The battle in hospitals over how COVID moves and kills

Frontline physical care personnel are engaged in a hot confrontation with many infection specialists and hospital directors about how the new coronavirus spreads and, therefore, what point of the protective device is appropriate.

The question is the extent to which the virus is suspended in the air, capable of spreading through tiny and persistent traces of aerosols in the air, or basically transmitted through giant drops that fall faster, for example, a sneeze or cough. has a real effect on the type of safety measures that fitness companies will have to take to protect their patients and workers.

On Friday, the Centers for Disease Control and Prevention caused confusion in the debate with a recommendation on air transmission and stated that small aerosol particles, as well as larger droplets, are the “main means of spreading the virus. “By Monday, the wording had disappeared from his and the firm said that he had published an “provisional edition of the proposed amendments” by mistake and that the experts were still working to update the “air transmission recommendations”.

KHN and The Guardian attach the deceased physical condition of COVID-19 and write about their lives and what happened in their final days.

Dr. Anthony Fauci, America’s leading infectious disease expert, addressed the head-on discussion in a September 10 webcast for Harvard Medical School, pointing to aerosol scientists claiming that the CDC “had actually existed for many, many years. “

“At the end of the day, there are a lot more aerosols [transmission] than we thought,” Fauci said.

The factor has been deeply divisive within hospitals, largely due to the question of whether a disease spreads through drops or spray effects on two other sets of protective practices, affecting everything from airflow in hospital wards to patient isolation and selection of protective equipment. Improved protections would be costly and harmful to a number of industries, but especially hospitals, which have struggled to obtain protections opposed to lower-level “droplets. “

Hospital directors and epidemiologists who argue that the virus spreads mainly through droplets cite studies showing it spreads to a small number of people, such as people without blood or flu. for patients with COVID-19, these officials say.

On the other hand, there are many occupational protection experts, aerosol scientists, frontline fitness personnel and their unions, who are quick to notice that the new coronavirus is much more fatal than influenza, and argue that science suggests that the higher quality, more expensive, N95 respirators will be needed for the treatment of the COVID-19 patient regimen.

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High-protection respirators have been scarce across the country and their value has soared from around $1 to $7 each. Meanwhile, studies have shown the highest rates of asymptomatic transmission of the virus, placing N95s first among frontline health care staff in virtually every environment.

The debate has reached its climax in hospitals from coast to coast, as studies have emerged that suggest that the live virus is suspended in the hospital rooms of patients with COVID-19 even in the absence of “aerosol generator” procedures (such as intubations or breathing treatments) and has contributed to outbreaks in a nursing home, a back and going and a choir.

KHN and The Guardian U. S. read about more than 1,200 deaths of physical care personnel due to COVID-19, many of whom their families or colleagues reported running under insufficient private protective equipment.

However, some managers and frontline managers disagree on how and why fitness services get sick.

Infection and hospital epidemiology officials cite studies suggesting that many fitness staff contract the virus outdoors and at rates that reflect what is happening in their communities.

Last July, an organization of Epidemiologists at Penn Medicine described aerosol transmission studies as unconvincing and cited “numerous evidence published around the world” that suggests that the “overwhelming majority” of coronavirus spread occurs “through giant breathing drops. “

However, trade unions, occupational fitness researchers, and aerosol scientists refer to a series of studies that indicate that health care personnel have been much more affected than the average hospital room. These debris can remain suspended in the air for up to 3 hours.

Echoing their concerns, a Letter of 6 July signed through 239 scientists suggested that the medical network and the World Health Organization recognize “the possibility of covid-19 air propagation. “

The letter referred to studies showing that talking, exhaling and coughing emit small debris that is suspended in the air much longer than drops and “pose a threat of exposure. “

At a branch of a Dutch retirement home with air recirculation, investigators found that 81% of citizens had been diagnosed with COVID-19. Virus.

Although researchers may simply not rule out transmission through the method, the “almost simultaneous detection” of the virus among almost all citizens highlighted the spread of aerosols.

