My reaction to these pictures was one of a joyful heart.
Seeing pictures like these show that people being kind to each other is not dead like many people think it is. These pictures just go to show that there are still good people left in the world. Any time when there is doubt about the goodness or kindness of other people, just look back at pictures like these and you will see that there is still goodness in America.
This was on Facebook. This is important information both for people with parents or other family members, or other loved ones, already in nursing homes, and those who may have parents or other family members, or other loved ones, in a nursing home in the not too distant future.
Two-thirds of coronavirus-related deaths in metropolitan Phoenix have occurred in nursing homes and other long-term care facilities, AARP’s Arizona director on Thursday told members of a House of Representatives subcommittee examining how COVID-19 has affected such facilities in similar ways all across the country.
“AARP has heard from thousands of people all across the country whose loved ones – their mothers, fathers, grandparents, aunts, uncles and dear friends – lost their lives in nursing homes,” Dana Marie Kennedy told the House Ways and Means Committee’s health subcommittee. “We are deeply alarmed by the rising death toll and the continued lack of urgent action. Much more is needed now to protect residents, staff, their loved ones and the surrounding communities from this disease.”
Kennedy was one of seven witnesses to testify during a virtual subcommittee hearing on how the coronavirus has had an impact on nursing homes. Nationwide, more than 50,000 nursing home residents have succumbed to COVID-19, according to the Kaiser Family Foundation.
Kennedy shared AARP’s five-point plan for helping to stem the continued loss of life and improve conditions in the nation’s long-term care facilities. The points are:
Ensuring adequate staff and the ability of long-term care ombudsmen to have access to the facility
Requiring transparency of COVID-19 data, including cases at a facility, transfer and discharge rights, and how nursing homes are using the federal relief funds they have received
Requiring facilities to provide residents and their families with virtual visits
Rejecting proposals to grant broad legal immunity to nursing homes and other long-term care facilities
All of the witnesses at the hearing, which included a Texas woman who lost her brother to the virus, a licensed practical nurse as well as a researcher and advocates, said they continue to hear firsthand reports that long-term care facilities still lack the PPE they need and that testing for the virus is still lacking.
“Today we are still understaffed, overworked and don’t have enough PPE,” said Melinda Haschak, a licensed practical nurse at a Connecticut nursing home. Haschak, a single mother, said she frequently has had to unknowingly care for residents who tested positive for the coronavirus and when she contracted the illness she had to isolate herself from her two teenage daughters and ailing sister.
Haschak said she was grateful for donations of food to her and her coworkers as well as the occasional pizza party. But, she said, “I do not need a pizza party, we need PPE.”
David Grabowski, a professor at the Harvard Medical School, said testing in nursing homes is still not adequate. “Until we get rapid and accurate testing for all staff and residents, we won’t be able to contain COVID,” Grabowski said. “This can’t be just a one-off. We need a surveillance program that regularly tests staff and residents in order to identify new cases as they emerge.”
Delia Satterwhite, whose brother died in an Austin, Texas, nursing home from the coronavirus, said after the facility called her on March 13 to say she could no longer visit, she was not able to have any contact with him except the occasional visit through a window. “The worst part is that he died alone,” Satterwhite said emotionally. Her brother died on April 16. “I should have been with him,” she said.
Kennedy also urged Congress to require virtual visitation. “In America, when the technology to facilitate virtual visits is not only abundant, but increasingly affordable, it is nothing short of a scandal that these visits are still not available on a regular basis to many Americans in these facilities,” she said.
It is hard for me to believe that America is stooping so low as to scrap the Star Spangled Banner as our National Anthem. We are a country that was founded FOR RELIGIOUS FREEDOM NOT FROM RELIGION. We are not a communist country, SO WHY IS EVERY MENTION OF RELIGION, GOD, JESUS OR HEAVEN BEING ERASED FROM OUR LIVES?????? Are the forces that be turning us little by little to communism?
At this point you’ve probably been made aware of the countless reasons people are giving to get out of wearing a face mask. Now, “Face Mask Exempt Cards” are making their way around the internet, citing the Americans With Disabilities Act as the reason people shouldn’t be “forced” to wear a mask. Many of these cards and flyers include a logo for the Freedom to Breathe Agency (FTBA), which is not a real government agency.
In fact, the real FTBA (which stands for Florida Transportation Builders’ Association) had to release a statement clarifying they weren’t associated with the FTBA that’s distributing the fake cards.
