Showing posts with label pandemic. Show all posts
Showing posts with label pandemic. Show all posts

08 November 2020

Protect your eyes from COVID19 infection.



 There’s a saying: if you’re the smartest person in the room, you’re in the wrong room. I recently found myself in the right room—a masked, backyard get-together with close friends.

My husband mentioned he’d added a face shield to his mask in indoor public places, to protect his eyes during the second wave of COVID-19. One of our friends, Brian Foody, said that using a face shield with a mask wouldn’t protect eyes from airborne COVID-19 but goggles would.

This statement was very surprising. Public health experts have been clear, given the airborne transmission of COVID-19, that face shields and goggles protect the eyes equally.

For the public, Dr. Anthony Fauci said in an interview, “. . . you should protect all of the mucosal surfaces, so if you have goggles or an eye shield, you should use it.”

In healthcare settings, face shields are irreplaceable to protect against splatter during procedures, but face shields and goggles are recommended by public health as interchangeable eye protection.

For protection during aerosol-generating medical procedures, Canadian Public Health recommends, “eye, nose and mouth protection (mask and eye protection, or mask and face shield, or mask with attached shield) that fully covers the eyes, nose and mouth and ensures that no part of the face is exposed.”

The CDC states, “The PPE recommended when caring for a patient with suspected or confirmed COVID-19 includes the following . . . Put on eye protection (i.e., goggles or a face shield that covers the front and sides of the face) upon entry to the patient room or care area.”

If face shields don’t protect the eyes from airborne COVID-19, the definition of “adequate PPE” changes and this may save lives. A large study of healthcare workers showed that they accounted for 10% to 20% of COVID-19 infections and, even more worryingly, “even among frontline healthcare workers reporting adequate PPE, the risk for COVID-19 was increased . . ..”

Given the importance of this issue for the public and for healthcare workers, I interviewed Brian Foody, president and chief executive officer of Iogen Corporation and an MIT-educated mechanical engineer, who specializes in fluid motion.

The movement of COVID-19 infected air is at the heart of this issue.

“Imagine two people wearing face masks, one has on a face shield and the other is wearing goggles, walking into a closed room where the ambient air contains COVID-19 infected aerosols,” Foody explained. “Whose eyes are better protected? For our wearer of the face shield, with every breath, the clean air behind her face shield is ventilated and exchanged with the contaminated ambient air. Because of this ventilation, the air behind the face shield will have the same concentration of aerosols as the rest of the room within a matter of minutes. On the other hand, for our goggle wearer, the clean air behind her goggles is sealed off from the ambient air.”

The mixing of air behind a face shield is based on the basic scientific principles of fluid dynamics: if there are COVID-19 particles, they’ll be drawn into the face shield and up to the eyes.

This behaviour of aerosols is supported by a 2014 study. “Face shields can substantially reduce the short-term exposure of health care workers to large infectious aerosol particles, but smaller particles can remain airborne longer and flow around the face shield more easily to be inhaled,” it noted.

A review of the literature in March, 2020 stated that, “There is a lack of research on the effectiveness of different forms of eye protection.”

And yet, certainly the public health recommendations consider goggles and face shields as equivalent.

I am reminded of the early days when many of us recognized the pattern of airborne transmission of COVID-19 infections and advocated for masks, contradicting public health recommendations. Now the widespread use of masks is recognized as an important tool to limit COVID-19. This information on face shields is just as important: face shields protect from splatter but do not offer eye protection and public health recommendations for the public and healthcare workers must change.

Then Brian asked a crucial question: “What are the chances of getting infected through your eyes?”

To begin to find my way through this issue, I had to enter the right room, so I unabashedly called my friend, Dr. Sherif El-Defrawy, at his cottage on Thanksgiving.

Dr. Sherif El-Defrawy is an ophthalmologist who’s chair of the Department of Ophthalmology at the University of Toronto, before which he held a similar position at Queen’s University. He’s also president of the Canadian Ophthalmological Society and of the Association of Canadian University Professors of Ophthalmology.

In short, Dr. El-Defrawy knows eyes.

“If COVID-19 infects the conjunctiva of the eye, it could travel to the nose via the nasolacrimal duct and colonize the nose or throat,” he explained. “However, we would expect to see conjunctivitis. I find it highly unlikely that there would be enough COVID-19 to cause illness without seeing conjunctivitis.”

