Open innovation to help in COVID-19 pandemic

We are living in the middle of the emergency over coronavirus all over the world. The reactions to the COVID-19 pandemic and its effects on societies and economies around the world cannot be understated. Because an estimated 15% of COVID-19 patients require hospitalization and 5% require intensive care (Z. Wu and McGoogan 2020), the ongoing COVID-19 pandemic has the potential of posing a substantial challenge to medical systems around the world (Remuzzi and Remuzzi 2020; Grasselli, Pesenti, and Cecconi 2020).

Necessity is the mother of invention. A need or problem encourages creative efforts to meet the need or solve the problem. This saying appears in the dialogue Republic, by the ancient Greek philosopher Plato.

“Necessity is the mother of invention” is an English-language proverb. It means, roughly, that the primary driving force for most new inventions is a need. When the need for something becomes imperative, you are forced to find ways of getting or achieving it.

With the spread of the COVID-19 pandemic around the world, many companies have joined the fight to stop the deadly virus by creating and producing various types of medical supplies and healthcare solutions. Clothing companies began to sew aprons and protective N95 masks, chemical companies produced antibacterial gels, public and private universities and research centers started projects to create solutions that would help in a simple and quick way to study and prevent the disease.

Here are some examples of sort of ingenuity we need now in the middle of pandemia. Already many people contributed those efforts. Check out on those links what is already done if you can find any useful information or can contribute to those efforts you see as good idea. Start your reserach with 7 open hardware projects working to solve COVID-19 article.

I have collected here a list of interesting open hardware project and instructions that can be useful or educational. Hopefully this list I have contributed here will be useful for someone. Keep in mind that many of those ideas are potentially dangerous if the instructions are not entirely correct, implemented exactly right and used by people that know what they are doing. You have been warned: Do not try those at home yourself! We are dealing here with things that can easily injure or kill someone if improperly implemented or used – but at right place the best ideas from those could potentially save lives.

Repairing hospital equipment

The right thing to do in his situation is that medical companies to release service manuals for ALL medical equipment so they can be repaired and maintained where they are most needed.

In the face of ventilator shortages for COVID-19 victims, iFixit is looking to make maintaining and repairing equipment as easy as possible. iFixit Launches Central Repository for Hospital Equipment Repair and Maintenance Manuals

https://www.ifixit.com/News/36354/help-us-crowdsource-repair-information-for-hospital-equipment

https://www.hackster.io/news/ifixit-launches-central-repository-for-hospital-equipment-repair-and-maintenance-manuals-a19dc9ce8405

Site http://www.frankshospitalworkshop.com offers links many service manuals

Robotics

COVID-19 pandemic prompts more robot usage worldwide article tells that the coronavirus has increased interest in robots, drones, and artificial intelligence, even as some testing of autonomous vehicles pauses on public roads. It is believed that these technologies can help deal with massive staffing shortages in healthcare, manufacturing, and supply chains; the need for “social distancing;” and diagnosis and treatment.

Here are some robotics related links that could be useful:

Medical robotics expert Guang-Zhong Yang calls for a global effort to develop new types of robots for fighting infectious diseases.
https://spectrum.ieee.org/automaton/robotics/medical-robots/coronavirus-pandemic-call-to-action-robotics-community

Elements of Robotics Open Access Textbook
https://link.springer.com/book/10.1007/978-3-319-62533-1

Ventilators

A ventilator is a machine designed to provide mechanical ventilation by moving breathable air into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. Ventilators are sometimes colloquially called “respirators”.

A ventilator, also called a respirator, is designed to provide mechanical ventilation by oxygen into and out of the lungs, to deliver breaths to a patient who is physically unable to breathe, or breathing insufficiently. The machines can be used to help a person breath if they have conditions making it difficult to breathe, such as lung diseases, during and post-surgery. For patients critically ill with coronavirus access to a ventilator could be a matter of life or death.

In its simplest form, a modern positive pressure ventilator consists of a compressible air reservoir or turbine, air and oxygen supplies, a set of valves and tubes, and a disposable or reusable “patient circuit”. Modern ventilators are electronically controlled by a small embedded system to allow exact adaptation of pressure and flow characteristics to an individual patient’s needs.

They work by placing a tube in a person’s mouth, nose or small cut in the throat and connect it to a ventilator machine. The air reservoir is pneumatically compressed several times a minute to deliver room-air, or in most cases, an air/oxygen mixture to the patient.


Because failure may result in death, mechanical ventilation systems are classified as a life-critical system, and precautions must be taken to ensure that they are highly reliable
. Modern commercial ventilator is a relatively complex piece of equipment with lots of components and a dedicated supply chain.

Because there is a lack of ventilators on many hospitals in several countries, there has been a lot of creative work done to help this problem.

There has been projects going on to repair old and non-working ventilators to a working conditions. For repairing some older devices, there has been problem to get spare parts from the manufacturer and that those spare parts can be very expensive. Also getting the service information for repairing those equipment seems to be hard to get from manufacturer, Ifixit has started a project Help commit industrial espionage for the greater good! to get the service information on-line at https://www.ifixit.com/News/36354/help-us-crowdsource-repair-information-for-hospital-equipment

In middle of the emergency some people have worked on to make their own spare parts when official parts are not available, thus making more devices available. For example a startup 3D-printed emergency breathing valves for COVID-19 patients at an Italian hospital in less than 6 hours. An Italian hospital that ran out of life-saving equipment for coronavirus patients was saved by a ‘hero’ engineer who used cutting-edge technology to design oxygen valves within a matter of hours. At least 10 lives were saved in this way.

So great thinking for 3d printing of valves. Are they sterilized and suitable? 3D printing has been used in numerous cases for medical parts already. Most 3D printing operates at relatively high temperatures and printed objects are actually naturally sterilized when they are made. Anyway the right kind of plastic needs to be selected and the part needs to be built in exactly right way that is works reliably as designed. If they are used and the individual gets worse, does the fact that equipment not medical certified (environment, storage, shipping, etc) put the hospital in additional jeopardy for a lawsuit? All valid questions each medical liability officer will have to address. But if people are going to literally die if you do nothing, then taking a risk with a part that you 3D print seems like an idea that is worth to try.

Links:

A startup 3D-printed emergency breathing valves for COVID-19 patients at an Italian hospital in less than 6 hours
https://www.businessinsider.com/coronavirus-italian-hospital-3d-printed-breathing-valves-covid-19-patients-2020-3?r=US&IR=T
https://it.businessinsider.com/coronavirus-manca-la-valvola-per-uno-strumento-di-rianimazione-e-noi-la-stampiamo-in-3d-accade-nellospedale-di-chiari-brescia/

Firm ‘refuses to give blueprint’ for coronavirus equipment that could save lives
https://metro.co.uk/2020/03/16/firm-refuses-give-blueprint-coronavirus-equipment-save-lives-12403815/

https://www.ibtimes.com/coronavirus-crisis-3d-printer-saves-lives-over-10-italian-patients-hospitalized-2941436

3D printed life-saving valves: already a dozen in operation
https://www.embodi3d.com/blogs/entry/436-3d-printed-life-saving-valves-already-a-dozen-in-operation/

Volunteers produce 3D-printed valves for life-saving coronavirus treatments
Volunteers made the valves for about $1
https://www.theverge.com/2020/3/17/21184308/coronavirus-italy-medical-3d-print-valves-treatments

Another tried trick is try to use one ventilator with more than one patient. Daily Mail writes that ventilators can be modified to help FOUR coronavirus patients breathe at the same time if the NHS is still critically short of the machines when the outbreak peaks, scientists say. Here are some links to material on using one ventilator to more than one patient:

https://www.dailymail.co.uk/health/article-8125219/Ventilators-modified-help-FOUR-coronavirus-patients-scientists-say.html

https://emcrit.org/pulmcrit/split-ventilators/

SAVING 4 PATIENTS WITH JUST 1 VENTILATOR
https://hackaday.com/2020/03/19/saving-4-patients-with-just-1-ventilator/

Here has been work going on in creating an open source ventilator design project. Here are some links to this project and some other DIY ventilator designs.

https://hackaday.com/2020/03/12/ultimate-medical-hackathon-how-fast-can-we-design-and-deploy-an-open-source-ventilator/

There’s A Shortage Of Ventilators For Coronavirus Patients, So This International Group Invented An Open Source Alternative That’s Being Tested Next Week
https://www.forbes.com/sites/alexandrasternlicht/2020/03/18/theres-a-shortage-of-ventilators-for-coronavirus-patients-so-this-international-group-invented-an-open-source-alternative-thats-being-tested-next-week/

Open-source Oxygen Concentrator
https://reprapltd.com/open-source-oxygen-concentrator/

https://blog.arduino.cc/2020/03/17/designing-a-low-cost-open-source-ventilator-with-arduino/

https://www.instructables.com/id/The-Pandemic-Ventilator/

Macgyvilator Mk 1 (3-19-2020) – “ventilator” for disasters and/or low resource environments
Macgyvilator Mk 1 is a disaster “ventilator”, a simple apparatus to compress a bag-valve-mask with some control over tidal volume and rate. Constructed quickly and simply using wood, PVC, velcro, common fasteners, and easily sourced and assembled electronic components.