The concept that the virus spreads through droplets or aerosols is an overssimplified, said Dr. Shruti Gohil, associate director of epidemiology and infection prevention at the University of California, Irvine School of Medicine.

Gohil said it had more than one spectrum, as the virus was also transmitted through a few drops and giant aerosol particles.

However, the number of other people inflamed through a poorly ill user is a metric in which other people focus on the scope of infection in hospitals. For COVID-19, studies have shown that the number is approximately two, similar to an Unequivocal air transmission disease such as measles, the number is closer to 12 to 18.

Measles is “what [transmission] looks like by air,” Gohil said. “If it were a number one disease that can be transmitted through aerosol, we would be in a world of suffering. “

Hospital epidemiologists are also focusing on the home spread rate of the new coronavirus. With measles, the threat of a member of an unen vaccinated family in poor health is 85%, said Dr. Rachael Lee, a hospital epidemiologist and assistant professor at the University of Alabama-Birmingham. For COVID-19, he said, the threat is closer to 10%.

Although the idea is for the virus to spread more through droplets than through aerosol particles, Lee said, UAB University Hospital staff use an N95 respirator for an additional layer of coverage and because patients want so many respiratory remedies or “aerosol generator” procedures. “

These practices are not universal. At the University of Iowa Hospital, physical care personnel use N95 and facials for procedures that generate aerosols, but in a different way use surgical masks and facial protectors for the treatment of regimens for COVID patients, said Dr. Daniel Diekema, director of the Infectious Division. Diseases in college.

He said those “enhanced precautions against drops” work. Places where staff wear medical masks and face shields do not see any significant spread of the disease among staff, although one such report has focused on the spread of a single patient.

Elsewhere, patients have also been in soils where patients with COVID-19 and non-virus patients have been placed in adjacent rooms, a practice that others involved in the spread of aerosols do not approve of.

“It’s not an airborne disease like measles or tuberculosis,” dr. Shira Doron, epidemiologist at Tufts Medical Center in Boston and an assistant professor at the Tufts School of Medicine. “We know this because we don’t see epidemics affecting patients on the same floor. “

Origin of the debate

CDC has helped set the level for the existing discussion. In March, the firm issued revised rules that necessarily said it was “acceptable” for fitness personnel to wear a surgical mask, rather than N95, for regimen care. the maximum likely maximum transmission source and N95 only for aerosol generation procedures.

“The contribution of small breathable particles, called aerosols or droplet nuclei, to transmission nearby is uncertain lately. However, person-to-person transmission over long distances is unlikely,” according to guidelines.

The California Hospital Association has sent a letter to the state congressional delegation requesting that the review be permanent.

“We want CDC to pass clearly and conditionally precautions against droplets for patients and fitness workers,” the letter says. This would allow hospitals to retain PPE materials and restrict the use of special isolation rooms for COVID patients.

A spokesman for the agreement told KHN that the organization did influence science, but only insisted that regulations be clear.

Christopher Friese, professor of nursing, fitness control and politics at the University of Michigan, is among the experts who have been put at risk by physical care personnel by regulations.

“We spend a lot of time and, frankly, live because the first recommendation is to use the N95 only for those express procedures,” Friese said.

Family members and union leaders from Missouri to Michigan and California have raised considerations about the death of nurses by COVID-19 after treating inflamed patients with the N95 respirator virus In such cases, hospitals have stated that they are following CDC guidelines.

Friese echoed some office security experts who warned that the CDC’s strictest rules since the beginning of the call for suspended illness in the air may have had an effect, perhaps pressuring President Donald Trump to invoke the Defense Production Act to build N95 materials so that “we may have the source we want anywhere we want Friese said.

Surveys across the country show that there is still a shortage of non-public devices in many fitness facilities.

The CDC rules published Friday reportedly emphasized some hospitals’s protective measures, which they would have resisted, and said the virus can spread when a user sings, speaks, or breathes.

