Battle Rages Inside Hospitals Over How COVID Strikes and Kills

Front-line health care workers are locked in a heated dispute with many infection control specialists and hospital administrators over how the novel coronavirus is spread ― and therefore, what level of protective gear is appropriate.

At issue is the degree to which the virus is airborne ― capable of spreading through tiny aerosol particles lingering in the air ― or primarily transmitted through large, faster-falling droplets from, say, a sneeze or cough. This wonky, seemingly semantic debate has a real-world impact on what sort of protective measures health care companies need to take to protect their patients and workers.

The Centers for Disease Control and Prevention injected confusion into the debate Friday with guidance putting new emphasis on airborne transmission and saying the tiny aerosol particles, as well as larger droplets, are the “main way the virus spreads.” By Monday that language was gone from its website, and the agency explained that it had posted a “draft version of proposed changes” in error and that experts were still working on updating “recommendations regarding airborne transmission.”

Dr. Anthony Fauci, the top U.S. infectious disease expert, addressed the debate head-on in a Sept. 10 webcast for the Harvard Medical School, pointing to scientists specializing in aerosols who argued the CDC had “really gotten it wrong over many, many years.”

“Bottom line is, there’s much more aerosol [transmission] than we thought,” Fauci said.

The topic has been deeply divisive within hospitals, largely because the question of whether an illness spreads by droplets or aerosols drives two different sets of protective practices, touching on everything from airflow within hospital wards to patient isolation to choices of protective gear. Enhanced protections would be expensive and disruptive to a number of industries, but particularly to hospitals, which have fought to keep lower-level “droplet” protections in place.

The hospital administrators and epidemiologists who argue that the virus is mostly droplet-spread cite studies that show it spreads to a small number of people, like a cold or flu. Therefore, N95 respirators and strict patient isolation practices aren’t necessary for routine care of COVID-19 patients, those officials say.

On the other side are many occupational safety experts, aerosol scientists, front-line health care workers and their unions, who are quick to note that the novel coronavirus is far deadlier than the flu ― and argue that the science suggests that high-quality, and costlier, N95 respirators should be required for routine COVID-19 patient care.

The highly protective respirators have been in short supply nationwide and have soared in price, from about $1 to $7 each. Meanwhile, research has shown high rates of asymptomatic virus transmission, putting N95s in high demand among front-line health care workers in virtually every setting.

The debate has come to a head at hospitals from coast to coast, as studies have emerged showing that live virus hangs in COVID-19 patients’ hospital rooms even in the absence of “aerosol-generating” procedures (such as intubations or breathing treatments) and has contributed to outbreaks at a nursing home, shuttle bus and choir practice.

KHN and The Guardian U.S. are examining more than 1,200 health care worker deaths from COVID-19, including many in which their family or colleagues reported they worked with inadequate personal protective gear.

Yet some front-line workers and managers disagree about exactly how and why health care workers are getting sick.

The hospital infection-control and epidemiology leaders cite studies suggesting that many health care workers are contracting the virus outside of work and at rates that mirror what’s happening in their communities.

A group of Penn Medicine epidemiologists in late July characterized research on aerosol transmission as unconvincing and cited “extensive published evidence from across the globe” showing the “overwhelming majority” of coronavirus spread is “via large respiratory droplets.”

Unions, occupational health researchers and aerosol scientists, though, reference another pile of studies showing health care workers have been hit far harder than average people ― and a study that showed active viral particles can drift in the air up to 15 feet from a patient in a hospital room. Such particles can hang in the air for up to three hours.

Backing their concerns, a July 6 letter signed by 239 scientists urged the medical community and World Health Organization to recognize “the potential for airborne spread of Covid-19.”

The letter pointed to studies that say talking, exhaling and coughing emit tiny particles that remain suspended in the air far longer than droplets and “pose a risk of exposure.”

In one ward of a Dutch nursing home with recirculated air, researchers found that 81% of the residents were diagnosed with COVID-19. Half of the workers on the ward ― who all wore surgical masks during patient care but not during breaks ― also tested positive for the virus.

Although researchers couldn’t exclude transmission by another method, the “near-simultaneous detection” of the virus among nearly all the residents pointed to aerosol spread.

The idea that the virus is spread by either droplets or aerosols is an oversimplification, said Dr. Shruti Gohil, associate medical director of epidemiology and infection prevention at the University of California-Irvine School of Medicine.