An Arduino based Open Source Ventilator to Fight against COVID-19?
https://www.cnx-software.com/2020/03/21/an-arduino-based-open-source-ventilator-to-fight-against-covid-19/
Low-Cost Open Source Ventilator or PAPR
https://github.com/jcl5m1/ventilator

Low-cost Ventilators
https://procrastineering.blogspot.com/2020/03/low-cost-ventilators.html

Arduino Respirator Prototype (pen source solution from Reesistencia Team, which is undergoing testing)
https://www.facebook.com/official.arduino/videos/2557115014604392/

OxyGEN project
https://oxygen.protofy.xyz
“OxyGEN is an open hardware project to build an emergency mechanism that automates an AMBU type manual ventilator in extreme shortage situations such as the one caused by coronavirus (COVID-19) in some parts of the world.”

NOTE: Take a look at the expression VILI before thinking about trying one of these. It is hard making a ventilator that doesn’t harm the lungs. It is easy to get Ventilator-associated lung injury or die if the ventilator does not work exactly correctly all the time.

Testing for infection

There are many approaches thought to be helpful to finding out if someone is infected or something is contaminated.
Thermal scanners are effective in detecting people who have developed a fever (i.e. have a higher than normal body temperature) because of infection with the new coronavirus
. However, they cannot detect people who are infected but are not yet sick with fever (it can take 2-10 days before infected people get the fewer).

Open-Source Collaboration Tackles COVID-19 Testing
https://hackaday.com/2020/03/10/open-source-collaboration-tackles-covid-19-testing/

Low-cost & Open-Source Covid19 Detection kits
https://app.jogl.io/project/118?

This Open Source Device Can Detect Coronavirus on Surfaces
The Chai team has developed a detection test that works with their Open qPCR tool.
https://www.hackster.io/news/this-open-source-device-can-detect-coronavirus-on-surfaces-3da1d7b1c73a

Prevent touching face

It is recommended to stop touching your face to minimize spread of coronavirus and other germs. People touch their faces frequently. They wipe their eyes, scratch their noses, bite their nails and twirl their mustaches.

Not touching your face is a simple way to protect yourself from COVID-19, but it’s not easy. If you can reduce face-touching, you can lower people’s chances of catching COVID-19. Why is it so hard to stop? Face-touching rewards us by relieving momentary discomforts like itches and muscle tension.

If you you want to change, you can try to replace it with a competing response that opposes the muscle movements needed to touch your face. When you feel the urge to touch your face, you can clench your fists, sit on your hands, press your palms onto the tops of your thighs or stretch your arms straight down at your sides. Some sources recommend object manipulation, in which you occupy your hands with something else. You can rub your fingertips, fiddle with a pen or squeeze a stress ball.

Related links:

This pair of Arduino glasses stops you from touching your face
https://blog.arduino.cc/2020/03/10/this-pair-of-arduino-glasses-stops-you-from-touching-your-face/

Don’t Touch Your Face
Don’t touch your face — easy to say, hard to do. This device, worn like a watch, will buzz whenever your hand aims for trouble.
https://www.hackster.io/mike-rigsby/don-t-touch-your-face-e8eac3

Hand sanitizer

Hand sanitizer is a liquid or gel generally used to decrease infectious agents on the hands. It depends on the case if hand washing with soap and water or alcohol-based hand sanitizer is preferred. For Covid-19 WHO recommends to wash your hands with soap and water, and dry them thoroughly. Use alcohol-based handrub if you don’t have immediate access to soap and water.

It seems that there are many places where there is shortage of hand sanitizers. This has lead to situation where people have resorted to making their own. Recipes for DIY hand sanitizer are popping all over the internet. A quick search reveals news articles, YouTube how-to’s and step-by-step visual guides. But think twice about joining them — experts are wary and even caution against the idea. The World Health Organization even has an official guide to making hand sanitizer. But it’s intended for populations that do not have clean water or other medical-grade products in place. Don’t try to make your own hand sanitizer just because there’s a shortage from coronavirus.

Can’t get your hands on hand sanitizer? Make your own
https://www.cbsnews.com/amp/news/hand-sanitizer-coronavirus-make-your-own/

Photos show why hand sanitizer doesn’t work as well as soap and water to remove germs
https://www.businessinsider.com/coronavirus-photos-why-you-should-wash-hands-with-soap-water-2020-3?amp

Emergency DIY hand sanitizers (read the description)

“Every time a new health incident occurs there’s a rush on hand sanitizers, often causing shops to sell out.
Here’s how to make some simple emergency sanitizers at home, noting that they are not as effective as just washing your hands, and only some viruses can be damaged by simple sanitizers. These options are offered as a last resort when commercial versions are not available.”
“For the alcohol one the higher the percentage of alcohol the better, up to around 70-80%.”

Make Your Own Hand Sanitizer At Home When It’s Sold Out Everywhere
https://www.forbes.com/sites/tjmccue/2020/03/03/make-your-own-hand-sanitizer-at-home-when-its-sold-out-everywhere/

Sanitizing things

With deadly coronavirus spreading worldwide at an alarming speed, personal hygiene has become paramount importance to contain the infection spread further. Mobile phones are known to house several germ, and if you thing they are contaminated, you should maybe disinfect them. The CDC recommends that everyone “clean all “high-touch” surfaces every day” to protect against the spread of COVID-19.

How to Disinfect Your Smartphone article says CDC recommends that for your smartphone you should use 70% rubbing alcohol or alcohol-based disinfectant spray to wipe down the back and sides of your device. For example Apple recently updated its official cleaning advice, so ccording to Apple, it’s now safe to clean your iPhone with disinfecting wipes if you do it correctly. You should not try to spray any liquid to your phone.

The other option is to use a smartphone sanitizer device that cleans using UV rays. Sanitizers that use ultraviolet (UV) rays to kill bacteria and viruses have been around for a while now and they can kill 99% of bacteria in as little as five minutes. However its efficacy hasn’t been tested against nasties like SARS-CoV-2, the virus responsible for COVID-19. Coronavirus effect: Samsung offers UV-C sanitizing service for Galaxy devices. Samsung is using Ultraviolet germicidal irradiation (UVGI) disinfection technology, which uses of uses short-wavelength ultraviolet (UV-C) light to kill or inactivate bacteria, virus, molds and other pathogenic microorganisms on smartphones.

The UV-C light is capable of destroying nucleic acids and DNA. It will kill many things, but you don’t want that hitting your eye or skin. World Health Organization only states: “UV lamps should not be used to sterilize hands, or other areas of skin as UV radiation can cause skin irritation.

Here are some UV C related links:

https://www.light-sources.com/blog/killing-bacteria-with-uv-light/

https://russellsrandomthoughts.blogspot.com/2013/05/the-gtl3-bulb-simple-and-inexpensive.html?m=1

Good UV versus bad UV. All available on eBay.

Protective masks

The protective mask ratings used by hospitals are typically N95, FFP2 or FFP3. FFP2 protection level is 94%. FFP3 protection level is 99%. N95 protection level is 95%. An N95 FFR is a type of respirator which removes particles from the air that are breathed through it. These respirators filter out at least 95% of very small (0.3 micron) particles. N95 FFRs are capable of filtering out all types of particles, including bacteria and viruses. The N95 mask is mainly for use if you already have the virus to keep it from spreading and many have argued that coronavirus is smaller than the 0.3 micron filter rating of the mask and thus, not that helpful, for people outside of healthcare. In fact, the U.S. Surgeon General wants consumers to stop buying masks.

Due to the worldwide pandemic of COVID-19, there has been a huge shortage of N95 masks. Promoting simple do-it-yourself masks: an urgent intervention for COVID-19 mitigation claims that widespread use of masks by the general population could be an effective strategy for slowing down the spread of COVID-19: “Since surgical masks might not become available in sufficient numbers quickly enough for general use and sufficient compliance with wearing surgical masks might not be possible everywhere, we argue that simple do-it-yourself designs or commercially available cloth masks could reduce the spread of infection at minimal costs to society”.