“These wastes can be inhaled through the nose, mouth, airlines and lungs and cause an infection,” he says. “It is an idea that is the main means of spreading the virus. “

On Monday morning, the online page had returned to say that the virus was basically spread through droplets, noting that the draft text had been published by mistake.

The University of Nebraska Medical Center has taken so-called airborne precautions from the start. There, Dr. James Lawler, a physician and director of the university’s Global Center for Health Safety, said his colleagues had documented that the virus could simply be in the air. and live on surfaces away from patients.

He said the hospital was examining all patients admitted to the virus and keeping patients with COVID-19 out of the general population; said they were paying special attention to cleaning shared spaces and tracking airflow in the limited unit. The staff also had N95 or PAPRS, respirators, which are bells powered by pumped filtered air.

All of this has resulted in a “very low” of fitness workers’ infections.

Amid the uncertainty surrounding the virus, and as an unprecedented number of health care personnel die, adopting the “highest possible” coverage bureaucracy is the solution, said Betsy Marville, nurse organizer of the 1199SEIU United Healthcare Workers East union in Florida.

This would mean a deviation from CDC rules that now say physical care personnel want an N95 respirator for “aerosol-generating” procedures, such as intubations or other respiratory remedies. protection device, or unprotected, when patients urgently want such remedies.

“You don’t leave your patient in misery and you don’t look for a mask,” he says. I said, “It’s crazy. “

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The question is to what extent the virus is suspended in the air, able to spread through tiny and persistent aerosol debris in the air, or basically transmitted through giant droplets that fall faster, for example, a sneeze or a cough. it has a real effect on the kind of security measures that fitness service companies will have to adopt to protect their patients and workers.

On Friday, the Centers for Disease Control and Prevention caused confusion in the debate with a recommendation on air transmission and stated that small aerosol particles, as well as larger droplets, are “the main means of spreading the virus. “By Monday, the wording had been completed. disappeared from his and the firm said he had published an “provisional edition of the proposed amendments” by mistake and that experts were still working to update the “air transmission recommendations”.

“At the end of the day, there are a lot more aerosols [transmission] than we thought,” Fauci said.

The factor has been deeply divisive in hospitals, largely because the question of whether a disease spreads through droplets or aerosols has effects on two other sets of protective practices, affecting everything from airflow in hospital wards to patient isolation and selection of protective equipment. Improved protections would be costly and harmful to a number of industries, but especially hospitals, which have struggled to obtain protections opposed to lower-level “droplets. “

On the other hand, there are many occupational protection experts, aerosol scientists, front-line fitness personnel, and their unions, who are quick to note that the new coronavirus is far more fatal than influenza, and argue that science suggests that the high-quality, more expensive, N95 respirators will be needed to treat the COVID-19 patient regimen.

High-protection respirators have been rare across the country and their costs have soared from around $1 to $7 each. Meanwhile, studies have shown the highest rates of asymptomatic transmission of the virus, placing N95s first among frontline fitness care in virtually all cases. Settings.

KHN and The Guardian U. S. read about more than 1,200 deaths of physical care personnel due to COVID-19, many of whom their families or colleagues reported running under-protection equipment.

However, some managers and frontline managers disagree on how and why fitness services get sick.

Officials of infections and hospital epidemiology cite studies suggesting that many fitness staff contract the virus outdoors and at rates that reflect what is happening in their communities.

Yet unions, occupational fitness researchers, and aerosol researchers refer to another pile of studies that seem to indicate that fitness care staff have been much more affected than the rest of the average people, and an exam that showed active viral debris can reach 15 feet from a patient in a hospital room. These wastes can remain suspended in the air for up to 3 hours.

Echoing their concerns, a letter of 6 July signed through 239 scientists suggested that the medical network and the World Health Organization recognize “the possibility of air propagation of Covid-19”.

The letter referred to studies showing that talking, exhaling and coughing emit small debris that is suspended in the air for much longer than drops and “pose a threat of exposure. “

At a branch of a Dutch retirement home with air recirculation, researchers found that 81% of citizens had been diagnosed with COVID-19. Virus.

