Vaccine Purgatory and Masks will be the Reality for the Next Year

Home Disinfection After Patient Recovers

Key West Airport will have a Patrolling UV Robot

LG Electronics Robots Spray Disinfectant or Provide UV Light

More Efficient Filters are More Cost Effective Than Outdoor Air Dilution

Tennessee Aquarium Installs Ten New HVAC Systems

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Vaccine Purgatory and Masks will be the Reality for the Next Year

Sarah Zhang of the Atlantic wrote that we will be in vaccine purgatory for a number of months.  She points out that even with a 95% efficient vaccine it will be wise to wear a mask. Even a 5% risk makes this effort worthwhile.

The next six months will almost certainly bring delays in vaccine timelines, fights over vaccine priority, and questions about how immune the newly vaccinated are and how they should behave. We’ve spent 2020 adjusting to a pandemic normal, and now a strange, new period is upon us. She calls it vaccine purgatory.

The biggest unknown is how long we will be left in purgatory. Operation Warp Speed officials have laid out an aggressive timeline to get nearly all Americans vaccinated by June, but this presumes several pieces going perfectly. The vaccines from Pfizer, which was just recommended for FDA authorization, and Moderna, which is expected to follow next week, cannot hit manufacturing delays, and additional vaccine candidates, from AstraZeneca and Johnson & Johnson, must earn speedy authorization from the FDA early next year. Pfizer earlier revised down the number of doses it will deliver in 2020 and separately has said it cannot supply any additional doses to the U.S., beyond the 100 million already ordered, before June. The timeline for authorizing AstraZeneca’s vaccine is up in the air after a messy clinical trial. And Johnson & Johnson’s has not yet been proved to work.

Your experience of this purgatory may depend on where you live. While a CDC committee sets recommendations of how to prioritize initially scarce doses, each state ultimately decides how to allocate the vaccines it receives. A person who qualifies as an essential worker in Illinois might not in Indiana. One city could end up opening vaccinations to the general public before its neighbor. This system is meant to be local and flexible, but that will necessarily mean a patchwork of policies that could come off as unfair or inconsistent.

“It is such a complicated and large logistical challenge that a lot of things will go wrong. A lot of things will not go to plan,” says Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. “The important thing is not to get hung up on that.” Hard trade-offs are ahead, as many groups have some claim to priority but they by definition cannot all be prioritized. Toner says not to lose sight of the ultimate goal: “Let’s just keep vaccinating people.”  

The decisions still being made about how to prioritize vaccines will dramatically color individual people's experiences over the next months. But ultimately getting out of purgatory will require reaching herd immunity, which is something we can only achieve collectively. Vaccines can protect individuals, but vaccination as a public-health strategy protects a community. Every person who gets vaccinated is a small step toward herd immunity, toward bringing down the amount of circulating virus. Eventually, we can go all back to schools and dinner parties and concerts.

Vaccines will do very little to change life for the average American in 2020. The very first Americans to receive COVID-19 vaccines will be health-care workers and residents of long-term care facilities. These priorities, set by the CDC’s Advisory Committee on Immunization Practices last week, are meant to preserve the health-care system and to save lives. People in long-term care facilities account for many of the hospitalizations and roughly 40 percent of U.S. COVID-19 deaths, according to data from the COVID Tracking Project at The Atlantic, even though only a small fraction of the country’s population—less than 1 percent—lives in these facilities.

Because the first shipments of vaccines will not cover all 24 million people in these two groups, the CDC has recommended sub-prioritizations too. Hospital workers who are in contact with patients are first on the list—including janitorial and support staff. The CDC also asks hospitals to consider that people who have recovered from COVID-19 likely have some immunity, so they do not need to be vaccinated first, though they won’t be prevented from getting vaccinated when doses are available later. For long-term care facilities, the CDC recommends putting skilled-nursing facilities, which have the sickest patients, before assisted-living facilities.

After vaccination begins, hospitals and nursing homes will not change overnight. Both the Pfizer and Moderna vaccines require two doses, three and four weeks apart, respectively, and even then the vaccines take time to build immunity—the companies measured 95 percent protection from COVID-19 symptoms only after one or two weeks. That will be well into 2021 for even the first people vaccinated this year. (The first dose may offer some protection after 10 days, but that likely wouldn't be as strong or long-lasting as the full regimen.)

Scientists also do not yet have the data to confirm that the vaccines actually prevent people from spreading the coronavirus asymptomatically in addition to preventing COVID-19 symptoms. This is likely, but data on this won’t be available until early next year. For now, a vaccine can clearly offer some protection to the recipient—but that person can’t be fully confident about not spreading the disease to others. A nurse might feel safer at work but still worry about bringing the virus home to their family.