With masks sold out during the coronavirus outbreak, many people will have to make do with what some scientists have called “the last resort”: the DIY mask. Many people have been working on designs for a DIY mask that may be able to protect those who haven’t been able to secure their own masks. It seems that cotton homemade masks may be quite effective as alternatives and there are also other ideas. For any DIY ideas, be warned that there is no guarantee that those designs are effective. So I don’t recommend to use them as alternative to proper mask when they are available. Bit of proper marks are not available, they can be better than nothing.

Keep in mind the right filter type to use: Hepa filters do have the ability to filter particles and viruses, but they wont protect you 100% of the time. The real secret is layers. The problem is, more layers, more restriction. Keep in mind that charcoal filters will make your air fresher, but have almost no effect on cleaning the air of viruses. Coronavirus virions (or ‘particles’) are spherical particles with diameters of approximately 125 nm (0.125 microns). The smallest particles are 0.06 microns, and the largest are 0.14 microns. This means coronavirus particles are smaller than PM2.5 particles, but bigger than some dust particles and gases.

General information:

Guide to Dust Mask Ratings
https://www.seton.co.uk/your-guide-to-dust-masks-ratings

Can Masks Protect People from The Coronavirus?
https://smartairfilters.com/en/blog/coronavirus-pollution-masks-n95-surgical-mask/

Hengityksensuojaimet
https://www.tays.fi/fi-FI/Ohjeet/Infektioiden_torjunta/Mikrobikohtaiset_ohjeet/Hengityksensuojaimet(51207)

DIY project links:

Homemade N95 Masks In A Time Of Shortage
https://hackaday.com/2020/03/18/homemade-n95-masks-in-a-time-of-shortage/

“According to a studied performed at Cambridge University during the 2009 H1N1 flu pandemic, while surgical masks perform the best at capturing Bacillus atrophaeus bacteria (0.93-1.25 microns) and Bacteriophage MS virus (0.023 microns), vacuum cleaner bags, tea towels, and cotton T-shirts were not too far behind. The coronavirus is 0.1-0.2 microns, well within the range for the results of the tests.”

What Are The Best Materials for Making DIY Masks?
https://smartairfilters.com/en/blog/best-materials-make-diy-face-mask-virus/

“Data shows that DIY and homemade masks are effective at capturing viruses. But if forced to make our own mask, what material is best suited to make a mask? As the coronavirus spread around China, netizens reported making masks with tissue paper, kitchen towels, cotton clothing, and even oranges!”

Can DIY Masks Protect Us from Coronavirus?
https://smartairfilters.com/en/blog/diy-homemade-mask-protect-virus-coronavirus/

“DIY masks to protect against from viruses sounds like a crazy idea. Data shows masks work incredibly well, and they’re also really cheap. Surgical masks cost a few pennies, and they’re capable of filtering out 80% of particles down to 0.007 microns (14 times smaller than the coronavirus).”

“The homemade cotton masks captured 50% of 0.02-1 micron particles, compared with 80% for the surgical mask. Although the surgical masks captured 30% more particles, the cotton masks did surprisingly well. The researchers concluded that homemade masks would be better than nothing.”

“The Cambridge data shows that homemade masks made using cotton t-shirts can filter out some particles that are 0.02–1 microns in size. That’s pretty good, however its only one test.”

Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440799/

Can Masks Protect People from The Coronavirus?
https://smartairfilters.com/en/blog/coronavirus-pollution-masks-n95-surgical-mask/

This old hack doesn’t require any cutting or sewing:
http://how2dostuff.blogspot.com/2005/11/how-to-make-ninja-mask-out-of-t-shirt.html

Copper 3D makes the free N95 mask design to fight COVID-19 pandemic spread
https://3dprintingcenter.net/2020/03/18/copper-3d-makes-the-free-n95-mask-design-to-fight-covid-19-pandemic-spread/?fbclid=IwAR2iXJD5ybU8ReADakvCyDKsfzuRDOBEWxZ3ACCjZoz2dKNwvy07htUhon4

Copper 3D – A Chilean manufacturer of innovative antibacterial filaments designed the own version of the popular N95 protective mask and prepared it perfectly optimized for 3D printing on desktop 3D printers of the FDM / FFF type. The project is released under an open-source license and has been simultaneously patent pending to prevent other entities from commercializing it.”

“Copper 3D team quickly got to work on developing the patent for a model similar to a standard N95 mask but with some peculiarities (Antiviral, Reusable, Modular, Washable, Recyclable, Low-Cost), which were completely designed in a digital environment so that it could be downloaded anywhere in the world and 3D printed with any FDM/FFF equipment, even a low cost one. The mask was called “NanoHack”.”

#HackThePandemic site offers the technical details of the N95 mask and download set of STL files for printing on own 3D printer
https://copper3d.com/HACKTHEPANDEMIC/

SaltMask
https://robots-everywhere.com/re_wiki/pub/web/Cookbook.SaltMask.html
https://www.nature.com/articles/srep39956

“This is NOT a straight replacement for a N95 mask. In a real emergency it is recommended to combine a full face shield with a filter mask.”

Prusa Protective Face Shield – RC2
https://www.prusaprinters.org/prints/25857-prusa-protective-face-shield-rc1

“In a real emergency it is recommended to combine a full face shield with a filter mask.”

Promoting simple do-it-yourself masks: an urgent intervention for COVID-19 mitigation
https://medium.com/@matthiassamwald/promoting-simple-do-it-yourself-masks-an-urgent-intervention-for-covid-19-mitigation-14da4100f429

“Since surgical masks might not become available in sufficient numbers quickly enough for general use and sufficient compliance with wearing surgical masks might not be possible everywhere, we argue that simple do-it-yourself designs or commercially available cloth masks could reduce the spread of infection at minimal costs to society”

“Potentially, simply wrapping a suitable, large cloth around the face is easy to implement (Fig. 2), would arguably be more socially acceptable than surgical masks, and would be superior to a complete lack of face mask use.”

1,327 Comments

  1. Tomi Engdahl says:

    Why the WHO took two years to say COVID is airborne
    https://www.nature.com/articles/d41586-022-00925-7?error=cookies_not_supported&code=c1e4d5bc-9fe0-4200-b1a7-265ddaa178e2&utm_medium=Social&utm_campaign=nature&utm_source=Facebook#Echobox=1649257475

    Early in the pandemic, the World Health Organization stated that SARS-CoV-2 was not transmitted through the air. That mistake and the prolonged process of correcting it sowed confusion and raises questions about what will happen in the next pandemic.

    The seemingly uncontroversial statement marked a clear shift for the Switzerland-based WHO, which had tweeted categorically early in the pandemic, “FACT: #COVID19 is NOT airborne,” casting the negative in capital letters as if to remove any doubt. At that time, the agency maintained that the virus spreads mainly through droplets produced when a person coughs, sneezes or speaks, an assumption based on decades-old infection-control teachings about how respiratory viruses generally pass from one person to another. The guidance recommended distancing of more than one metre — within which these droplets were thought to fall to the ground — along with hand washing and surface disinfection to stop transfer of droplets to the eyes, nose and mouth.

    It took until 20 October 2020 for the agency to acknowledge that aerosols — tiny specks of fluid — can transmit the virus, but the WHO said this was a concern only in specific settings, such as indoor, crowded and inadequately ventilated spaces. Over the next six months, the agency gradually altered its advice to say that aerosols could carry the virus for more than a metre and remain in the air (see ‘Changing views of how COVID spreads’).

    But this latest tweak is the WHO’s clearest statement yet about airborne transmission of SARS-CoV-2. And it places the virus among a select group of ‘airborne’ infections, a label long reserved for just a handful of the world’s most virulent pathogens, including measles, chickenpox and tuberculosis.

    The change brings the WHO’s messaging in line with what a chorus of aerosol and public-health experts have been trying to get it to say since the earliest days of the outbreak. Many decry the agency’s slowness in stating — unambiguously — that SARS-CoV-2 is airborne.

    For example, even in the middle of the fast-moving epidemic, the WHO dismissed field epidemiology reports as proof of airborne transmission because the evidence was not definitive, something that is difficult to achieve quickly during an outbreak. Other criticisms are that the WHO relies on a narrow band of experts, many of whom haven’t studied airborne transmission, and that it eschews a precautionary approach that could have protected countless people in the early stages of the pandemic.