Although researchers may simply not rule out transmission through the method, the “almost simultaneous detection” of the virus among almost all citizens highlighted the spread of aerosols.

Gohil said it had more than one spectrum, as the virus was also transmitted through a few drops and giant aerosol particles.

However, the number of other people inflamed by a poorly ill user is a metric in which other people focus on the scope of infection in hospitals. For COVID-19, studies have shown that the number is approximately two, similar to an Unequivocal air transmission disease such as measles, the number is closer to 12 to 18.

Measles is “what aerial [transmission] looks like,” Gohil said. “If it were a number one disease that can be transmitted through aerosols, we would be in a world of suffering. “

Hospital epidemiologists are also focusing on the home spread rate of the new coronavirus. With measles, the threat of an un vaccinated family member in poor health is 85%, dr. Rachael Lee, hospital epidemiologist and assistant professor at the University of Alabama-Birmingham. For COVID-19, he said, the threat is closer to 10%.

These practices are not universal. At the University of Iowa Hospital, physical care personnel use N95 and facials for procedures that generate aerosols, but in a different way use surgical masks and face shields for the treatment of regimens for COVID patients, said Dr. Daniel Diekema, director of the Division of Infectious Diseases at the University.

Elsewhere, patients were also on floors where COVID-19 patients and those 19 and those 19 had no viruses were placed in adjacent rooms, a practice that other people involved in spreading aerosols do not approve of.

Origin of the debate

The California Hospital Association has sent a letter to the state congressional delegation requesting that the revised rules be permanent.

“We want CDC to move clearly and conditionally, from airborne precautions to droplet precautions for patients and physical health workers,” the letter says. This would allow hospitals to retain PPE materials and restrict the use of special isolation rooms for COVID patients.

A spokesman for the agreement told KHN that the organization did influence science, but that he only insisted that the regulations be clear.

Christopher Friese, professor of nursing, control and fitness policies at the University of Michigan, is among the experts that regulations have put fitness personnel at risk.

“We spend a lot of time and, frankly, live because the first recommendation is to use the N95 only for those express procedures,” Friese said.

Family members and union leaders from Missouri to Michigan and California have raised considerations about the death of nurses by COVID-19 after treating inflamed patients with N95 virus respirators In such cases, hospitals have stated that they are following CDC guidelines.

Friese echoed some office security experts who warned that the CDC’s strictest rules since the beginning of the call about airborne illnesses may have had an effect, perhaps presing President Donald Trump to invoke the Defense Production Act to build N95 materials so we may have the source we want anywhere we want Friese said.

Surveys across the country show that there is still a shortage of non-public equipment in many fitness facilities.

The CDC rules published Friday reportedly emphasized some hospitals’s protective measures, which they would have resisted, and said the virus can spread when a user sings, speaks, or breathes.

“These wastes can be inhaled through the nose, mouth, airlines and lungs and cause an infection,” he says. “It is an idea that is the main means of spreading the virus. “

On Monday morning, the online page had returned to say that the virus was basically spread through droplets, noting that the draft text had been published by mistake.

The University of Nebraska Medical Center has taken so-called airborne precautions from the beginning. There, Dr. James Lawler, a physician and director of the university’s Global Center for Health Safety, said his colleagues had documented that the virus could simply be in the air. and they live on surfaces far from patients.

He said the hospital was examining all patients admitted to the virus and keeping patients with COVID-19 out of the general population. He said they were paying particular attention to cleaning shared spaces and tracking airflow in the limited unit. respirators, which are hoods supplied with filtered air pumped.

All of this has resulted in a “very low” of fitness workers’ infections.

This would mean a deviation from CDC rules that now say physical care personnel want an N95 respirator for “aerosol-generating” procedures, such as intubations or other respiratory remedies. She said the rule had allowed the nurses she represents in Florida to fight for protective apparatus – or unprotected – when patients urgently want such remedies.

