The Plan to Stop Every Respiratory Virus at Once

When London vanquished cholera in the 19th century, it took not a vaccine, or a drug, but a sewage system.

London never experienced a major cholera outbreak after 1866. All that was needed was 318 million bricks, 23 million cubic feet of concrete, and a major reengineering of the urban landscape.

The United States eliminated yellow fever and malaria, for example, with a combination of pesticides, wide-scale landscape management, and window screens that kept mosquitoes at bay.

In 1977, a single ill passenger transmitted the flu to 72 percent of the people on an Alaska Airlines flight. The plane had been grounded for three hours for repairs and the air-recirculation system had been turned off, so everyone was forced to breathe the same air.

….wearing face masks to walk down the street and then taking them off as soon as they sit down at restaurants, which are operating at full capacity. It’s like some kind of medieval ritual, she says, with no regard for how the virus actually spreads.

..the vaccines looked like they were going to quickly end the pandemic—but then they didn’t,

We just have to reimagine how air flows through all the places we work, learn, play, and breathe.

A rule of thumb, Noakes suggested, is at least four to six complete air changes an hour in a room, depending on its size and occupancy.

The challenge ahead is cost. Piping more outdoor air into a building or adding air filters both require more energy and money to run the HVAC system.

Nosocomial respiratory syncytial virus infections: the "Cold War" has not ended

Respiratory syncytial virus (RSV) is a major nosocomial hazard on pediatric wards during its annual outbreaks. It produces significant morbidity in young children and is most severe in those with underlying conditions, especially cardiopulmonary and immunosuppressive diseases. In older patients, RSV may exacerbate an underlying condition or pulmonary and cardiac manifestations.

RSV is primarily spread by close contact with infectious secretions, either by large-particle aerosols or by fomites and subsequent self-inoculation, and medical staff are often instrumental in its transmission. Thus, integral to any infection control program is the education of personnel about the modes of transmission, the manifestations, and the importance of RSV nosocomial infections. Hand washing is probably the most important infection control procedure. The choice of barrier controls should be decided by individual institutions depending on the patients, the type of ward, and the benefit relative to cost.

Respiratory viruses may be transmitted by any of 3 possible mechanisms. The first is transmission by small-particle aerosols (<10 µm mass median diameter), usually generated by coughing or sneezing, which may traverse distances ≥1.8 m. Transmission by small-particle aerosols, therefore, does not require close or direct contact with the infected subject or with infectious secretions. Typically, viruses spread by small-particle aerosols cause explosive outbreaks of infection in a susceptible population, such as occur with measles, varicella, and sometimes influenza. The second mechanism is transmission by droplets or large particles. In contrast to aerosols of small particles, aerosols of large particles require close person-to-person contact, usually at a distance of ≤0.9 m, for infection to occur. Third, the virus can also be transmitted via fomites; that is, by self-inoculation after touching contaminated surfaces. For this to occur, the virus must be able to remain infectious on environmental surfaces, to be transferred to the skin, and to remain infectious for a time sufficient to allow self-inoculation into the respiratory tract.

Tuberculosis

Do not repeat testing unless there are new risk factors since the last negative test.

The law requires that a health care provider administer this questionnaire.

California law requires that school staff working with children and community college students be free of infectious tuberculosis (TB).

California law requires that school staff working with children and community college students be free of infectious tuberculosis (TB). These updated laws reflect current recommendations for targeted TB testing from the federal Centers for Disease Control and Prevention (CDC), the California Department of Public Health (CDPH), the California Conference of Local Health Officers and the California Tuberculosis Controllers Association (CTCA).

What specifically did AB 1667 change on January 1, 2015?

1. Replaces the mandated TB examination on initial employment with a TB risk assessment, and TB testing based on the results of the TB risk assessment, for the following groups:

   1. Persons initially employed by a school district, or employed under contract, in a certificated or classified position (California Education Code, Section 49406)

   2. Persons initially employed, or employed under contract, by a private or parochial elementary or secondary school or any nursery school (California Health and Safety Code, Sections 121525 and 121555)

   3. Persons providing for the transportation of pupils under authorized contract (California Health and Safety Code, Section 121525)

Ethics of refusal to treat patients as a social statement

If we are to maintain the special social relationship that enables so much of what we do, the suffering of our patients must never be accepted as the proper battleground upon which to act out our displeasure with poorly-conceived public policies.

James W. Jones, MD, PhD, MHA,
Laurence B. McCullough, PhD, and
Bruce W. Richman, MA, 
Houston, Tex; and Columbia, Mo

Health promotion ethics is moral deliberation about health promotion and its practice. It is regaining attention over the broader literature on public health issues. Health promotion can be approached as a normative ideal and as a practice. Normative ideal deals with the equity of social arrangements. The two main ethical questions that arise are:

a. What is a good society?
b. What should health promotion contribute to a good society?

Health promotion deals with four main issues: the potential for health promotion to limit or increase the freedom of individuals; health promotion as a source of collective benefit; the possibility that heath promotion strategies might stigmatize those who are at higher risk of disease; importance of distributing the benefits of health promotion fairly. Health promotion ethics should thoughtfully connect social and political philosophy with and applied, empirically informed ethics of practice.

1. Producing benefits, often but not exclusively health benefits, and often interpreted in health policy as a utilitarian commitment to maximizing aggregate health benefits.

2. Preventing harms, often health harms, such as preventable morbidity and premature death.

3. Distributing health benefits fairly or distributive justice (fair distribution of social goods).

4. Procedural justice (fair process), participation, and transparency.

5. Respecting individual autonomy and liberty of action.

6. Respecting and fulfilling universal human rights.

7. Respecting privacy and confidentiality.

8. Protecting non-dominant subgroups from marginalization and stigmatization.

9. Building and maintaining trust.

N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel

Findings

In this pragmatic, cluster randomized clinical trial involving 2862 health care personnel, there was no significant difference in the incidence of laboratory-confirmed influenza among health care personnel with the use of N95 respirators (8.2%) vs medical masks (7.2%).

Meaning

As worn by health care personnel in this trial, use of N95 respirators, compared with medical masks, in the outpatient setting resulted in no significant difference in the rates of laboratory-confirmed influenza

Contamination by respiratory viruses on outer surface of medical masks used by hospital healthcare workers

In *healthcare* settings, medical masks are used by HCWs to protect from splashes and sprays of blood and body fluids, and by *sick* individuals to prevent spread of respiratory infections to others.

Respiratory pathogens may be present on used masks layers and lead to infection of the wearer.

One in ten masks were positive for any virus which highlights the risk of self-contamination to the wearer, particularly on doffing.

While using masks, or during long periods of time of re-using them, these pathogens may cause infection through hand or skin contamination, ingestion, or mucus membrane contact.