    Critics say that inaction at the agency led to national and local health agencies around the world being similarly sluggish in addressing the airborne threat. Having shifted its position incrementally over the past two years, the WHO also failed to adequately communicate its changing position, they say. As a result, it didn’t emphasize early enough and clearly enough the importance of ventilation and indoor masking, key measures that can prevent airborne spread of the virus.

    doesn’t think that confusion over whether the virus is airborne has had a defining impact on how the pandemic has played out. “It’s not the cause of the catastrophe we’ve seen,” he says.

    Some other researchers defend the agency’s response, given the rapidly evolving situation. “I really don’t think anybody dropped the ball, including WHO,” says Mitchell Schwaber, an infectious-diseases physician at Israel’s ministry of health and an external adviser to the WHO. “So many assumptions that we had about this virus were proven false. We always, we always were learning new things.”

    Resolving this debate about how to assess the transmission of respiratory viruses matters, say researchers, because a more deadly variant of SARS-CoV-2 could emerge at any time, and new respiratory viruses will almost certainly plague humanity at some point. It’s not clear whether the WHO and the world will be ready.

    especially in the early days, the concerns brought to the WHO about airborne transmission were “largely unfounded” and lacked credible evidence, such as the isolation of infectious virus particles from air samples. Epidemiological data from outbreak investigations were “especially weak”

    Throughout 2020, there was also mounting evidence that indoor spaces posed a much greater risk of infection than outdoor environments did. An analysis of reported outbreaks recorded up to the middle of August 2020 revealed that people were more than 18 times as likely to be infected indoors as outdoors3. If heavy droplets or dirty hands had been the main vehicles for transmitting the virus, such a strong discrepancy would not have been observed.

    Still, Li is disappointed that it took the WHO until October 2020 to acknowledge that aerosols play a part in disease transmission in community settings. And in its updated guidelines on mask use, in December 2020, the agency still emphasized shortfalls and gaps in the evidence for aerosol transmission, and the need for more “high quality research” to understand the specifics of how the virus spreads. It wasn’t until the end of April 2021 that long-range aerosol transmission was added to a question-and-answer section on the agency’s website about how the virus spreads. And the term airborne wasn’t officially added until December 2021.

    Conservative approach
    Some scientists note that the WHO’s decision to classify SARS-CoV-2 as airborne, belated as it was, is momentous. That’s because it flies in the face of the established view of respiratory virus transmission that held sway when the pandemic began — that nearly all infectious diseases are spread by droplets, not through the air. And researchers say that this change is particularly important because the organization generally takes a conservative approach. “What the WHO says is normally based on a consensus of expert advice and opinion,”

    And although the WHO has drawn strong criticism for the way in which it assessed SARS-CoV-2 transmission, some researchers don’t find the agency’s response surprising. The international community looks to the WHO for early warnings of disease outbreaks. But when it comes to science, the agency “sees its role as certifying the current expert consensus, not (usually) advancing new, tentative knowledge”, says Peter Sandman,

    Schwaber says: “Individuals and governments and public-health bodies are looking to a WHO GDG, not to conjecture. They’re looking to a WHO GDG to put out guidance. That everything that we say can be backed by evidence.”

    The WHO frequently gets attacked, “so you can understand how they’d be risk averse”

    Frieden is critical of some aspects of the WHO’s pandemic response, including how slow it was to recommend the use of masks. But he says that the agency is in a difficult position during health crises.

    In 2009, for instance, it was accused of being alarmist over the H1N1 swine influenza outbreak that petered out with few lives lost. “WHO got hit hard for that,”

    the WHO treads a difficult line, and tends to be quite conservative in its recommendations to avoid putting out information that later proves to be incorrect. “You can’t be backtracking” on advice, adds Fisher, because “then you lose complete credibility”.

    In practice, applying the precautionary approach to the question of how SARS-CoV-2 — or any newly emerged pathogen — is transmitted would mean initially assuming that all routes of transmission are possible. “That should be your starting point, and then you can strike out routes if you’re sure,” says Loomans.

    But Schwaber says that this approach carries risks. “To say, well, the best interests of the patient and the best interests of the health-care worker involve invoking the precautionary principle would also imply that there’s no downside to invoking it,” he says. Taking full precautions against airborne transmission would require major changes at hospitals, such as using negative-air-pressure isolation rooms and uncomfortable N95 masks for all staff and visitors. Such changes need to be weighed against the evidence that they are required, he says.

    Sobsey says that the WHO did adopt the precautionary principle, in part because of the advice from aerosol scientists. That’s why, he says, the agency stated in July 2020 that airborne transmission couldn’t be ruled out — and why it started placing more emphasis on ventilation as a protective measure, even though the evidence for airborne transmission was weak at the time.

    “They are not totally wrong,”

    Communication problems
    One thing that’s still missing, says Jimenez, is a clear communication campaign from the WHO. Its director-general, Tedros Adhanom Ghebreyesus, acknowledged the challenges in his opening remarks at the agency’s global conference on communicating science during health emergencies, on 7 June 2021. “Scientific processes, decision-making in an emergency context and mass communication do not fit together easily,” Tedros said, adding that “high-quality research takes time, but time is something we don’t have in an emergency”.

    During the early months of the pandemic, the WHO was fighting battles on other fronts. While it grappled with shortages of protective equipment and ventilators, it was also contending with misinformation about unproven treatments for COVID-19 and US threats to pull its funding from the organization.

    But critics say that even two years into the pandemic, the WHO hasn’t clearly communicated the risks from airborne transmission. And, perhaps as a result, governments around the world spent much of the pandemic focusing on hand washing and surface cleaning, instead of ventilation and indoor masking.

    “The cacophony of changing messages has undoubtedly contributed greatly to resistance to masks and other measures,” says Jimenez.

    On 15 December 2021, less than two weeks before the latest change in wording on the WHO’s website, Jimenez put out a call on Twitter for evidence of how governments and organizations either “don’t know how to protect their citizens, or use @WHO’s ambiguity to avoid doing so”. He enumerated more than 100 examples in which health advice at the time was at odds with airborne precautions, indicating that the message was not filtering out from the agency.

    “To say that COVID was definitively not airborne unfortunately meant there was a massive hill to climb to undo that,” she says. Right from the beginning, the WHO and other public-health authorities and governments should have emphasized that SARS-CoV-2 was a new coronavirus, and that guidelines would inevitably change, she says. “And when they do, it’s a good thing because it means we know more.”

    “We’re really talking here about two failures, not one,” says Sandman. “Being reluctant to change your mind, and being reluctant to tell people you changed your mind.” Like other public-health and scientific organizations, the WHO “are afraid of losing credibility by acknowledging that they got something wrong”, he says.

    But when Lanard worked with the WHO in 2005 to draft its risk-communications guidelines, one tenet that she advocated — to admit mistakes and errors when they occur — was removed from the final draft. She says that there were good reasons behind that decision, including that health officials in some countries could have faced imprisonment — or worse — if they had promoted information from the WHO that turned out to be incorrect. Officials and scientific advisers in several countries have received death threats during the pandemic. “Inevitably you’ll get it wrong sometimes,” says Frieden. And the WHO is in a position that means “whatever they do, they get attacked”, he says.

    On the science front, questions remain about how much of COVID-19 transmission is airborne. Sobsey says that researchers still need to come up with evidence that the airborne route makes “an important contribution to the overall disease burden”. Many on the other side of the aisle, such as Jimenez, are convinced that airborne transmission predominates.

    The US Office of Science and Technology Policy voiced strong support for this view on 23 March, when its head, Alondra Nelson, issued a statement called ‘Let’s Clear the Air on COVID’, which said “the most common way COVID-19 is transmitted from one person to another is through tiny airborne particles of the virus hanging in indoor air for minutes or hours after an infected person has been there.”

    Other viruses long suspected of being airborne — including influenza and common cold viruses — will also be scrutinized.

    In the WHO, too, attitudes have shifted, according to Sobsey. “I think there’s been a sea change in thinking at WHO as a consequence of the experience with this virus,” he says, “which is — be more precautionary, even if you’re not sure.”

    Reply
  2. Tomi Engdahl says:

    On April 18, the federal mask mandate for public transportation is due to expire. The airline industry has been pushing the Biden administration to end the mandate, but multiple public surveys suggest that the majority of Americans are still not quite ready to see it go. The Harris Poll reports six out of 10 Americans support extending the mask mandate. https://trib.al/zzvbuHq

    Reply
  3. Tomi Engdahl says:

    Vitamin D, a tale of two studies
    https://www.youtube.com/watch?v=88_CUmG6n3M

    Vitamin D Supplements for Prevention of Covid-19 or other Acute Respiratory Infections: a Phase 3 Randomized Controlled Trial (CORONAVIT)

    Vitamin D Supplements for Prevention of Covid-19 or other Acute Respiratory Infections: a Phase 3 Randomized Controlled Trial (CORONAVIT)
    https://www.medrxiv.org/content/10.1101/2022.03.22.22271707v1

    Trial of Vitamin D to Reduce Risk and Severity of COVID-19 and Other Acute Respiratory Infections (CORONAVIT)
    https://clinicaltrials.gov/ct2/show/NCT04579640

    CONCLUSIONS

    Implementation of a test-and-treat approach to correcting sub-optimal vitamin D status in the U.K. population was safe and effective in boosting 25(OH)D concentrations of adults with baseline concentrations less than 75 nmol/L.