“You don’t leave your patient in misery and look for a mask,” she says. “It’s crazy. “

“At the end of the day, there are a lot more aerosols [transmission] than we thought,” Fauci said.

On Friday, the Centers for Disease Control and Prevention caused confusion in the debate with a recommendation on air transmission and stated that tiny aerosol particles, as well as larger droplets, are “the main means of spreading the virus. “By Monday, the wording had disappeared from his and the firm said that it had published an “provisional edition of the proposed amendments” by mistake and that experts were still working to update the “air transmission recommendations”.

“At the end of the day, there are a lot more aerosols [transmission] than we thought,” Fauci said.

Hospital directors and epidemiologists who argue that the virus spreads primarily through droplets cite studies showing it spreads to a small number of people, such as a person without blood or flu. As a result, N95 respirators and strict patient isolation practices are not for regimen care. for patients with COVID-19, these officials say.

KHN and The Guardian U. S. read about more than 1,200 deaths of physical care personnel due to COVID-19, many of whom their families or colleagues reported running under-protection equipment.

However, some managers and frontline managers disagree on how and why fitness services get sick.

Hospital epidemiology and infection officials cite studies suggesting that many members of the fitness staff contract the virus outdoors and at rates that reflect what is happening in their communities.

Trade unions, occupational fitness researchers, and aerosol researchers, however, refer to another stack of studies that suggest that fitness care personnel have been much more affected than other people’s average, and an examination showing that active viral waste can air up to 15 feet of a patient in a hospital room. These wastes can remain suspended in the air for up to 3 hours.

The letter referred to studies showing that talking, exhaling and coughing emit small debris that is suspended in the air for much longer than drops and “pose a threat of exposure. “

At a branch of a Dutch retirement home with air recirculation, researchers found that 81% of citizens had been diagnosed with COVID-19. Virus.

Although researchers may simply not rule out transmission through the method, the “almost simultaneous detection” of the virus among almost all citizens highlighted the spread of aerosols.

Gohil said it had more than one spectrum, as the virus was also transmitted through a few drops and giant aerosol particles.

However, the number of other people inflamed through a poorly ill user is a metric in which other people focus on the scope of infection in hospitals. For COVID-19, studies have shown that the number is approximately two, similar to one in the case of an unequivocal air transmission disease such as measles, the number is closer to 12 to 18.

Measles is “what airborne [transmission] looks like,” Gohil said. “If it were a number one disease that can be transmitted by aerosol, we would be in a world of suffering. “

Although the idea is that the virus spreads more through droplets than aerosol particles, Lee said, staff at the UAB University Hospital wear an N95 respirator for an extra layer of coverage and because patients want so many remedies. or “aerosol generating” breathing procedures.

Elsewhere, patients were also on floors where patients with COVID-19 and those 19 and those 19 had no viruses were placed in adjacent rooms, a practice that others involved in the spread of aerosols do not approve of.

“It’s not an airborne disease like measles or tuberculosis,” said Dr. Shira Doron, an epidemiologist at Tufts Medical Center in Boston and an assistant professor at the Tufts School of Medicine. “We know this because we do not see epidemics that affect patients on the same floor. “

Origin of the debate

The CDC has helped set the level for the existing discussion. In March, the firm issued revised rules that necessarily said it was “acceptable” for physical care personnel to wear a surgical mask, rather than N95, for regimen care. were the highest likely maximum source of transmission and N95 only for aerosol generation procedures.

“The contribution of small respirable particles, called aerosols or droplet nuclei, to transmission in the immediate vicinity is uncertain lately. However, transmission from person to person over long distances is unlikely,” according to the guidelines.

The California Hospital Association has sent a letter to the state congressional delegation requesting that the review be permanent.

A spokesman for the agreement told KHN that the organization did influence science, but that he only insisted that the regulations be clear.

Christopher Friese, professor of nursing, fitness control and politics at the University of Michigan, is among the experts who have been put at risk by physical care personnel by regulations.

“We spend a lot of time and frankly live because the first recommendation is to use the N95s only for those express procedures,” Friese said.