Moreover, “even with a vaccine that is 95 percent effective, you don’t know if you are in the 5 percent,” Marci Drees, the infection-prevention officer at ChristianaCare and a representative on the CDC advisory committee, points out. Health-care workers who come in contact with COVID-19 patients will continue to need full personal protection equipment. Drees says she doesn’t anticipate any changes in PPE or quarantine-after-exposure policies in the near term.

Slowly, though, small corners of the world could start to change. In nursing homes

where every staff member and resident gets vaccinated—essentially reaching building-wide herd immunity—some restrictions could be loosened. Residents could increase their very limited socializing with one another. Jason Belden, the director of emergency preparedness for the California Association of Health Facilities, says the buildings might eventually open to some visitors, but symptom checks and masking will continue. With everyone inside vaccinated, the risk from unknowingly letting in a visitor who is infected is diminished, but not zero.  

The inclusion of nursing-home residents in the first priority group by the CDC advisory committee also came as a bit of a surprise to states, which did not expect it when they drew up vaccine plans earlier this year. The federal government has contracted with CVS and Walgreens to help vaccinate nursing-home residents, but this division of responsibility between the federal and state levels has also introduced confusion. Ehresmann says she’s been told to reserve some number of her state’s 183,000 initial doses for nursing homes, even though the nursing-home vaccination program also won’t be ready to start for a few more weeks. In California, Belden says, facilities in the association are still waiting to find out which ones will get how many doses when. “All of our members are reaching out every day. Am I going to be first? Am I going to be second? What's it going to look like? None of those questions have been answered,” he told me. “But I do suspect we’ll get answers very soon.”

Pfizer and Moderna expect to have 35 to 40 million doses of their vaccines ready by the end of the year, which is almost enough to cover hospitals and nursing homes at two doses per person. By early 2021, states will be getting ready for the next priority group.

In some ways, the very first group is actually the easiest to vaccinate. Health-care workers and residents of long-term-care facilities are relatively well-defined groups, and they are already concentrated in hospitals and nursing homes. “The real test will be what comes after that,” says Saad Omer, a vaccinologist and the director of the Yale Institute for Global Health. It only gets harder from here.

The first hard choice is a stark one: Who should come next, essential workers, or adults over 65 or with comorbidities? The question boils down to which strategy to prioritize, Omer says: reducing transmission out in the community, by vaccinating essential workers interfacing with the public, or reducing deaths, by vaccinating the people most at risk of dying of COVID-19.

The CDC advisory committee has indicated that it will recommend essential workers next, though the National Academies and the World Health Organization have recommended the opposite. None of this guidance is binding. The decision is ultimately up to the states, though they have historically followed the CDC.

Essential workers are also a nebulous category, and again, states get to set their own definitions. “There are an awful lot of interest groups that are lobbying states and lobbying feds to get their members or their constituents vaccinated sooner,” Toner told me. Should bank tellers count as essential workers? Teachers? Exterminators? And how should states prioritize different groups of essential workers? One study found that 70 percent of American workers can be defined as essential workers and 42 percent as frontline workers that directly interact with the public.

The decision to prioritize essential workers also has to do with reaching working-class Black and Latino communities that have been disproportionately hit by the coronavirus. But these are the same communities that may be hardest to reach—because of distrust in the government and language barriers. As part of their vaccine planning, state health departments are planning to connect with churches, nonprofit groups, and other leaders in those communities. Without this effort, vaccines will go only to people who come asking for it. “The people who are capable of advocating for themselves in these situations are sometimes people who are less in need of the services than those who are not advocating for themselves,” says Kelly Moore, an associate director of the Immunization Action Coalition. These communities might take longer to reach, which means the overall vaccination might proceed a bit slower. There can be tension, Toner adds, between vaccinating as many people as quickly as possible and actually reaching priority groups.

States and the CDC are still working out who will qualify as adults at high risk for COVID-19. Again, there’s a trade-off: Requiring proof will make getting the vaccines out harder but forgoing it might mean someone who doesn’t strictly qualify gets a vaccine. “I don’t think we should get mired in documentation,” Toner said. “I don’t feel like they should have to show their medical record to prove that they’re diabetic. Or if they say they’re 65, but they’re only really 64, I wouldn’t have them bring a birth certificate. I think to some extent, we would have to trust people.”