    However, this was not associated with protection against all-cause ARI or Covid-19.

    Incidence of hospitalization for ARI was low, and we therefore lacked power to detect an effect of the intervention on severity of Covid-19 and other ARIs.

    Reply
  4. Tomi Engdahl says:

    Hurja väite ja vaatimus korona-asiantuntijaryhmän jäseneltä – ylilääkäri: ”voitaisiinko tällä todella oleellisesti estää tartuntaketjuja?”
    Koronan sairastaminen aiheuttaa aivojen rakenteissa muutoksia, mutta näiden muutosten merkitystä tai kestoa ei vielä tiedetä.
    https://www.iltalehti.fi/terveysuutiset/a/275200fc-f59a-483b-bdec-10b4c4fd5a6a

    Neurotieteilijä väittää mielipidekirjoituksessaan, että kovan tason tutkimuksen mukaan koronan sairastaminen vanhentaa aivoja keskimäärin 10 vuotta.
    Neurologian professorin mukaan väite ei ole perusteltu.
    Se lienee varmaa, että koronan sairastaminen vaikuttaa aivoihin, mutta on vielä epäselvää, mitä kaikkea voi tapahtua ja kuinka kauan vaikutus kestää.

    Jokainen lieväoireinenkin koronatartunta vanhentaa aivoja keskimäärin kymmenen vuotta. Näin väittää neurotieteilijä, solubiologian dosentti Pirta Hotulainen Helsingin Sanomien julkaisemassa mielipidekirjoituksessa.

    Hotulaisen mukaan koronan aiheuttaman aivojen vanhenemisen osoittaa korkeatasoinen Nature-lehden julkaisema tutkimus.

    – Kyseessä on Hotulaisen oma käsitys. Väite ei ole perusteltu. Tiede ei ole ihan näin yksinkertaista, kommentoi neurologian professori Risto O. Roine.

    Tutkimuksessa vertailtiin lähes 800 henkilön hyvin tarkkoja aivokuvia ennen ja jälkeen koronan sairastamisen. Tutkimus on Roineen mukaan saavuttanut suurta huomiota.

    – Pidän tutkimuksen tulosta luotettavana. Asia on kuitenkin monimutkaisempi kuin ensin voi vaikuttaa.

    Roine luonnehtii aivojen tilavuudessa mitattuja eroja karkean tason mittariksi.

    – Jotain mitattavaa aivoissa tapahtuu koronassa, se nyt tiedetään. Toistaiseksi emme kuitenkaan tiedä esimerkiksi sitä, miten nämä muutokset ovat kehittyneet, miten pysyviä muutokset ovat ja korreloivatko aivomuutokset oireiden pitkittymiseen.

    Nature-lehdessä julkaistussa tutkimuksessa kuvattiin koronapotilaiden aivoja aivan pandemian alussa. Silloin tautia aiheuttivat koronaviruksen varhaiset variantit.

    – Tämä tutkimus ei kerro mitään siitä, mitä muutoksia esimerkiksi nyt vallalla oleva omikronvariantti saa aivoissa aikaan, Roine sanoo.

    Koronan tautitilanne on erilainen kuin kaksi vuotta sitten myös rokotteiden vuoksi. Rokotteet voivat antaa suojaa myös virustartunnan aiheuttamia aivomuutoksia vastaan.

    Olisi kiinnostavaa verrata koronan aiheuttamaa aivojen tilavuuden muutosta esimerkiksi influenssan mahdollisesti aiheuttamiin muutoksiin. Influenssan vaikutuksista ei kuitenkaan ole samanlaista tutkimusta tehty.

    Jokainen lieväoireinenkin koronatartunta vanhentaa aivoja keskimäärin kymmenen vuotta
    Tutkijat havaitsivat, että aivoista hävisi massaa enemmän kuin olisi hävinnyt normaalin vanhenemisen seurauksena.
    https://www.hs.fi/mielipide/art-2000008727297.html

    Reply
  5. Tomi Engdahl says:

    CHINA STRAPS LOUDSPEAKERS TO ROBOT DOG SO IT CAN SCREAM AT PEOPLE TO STAY HOME
    https://futurism.com/the-byte/china-loudspeakers-robot-dog-stay-home

    Reply
  6. Tomi Engdahl says:

    A Case Of Shrunken Brains: How Covid-19 May Damage Brain Cells
    https://www.forbes.com/sites/williamhaseltine/2022/03/21/a-case-of-shrunken-brains-how-covid-19-may-damage-brain-cells/

    Comparing brain volume before and after individuals were exposed to SARS-CoV-2, this study documents significant cortical gray matter loss, equivalent to nearly 10 years of aging. Gweanaelle Douaud, the study’s first author and Professor at the University of Oxford, says that infected individuals display structural “differences over time above and beyond any potential baseline differences.” Most strikingly, individuals that experienced no or only mild symptoms with Covid-19 displayed specifically significant changes, but cortical damage seems to occur regardless of disease severity, age, or sex. The effect of vaccination status not yet been investigated. It may be years before the long-term consequences of these structural differences are fully understood.

    Reply
  7. Tomi Engdahl says:

    A study examined the impact of antidepressants on Covid-19 hospitalizations.

    Common Antidepressant Likely Cuts Risk Of Covid Hospitalization, Study Finds
    https://www.forbes.com/sites/roberthart/2022/04/06/common-antidepressant-likely-cuts-risk-of-covid-hospitalization-study-finds/

    Fluvoxamine, a cheap and widely available pill used around the world to treat mental illness, is very likely to reduce the risk of being hospitalized with Covid-19, according to new peer reviewed research published in JAMA Network Open, opening up another possible treatment option for the disease using a medicine with a decades-long track record.

    Based on an analysis of data from three different clinical trials, the researchers said there is a “high probability” fluvoxamine was associated with “at least a moderate reduction in Covid-19 hospitalizations.”

    The trials, which enrolled a total of nearly 2,200 unvaccinated Covid-positive patients from the U.S., Brazil and Canada, evaluated how well 100mg of fluvoxamine taken twice a day reduced the risk of being hospitalized with the disease.

    The analysis, coupled with the fact that fluvoxamine is “immediately available, safe and inexpensive” around the world, makes the drug a “reasonable option for high-risk outpatients” who don’t have access to other Covid treatments like antiviral drugs or monoclonal antibodies, the researchers said.

    However, they stressed it is important clinical trials examining fluvoxamine continue to bolster the results, especially those studying lower doses of the drug and how effective it is in vaccinated individuals.

    A similar and widely available antidepressant, fluoxetine, should also be studied for its potential to treat Covid-19, the researchers said.

    The researchers noted that circulating Covid variants varied between studies and all predated omicron and delta variants, which could affect the baseline levels of risk and any reduction calculated.

    Reply
  8. Tomi Engdahl says:

    Anti-Covid Pill Coming To All U.S. Pharmacies Under Reported Biden Plan
    https://lm.facebook.com/l.php?u=https%3A%2F%2Fwww.forbes.com%2Fsites%2Fzacharysmith%2F2022%2F04%2F22%2Fanti-covid-pill-coming-to-all-us-pharmacies-under-reported-biden-plan%2F%3Futm_campaign%3Dforbes%26utm_source%3Dfacebook%26utm_medium%3Dsocial%26utm_term%3DGordie&h=AT14OqDqdxcGC2xHKX_5FcNAOuOR6SIUYqju9x1CpsUHyahvgM00HuN7snYe_MG-tKMrsw3h3X0Ymb6Eh4k8tS9zAeZDeK-fnmegZZzf71Zu9TDsHfcyWW10RQdSWIxt0A

    The Biden Administration is working on a plan to make Pfizer’s Covid-19 antiviral pill Paxlovid available across the U.S. following shortages of the lifesaving drug, Bloomberg reported Friday, citing an unnamed administration official.

    Reply
  9. Tomi Engdahl says:

    Smell loss from Covid-19 has been linked to depression symptoms and dementia, researchers at Virginia Commonwealth University said.