Laura has struggled with mental illness since she was 12 years old. Several diagnoses have come and gone since then. In the midst of it all, she discovered her passion for writing. Her dream is to use her gift to help destroy the stigma that surrounds mental illness and its sufferers. She is also a service dog team with her better half, Leo, who mitigates several disabilities. Laura is passionate about advocating for both the service dog/disability community, and the mental health community – while also still discussing the laws on service dogs and educating those who are unaware of the laws and service dog etiquette. You can find Laura’s blog below, where you will find links to her personal contact and social media accounts, in addition to more of her writings that have not been submitted/published on The Mighty understandingchaos.squarespace.com
The picture is from Facebook,a partial birth abortion. The written comment is from me. They can call it abortion all they want to, but it is out and out MURDER. That is a full term baby, but because it hasn’t taken a breath outside the womb, it’s called an abortion. CALL IT WHAT IT IS, ABORTION!!!!!!!!!
They can call it partial birth abortion all they want to, but it is out and out MURDER. That is a full term baby, but because it hasn’t taken a breath outside the womb, it’s called an abortion. CALL IT WHAT IT IS, MURDER!!!!!!!!!
When abortion law was first passed, I couldn’t believe it. There had been cases where girls were raped and ended up pregnant. They had to carry the baby and give birth to it, after being put into foster care. Women that were kidnapped when they were pregnant and the baby ended up dying, the offender would be charged with MURDER. or if a pregnant woman was abused by her husband and the baby died, the husband was charged with murder. But if, for whatever reason, the woman did not want the baby and wanted to kill it herself, then it was called ABORTION.
Abortions started out only being allowed for the first few weeks, saying that the fetus was only unformed tissue. As long as the baby did not take a breath, this was the case. To my way of thinking, ABORTION and MURDER are both equal, they are both the same thing, however you want to word it MURDER and ABORTION are interchangeable.
As I got older, the abortion law made less and less sense to me, not that it ever made sense to me to begin with, but it turned my stomach either way. All I could think about was how many people there were, that would have loved to adopt those babies that were being killed on purpose. When I found out that I had endometrosis, and probably would not be able to even become pregnant, period, or I would lose the baby before the second month, I figured that I would have to adopt if I was ever to have any children.
Unfortunately, that didn’t happen either. I ended up divorced twice and had no children. Luckily I had nieces and nephews to love and send different things to. I lived in a different state, so I was not able to see them as much as I would have liked to. But, I had a lot of friends with children and was able to be close to them.
Some of my friends called me Honorary Aunt, and some of them, as I aged, called me Grandma Bonnie, and now I am called Mamma Hen, because I am always doing for others and fussing about wanting to help, but they don’t want me to do too much and get tired out.
Since I had a shoulder replacement in April of 2018, I have basically stopped being able to do too much of anything. As a matter of fact I have had to have a caregiver myself.
Had any of the babies that were aborted been given up for adoption, and I was financially able to do it, I would have gladly adopted one or two of them for my own children.
They can call it abortion all they want to, but it is out and out MURDER. That is a full term baby, but because it hasn’t taken a breath outside the womb, it’s called an abortion. CALL IT WHAT IT IS, ABORTION!!!!!!!!!
This was on my Facebook. I just thought some people would like to read this article and see that there are many things that married couples may face. Possibly some people will realize that they aren’t the only ones that have to face trials and tribulations.
So as a white woman married to a black man and raising a biracial child I’ve had to unlearn a lot of things. I’ve also had to LEARN twice as much. I’ve had to become aware and start to notice things my mind never would have before. My husband, Walter, and I were recently discussing these things and here’s a list of all the things we’ve encountered:
-I have to drive basically anytime we are leaving the Dayton area. We don’t talk about it each time, we just both know that if we are leaving our general “safe” area and heading to smaller town Ohio roads I’m the one driving.
-I have to handle store clerks, returns, getting documents signed, anything with any federal building or administrative work, I get further with any type of “paperwork” thing that needs handled, people listen to me and are much more agreeable than with him.
-The chances that we find a Black or Interracial couple on a greeting card are SLIM. Unless you want to give the same Black Couple card every year, which we have . There are hundreds of white couples to choose from though!
-My husband goes out of his way to be nice and talk to EVERYONE. Not because he’s a people person, but because he has learned that a 6’5 Black man intimidates people and so he overcompensates by being overly friendly so people won’t be afraid of him.
– If Walter is pushing the cart I always have to have my receipt ready when leaving the store.