Gohil said it’s more of a spectrum, with the virus being transmitted by some droplets and some large aerosol particles as well.

One metric people in the hospital infection-control field focus on, though, is how many people one sick person infects. For COVID-19, research has shown that the number is about two ― similar to a cold or the flu. For an unequivocally airborne disease like measles, the number is closer to 12 to 18.

Measles is “what airborne [transmission] looks like,” Gohil said. “If this was truly a primary aerosol-transmissible disease, we’d be in a world of hurt.”

Hospital epidemiologists are also focused on the rate of household spread of the novel coronavirus. With the measles, the risk of an unvaccinated member of a household getting sick is 85%, said Dr. Rachael Lee, a hospital epidemiologist and assistant professor at the University of Alabama-Birmingham. For COVID-19, she said, the risk is closer to 10%.

Though the virus is believed to be spread more by droplets than aerosol particles, Lee said, staffers at UAB University Hospital wear an N95 respirator for an extra layer of protection and because the patients require so many breathing treatments or procedures considered “aerosol-generating.”

Such practices are not universal. At the University of Iowa’s hospital, health care workers use N95s and face shields for aerosol-generating procedures but otherwise use surgical masks and face shields for routine care of COVID patients, said Dr. Daniel Diekema, director of the division of infectious diseases at the university.

He said such “enhanced droplet precautions” are working. Places where workers are correctly using regular medical masks and face shields are finding no significant spread of the disease among staffers, although one such report focused on spread from a single patient.

Elsewhere, patients have also been safe on floors where COVID-19 patients and those without the virus have been placed in adjacent rooms ― a practice those concerned about aerosol spread do not endorse.

“It’s not an airborne disease the way measles or tuberculosis is,” said Dr. Shira Doron, an epidemiologist at Tufts Medical Center in Boston and an assistant professor at Tufts medical school. “We know because we don’t see outbreaks that affect multiple patients on a floor.”

Origin of the Debate

The CDC helped set the stage for the current debate. In March, the agency issued revised guidance essentially saying it was “acceptable” for health care workers to use surgical masks ― instead of N95s ― for routine care. The guidance said respiratory droplets were the most likely source of transmission and recommended N95s only for aerosol-generating procedures.

“The contribution of small respirable particles, sometimes called aerosols or droplet nuclei, to close proximity transmission is currently uncertain. However, airborne transmission from person-to-person over long distances is unlikely,” according to the guidance.

The California Hospital Association sent a letter to the state’s congressional delegation urging the revised guidance be made permanent.

“We need the CDC to clearly, not conditionally, move from airborne to droplet precautions for patients and health care workers,” the letter said. Doing so would enable hospitals to preserve PPE supplies and limit the use of special isolation rooms for COVID patients.

An association spokesperson told KHN that the group wasn’t weighing in on the science, merely pressing for clarity of the rules.

Christopher Friese, professor of nursing, health management and policy at the University of Michigan, is among the experts who think those rules have endangered health care workers.

“We lost a tremendous amount of time and, candidly, lives because the early guidance was to wear N95s only for those specific procedures,” Friese said.

Family members and union leaders from Missouri to Michigan to California have raised concerns about nurses dying of COVID-19 after caring for virus patients without N95 respirators. In such cases, hospitals have said they followed CDC guidance.

Friese echoed some occupational safety experts who suggested stronger guidance from the CDC early on calling the disease airborne might have had an impact ― perhaps pressuring President Donald Trump to invoke the Defense Production Act to boost supplies of N95s so “we might have the supply we need everywhere we need,” Friese said.

Surveys across the country show there’s still a shortage of personal protective equipment at many health care facilities.

The CDC guidance posted Friday would have put pressure on some hospitals to bolster their protective measures, something they have reportedly resisted. It said the virus can spread when a person sings, talks or breathes.

“These particles can be inhaled into the nose, mouth, airways, and lungs and cause infection,” the site said. “This is thought to be the main way the virus spreads.”

By Monday morning, the website was back to saying the virus mainly spreads through droplets, noting that draft language had been posted in error.

The University of Nebraska Medical Center has been taking so-called airborne precautions from the start. There, Dr. James Lawler, a physician and director of the Global Center for Health Security at the university, said his colleagues documented that the virus can drift in the air and live on surfaces at an extensive distance from patients.

He said the hospital tests all admitted patients for the virus and keeps COVID-19 patients apart from the general population. He said they pay close attention to cleaning shared spaces and monitoring airflow within the restricted-access unit. Workers also had N95 respirators or PAPRS, which are fitted hoods with filtered air pumped in.

