All posts by nedhamson

Activist, writer, researcher, addicted to sharing information and facts.

Rand Paul Says Biden’s Plan to Raise the Minimum Wage Means He Hates Black Teenagers. Read That Again

Racism and stupid are special traits of this jerk… lpionwbyedyjhzqzclyw.jpg

White conservatives are the worst kind of racist. These people are adamant that systemic racism isn’t a thing in America, they dismiss critical race theory out of hand, and, I swear, they all need to have “died wondering why everyone keeps playing the race card” inscribed on their tombstones—but none of that stops…

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What a recent Covid-19 flight outbreak tells us about spread on planes


Airline passengers are seen wearing hazmat suits at an airport in Fort Lauderdale, Florida, on November 25, 2020. | MediaPunch via Getty Images

“Is flying safe?” is the wrong question.

As a doctor, one of the most common questions I’ve gotten throughout the pandemic is whether flying is “safe.”

The question has new urgency, with more contagious variants of Covid-19 spreading around the world, and with the new US policy, effective January 26, that requires all passengers flying into the country to test negative for Covid-19 within three days of their flight.

Psaki: “With the pandemic worsening & more contagious variants spreading, this is not the time to be lifting restrictions on intl travel… beginning tmrw intl travelers to the US must provide proof of a negative test within 3 days of travel to airlines prior to departure.” pic.twitter.com/r9mchHE6T9

— Aaron Rupar (@atrupar) January 25, 2021

The answer to whether flying is safe, as with most questions in this epidemic, is that it’s complicated.

Outbreaks of Covid-19 on flights have been documented multiple times since the start of the pandemic, albeit seemingly more so before masks were widely worn on planes. But one recent outbreak on a long-haul flight from Dubai to New Zealand highlights why flights can be anywhere from safe to unsafe depending on a number of factors. It’s also an example of why viral transmission is not so much a single event, but the result of multiple lapses in safety.

New genomic data from the flight outbreak this fall sheds light on exactly how complicated tracing the dynamics of transmission in any environment can be — even one as controlled as an international plane ride.

We still don’t know exactly why this flight turned into a spreading event

On an 18-hour flight from Dubai to New Zealand this past September, four passengers were infected by one other passenger who boarded the flight unaware that they were infected with Covid-19. Some have pointed to this outbreak as evidence that flying is unsafe, but I think this misses a number of more crucial points.

It’s most important to understand that transmission doesn’t just happen. It actually takes a number of protections falling apart one after the other. This is invoked in the “Swiss cheese model,” in which most single methods of prevention cannot block all transmission, but a layered approach of multiple precautions can stop most spread.

In this particular outbreak, two of the four passengers who got infected reported wearing masks during the flight. It also happened despite pre-departure testing. The person who brought the virus onto the plane was incorrectly reported as having been tested within 48 hours of the flight, when in fact their negative test was from four days before. The people involved in the outbreak were sitting within four rows of one another, but not everyone in that radius later tested positive for the virus. Additionally, the plane’s power unit was down for 30 minutes during a refueling in Kuala Lumpur, meaning the ventilation system was turned off.

All of these factors introduce a number of “what ifs” that we can ask about what could have prevented the transmission — and whether improving these steps could make other flights safer.

For example, what if the index case had tested within two or three days of the flight? It’s very possible that their infection would have been picked up and they never would have boarded. What if the airline used rapid antigen testing at the airport, which we know is excellent at detecting people who are very contagious? Of note for this outbreak is that the index case didn’t report any symptoms until two days after the flight, so pre-boarding symptom screening or fever checks also would not have caught them.

What if the passengers were sitting further from the index case, or if the flight were shorter? We know that distance from index case and duration of contact during travel are both related to a higher virus attack rate.

As of now, only Delta blocks middle seats, and Alaska Airlines does so in the premium section. And in the September outbreak, none of those who caught the virus on the flight were sitting directly next to the index case. Some were two rows ahead, others behind.

What if the power unit had not been turned off? We know airplanes have great ventilation with HEPA filtration that can block viruses — when the system is running. But there is virtually no way to guarantee a flight won’t have to power off its air systems for unforeseen reasons, such as maintenance issues or de-icing.

What if the passengers and index cases were all wearing better masks — such as high-filtration KF94, KN95, elastomeric N95, or N95 masks, which can provide better control of virus spread and personal protection? We know that these “hi-fi” masks can function as effectively as vaccines, if not better, in stopping transmission when worn correctly and at times of high risk.