Family members and union leaders from Missouri to Michigan and California have raised considerations about the deaths of COVID-19 nurses after treating inflamed patients with N95 virus respirators In such cases, hospitals have stated that they are following CDC guidelines.

Surveys across the country show that there is still a shortage of non-public equipment in many fitness facilities.

The CDC rules published Friday reportedly emphasized some hospitals’s protective measures, which they would have resisted, and said the virus can spread when a user sings, speaks, or breathes.

“These wastes can be inhaled through the nose, mouth, airlines and lungs and cause infections,” he says. “It is an idea that is the main means of spreading the virus. “

On Monday morning, the online page had returned to say that the virus was basically spread through droplets, noting that the draft text had been published by mistake.

He stated that the hospital screened all patients admitted for the virus and kept COVID-19 patients out of the general population; He said they were paying particular attention to cleaning shared spaces and monitoring airflow in the limited unit. Staff also had N95 or PAPRS. respirators, which are hoods fed with pumped filtered air.

All of this has resulted in a “very low” of fitness workers’ infections.

Amid the uncertainty surrounding the virus, and when an unprecedented number of physical care personnel die, adopting the “highest possible” coverage bureaucracy is the solution, said Betsy Marville, nurse organizer of the 1199SEIU United Healthcare Workers East union in Florida.

This would mean a deviation from CDC rules that now say physical care personnel want an N95 respirator for “aerosol-generating” procedures, such as intubations or other respiratory remedies. She said the rule had allowed the nurses she represents in Florida to fight for protective apparatus – or unprotected – when patients urgently want such remedies.

“You don’t leave your patient in misery and you don’t look for a mask,” he says. I said, “It’s crazy. “

KHN and The Guardian U. S. read about more than 1,200 deaths of physical care personnel due to COVID-19, many of whom their families or colleagues reported running under-protection equipment.

However, some managers and frontline managers disagree on how and why fitness services get sick.

Officials of infections and hospital epidemiology cite studies suggesting that many fitness staff contract the virus outdoors and at rates that reflect what is happening in their communities.

However, trade unions, occupational fitness researchers, and aerosol researchers refer to another stack of studies that suggest that fitness care staff have been much more affected than the rest of the average people, and an examination showing that active viral waste can reach 15 feet of a patient in a hospital room. These wastes can remain suspended in the air for up to 3 hours.

The letter referred to studies showing that talking, exhaling and coughing emit small debris that is suspended in the air much longer than drops and “pose a threat of exposure. “

At a branch of a Dutch retirement home with air recirculation, researchers found that 81% of citizens had been diagnosed with COVID-19. Virus.

Although researchers may simply not rule out transmission through the method, the “almost simultaneous detection” of the virus among almost all citizens highlighted the spread of aerosols.

Gohil said it had more than one spectrum, as the virus was also transmitted through a few drops and giant aerosol particles.

Measles is “what [transmission] looks like over the air,” Gohil said. “If it were a number one disease that can be transmitted by aerosol, we would be in a world of suffering. “

Although the virus is thought to spread more through droplets than aerosol particles, Lee said, UAB University Hospital staff use an N95 respirator for an additional layer of protection. and because patients want so many respiratory remedies or procedures “aerosol generators. “”

These practices are not universal. At the University of Iowa Hospital, physical care staff use N95 and facials for aerosol-generating procedures, but in a different way use surgical masks and face shields for the regimen treatment of COVID patients, said Dr. Daniel Diekema, director of the Infectious Division. Diseases at the University.

Elsewhere, patients have also been on floors where patients with COVID-19 and non-virus patients have been placed in adjacent rooms, a practice that other people involved in the spread of aerosols do not approve of.

Origin of the debate

The CDC has helped set the level for the existing discussion. In March, the firm issued revised rules that necessarily said it was “acceptable” for fitness personnel to wear surgical masks, rather than N95, for regimen care. the maximum likely maximum transmission source and N95 only for aerosol generation procedures.