    Omicron May Be Less Likely To Cause Smell Loss Than Other Covid Variants, Researchers Say
    https://www.forbes.com/sites/zacharysmith/2022/05/10/omicron-may-be-less-likely-to-cause-smell-loss-than-other-covid-variants-researchers-say/?utm_campaign=socialflowForbesMainFB&utm_medium=social&utm_source=ForbesMainFacebook&sh=2482c4e74016

    Reply
  10. Tomi Engdahl says:

    https://hackaday.com/2022/06/12/hackaday-links-june-12-2022/

    And finally, from the, “Oh, hell no!” files, we present this automated nose-probing robot. The Korean nasopharyngeal sampling robot, obviously built to aid with COVID testing, is billed as “inherently safe.” While we can see that a small, lightweight robot with built-in force sensors would be much safer than a big general-purpose industrial robot for such a delicate task, we won’t be lining up to help prove it anytime soon. Although we have to say, we’ve heard enough horror stories about testing to believe that human swabbers are sometimes overworked, undertrained, or just plain pissed-off enough to do some real damage, so getting the human element out of testing might not be a bad idea.

    An Inherently Safe NP Swab Sampling Robot for COVID-19
    https://www.youtube.com/watch?v=1ymRmeUqK78

    [Specifications and Advantages]
    - 3 DOF (RCM, swab insertion, swab rotation)
    - Nonsingular RCM mechanism (-45~90 deg)
    - Extremely small distal mass (35 g)
    - Mechanical compliance with accurate limit force (0.5 N)
    - Automatic swab releasing mechanism for recapping

    [Further works]
    - Complete the entire system considering vial capping and sanitization.
    - Apply face and nostril detection algorithms.
    - Develop a safety algorithm using the force sensor.
    - Perform the clinical tests.
    - Most of all, make it less scary :)

    Reply
  11. Tomi Engdahl says:

    The Fatal Flaw of the Pulse Oximeter Racial bias led to faulty product design led to its inability to work properly with melanin-rich skin
    https://spectrum.ieee.org/pulse-oximeters-encode-racial-bias-with-clear-consequences-for-covid-19-patients?share_id=7108656

    If someone is seeking medical care, the color of their skin shouldn’t matter. But, according to new research, pulse oximeters’s performance and accuracy apparently hinges on it. Inaccurate blood oxygen measurements, in other words, made by pulse oximeters have had clear consequences for people of color during the COVID-19 pandemic.

    “That device ended up being essentially a gatekeeper for how we treat a lot of these patients,”

    For decades, scientists have found that pulse oximeters, devices which estimate blood oxygen saturation, can be affected by a person’s skin color. In 2021, the FDA issued a warning about this limitation of pulse oximeters. The agency says they plan to hold a meeting on pulse oximeters later this year. Because low oxygen saturation, called hypoxemia, is a common symptom of COVID-19, while low blood oxygen levels qualify patients to receive certain medications. In the first study to examine this issue among COVID-19 patients, published in JAMA Internal Medicine in May, researchers found that the inaccurate measurements resulted in a “systemic failure,” delaying care for many Black and Hispanic patients, and in some cases, preventing them from receiving proper medications. The study adds a growing sense of urgency to an issue raised decades ago.

    Pulse oximeters work by passing light through part of the body, usually a finger. These devices infer a patient’s blood-oxygen saturation (i.e. the percentage of hemoglobin carrying oxygen) from the absorption of light by hemoglobin, the pigment in blood that carries oxygen. In theory, pulse oximeters shouldn’t be impacted by anything other than the levels of oxygen in the blood. But research has shown otherwise.

    “If you have melanin, which is the pigment that’s responsible for skin color… that could potentially affect the transmittance of the light going through the skin,”

    The researchers found that the pulse oximeter overestimated blood oxygen saturation by an average of 1.7 percent for Asian patients, 1.2 percent for Black patients, and 1.1 percent for Hispanic patients.

    To qualify for COVID-19 treatment with remdesivir, an antiviral drug, and dexamethasone, a steroid, patients had to have a blood oxygen saturation of 94 percent or less. Based on the researchers’ model, nearly 30 percent of the 6,673 patients they had enough information about to predict their arterial blood gas measurements met this cutoff. Many of these patients, most of whom were Black or Hispanic, had their treatment delayed for between five and seven hours, with Black patients being delayed on average one hour more than white patients.

    “We found that in Black and Hispanic patients, there was a significant delay in identifying severe COVID compared to white patients,”

    There were 451 patients who never qualified for treatments but that the researchers predicted likely should have; 55 percent were Black, while 27 percent were Hispanic.

    The study “shows how urgent it is to move away from pulse [oximeters],”

    Studies finding that skin color can impact pulse oximeters go back as far as the 1980s. Despite knowledge of the issue, there are few ways of addressing it. Wu says increasing awareness helps, and that it also may be helpful to more do more arterial blood gas analyses.

    A long-term solution will require changing the technology

    Although the problem of the racial bias of pulse oximeters has no immediate solution, said the researchers, they are confident the primary hurdle is not technological.

    “We do believe that technology exists to fix this problem, and that would ultimately be the most equitable solution for everybody,” said Wu.

    Reply
  12. Tomi Engdahl says:

    ‘Racially biased’ devices caused delayed treatment for Black COVID-19 patients
    Pulse oximeters overestimated blood oxygen levels in minorities
    https://www.science.org/content/article/racially-biased-devices-caused-delayed-treatment-black-covid-19-patients

    COVID-19 treatment for Black patients was delayed because of inaccurate blood oxygen measurements from “racially biased” medical instruments, STAT reports. Pulse oximeters, which indirectly measure oxygen saturation levels using light that passes through blood in a fingertip, are widely used but have been criticized before because they can give erroneous measurements in darker skinned patients.

    In a study published on 31 May in JAMA, researchers analyzed data from more than 7000 COVID-19 patients who were treated in five hospitals in Baltimore between 2020 and 2021. They found that, compared with white patients, pulse oximeters overestimated blood oxygen levels by 1.2% for Black patients, 1.1% among Hispanic patients, and 1.7% for Asian patients. Although small, these differences were significant, STAT notes, because Black and Hispanic patients were 29% and 23%, respectively, less likely than white patients to be recognized as eligible for COVID-19 medications. Black patients whose eligibility was eventually confirmed by pulse oximeters had treatment delayed by an average of 1 hour, compared with white patients, the JAMA study found.

    Pulse oximeters without the known racial bias are available, but are not commonly used yet. A JAMA commentary urged their adoption. “Although the device measurement error is real and based purely on optics, the decision to do nothing about a faulty device is a human one, and one that can and should be corrected,” its authors said.

    Faulty oxygen readings delayed Covid treatments for darker-skinned patients, study finds
    https://www.statnews.com/2022/05/31/faulty-oxygen-readings-delayed-covid-treatments-darker-skin-patients/

    Widely used pulse oximeters, which measure oxygen levels by assessing the color of the blood, have been under increasing scrutiny for racial bias because they can overestimate blood oxygen levels in darker-skinned individuals and make them appear healthier than they actually are. A 2020 study comparing oxygen levels measured by the devices with readings taken from “gold standard” arterial blood samples found pulse oximeters were three times less likely to detect low oxygen levels in Black patients than in white patients.

    The study provided evidence that undetected low oxygen levels led to delays in Black and Hispanic patients receiving potentially lifesaving therapies such as the drugs remdesivir and dexamethasone, and in many cases, led to patients not receiving treatment at all.

    “These are likely patients who were seen in emergency rooms and sent home,” said Tianshi David Wu, an assistant professor of medicine at Baylor College of Medicine and co-lead author of the new study. He called pulse oximeters “de facto gatekeepers” for Covid treatment because low readings on these devices are key criteria for deciding how aggressively patients should be treated. “There are patients that probably should have had these therapies, and the majority were Black patients.”

    The authors, both pulmonary critical care physicians who have been treating Covid patients, said they were motivated to determine whether the inaccuracies in readings were clinically relevant because they felt many physicians — despite the fact that concerns about bias in pulse oximeters have been raised in the scientific literature for decades — remained unaware of how the inaccuracies in these critically important diagnostic devices might impact patients of color. The issue has not been part of standard medical school curricula, they said.

    For Covid, drug treatments are indicated when oxygen levels fall below 94%, yet the study showed many patients had blood oxygen levels below that level, despite what their pulse oximeters read. “It’s a good illustration of how a relatively small bias in accuracy can have a large effect,” said Wu.

    Black patients whose eligibility for Covid treatment was eventually confirmed by pulse oximetry had treatment delayed by an hour, compared to white patients, the researchers found. (Patients who never received treatment were not included in this accounting.) Wu said it was not clear if that delay was clinically significant.