When vaccines become available to the general public depends on a few unknowns. First, how many other vaccine candidates, like AstraZeneca’s and Johnson & Johnson’s, will actually also get authorized? These companies have already ramped up manufacturing, so doses can be ready to go as soon as the FDA gives the green light. Second, will they run into manufacturing delays? The mRNA vaccines from Pfizer and Moderna rely on a new technology that has never been used in an approved vaccine, let alone produced at the scale needed now. During manufacturing of the more routine H1N1 swine-flu vaccine during the 2009 pandemic, the U.S. ran out of “fill and finish” facilities that package bulk vaccines into vials. The government set up a program to prevent this bottleneck in the future, but other unforeseen snags may come up.

The last stage of purgatory will be getting vaccines to the general public. Some parts of the country may allow everyone to get the vaccine sooner than others. In 2009, says Moore, who was running Tennessee’s immunizations program at the time, demand for the swine-flu vaccine in priority groups varied across the state. Some vaccine providers had doses for priority groups sitting unused, while members of the general public were asking about shots. Moore let those providers begin giving the vaccine to anyone who asked. This dynamic is very likely to play out between cities and between states with the COVID-19 vaccine, where doses are currently being allocated by census population but demand may vary.

This decision is tough because it’s likely to be criticized either way. “Visualize the frustration … if Georgia and Tennessee and Alabama all have different groups being allowed to be vaccinated at different times. But if you don’t, if you try to make everyone in the whole country do these groups in lockstep, then you can imagine that that also is terribly unfair,” Moore says, if “there are lots of willing people who could be protected, and vaccine is being withheld.”

Vaccine hesitancy is, of course, also a more general concern across the country. But Americans’ willingness to take a COVID-19 vaccine has risen as data on the vaccines’ efficacy have come out, and experts expect it to keep rising if early vaccination goes well. Many people have said they are more comfortable waiting a few months to get the vaccine, which is in effect what will happen.

Eventually, our social lives can start getting back to normal. It won’t happen in a moment, but stepwise, in small ways and then larger ones. Omer says small gatherings like dinner parties and game nights might be safe if everyone in the group is vaccinated. School reopenings and mass gatherings will likely happen only when widespread vaccination—along with masks and social distancing through the winter and spring—pushes COVID-19 rates to low levels.

Public-health experts stress that vaccines work in tandem with other measures: The start of a vaccination campaign cannot be an excuse to abandon the measures that are working right now. Moore likens vaccines to another slice on a pile of Swiss cheese, where each slice is an intervention that is by itself imperfect (masks, social distancing, even vaccines) but they drastically reduce risk when stacked together. Rochelle Walensky, President-elect Biden’s pick for CDC director, made this analogy on Twitter: “If I have a cup of water, I can put out a stove fire. But I can’t put out a forest fire, even if that water is 100% potent. That’s why everyone must wear a mask. As a nation, we’ll recover faster if you give the vaccine less work to do when it’s ready.”

There will likely be many frustrating and imperfect things about the vaccine rollout in the next few months. But the goal is to get the country—and, really, the world—back to normal, and that happens not when you as an individual are vaccinated but when enough people all over are vaccinated. It might take longer than we like, but we get there together.

https://www.theatlantic.com/health/archive/2020/12/next-six-months-will-be-vaccine-purgatory/617371/

 

Sarah Zhang is a staff writer at The Atlantic.

 

Home Disinfection After Patient Recovers

The COVID-19 pandemic has spawned a new business that’s booming— home disinfection services 

It may be a job for electrostatic disinfection. It is used at schools and offices and is now making the rounds after coronavirus hits home.

(Photo: CBS2)

“It’s 360-degree coverage. It will get into every crack and crevice, much better than a surface wipe can ever do,” said Doug Baruchin of I.T.S. Environmental Services. Baruchin is a certified environmental infection control remediator.

Homes get a full wipe-down and fogging with peroxide- or ammonia-based products or plant-based disinfectants.

“It’s basically the herb thyme and it’s just as effective on coronavirus, but safer for aquatic life, pets,” Baruchin said. The process takes the work and worry out of returning a home to health after someone has been sick.

But is this overkill? CBS2’s Dr. Max Gomez says there is no harm as long as the disinfection products are safe. However, he cautions, “Surface transmission just isn’t a high-probability event. The CDC has said its really airborne and that’s why it’s so important to wear a mask.”

Sharntai Harris, a Brooklyn hairdresser who recovered from COVID-19, hired Kristal Klean to do what’s called a “COVID cleanse” of the house she shares with her mother and child.

“This is something that kills COVID on the surface, so I want it killed. I want it out of my house. I want it away from my loved ones,” Harris said.

Disinfectant is applied with a sprayer for customers who simply don’t want to go near rooms that were used for COVID isolation.