-None of our neighbors thought we owned our home, multiple neighbors stopped my father and asked him if he was the new landlord for us. Because of course, the old white man must have purchased the home. Not only do we own our home, it’s fully paid off, we have no mortgage and we paid for it BY OURSELVES.
-It took us YEARS to find a church without racist undertones and low key racist members, YEARS!
-When doll shopping our daughter gets 25 white options and 1-2 black or mixed race doll options.
-The same people who stop us daily to say how adorable our daughter is, are the same people who would cross the street if Walter was walking alone.
-We avoid all places with confederate flags.
-If we go to Bob Evans (or any restaurant that caters to “seniors”) too early we are met with a lot of stares, the old racists eat between 4-5pm.
-When Walter goes to a playground with our daughter he constantly stays by her side, if not he gets stares and people wonder what the “big black man” is doing on the park bench.
-Walter is concerned our Black Lives Matter sign by the door will make us a target when he is not home so he asked me to remove it
Now this post isn’t to make people say “oh poor you, I’m so sorry” etc etc. we have a wonderful life and are thankful for it. But…changes need to happen. This is just a small glimpse into the intentional and unintentional racism that happens everywhere, all the time. I want a better world for our daughter so I’m happy that things are changing. I know a lot of you are tired of the protests and tired of the changes and tired of people complaining. Well I’m tired of having to find a different gas station when the one we drive by has two trucks with confederate flags and 6 white boys in sleeveless shirts standing around outside. I’m tired of my husband having to talk to everyone and never complain even when they mess up his order 10,000 times, I’m tired of driving Damn near everywhere, I’m tired of the sick feeling I get when a cop pulls behind us, I’m tired of having to worry anytime my husband has to work OT and leaves in the middle of the night, I’m tired and I’ve only been on this ride 7 years, imagine a lifetime of this!
-edited to Add our Picture because I hope when you see those images on the news of riots and destruction you also remember that the majority of those protesting and fighting for rights are just regular folks like us who want our hearts to be seen. Peaceful loving families who just want a better world.
This was on Facebook. These tips are worth reading, and then decide which one or ones might work for you. Unfortunately, there is always the chance that none of them will work for you. I hope one or two of them will though.
Sweaty Face Mask? 5 Tips to Keep Cool While Covered Up
Staying safe and comfortable as temperatures rise
by Andy Markowitz, AARP, June 25, 2020|Comments: 20
With health authorities continuing to urge face-covering in public to curb the spread of COVID-19, we’ve become familiar with the minor irritants of wearing masks: chafed ears, foggy glasses, snapped straps. The arrival of summer takes the potential discomfort up a notch, trapping sweat and heat under our facial sheaths.
“As physicians, when we are wearing masks for long periods of time, for example in surgery or during a procedure, you’ll notice we keep the rooms what patients call ‘uncomfortably cold,’” says Gregory Poland, a physician and vaccine researcher at the Mayo Clinic. “There’s a reason for that.”
Fortunately, there are ways to stay cool or, at least, cooler while masked up. Here are five tips from experts for more comfortably keeping your respiratory droplets in check.
1. Choose the right fabric
A light, breathable material like cotton will likely keep your face cooler than medical and N95 masks made from synthetic materials, and in the right configuration can be effective in preventing contagion, according to new research by Taher Saif, a professor of mechanical science and engineering at the University of Illinois.
Saif’s team tested 10 common fabrics, from 100 percent cotton to polyester and silk blends, to see which best balance comfort and droplet-blocking impermeability. The “sweet spot,” he says, is a two-layer mask made from a cotton T-shirt, which comes close to matching a surgical mask’s efficiency in stopping potentially infectious droplets from coughs and sneezes and is about twice as breathable.
All-cotton tested best, but up to 40 percent polyester will do the job, Saif says. “I’m not a cloth expert. I just buy things from Walmart and Target,” he adds with a laugh. “Our study showed that if you have these layers on top of your mouth and nose, you don’t have to have an official mask where it goes with the elastic behind your ears. You can just wrap it around your nose and mouth, like a bandana.”
Lighter, softer cotton coverings can also help you avoid chafing, heat rash or inflaming a skin condition like eczema or dermatitis, says Carrie Kovarik, an associate professor of dermatology at the University of Pennsylvania’s Perelman School of Medicine and a member of the American Academy of Dermatology’s COVID-19 task force.
“They make masks out of a lot of different material, so you want to feel it and make sure it’s something that feels soft against your skin,” she says. “A lot of people are making masks for fashion, they want it to look nice and pretty on the face, but make sure it feels good.”