When I tweeted about this outbreak, a number of people quickly chimed in — some saying transmission happened because the vents were off, others saying because passengers didn’t have better masks. Ultimately, we don’t know for sure which of these things it was; more likely, it was a combination of all of them.

What this also demonstrates is that it can actually be somewhat complicated to fully understand how much Covid-19 transmission is happening directly on flights — and in other venues.

We’re probably missing most Covid-19 spread on planes in the US

In the case of this particular flight, New Zealand — which has had a remarkably low incidence of Covid-19 — actually had a mandatory quarantine period during which passengers were in government facilities for 14 days, and were monitored with regular testing. This allowed researchers to isolate the potential transmission points to the flight or airport. But infected passengers reported no close contact with one another in the airport. Genomic studies helped trace the infections as having most likely occurred on the flight itself, given that the viral samples all shared the same lineage. This level of follow-up is rarely happening in the US.

In the US currently, you can walk off a flight and your quarantine period and subsequent testing are just scout’s honor, despite being recommended by the CDC. If people don’t strictly quarantine, it quickly becomes much harder to know if transmission happened on the flight or afterward, like on your ride-share from the airport, at your relative’s house, or during some other activity.

We really don’t have a great understanding of how many infections are happening on flights. And as planes become more crowded, community transmission increases, and new, more contagious variants of the virus proliferate, the chance that someone who is actively infected is sitting next to you goes up as well.

One proxy for this risk might be the infection rate among airline staff, and this could be interesting and important to monitor over time. In Canada, infections and exposures on flights are far more readily documented, with a nearly daily list of flights that had infected passengers. Since the beginning of the pandemic, the country’s health officials have identified more than 3,000 flights landing in Canada (domestic and international) on which at least one person had Covid-19. The US would benefit from doing the same, although this needs to be coupled with rapid contact tracing as well.

Does all this mean that flights are dangerous? Does this mean not to fly?

I would say that ultimately, it depends on numerous protections holding up, which at times can and will be out of our control, both for flights and for all other activities that we partake in.

I would recommend against unnecessary travel right now, not only because I am concerned about what happens on the flight (even if many flights are ultimately low-risk) but also because of what happens after the flight. We have no enforcement on quarantining after travel, and many people cannot safely quarantine at home. The more we move around and meet up with others, the more the virus spreads.

And a single negative test three days beforehand won’t stop that, even if it picks up some infections and prevents some outbreaks on international flights. We should in fact be increasing all prevention measures on domestic flights especially. With new Covid-19 variants, even our airplane travel will require that we do many things right to avoid one especially wrong outcome.

Abraar Karan is a physician at Brigham and Women’s Hospital and Harvard Medical School. He previously worked on the Massachusetts state Covid-19 response, and is a consultant to the Independent Panel for Pandemic Preparedness and Response. The views expressed here are his own.

After Newsom lifts state decree, 2 LA County supervisors swiftly urge reopening outdoor dining

Politics over health again? Get over it – health first or more people die needlessly!!!

When Gov. Gavin Newsom  lifted the wider stay-at-home orders Monday, Jan. 25, the state returned to a county-by-county approach to monitoring the coronavirus outbreak. That puts Los Angeles County — burdened with some of the highest rates of infection and death in the country — back into the “purple tier” indicating widespread transmission.

With decisions back in the hands of local leaders, the move could signal the reopening of outdoor dining, but it was unclear if changes were at hand.

The decision rests in the hands of the county’s public health officials — but, ultimately, with county supervisors, two of whom issued statements Monday in support of reopening outdoor dining immediately. Though public health officials may oppose easing such limits — citing the declining but still-alarming levels of hospitalizations — the board could overrule those concerns and respond to the pleas from restaurant owners and business associations.

While rules for other businesses may change only slightly, under the state guidelines for purple tier, counties can indeed allow outdoor dining. However, L.A. County chose to institute stricter rules in late November before the wider state order took effect in early December.

Pasadena, which operates its own health department, allowed outdoor dining then. Long Beach, also independent of the county health department, aligned with the county restrictions until the state took control. Neither city had issued any new orders as of Monday morning.

The ban on outdoor dining in L.A. County was challenged in court by the California Restaurant Association and a Los Angeles restaurant in November with a Superior Court Judge on Dec. 8 ruling against the county.

Judge James Chalfant said the county acted “arbitrarily” and couldn’t sufficiently show a rational for the decision to close outdoor dining stalls. The county needed to show a “risk-benefit analysis” for not allowing outdoor dining beyond just that it introduced a risk to transmission because patrons are unmasked.