All of it has added up to a “very low” rate of health care worker infections.

Amid uncertainty about the virus, and as an unprecedented number of health care workers are dying, adopting the “highest possible” forms of protection seems the best course, said Betsy Marville, nurse organizer for the 1199SEIU United Healthcare Workers East union in Florida.

That would mean a departure from CDC guidelines that now say health care workers need an N95 respirator only for “aerosol-generating” procedures, like intubations or other breathing treatments. She said the rule has left the nurses she represents in Florida scrambling for protective gear ― or unprotected ― when patients need such treatments urgently.

“You don’t leave your patient in distress and go looking for a mask,” she said. “That’s crazy.”


This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

What are the Effects of CBD on Menopause Symptoms?

The internet is full of the benefits and dangers of CBD that are often presented side by side. But in between all this, no one should forget the medicinal effects of CBD, especially on women’s health. There is a whole new debate on the safety levels of CBD products for menopausal women. The experts are still working on it but there are so many CBD infused products such as bath salts, lubricants, and vagina suppositories for dryness that people are buying.

Menopause is a difficult stage of every women’s life where her body shows many uncomfortable symptoms and eventually it changes their mood. There are so many products available to ease the symptoms of menopause. Some women take supplements, some go for hormone replacement therapy while a large number of the population relies on conventional remedies, and using CBD for menopause is one of them.

But it is hard to determine if these CBD infused products are safe or not; whether they would ease the menopausal symptoms or not.

Dr. JoAnn V. Pinkerton teaches at the University of Virginia, he says that using CBD for menopause is still an unproven remedy because despite these products being available so easily, there are no clinical trials and safety tests conducted for them. So everyone who is buying these products must know that these CBD infused products are not the first line of treatment for menopause symptoms.

Many medical experts acknowledge the medicinal benefits of CBD but still, it is hard to say that it is completely safe to use. Cannabis or marijuana is a common plant that has certain phytochemicals inside that are well-known for their psychoactive effects. These phytochemicals include tetrahydrocannabinol THC and Cannabidiol (CBD).

THC gives the cannabis plant its traditional “high” effects while CBD is not as psychoactive and doesn’t cause intoxication. This is why CBD-infused products do not make their users high or intoxicated.

There is so much research on CBD oil to show benefits on a number of medical conditions such as epilepsy, pain relief, and addiction treatment. But the information on the benefits of CBD in menopause symptoms is limited.

But there is research-based evidence that suggests the effects of CBD on inflammation and pain. while many women have used these CBD infused products to relieve menopausal symptoms and they are quite happy with their results.

The researchers from the University at Albany collected data on menopausal and postmenopausal women that have used these CBD products to relieve their symptoms within the previous year. The results indicated that a majority of women were satisfied with their experience but these CBD products didn’t relieve “all” symptoms of menopause.

Women shared their most uncomfortable symptoms as muscle pain, irritability, sleeping irregularities, stress, vaginal dryness, bladder problems, etc. using CBD products has relieved many of these problems so CBD does have physiological and psychological benefits on the women.

THC and CBD both are natural anti-inflammatory agents. They ease muscular pain and relieve stress-related disorders. This way they improve the mood and prevents agitation and behavioral changes. Due to its calming effect, the user feels more relaxed and it even regulates the sleeping cycle.

Also read: The Truth Behind Keto Candy for Weight Loss 

But even after all these proven benefits, there is not much to predict if CBD infused products are 100% safe for women. Despite the benefits of CBD for menopause, there remain some risks associated with them.

For example, a study on investigating the effects of CBD on epilepsy revealed that many patients experienced worse side effects of it in the form of reduced appetite, abdominal discomfort, diarrhea, and insomnia. Some of them also showed liver problems.

Also, there is a high chance of CBD interacting with other medicines that a user might be taking; for example anti-depressants and sleeping pills. This gap in the regularity of the CBD-infused products would always remain a big safety concern and could only be solved with safety tests of these products.

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3 ways sobriety made me a better advisor

Addiction Recovery Bulletin

Traditions – 

Sep. 17, 2020 – People rarely, if ever, get sober alone. In sobriety and in business, being part of a group allows you to benefit from the experience, strength and the hope of those around you.