2. Keep it dry
Cotton traps less air and moisture than standard medical and industrial masks, and it’s more absorbent, but if it gets damp due to breathing and sweating it can be less effective in filtering respiratory particles, not to mention uncomfortable and abrasive to the skin.
“Try to stay in well-ventilated locations to keep air and vapor mixing, which can help evaporate any extra water (and also keep the rest of your skin/body feeling cooler),” says Jennifer Vanos, a biometeorologist at Arizona State University who studies the effects of heat on health.
Vanos also suggests trying masks made of especially absorbent materials like bamboo, which “can absorb up to three times the amount of water as cotton.” Hemp also wicks moisture well, and washable hemp-blend masks are widely available online, although like bamboo they tend to cost more than cotton face coverings.
3. Time trips to beat the heat
Avoid going out at the hottest parts of the day and for extended periods. Stop at home between errands if you can, to cool off and doff your mask. When you do have to be out, stay well-hydrated and seek the shade.
Being cognizant of the heat is about much more than keeping your mask fresh. “We have major issues every summer with heat exhaustion and heat stroke and heat-related deaths,” the Mayo Clinic’s Poland says, and older adults are “definitely at increased risk.”
An ice pack or damp cloth applied to the head or neck can help you cool off — just take care not to get your mask wet or touch your face. Poland notes other heat hacks he’s observed traveling in parts of Asia where mask-wearing has long been routine.
“They more often carry a hand-powered fan or small, battery-powered fan,” he says. That trick comes with a caveat — if you are “around a lot of people’s exhalation, you’re just fanning that air at yourself” — but with sufficient social distancing you may be able to use a fan to stay comfy while still protecting yourself.
“The other thing you see a lot of people doing in Asian countries during the summer is shading themselves with an umbrella,” Poland says. “Turns out that things like that actually do help.”
4. Skip the makeup
Heat and perspiration mixed with makeup or oily skin care products makes for a gunky mess under your mask. “You don’t have the ability to have sweat evaporate when you have the mask on. It all sits there and collects,” says Kovarik, the dermatology professor. That clogs pores and contributes to the lower-face skin eruptions that have been dubbed “maskne,” a combination of the words mask and acne.
Kovarik recommends masking up with your face clean, save perhaps for a bit of moisturizer (preferably with some SPF, if you plan to be out long). “Creams that have dimethicone in them are a good moisturizer but also is a barrier cream, so it creates some protection between your skin and the mask,” she says. “It will actually create a barrier to the friction.”
Another change to make to your skin care regimen: Avoid products with retinoids or salicylic acid, which some older people use to diminish wrinkles or sun damage.
“Those can be very, very irritating if used under occlusion or under some kind of covering. We don’t want to put them under the mask,” Kovarik says. “If [people] are using those products, it’s better to put them on at night and then wash your face in the morning.”
5. Bring a spare
If you can’t keep your mask from getting icky and sticky, there’s no better remedy than swapping it for another. “I recommend people do that anyway,” whatever the weather, Poland says. “When you’re outside with the mask on, that mask has a limited lifespan.”
On especially hot and humid days, pack multiple masks, recommends Vanos, the heat expert. Just make sure to follow the other CDC safety recommendations when changing masks, like avoiding crowds and washing or sanitizing your hands.
“If you really need to remove it to cool off, move away from people, cool off, maybe switch the mask to a new one, and then go back,” Vanos says.
This was on my Facebook. The article was focused on the anxiety that grandparents are going through due to the separation from their grandchildren during the COVID-19 quarantine. The article brings out many good points about the anxiety that is suffered. But the anxiety that is suffered, is not only by grandparents and grandchildren, but also by aunts and uncles and their nieces and nephews, and parents and children, if the children have already left home due to marriage or continued education. So if by chance you are some other relative besides a grandparent, just substitute what your relationship is with the child/children, every time the article mentions grandparents.
Gloria Warnicki’s family room is set up to entertain her grandchildren. Until recently, they spent endless weekends at her Darien, Illinois, home, mostly in this room full of toys, art supplies and coloring books.
But the room has been still since stay-at-home orders were enacted to slow the spread of the coronavirus. No weekend sleepovers with “Gigi,” the name her 10 grandchildren call her. No more trips to the ice cream parlor or Barnes & Noble. Instead, they see each other over Zoom video chat, or wave from the car.