“They treat it like the red zone, like ‘she was up there, you can start up there.’ They usually don’t even go back in until we come,” Kristal Klean owner Krystle Vives said.

You can, of course, follow CDC guidelines and carefully disinfect your own home, but for services starting at $100, customers say they’re buying peace of mind.

Electrostatic disinfection typically runs around $300-$400 for a few rooms but can go as high as $1,500 for an entire large house.

https://newyork.cbslocal.com/2020/12/03/coronavirus-covid-19-electrostatic-disinfection-homes/

 

Key West Airport will have a Patrolling UV Robot

A coronavirus-fighting robot is poised to begin patrolling Key West International Airport’s interior spaces after hours beginning Tuesday, December 15.

The robot emits high-intensity ultraviolet UV-C wavelength light that kills harmful pathogens in the air and on surfaces.

The ultraviolet disinfection robot, developed by UVD Robots, is designed to remove 99.9% of pathogens including COVID-19. Key West International Airport is among the first airports in the United States to acquire one of the sophisticated units that provides non-chemical disinfection, according to a manufacturer’s representative.

The equipment’s acquisition was motivated by a desire to augment the airport’s other cleanliness and passenger protection practices to safeguard against coronavirus, said Richard Strickland, director of airports for the Keys’ Monroe County.

Airport officials and manufacturers’ representatives demonstrated the robot Wednesday and Strickland said Thursday that the manufacturer’s representatives should be finished programming and training Key West airport staff by early next week.

“Passengers should know that as they travel to and utilize the facilities here, we’ve made every effort possible against COVID-19 to protect passengers’ safety,” said Strickland. “And now, with the ultraviolet light robot that we have here, we’ll be able to step that up even another notch.”

Standing nearly 6 feet tall and weighing over 300 pounds, the robot can move around the airport autonomously once it has been programmed and “mapped” spaces. A human operator is to ensure people are away from spaces the robot will sanitize and monitors its progress via an electronic smart tablet.

The robot’s autonomous operation is vital, since the light it emits during the active disinfection cycle is so intense it can only be used after hours when people are not present. For further safety, a sensor will shut the light down if a human presence is detected to protect people from UV-C exposure.

Officials said the robot can disinfect the entire airport’s interior spaces in approximately two-and-one-half hours. Airport officials are to continue to utilize other efforts, including manual disinfection and requiring that all personnel and passengers wear masks, to help mitigate spread of the COVID-19 virus.

Even with the promise of mass vaccination, effective disinfection is still a key element in containing the spread of Covid-19. Museums, theme parks and other attractions are seeking ways to ensure their venues are as safe as possible and thorough disinfection is part of this protocol. Robots using UVC offer large benefits as effective ways of sterilizing not just surfaces but also the air, particularly in indoor areas of attractions.

 

LG Electronics Robots Spray Disinfectant or Provide UV Light

LG Electronics is set to introduce the CLOi robot at the 2020 Korea Electronics Show being held at the Digital Innovation Centre in Seoul. The robot stands 160 centimeters high and contains panels with ultraviolet-C (UVC) lamps. LG claims it is 99.9 percent effective in killing bacteria coliform and staphylococcus aureus from a meter radius. The robot has autonomous driving technology allowing it to move easily around obstacles. LG is also developing a different robot that will spray disinfectant rather than use the UVC lamps.

LG is not the only company with UVC disinfection robots. Xenex has launched the LightStrike robot which can kill 99.9 percent of SARS-CoV-2 virus in two minutes at a distance of one meter. “Pathogens have evolved, but our tools to clean the environment have not,” said Mark Stibich, chief science officer and co-founder of Xenex. “We need a new tool to fight them, not just a mop and bucket.”

UVC is a form of ultraviolet light, shorter than UVA and UVB. It has a wavelength of between 100 to 280 nanometers (nm). It is the type of UV light understood to be most effective at killing germs, and is commonly used to disinfect, surfaces, air and liquids. Different wavelengths disable viruses in different ways. The most common wavelength for germicidal light is 254nm which damages the viral DNA or RNA so the virus cannot reproduce. Meanwhile far UVC (between 207 and 222 nm in wavelength) damages proteins on the surface of the virus so it can’t attach to human cells.

As Blooloop reported recently, many companies have been researching and developing applications for UVC light and these innovations have far-reaching possibilities for the attractions industry.

Recent studies have shown that UVC light can be effective in killing large amounts of the new coronavirus. A study in The American Journal of Infectious Control (AJIC) found that UVC light exposure inactivated the virus entirely within nine minutes. Another study, also reported in the AJIC found that far-UVC light reduced live coronavirus by 99.7 percent in 30 seconds.