2. What other people think of you is none of your business

As a young advisor, I focused on what I should do and was consumed with what others might think of me. Older people made suggestions about where I should live, how I should dress and where I should go to be seen.

I took their advice but ended up feeling incredibly inauthentic and unhappy.

As I continued in my sobriety, letting go of what others might think reinforced the importance of my job as a planner — to help clients discern and live their dreams rather than living out some idea influenced by what their parents did or what their friends planned to do.

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‘The Centers’ CEO resigns in Ocala

Addiction Recovery Bulletin

Intriguing –

Sept. 13, 2020 – “Along the way, through each and every one of those mergers and acquisitions, the organization has gotten stronger, has provided a better level of care and we’re able to respond to community needs in a better way,” he said. “We’re able to do more with scale than we would otherwise be able to do.”

Organizations like The Centers and SMA rely largely on funding from the state. Private insurance, Medicaid and Medicare only cover a small portion of services, Norman said.

“Florida, in the nation, sits at 49th in mental health and substance abuse funding. It should be an embarrassment. The only reason we can’t get to 50 is that there is a state out there that gives nothing,” Norman said.

Baracskay took over the agency soon after an aborted attempt to transform itself into a combined mental and primary healthcare organization. The CEO then, Tim Cowart, wanted to offer primary healthcare services to increase the agency’s revenue.

The Centers’ board, in moving away from the effort, felt it distracted from the founding goal of providing mental health and substance abuse programs.

Founded in 1972 as Marion-Citrus Mental Health Center, mental health treatment remains central to the organization’s mission.

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Struggling addicts turn to telehealth for better or worse

Addiction Recovery Bulletin

Soulless Screens? –

Sept. 14, 2020 – Amid the global pandemic, group gatherings have become nearly impossible. Weddings have been put on hold indefinitely, schools are turning to virtual learning and offices are encouraging employees to work from home until it’s safe to be in close proximity.

Though everyone has been impacted in some way by the new restrictions put in place due to COVID-19, people struggling with addiction have had it especially hard in quarantine. Social isolation, economic despair and a global health crisis have made COVID-19 “the perform storm” for individuals with substance use disorders — and on top of all that, normal outlets like group meetings and therapy no longer exist in the traditional sense because meeting face-to-face is now dangerous.

With nowhere else to go, people living with addiction are turning to online resources like virtual support groups and Zoom therapy until things return to normal. And because of the pandemic, there are far more online resources to leverage: According to a recent study from the University of Michigan Addiction Center, policy shifts have made it much easier for addiction care specialists to pivot to telemedicine.

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Nikki Sixx talks recovery, sobriety

Addiction Recovery Bulletin

WATCH – Sixxed to the twelve steps – 

Sept. 15, 2020 – But then again, there was a time when people wouldn’t have expected Sixx, now age 61, to even be alive in 2020. As chronicled in his harrowing memoir The Heroin Diaries, the band autobiography and Netflix film adaptation The Dirt, and VH1’s Behind the Music, Sixx overdosed on heroin multiple times in the ‘80s — most famously on Dec. 23, 1987, when he was declared clinically dead for two minutes before being revived. But now that Sixx has been clean for nearly 20 years now, he has made it his mission to help other addicts, even if there are some Crüe fans out there who don’t think sobriety is very “cool.” 

Sixx’s latest endeavor, with his other band Sixx:A.M., is the all-star Artists for Recovery charity single “Maybe It’s Time,” which features Def Leppard’s Joe Elliott, Slash, country star Brantley Gilbert, Corey Taylor of Slipknot and Stone Sour,  Five Finger Death Punch’s Ivan Moody, AWOLNATION, and Bad Wolves’ Tommy Vext. The song is part of an initiative to draw attention to the opioid crisis and raise funds for the recovery community, timed with National Recovery Month; all artist royalties from the song will go to the Global Recovery Initiatives Foundation (GRI), with a matching contribution from Better Noise Music. The song is also featured on the soundtrack for Better Noise Films’ Sno Babies, a raw depiction of teenage drug addiction in a seemingly picturesque suburban town.

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Family sells t-shirts to benefit overdose victim’s child

Addiction Recovery Bulletin

WATCH – The little ones left behind –

Sep. 14, 2020 – Both men were into racing so the Schultz family hopes these t-shirts in his memory alert others to the danger of street drugs laced with fentanyl.

“I hope they raise awareness for what fentanyl can do for anybody and obviously to raise money for her 3-year-old daughter to help her later in life,” Tanner’s mother, Marcia Leonard, said. 