“I miss feeling them, holding those little hands,” says Warnicki, 72, an office administrator whose four grown children live in the greater Chicago area, close enough for Warnicki to play an active role in their lives. Until lately.
“I don’t want them to lose that feeling of wanting to be with me and wanting to spend time with me.”
— Gloria Warnicki
The coronavirus pandemic has upended the daily lives of Americans, and for many of the country’s 70 million grandparents, contact with young grandchildren has been cut off. Older Americans have a higher risk of developing complications from COVID-19, and children may be asymptomatic carriers. So intimate relationships have been frozen in time, leaving grandparents longing for a connection they once took for granted.
“Grandparents are these enormously important attachment figures,” says psychiatrist Alan Schlechter, a clinical associate professor in the Department of Child and Adolescent Psychiatry at New York University Langone Health. Though families worry the separation could weaken the bond between grandparent and grandchild, Schlechter does not see a significant risk. “Children are not going to forget loving grandparents,” he says. “That’s not the way human brains work.”
The bond may be lasting, but childhood is not. Children grow quickly, and an older grandparent may see the clock ticking. “If you’re in your 60s, late 70s, and say, ‘When am I going to see my grandchildren again?,’ that’s a legitimate question,” says Adi Loebl, a family and geriatric psychiatrist and chief medical officer at the Ackerman Institute for the Family in New York City.
Warnicki, who has hypertension, is worried about the health risk her grandchildren pose to her and her 92-year-old mother, a cancer survivor with hypertension, who is staying with her. So Warnicki sees her grandchildren over Zoom. Her 7-year-old grandson, Sebastian, plays his drums, guitar and keyboard for her over the internet. The videos help, but they’re no substitute for babysitting him after school every Friday. “We used to do puzzles and games. We used to spin Beyblades [a toy],” she says. “He misses that kind of closeness.”
To keep her grandchildren engaged, she calls them daily, asking pointed questions about their friends and schoolwork. “I don’t want them to lose that feeling of wanting to be with me and wanting to spend time with me,” she says.
Occasionally, Warnicki drives by her children’s homes to visit from the driveway. Once, she wore a coat backward, creating a barrier to give her granddaughter a hug. “You want to cry. You just don’t realize how important that is,” Warnicki says. “My granddaughter, she didn’t want to let go, and when she did let go, she stood back and she was crying and I was crying.”
Medical experts see such outdoor encounters as relatively safe. Small children “are short, so they’re at your knees. A quick hug. What can you do?” says geriatrician Caroline Blaum, director of the Division of Geriatric Medicine at NYU Langone Health, who suggests washing hands after the embrace.
For grandparents who live far from their grandchildren, the start of summer has meant canceling family gatherings. Barbara Mitcho, 70, a retired school nurse in Glassboro, New Jersey, doubts her three oldest grandchildren will be able to visit for a week as they usually do. And she recently canceled a summer vacation rental on the Jersey Shore, where she and her husband, Carmen Mitcho, 72, had planned to gather with their two sons and their families.
But Mitcho’s relationship with her 6-year-old granddaughter in North Carolina, Mary Wynn, has taken an unexpected turn. Mary now contacts her grandmother daily over Messenger Kids, a communications app. “She called me at 7 in the morning and she said, ‘Do you want to help me pick out what I’m going to wear today?’” Mitcho says.
The calls can’t replace a visit, but “this is new — the fact that she feels comfortable to do that with me,” Mitcho says. “I do look forward to the calls.”
I do not have any children of my own due to a disease or condition called endometriosis. I had to have surgery when I was 30. Also, I live in a different state from any of my family, and do not own a car. All of my grandparents have passed on. That being said, the titles that I can claim are; daughter, sister, niece, cousin, and aunt. With living in a different state from any other family, I have had to substitute for any contact with family by being close friends to many people with children, where I live.
I have been ecstatic to babysit for them anywhere from a few hours to a few days. But every time any article focuses on grandparents, I have felt a huge vacant place in my heart, and have even had tears to well up in my eyes and run down my cheeks. There is no way I can understand why people like myself cannot be included in references about children and grownups relationships to them. We have just as much love for the relationship that we have with the children as the grandparents do with their relationships to their grandchildren.
There are some friends that have their children affectionately refer to me as Grandma Bonnie, and I love it. There are some that I could not love anymore than what I already do if they were my actual grandchildren, and some that even call me Mom. But nowhere do I ever see it mentioned that there is any kind of recognition for the anxiety that people like myself suffer, for these others, that we love as if they actually were whatever kin to us.