Disinfecting robots are efficient, thorough and time-saving. However they also offer another major benefit – safety. UVC does not appear to cause skin cancer or cataracts (as UVA and UVB can) but doctors are concerned that it could affect human eyesight. Evidence shows that far-UVC light is the safer form of UVC light as it doesn’t penetrate beyond the outer (dead) layer of skin cells and the liquid film on the eyes. Unlike standard UVC, it doesn’t cause ‘welder’s flash’. Research is underway on the potential effects on human eyes. “I would like to see more research on longer term exposure before I am convinced,” said Karl Linden, professor of environmental engineering at the University of Colorado talking the US National Institutes of Health.

 

More Efficient Filters are More Cost Effective Than Outdoor Air Dilution

Since the start of the COVID-19 pandemic, many eyes have turned to buildings’ HVAC systems to help mitigate the spread of coronavirus indoors. There are a range of options designed to prevent the virus from traveling through a system. But how effective are they? At the SMACNA Edge event this fall, Steve Taylor, principal of Taylor Engineering in Alameda, California, attempted to answer that question.

One of the biggest questions to be answered: Which is better at preventing the spread of viruses — filtration or outside air? Taylor said there is plenty of evidence that more frequent air changes help, but that air doesn’t have to come from the outside. A study of the flu offers some insight into which of the two is more effective. This study finds that filters are the best defense. And MERV 13 filters work as well as higher level filters.

Taylor said many contractors argue they cannot place a MERV 13 filter into the 2-inch space available. They say the pressure drop is too tight as a result. Taylor said most pressure drop calculations are conservative.

“If you had MERV 8 filters and you replace them with MERV 13 filters, it would simply work, fans would speed up all by themselves, and you'd have plenty of motor horsepower to handle it because we engineers are very conservative,” he said. “So we really think that MERV 13 is a very practical requirement, something that most systems will be able to do without any changes being made.”

Filter Costs: During his online presentation for the SMACNA Edge event, Steve Taylor shows the effectiveness of filters versus increased outside air in preventing the spread of the flu. The risk reduction with outdoor air introduction is $700-$900 whereas a MERV 16 filter with the same risk reduction of  65 % is only $250.

Another tool promoted to fight the virus is UV lights. Taylor said they are effective, but not recommended for air handlers. He said better filters are just as easy to use, less expensive, and as effective while using less energy. The filter housing is already there.

Some object that filters only capture the virus rather than kill it. Taylor said that’s untrue. The virus dies without a living host.

What about humidity? Taylor said early studies showed that a higher relative humidity, between 40% to 60%, helped prevent spread. Further studies found little effectiveness from higher relative humidity.

“So all in all, there's not enough evidence supporting humidification is a good mitigation measure,” Taylor said.

Humidification can also create a lot of problems on its own, he said. It can cause condensation in the ductwork immediately downstream of the humidifiers, as well as humidification within the walls. If the vapor barrier is not in the right place, it can certainly cause it on windows if they're only single glazed, Taylor said.

“And wherever there's condensation, there can be microbial growth,” he said.

He concluded that the best solution for improving an HVAC system to prevent the spread of coronavirus is improving air filters to MERV 13 or better. Taylor said this move has benefits in many parts of the country, even if the pandemic ends. It improves IAQ in general and is especially useful when regions are dealing with the smoke from wildfires.

Of course, the best filter is the one closest to a building’s occupants — in other words, masks.

“There's no practical amount of ventilation that's going to protect you from viruses unless you have masks,” Taylor said. “They are mandatory.

https://www.achrnews.com/articles/144101-filtration-proves-the-most-efficient-upgrade-for-virus-prevention

Tennessee Aquarium Installs Ten New HVAC Systems

The Tennessee Aquarium has used a grant to upgrade its HVAC systems as a safeguard against the indoor transmission of the virus that causes COVID-19.

The aquarium in Chattanooga says it used an $800,000 Tennessee Community CARES Program grant from the state Department of Human Services in part to buy 10 new HVAC units. The equipment has ultraviolet light filters intended to help disinfect the air.

“The science tells us that increased airflow and better filtration greatly reduces the risk of exposure,” Rodney Fuller, the aquarium’s director of facilities and maintenance, said in a news release. “As a nonprofit, we were grateful to receive the funding to add another layer of safety for our guests, staff and volunteers.”

The aquarium reopened to guests in June under new health protocols, including mask requirements for guests older than 12, timed-entry tickets and capacity limits.