    The study is an excellent addition to accumulating evidence that the inaccuracies in these devices are taking a large toll

    Previous studies have shown that undetected low oxygen rates can lead to sequential organ failure and death in patients of color, but those studies were not conducted specifically on Covid patients as the new study was.

    “We’ve been searching for reasons Black and Hispanic people were more likely to die early in the pandemic,” Valley said. “This is pretty depressing that we had treatments available, many of those treatments tied to oxygen levels. Decisions on whether or not people were admitted to hospitals or put on ventilators, those were all based on blood oxygen levels.”

    “We were recommending that all the time, ‘If your O2 levels are not low, don’t come to the hospital,’” he said. “We don’t know how much harm that caused.”

    He said options for getting more accurate readings for darker-skinned patients, such as taking painful arterial blood samples when lighter-skinned patients can use a simple clip-on device for the same measurement, are “really just trading one bias for another.”

    “There is in my opinion only one fix,” he added. “We need pulse oximeters that work as well in Black patients as they do in white patients.” Many biomedical engineers have said that fixing the devices is not difficult technically; the issue is in getting the devices tested and approved, and having hospitals replace tens of thousands of the devices, which are more costly than the consumer versions.

    “The decision to do nothing about a faulty device is a human one,” the authors wrote, “and one that can and should be corrected.”

    Reply
  13. Tomi Engdahl says:

    Despite countless buyout offers, Stefania Triva’s snubbing the dealmakers and keeping the company firmly in the family.

    Meet The Family-Owned Company That Invented Swabs For Covid Tests
    https://www.forbes.com/sites/giacomotognini/2022/02/06/meet-the-family-owned-company-that-invented-swabs-for-covid-tests/?utm_source=ForbesMainFacebook&utm_campaign=socialflowForbesMainFB&utm_medium=social

    Swabs for Covid testing made Copan CEO Stefania Triva a billionaire. But, despite countless buyout offers, she’s snubbing the dealmakers and keeping the company firmly in the family.
    On a foggy early Janu­ary day in the northern Italian city of Brescia, which was hit hard by the first wave of Covid-19 in 2020, Stefania Triva, 57, sets out two swabs side by side on her desk. One is a regular cotton Q-tip, the other a special “flocked” swab, studded with tiny synthetic fibers that resemble split ends.

    That special swab—made by her family’s 43-year-old company, Copan—is the key element in hundreds of millions of Covid-19 PCR tests currently being plunged into noses around the world. Sitting in front of a large red-and-yellow abstract painting and a corkboard filled with photos of her three children, Triva delves into the subtle differences that make her flocked swabs the gold standard.

    “In a cotton swab, the fibers are twisted around the stick, creating a cage that traps the sample,” she says, pointing to the thickly wound Q-tip. “But it only releases 20% of that sample. In a flocked swab, thanks to the mechanics of how the fibers are attached to the stick, you have the opposite: 80% is released.”

    Those swabs—invented by Copan in 2003 and the subject of ongoing litigation with its leading rival, Maine-based Puritan Medical Products—have helped drive the company’s enormous growth; it manufactured 415 million of them in 2020, more than double the 2019 amount.

    After ramping up production, Copan now has the capacity to produce 1 billion a year. Net income nearly quintupled in 2020, to $79 million, on revenue of $372 million. It blew past that figure in 2021, with sales growing to $445 million. (Net income was not yet available at press time.) A full 84% of Copan’s sales come from flocked swabs, which have been used in at least a billion molecular tests conducted in doctor’s offices and clinics around the world since the beginning of the pandemic. (That figure doesn’t include swabs for rapid tests or at-home kits, a tiny fraction of Copan’s business.)

    “We love being free, eclectic and fast, knowing that we sometimes need to take calculated risks.”
    Stefania Triva

    Copan’s runaway success has attracted the attention of several investment funds—Triva won’t name them—but the daughter of the company’s founder has no intention of selling. “We receive offers almost every day,” she admits. Confirms her nephew and Copan’s 32-year-old heir apparent, Giorgio Triva: “We’re at a size similar to other firms being sought out by these funds.”

    The growth of the past two years means Copan can continue expanding while keeping ownership firmly within the family. “We love being free, eclectic and fast, knowing that we sometimes need to take calculated risks,” Triva says.

    Reply
  14. Tomi Engdahl says:

    Tiesitkö, että Helsingin Yliopistossa on kehitetty uudenlainen nenäsuihke, joka voisi toimia biologisena maskina koronavirusta vastaan? Tutkijatohtori Anna Mäkelän mukaan vastaavanlainen lääkinnällinen laite voisi tulevaisuudessa olla mahdollinen myös muille hengitysteiden kautta tarttuville virustaudeille, kuten influenssalle.

    Podcastissa kuulet lisää tästä suomalaisesta innovaatiosta. Live-podcast on kuunneltavissa suosituimmissa podcastpalveluissa (ÄLYcast) sekä linkin kautta (jakso 6.)

    https://dra.fi/fi/aly-2020/

    Reply
  15. Tomi Engdahl says:

    Latest COVID Strain Can Cause “Strange” New Symptom At Night, Says Professor
    “That mix of your immune system and the virus being slightly different might give rise to a slightly different disease – with strangely enough – night sweats being a feature,” explained Professor Luke O’Neill.
    https://www.iflscience.com/latest-covid-strain-can-cause-strange-new-symptom-at-night-says-professor-64487

    Reply
  16. Tomi Engdahl says:

    The evidence points to the Huanan market.

    The COVID Lab Leak Theory Is Dead. Here’s How We Know The Virus Came From A Wuhan Market
    The evidence points to the Huanan market
    https://www.iflscience.com/the-covid-lab-leak-theory-is-dead-heres-how-we-know-the-virus-came-from-a-wuhan-market-64896

    Together, these papers paint a coherent evidence-based picture of what took place in the city of Wuhan during the latter part of 2019.

    The take-home message is the COVID pandemic probably did begin where the first cases were detected – at the Huanan Seafood Wholesale Market.

    The Huanan market was the pandemic epicentre. From its origin there, the SARS-CoV-2 virus rapidly spread to other locations in Wuhan in early 2020 and then to the rest of the world.

    The Huanan market is an indoor space about the size of two soccer fields. The word “seafood” in its name leaves a misleading impression of its function. When I visited the market in 2014, a variety of live wildlife was for sale including raccoon dogs and muskrats.

    Wildlife were also on sale in the Huanan market in 2019. After the Chinese authorities closed the market on January 1 2020, investigative teams swabbed surfaces, door handles, drains, frozen animals and so on.

    Most of the samples that later tested positive for SARS-CoV-2 were from the south-western corner of the market. The wildlife I saw for sale on my visit in 2014 were in the south-western corner.

    This establishes a simple and plausible pathway for the virus to jump from animals to humans.

    The opportunity to find the direct animal host has probably passed. As the virus likely rapidly spread through its animal reservoir, it’s overly optimistic to think it would still be circulating in these animals today.

    The absence of a definitive animal source has been taken as tacit support for counter claims that SARS-CoV-2 in fact “leaked” from a scientific laboratory – the Wuhan Institute of Virology.

    Death knell for the lab leak theory
    The lab leak theory rests on an unfortunate coincidence: that SARS-CoV-2 emerged in a city with a laboratory that works on bat coronaviruses.

    Some of these bat coronaviruses are closely related to SARS-CoV-2. But not close enough to be direct ancestors.

    Sadly, the focus on the Wuhan Institute of Virology has distracted us from a far more important connection: that, like SARS-CoV-1 (which emerged in late 2002) before it, there’s a direct link between a coronavirus outbreak and a live animal market.

    For the lab leak theory to be true, SARS-CoV-2 must have been present in the Wuhan Institute of Virology before the pandemic started. This would convince me.

    But the inconvenient truth is there’s not a single piece of data suggesting this. There’s no evidence for a genome sequence or isolate of a precursor virus at the Wuhan Institute of Virology. Not from gene sequence databases, scientific publications, annual reports, student theses, social media, or emails.

    Even the intelligence community has found nothing. Nothing. And there was no reason to keep any work on a SARS-CoV-2 ancestor secret before the pandemic.

    Despite political barriers and a salivating media, the evidence for a natural animal origin for SARS-CoV-2 has increased over the past two years.