The shirts say, “Life is not about winning the race. It’s about finishing the race.”

The family has raised more than $1,300 for Sophia’s college fund. 

If you’d like to buy a t-shirt for $15 to help out, you can email Leonard at: [email protected]

more@KeloLand

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Sometimes I Feel Like…offers poetic inspiration

Addiction Recovery Bulletin

Encouragement in Life – 

Sep. 15, 2020 – Each poem is a testimony of the author’s strength and hope as he overcomes his experiences. Ultimately, the book offers readers inspiration and motivation to deal with the real life issues that they are going through, all while cleverly adding a poetic twist to each and every poem title.

“I would like my readers to know that it’s okay to feel whatever you want,” Hunter states. “I want them to know that they are not alone because there is at least one other person that’s feeling the same way. Finally, I want my readers to know that no matter how bad it gets there is a solution for making the best out any negative situation.

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Sebastian Velasquez looks back on his journey to five years of sobriety

Addiction Recovery Bulletin

Local Hero –

Sep. 17, 2020 – “In this profession, you have many temptations but being sober is part of who I am today. It’s easy to say no to people when I am offered a drink. It used to not be that way.” Going back to those times that it wasn’t easy to say no, Velasquez explained, “My alcoholism started off as just fun. Drinks here and there, parties, the good old times with the friends and ladies. Then, it became very bad when I started drinking on my own. Late-night calls to my mother crying for no reason, missing training sessions for Real Salt Lake, driving under the influence, showing up to training sessions hungover and smelling like alcohol.”

“One time, I had two of my RSL teammates do an intervention on me at my apartment, asking me to seek help because they thought I had a problem. I always denied it and keep moving forward as long as I was playing well. My drinking became almost drinking every day unless I was starting on the weekend so I wouldn’t drink Fridays to play Saturday. Soccer held a tab on me and it finally made me pay for all my unprofessional actions.”

With multiple professional seasons under his belt and his drinking getting worse, Velasquez talked about the low point for his battle with alcoholism. “It was in 2014, I had a DUI at RSL but that wasn’t enough for me to change,” he said. “It was the second DUI on December 11, 2014, in Greenville when I was on vacation visiting my dad.”

“I borrowed a car to go get a haircut. Atletico Nacional was playing the final of Copa Sudamericana so after my cut, I walked into a restaurant right beside the barbershop to watch the game. I started buying drinks for myself and was super hammered in less than 45 mins. I go in the car, and try to go back to my family’s house.”

He didn’t make it back to the family home that night. “I ended up running a red light to cross the bridge and the car hits the railing and almost flips, but it bounces back from the railing to stay on the road,” he recalled. “A cop sees this as it happens and puts the lights on me. I drive into the next parking lot and try to run away. I was so drunk that I trip over and they jump on me and lock me up. I wake up the next day in the jail cell, puking, crying, and all sorts.”

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Exploring science, addiction and the soul in ‘Transcendent Kingdom’

Addiction Recovery Bulletin

WATCH – Mind Blowing – 

Sep. 15, 2020 – Belief can be tricky. Either you wholeheartedly believe in your faith or you have niggling doubts that crop up at the most inopportune time. The narrator of our latest read finds herself trying to reconcile her religious upbringing with her scientific pursuits. 

Transcendent Kingdom by Yaa Gyasi In her brilliantly executed sophomore novel, Yaa Gyasi asks readers to follow the protagonist’s internal journey as Gifty struggles to reconcile her religious upbringing with her scientific research after her mother falls into a deep depression. Gifty is a talented scientist working on a Ph.D. in neuroscience as she studies the brain to try to understand if the brain can be trained to not want something it has grown addicted to. As Gifty tries to care for her mother who has been shipped from Alabama to Gifty’s small student apartment in California, she finds herself forced to think about her family and her childhood.

Gifty was raised by her Ghanaian immigrant parents and lived in the shadow of her talented and beloved older brother, Nana. With a distant father who abandoned her and Nana’s drug addiction, Gifty clung to her mother’s deep love of God to provide some stability in her life.

“Transcendent Kingdom” examines addiction, depression, immigration, racism, religion and science in a beautifully fluid manner that educates the reader while keeping them entranced in Gifty’s story. Readers will find themselves invested in Gifty’s scientific pursuits as she tries to determine whether she believes more in the corporeal practicalities of the mind or the spiritual nature of religion.

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