This was on Facebook. It not only shows that there are still good people in the world, but good children also. Obviously this little girl is being taught well and being brought up right, and she is certainly learning it well. We should all do our part to keep America beautiful and not all littered up. Ryleigh is going to go far in this world if she keeps up her good deeds and works hard.
We want to help spread this kindness. To Ryleigh, you are officially our first Cart Hero of 2020 and your good deed will not only be met with a golden cart trophy, but free school supplies for your entire classroom. To associate CJ, we’re going to make a $5,000 donation to a charity in his name for truly exemplifying what it means to live better.
Yesterday when leaving Walmart, Ryleigh noticed people not returning shopping carts and how were scattered everywhere. It “irritated” her that people weren’t following the rules or being kind. She spotted
grabbing shopping carts and putting them up. She looked at me and asked if she could help. She wanted to help him because, “That’s what we are supposed to do. We are supposed to be kind.” So she and I started to gather carts and push them to the store. Cart after cart, she pushed them to CJ. (It’s hard work pushing a line of carts, btw.) After 30 minutes or so, we pushed our last cart to Cj. Ryleigh ran to high five him and we parted ways.
Today we got out at Walmart and Ryleigh spotted a cart pushed on the curb. She immediately grabbed it and pushed it to the store, where she spotted her new friend working hard again.Alittle while later while browsing the toys, CJ walks up and hands Ryleigh a thank you card with $20. After reading the card she went around the aisle to hug him. Oh my heart.
Thank you Cj for the card. It truly meant alot! Ryleigh put the card on her dresser so it would remind her to always be kind. You now have a new friend with her.
I challenge everyone, to be kind today to someone. Do a random act of kindness, just because.
“Unexpected kindness is the most powerful, least costly, and most underrated agent of human change.” —Bob Kerrey
This was on my Facebook. It’s possible to see some infractions to the COVID-19 quarantine just in the first picture below. One of my cousins’ friends and her family did everything that the quarantine stated should be done. The Wife/Mother ended up with COVID-19 and her husband and children had to go someplace else while the Wife/Mother recuperated. Luckily she did get better and nobody else came down with the COVID-19 in her family.
How Exactly Do You Catch Covid-19? There Is a Growing Consensus
Surface contamination and fleeting encounters are less of a worry than close-up, person-to-person interactions for extended periods
Six months into the coronavirus crisis, there’s a growing consensus about a central question: How do people become infected?
It’s not common to contract Covid-19 from a contaminated surface, scientists say. And fleeting encounters with people outdoors are unlikely to spread the coronavirus.
Instead, the major culprit is close-up, person-to-person interactions for extended periods. Crowded events, poorly ventilated areas and places where people are talking loudly—or singing, in one famous case—maximize the risk.
These emerging findings are helping businesses and governments devise reopening strategies to protect public health while getting economies going again. That includes tactics like installing Plexiglas barriers, requiring people to wear masks in stores and other venues, using good ventilation systems and keeping windows open when possible.
Two recent large studies showed that wide-scale lockdowns—stay-at-home orders, bans on large gatherings and business closures—prevented millions of infections and deaths around the world. Now, with more knowledge in hand, cities and states can deploy targeted interventions to keep the virus from taking off again, scientists and public-health experts said.
“We should not be thinking of a lockdown, but of ways to increase physical distance,” said Tom Frieden, chief executive of Resolve to Save Lives, a nonprofit public-health initiative. “This can include allowing outside activities, allowing walking or cycling to an office with people all physically distant, curbside pickup from stores, and other innovative methods that can facilitate resumption of economic activity without a rekindling of the outbreak.”
The group’s reopening recommendations include widespread testing, contact tracing and isolation of people who are infected or exposed.
A Recipe for Infection
Getting the Covid-19 virus involves three steps.
Coughing, talking and breathing creates virus-carrying droplets of various sizes.
Enough virus has to make itself over to you or build up around you over time to trigger an infection.
The virus has to make its way into your respiratory tract and use the ACE-2 receptors there to enter cells and replicate.
Illustration: Erik Brynildsen/THE WALL STREET JOURNAL
One important factor in transmission is that seemingly benign activities like speaking and breathing produce respiratory bits of varying sizes that can disperse along air currents and potentially infect people nearby.
Health agencies have so far identified respiratory-droplet contact as the major mode of Covid-19 transmission. These large fluid droplets can transfer virus from one person to another if they land on the eyes, nose or mouth. But they tend to fall to the ground or on other surfaces pretty quickly.