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  17. Tomi Engdahl says:

    Heikki Hiilamon kolumni: Korona-aika lietsoi professorikunnassa erikoisen ilmiön – tieteentekijät mestaroivat alalla, jota eivät tunne
    Suutari pysyköön lestissään, kehottaa vanha sananlasku. Samaa voisi suositella professorikunnalle. Korona-aika opetti, että kun tieteentekijä ryhtyy kansalaisaktiiviksi, lopputulos ei ole tiedettä.
    https://yle.fi/uutiset/3-12597842?origin=rss

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  18. Tomi Engdahl says:

    Masks for COVID: Updating the evidence
    https://www.fast.ai/2022/07/04/updated-masks-evidence/

    Danish study of surgical masks with “several design limitations” which “demonstrated only a modest benefit in limiting COVID-19 transmission”. The authors note that “laboratory studies have demonstrated the ability of surgical masks to block SARS-COV-2 and other viruses”, with the masks “60%–70% effective at protecting others and 50% effective at protecting the wearer”.

    “masks as a group had protective efficacy in excess of 80% against clinical influenza-like illness.”

    An observational study of Beijing households analyzed the impact of mask use in the community on COVID-19 transmission, finding that face masks were 79% effective in preventing transmission, if used by all household members prior to symptoms occurring.

    found that transmission was around 7.5 times higher in countries that did not have a mask mandate or universal mask use, a result similar to that found in an analogous study of fewer countries. Similar results were found by numerous other papers.

    A paper investigating an upper bound on one-to-one exposure to infectious human respiratory particles concludes that “face masks significantly reduce the risk of SARS-CoV-2 infection compared to social distancing. We find a very low risk of infection when everyone wears a face mask, even if it doesn’t fit perfectly on the face.” They calculate that “social distancing alone, even at 3.0 m between two speaking individuals, leads to an upper bound of 90% for risk of infection after a few minutes”, but that when both source and susceptible wear a well-fitting FFP2 mask, there is only 0.4% after one hour of contact. They found that to achieve good fit it is important to mold the nose piece wire to the size of the nose, rather than leaving it in a sharp folded position.

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  19. Tomi Engdahl says:

    Mask wearing in community settings reduces SARS-CoV-2 transmission
    https://www.pnas.org/doi/10.1073/pnas.2119266119

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  20. Tomi Engdahl says:

    Open Source: Free As The Air You Breathe
    https://hackaday.com/2022/09/20/open-source-free-as-the-air-you-breathe/

    [Carolyn Barber] recently interviewed a 15-year-old who has been making Corsi-Rosenthal boxes for people in his community that are at risk for COVID. Not only is it great that a teenager has such community spirit, but it is also encouraging that [Richard Corsi] and [Jim Rosenthal] made an open-source design that can help people at a greatly reduced cost.

    Making Spaces Safer
    An easy-to-build box can help in the fight against COVID-19.
    https://news.eb.com/level2/making-spaces-safer/

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  21. Tomi Engdahl says:

    Post-COVID-19 syndrome: retinal microcirculation as a potential marker for chronic fatigue
    https://www.medrxiv.org/content/10.1101/2022.09.23.22280264v1

    Post-COVID-19 syndrome (PCS) summarizes persisting sequelae after infection with the severe-acute-respiratory-syndrome-Coronavirus-2 (SARS-CoV-2). PCS can affect patients of all covid-19 disease severities. As previous studies revealed impaired blood flow as a provoking factor for triggering PCS, it was the aim of the present study to investigate a potential association of self-reported chronic fatigue and retinal microcirculation in patients with PCS, potentially indicating an objective biomarker.

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  22. Tomi Engdahl says:

    Intranasal Vaccines: A Potential Off-Ramp For Coronavirus Pandemics
    https://hackaday.com/2022/09/29/intranasal-vaccines-a-potential-off-ramp-for-coronavirus-pandemics/

    An interesting and also annoying aspect about the human immune system is that it is not a neat, centralized system where you input an antigen pattern in one spot and suddenly every T and B lymphocyte in the body knows how to target an intruder. Generally, immunity stays confined to specific areas, such as the vascular and lymph system, as well as the intestinal and mucosal (nasal) parts of the body.

    The best outcome for a vaccine is when it both protects the individual, while also preventing further infections as part of so-called sterilizing immunity.

    This is where the current batch of commonly used SARS-CoV-2 vaccines are showing a major issue, as they do not provide significant immunity in the nasal passage’s mucosal tissues, even though this is where the virus initially infects a host, as well as where it replicates and infects others from. Here intranasal vaccines may achieve what OPV did for polio.

    Going For The Gut Punch

    Logically, targeting intranasal (IN) vaccines to address a coronavirus makes a lot of sense, since coronaviruses are among a group of viruses implicated in e.g. the common cold. Like rhino- and adenoviruses, they are viruses which are strongly adapted to the respiratory system, much like how the polio virus prefers the intestinal tract. Because of this knowledge, multiple intranasal vaccines have been developed and approved, most recently in India and China.

    The Chinese vaccine is developed by CanSino Biologics, and it is essentially the same as the regular viral vector-based intramuscular (IM) vaccine, except in a form that allows it to be inhaled in a nebulizer. It is approved for use as a booster after a primary IM-based vaccination course.

    The Indian vaccine (BBV154), produced by Bharat Biotech, is intended as a two-dose IN vaccination, rather than only as a booster. Both the CanSino and Bharat vaccines are based on a non-replicating adenovirus vector, which means that no special vaccine formulation is needed for the nebulized form. Upon inhalation of the nebulized vaccine, the adenovirus vector will simply do what it naturally does: get into mucosal cells to deposit its genetic payload.

    These IN vaccines join the Iranian Razi Cov Pars vaccine (three-dose recombinant protein subunit-based with IN booster), which received emergency use authorization in Iran on October 31st of 2021. While large-scale efficacy data is not available yet for any of these vaccines, a recent US study in mice has confirmed that a viral vector-based vaccine can induce robust immunity. In a 2021 study by Van Doremalen et al. using the ChAdOx1 nCoV-19/AZD1222 (AstraZeneca) viral vector it was found that IN vaccination of hamsters and macaques prevented large-scale infection and significantly reduced the mucosal viral load.

    These findings are essentially why scientists in the West are pushing for IN vaccines to be made available, with some US scientists, including Scripps Research’s Eric Topol, calling for an IN equivalent of the Operation Warp Speed (OWS) which originally produced the IM vaccines that have been in use in Europe and North America since late 2020. The hope is that an approved IN vaccine in the West may counteract the continued spread of the SARS-CoV-2 virus amidst waning efficacy of the IM vaccines against new virus variants.

    An aspect of the SARS-CoV-2 virus that is becoming ever more pertinent is the collection of chronic conditions referred to as ‘Long COVID’, which includes blood clots (Knight et al., 2022) and negative neurologic outcomes (Xu et al., 2022). Notable with such Long COVID cases is that it was not necessary for the patient to exhibit severe COVID-19 symptoms, nor to have been hospitalized.

    Although an infection with SARS-CoV-2 provides convalescent immunity (i.e. from fighting off an infection) within the mucosal tissues, this immunity fades over time, much like the immunity provided by SARS-CoV-2 vaccination. Since each infection comes with the risk of permanent damage (and death), the ideal way forward would seem to be to have an IN booster twice a year (matching the ~6 month fall-off in efficacy), that may provide sterilizing immunity.

    Making IN Vaccines Work

    Despite what one may think with already three IN vaccines in use with (emergency) authorization, IN vaccines are not very common. Perhaps the most well-known attempt dates from before the SARS-CoV-2 pandemic, in the form of the FluMist vaccine (LAIV) which to this date is the only FDA-approved IN vaccine. This flu vaccine is notable for using attenuated influenza virus, rather than the inactivated virus of IM flu vaccines, and provides efficacy comparable to IM flu vaccines. Its main attractiveness is that it avoids the use of needles, and does not require trained personnel to administer the vaccine.

    What is challenging with testing IN vaccines is the lack of standardized tests for mucosal immunity. This is largely due to IN not having received much attention, which makes running large-scale trials of such vaccines and assessing their efficacy largely unexplored territory for many regulators. Even so, AstraZeneca and other pharmaceutical companies are currently running trials for IN SARS-CoV-2 vaccines.

    Whether or not an IM vaccine can be adapted to work as an IN vaccine mostly depends on the type. The sub-unit type of vaccine (e.g. Razi Cov Pars) likely requires an adjuvant in order to create a strong enough response, while adenovirus-based IM vaccines can basically be used as-is, since as noted earlier, adenoviruses naturally infect mucosal tissue. For e.g. the AstraZeneca IN vaccine trials that are currently ongoing, the challenge would seem to be mostly in defining the efficacy, in the absence of clear protocols and techniques.

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