The ruling came about a week after the California regional stay-at-home orders so the legal point became moot, however, it was unclear how this case could affect the next choice by L.A. County public health officials or whether they will have to meet this new standard set by the judge in order to maintain restrictions on outdoor dining.

Reacting to the news Monday morning, L.A. County Supervisor Janice Hahn said she supported reopening outdoor dining.

“Now that Governor Newsom has lifted the statewide stay-at-home order, the question is what is L.A. County going to do?” Hahn said in a statement. “We should align ourselves with the state as much as possible which means, among other things, reopening outdoor dining with common-sense health protocols in place as soon as possible.  The restaurant industry was devastated by this lengthy shutdown and I know this would be welcome news to them.”

Supervisor Kathryn Barger, too, put forward her support for reopening outdoor dining.

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“I support following the Governor’s recommended guidelines for Southern California,” Barger said in a statement, “and reopening outdoor dining, personal care services and other industries that were previously closed by these orders. A data-driven and pragmatic policy approach is essential to protecting public health, while balancing the devastating social, emotional and economic impacts of this virus.”

Another major question is the timing of Newsom’s decision. While rates of new cases and hospitalizations have been coming down, they remain at extraordinary levels, stretching local hospitals to the limit. Intensive Care Unit capacity in the 11-county Southern California region are still at or below 0%, the state indicates on its dashboard. That number is a metric and doesn’t necessarily mean no ICU beds are available — but in recent weeks they have been severely limited.

The county’s rate of infection currently averages 150.7 positive cases per 100,000 people and an adjusted rate of 75.3. For the county to move beyond the purple tier, adjusted infection rate needs to fall below 7 per 100,000. In other words, the county has a long way to go.

The region has been in this cycle before — where restrictions are relaxed only to be tightened again. And the county and state are still months away from vaccine coverage. Dr. Paul Simon, Chief Science Officer for the Los Angeles County Department of Public Health, said last week that at the current rate of delivery, the county may not finish inoculating residents until next year.

Some experts, such as Dr. Yaneer Bar-Yam, founder of the COVID Action Group, criticized the governor’s move, saying it was not based on sound science and could lead the state to lose further ground in the fight against the pandemic.

As expected, businesses immediately called for easing restrictions.

“To say we are excited about the reopening of on-premise outdoor dining would be an understatement,” chief executive officer Mike Colonna of Norms Restaurants wrote in an email.

Like many Southern California eateries, the Bellflower-based chain of full-service restaurants, known for its discount steak breakfasts, was quick to supply itself with tents and outdoor tables when Newsom shut down dining rooms at the end of June.

“Our goal is to get up and running and bring music back to the areas that we serve,” said Lance Sterling, owner of The Canyon Club, a string of supper clubs in Southern California, which includes locations in Santa Clarita and Agoura Hills. “Whether that takes a month, six months, or 10 years, I have it as my mission to repair all the damage that the close-down has created,” he wrote in an email.

Sterling, who has been auctioning off his own guitars autographed by rock stars to help meet expenses, wants to reopen the outdoor patio restaurants as soon as the weather permits.

It’s unclear if county supervisors will act quickly, or overrule the recommendations of health officers, as they have previously during the pandemic.

Most recently, board chair Hilda Solis issued an executive order last week making all 65-year-old residents eligible for vaccines, even though sufficient doses have not yet been delivered to inoculate the county’s healthcare teams.

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SELF REFINEMENT😎

Soni's thoughts

Hey folks… I am back with a good topic on improving yourself…They say character does not change! Yes, i do agree but it can improve iff someone tries to do so..I would love to share how and which all aspects of mine i rectified in a good way…I had public fear…stage fear, discomfiture to initiate a conversation with new people…Now also i have but it has reduced alot… I am sure many of you would be having such feelings…So lets have a look on How i quashed all these issues…
*First thing is to just calm yourself down*

yes its very much vital part, to be sangfroid…yeah, being timorous, nothing will be acheived. As after all public means human being only, not any demon or ghost that they will harm you or kill you or any such… So no point of being over anxious… Keep yourself composed, it helps. (even…

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Madagascar : Popular food and dishes (part 2)

pe blog

“Mofo Gasy”, a kind of yummy cake , very popular for breakfast

Tomato salad to be served with the “Ravitoto” dish

The famous “Ravitoto” : cassava leaves with pork meat , for lunch.

THEY SAID : “GOOD FOOD, GOOD MOOD !”

I SAY : “ENJOY ! BON APPETIT!

HAVE A NICE WEEKEND !

PS : If you enjoyed this post, please like it, comment it, share it or follow my blog. Thank you for your visit !

Mizou

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