Some researchers say the new coronavirus can also be transmitted through aerosols, or minuscule droplets that float in the air longer than large droplets. These aerosols can be directly inhaled.
That’s what may have happened at a restaurant in Guangzhou, China, where an infected diner who was not yet ill transmitted the virus to five others sitting at adjacent tables. Ventilation in the space was poor, with exhaust fans turned off, according to one study looking at conditions in the restaurant.
Aerosolized virus from the patient’s breathing or speaking could have built up in the air over time and strong airflow from an air-conditioning unit on the wall may have helped recirculate the particles in the air, according to authors of the study, which hasn’t yet been peer-reviewed.
Sufficient ventilation in the places people visit and work is very important, said Yuguo Li, one of the authors and an engineering professor at the University of Hong Kong. Proper ventilation—such as forcing air toward the ceiling and pumping it outside, or bringing fresh air into a room—dilutes the amount of virus in a space, lowering the risk of infection.
Another factor is prolonged exposure. That’s generally defined as 15 minutes or more of unprotected contact with someone less than 6 feet away, said John Brooks, the Centers for Disease Control and Prevention’s chief medical officer for the Covid-19 response. But that is only a rule of thumb, he cautioned. It could take much less time with a sneeze in the face or other intimate contact where a lot of respiratory droplets are emitted, he said.
At a March 10 church choir practice in Washington state, 87% of attendees were infected, said Lea Hamner, an epidemiologist with the Skagit County public-health department and lead author of a study on an investigation that warned about the potential for “superspreader” events, in which one or a small number of people infect many others.
Members of the choir changed places four times during the 2½-hour practice, were tightly packed in a confined space and were mostly older and therefore more vulnerable to illness, she said. All told, 53 of 61 attendees at the practice were infected, including at least one person who had symptoms. Two died.
Several factors conspired, Ms. Hamner said. When singing, people can emit many large and small respiratory particles. Singers also breathe deeply, increasing the chance they will inhale infectious particles.
Similar transmission dynamics could be at play in other settings where heavy breathing and loud talking are common over extended periods, like gyms, musical or theater performances, conferences, weddings and birthday parties. Of 61 clusters of cases in Japan between Jan. 15 and April 4, many involved heavy breathing in close proximity, such as karaoke parties, cheering at clubs, talking in bars and exercising in gyms, according to a recent study in the journal Emerging Infectious Diseases.
The so-called attack rate—the percentage of people who were infected in a specific place or time—can be very high in crowded events, homes and other spaces where lots of people are in close, prolonged contact.
An estimated 10% of people with Covid-19 are responsible for about 80% of transmissions, according to a study published recently in Wellcome Open Research. Some people with the virus may have a higher viral load, or produce more droplets when they breathe or speak, or be in a confined space with many people and bad ventilation when they’re at their most infectious point in their illness, said Jamie Lloyd-Smith, a University of California, Los Angeles professor who studies the ecology of infectious diseases.
But overall, “the risk of a given infected person transmitting to people is pretty low,” said Scott Dowell, a deputy director overseeing the Bill & Melinda Gates Foundation’s Covid-19 response. “For every superspreading event you have a lot of times when nobody gets infected.”
The attack rate for Covid-19 in households ranges between 4.6% and 19.3%, according to several studies. It was higher for spouses, at 27.8%, than for other household members, at 17.3%, in one study in China.
Rosanna Diaz lives in a three-bedroom apartment in New York City with five other family members. The 37-year-old stay-at-home mother was hospitalized with a stroke on April 18 that her doctors attributed to Covid-19, and was still coughing when she went home two days later.
She pushed to get home quickly, she said, because her 4-year-old son has autism and needed her. She kept her distance from family members, covered her mouth when coughing and washed her hands frequently. No one else in the apartment has fallen ill, she said. “Nobody went near me when I was sick,” she said.
Being outside is generally safer, experts say, because viral particles dilute more quickly. But small and large droplets pose a risk even outdoors, when people are in close, prolonged contact, said Linsey Marr, a Virginia Tech environmental engineering professor who studies airborne transmission of viruses.
No one knows for sure how much virus it takes for someone to become infected, but recent studies offer some clues. In one small study published recently in the journal Nature, researchers were unable to culture live coronavirus if a patient’s throat swab or milliliter of sputum contained less than one million copies of viral RNA.
“Based on our experiment, I would assume that something above that number would be required for infectivity,” said Clemens Wendtner, one of the study’s lead authors and head of the department of infectious diseases and tropical medicine at München Klinik Schwabing, a teaching hospital at the Ludwig Maximilian University of Munich.
