to do.

For Godsakes, The Girl here doesn’t want sex with these idiots! She Knows their idiots! Believe me, she likely has moral, emotional, or and psychological reasons for her long abstinence. But – they give her some “special tea” and suddenly she “wedged between a Maori tribesman, and the two Finnish midgets.” While a simple reference to a orgy is perhaps good-inappropriate-humor, using drugs to bring the woman in to acceptance, all while viewing it as ‘doing her a favor,’ is not acceptable. How many times do we have to say this?!?!

I was shocked – by the movie and my reaction to it. How had this been acceptable 15 years ago? And now, when were we going to talk about it? And how?

The question that arises, is how is this discussed with the silent teen sitting by our side? Will his Dad bring it up in a discrete conversation? If not, was I not complicit in our own, home grown “locker room.” If we don’t start having conversations as things arise, our silence – my silence – makes us complicit, in part, in the indoctrination of the next generation. Watching these offenses slide by, passed off as not even of note – it sets the men of the world up to do these things – after all, maybe they are ‘doing us a favor!’

So what are the alternatives? Avoid all movies? Remember their inappropriateness 10 years later? Prescreen them. Stop watching them when the first inappropriateness occurs? Stop and talk at each offense. Talk at the end? In a blended pseudo-family, I am not even sure where to start.

Well – I do know, and that starts with my own investigation of what happened, and what my new options are, then talking with my partner, and encouraging him and us…. and the world, to talk to our sons, and daughters.

I know many of you will have strong opinions or advice on what I did, or did not do, or should have done. Save those. Thank you. I am NOT even addressing those things. This is just a blog on my reaction to watching 15 year old movie.

I AM writing THIS piece for those other people who find themselves in these situations and have not yet mastered how to manage them. You need to learn how to balance our new knowledge and dialog with those of precariously balanced relationships. You need to hear that it is hard. You need to hear that there is a significant learning curve.

I am just learning how to not tolerate locker room behavior in my own home and it is surprising to me. To find it there. To find it challenging.

My Blog – and Why

I am writing a blog because WordPress put this blank spot here, and I hate to leave tasks undone.  I started this Blog, so that I could write my opinion somewhere other than Facebook.  I think I have things of value for others. I certainly have things I think are important to say. Sometimes the two coincide, other times they don’t.  That part is up to you, the reader.  But I can’t be heard if I don’t speak out.

I am speaking my mind.

It changes from time to time.