He and his colleagues found samples from contagious patients with virus levels up to 1,000 times that, which could help explain why the virus is so infectious in the right conditions: It may take much lower levels of virus than what’s found in a sick patient to infect someone else.
Based on this emerging picture of contagion, some policies are changing. The standard procedure for someone who tests positive is to quarantine at home. Some cities are providing free temporary housing and social services where people who are infected can stay on a voluntary basis, to avoid transmitting the virus to family members.
The CDC recently urged Americans to keep wearing masks and maintaining a distance from others as states reopen. “The more closely you interact with others, the longer the interaction lasts, the greater the number of people involved in the interaction, the higher the risk of Covid-19 spread,” said Jay Butler, the CDC’s Covid-19 response incident manager.
If the number of Covid-19 cases starts to rise dramatically as states reopen, “more extensive mitigation efforts such as what were implemented back in March may be needed again,” a decision that would be made locally, he said.
CDC guidelines for employers whose workers are returning include requiring masks, limiting use of public transit and elevators to reduce exposure, and prohibiting hugs, handshakes and fist-bumps. The agency also suggested replacing communal snacks, water coolers and coffee pots with prepacked, single-serve items, and erecting plastic partitions between desks closer than 6 feet apart.
Current CDC workplace guidelines don’t talk about distribution of aerosols, or small particles, in a room, said Lisa Brosseau, a respiratory-protection consultant for the University of Minnesota’s Center for Infectious Disease Research and Policy.
“Aerosol transmission is a scary thing,” she said. “That’s an exposure that’s hard to manage and it’s invisible.” Ensuring infected individuals stay home is important, she said, but that can be difficult due to testing constraints. So additional protocols to interrupt spread, like social distancing in workspaces and providing N95 respirators or other personal protective equipment, might be necessary as well, she said.
Some scientists say while aerosol transmission does occur, it doesn’t explain most infections. In addition, the virus doesn’t appear to spread widely through the air.
“If this were transmitted mainly like measles or tuberculosis, where infectious virus lingered in the airspace for a long time, or spread across large airspaces or through air-handling systems, I think you would be seeing a lot more people infected,” said the CDC’s Dr. Brooks.
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Sampling the air in high-traffic areas regularly could help employers figure out who needs to get tested, said Donald Milton, professor of environmental and occupational health at the University of Maryland School of Public Health.
“Let’s say you detect the virus during lunchtime on Monday in a dining hall,” he said. “You could then reach out to people who were there during that time telling them that they need to get tested.”
Erin Bromage, a University of Massachusetts Dartmouth associate professor of biology, has been fielding questions from businesses, court systems and even therapists after a blog post he wrote titled “The Risks—Know Them—Avoid Them” went viral.
Courts are trying to figure out how to reconvene safely given that juries normally sit close together, with attorneys speaking to them up close, Dr. Bromage said. Therapists want to be able to hold in-person counseling sessions again. And businesses are trying to figure out what types of cleaning and disease-prevention methods in which to invest most heavily.
He advises that while wiping down surfaces and putting in hand-sanitizer stations in workplaces is good, the bigger risks are close-range face-to-face interactions, and having lots of people in an enclosed space for long periods. High-touch surfaces like doorknobs are a risk, but the virus degrades quickly so other surfaces like cardboard boxes are less worrisome, he said. “Surfaces and cleaning are important, but we shouldn’t be spending half of our budget on it when they may be having only a smaller effect,” he said.
Drugmaker Eli Lilly & Co. has a medical advisory panel that’s reading the latest literature on viral transmission, which it is using to develop recommendations for bringing back the company’s own workers safely.
To go into production facilities, some of which are in operation now, scientists must don multiple layers of personal protective equipment, including gloves, masks, goggles and coveralls. That’s not abnormal for drug-development settings, said Lilly Chief Scientific Officer Daniel Skovronsky. “The air is extensively filtered. There’s lots of protection,” he said.
The places he worries about are the break rooms, locker rooms and security checkpoints, where people interact. Those are spaces where the company has instituted social-distancing measures by staggering the times they are open and how many people can be there at once. Only a few cafeterias are open, and those that are have socially distanced seating. In bathrooms, only half the stalls are available to cut down on the number of people.
“We’ll never be more open than state guidelines,” Dr. Skovronsky said, but “we’re often finding ourselves being more restrictive because we’re following the numbers.”