He explained that the number of COVID-19 infected patients with conjunctivitis wasn’t that large but it was unclear how many patients were checked for this. Finally, he expressed surprise that goggles were not universally recommended in healthcare settings along with face shields.

So, first things first, I’m not a fan of primate studies but there was one that answered many questions about COVID-19 infection via the eyes, so with great regret I present it here.

Three rhesus macaques were infected with COVID, two via their conjunctiva and one via intratracheal route. The conjunctival swabs were positive for the first day only, “indicating that the inoculated virus may transfer from conjunctiva to respiratory tract and other tissues . . . specific IgG antibodies against SARS-CoV-2 were detected in the rhesus macaques, indicating that the animal was indeed infected with SARS-CoV-2 [showing] that conjunctiva is a route of SARS-CoV-2 transmission.”

A literature review concluded, “The overall prevalence of ocular symptoms in patients with COVID-19 was 11.2%, which is not a common finding. Nevertheless, this reported prevalence might be an underestimation because patients with COVID-19 present with life-threatening clinical scenarios, which may preclude a detailed ocular examination or relevant history.”

Speaking of ophthalmologists, we should acknowledge with deep gratitude that it was the ophthalmologist, Li Wenliang, who was one of the first people who warned the world about the new disease we now call COVID-19. He later succumbed to the disease after contracting the virus seemingly from an asymptomatic glaucoma patient in his clinic.

So, how does eye protection play out on the ground in healthcare settings? Here I turned to information from Dr. Rick MacDonald, a community paediatrician on staff at Halton Healthcare hospitals where he takes call seeing paediatric patients and works in the NICU.

When many other physicians’ offices were largely doing virtual visits, “we decided early on that if we were going to be a useful resource for our paediatric population. . . .We needed to see patients [and] to provide this service, PPE is the most important first step without which it could not be done.”

Dr. MacDonald spent hours sourcing PPE for his office, opting for an N95 and a face shield but now also wears goggles as well. “To [keep our office open] we need full protection. No skimping, no cheating, full attention to detail. . . . Overkill is better and no government official or cloistered ID staff will convince me otherwise.”

He’s correct: protection, including eye protection, is crucial. Doctors are often in closed examining rooms, crowded emergency departments or intensive care units, with potentially large volumes of COVID-19 aerosols. So are nurses, paramedics, respiratory therapists and many others.

Certainly, we could benefit from research on the fluid dynamics of COVID19 aerosols with people wearing face shields and masks. However, we are in the second wave of this pandemic and there are a frightening number of infections in the public and healthcare workers.

I’m asking public health, in light of the basic science of fluid dynamics of aerosols, to change their recommendations:

The public should wear eye protection if they are indoors with others.

Healthcare workers working with patients that are potentially COVID-19 positive, should use face shields for splatter alone. Goggles are the only safe eye protection for aerosols.

26 March 2020

Little Plague on the Prairie:
The 1918-19 Diary of Anna Eneboe


Page One of Anna Eneboe's diary, which she kept from 1918 until late 1919:

Miss Anna Eneboe
Pierpont So. Dak.
My day book
Come read my thoughts

Anna Eneboe and her Diary

She was the great aunt of my dear friend Allyson Giles Nagel, who graciously gave me permission to use Anna's writing. The diary is very short, very simple, very spare, written in a small red notebook that's pretty worn after all these years. Anna was 19 years old in 1918, unmarried, and treasurer of the local Independence Red Cross (organized June 13, 1918). Some of the people mentioned in the diary are her older brothers, Henry (called Hank) and Rudolph (called Rud), her two adopted sisters, Lillian (called Lillie) and Agnes, her parents, and her future husband, Bernt Nerland. The family all lived on a farm outside Pierpont, SD, up in Day County, in northwestern South Dakota. Today its population is 135, back then somewhere between 314-400 (the census of 1910 and 1920 respectively). I've guestimated it to be around 380 in 1918.

Now, before we get started reading excerpts from the diary, you need to remember that the Spanish Flu roared through the United States three times. The first was in the spring of 1918. It was fairly mild and it disappeared for the summer. People believed that it was over. And then with the fall, came the flu, and October - when this diary begins - was the deadliest month of all. 195,000 Americans died that month from the Spanish Influenza.

Wikipedia – Link
Victims died within hours or days of developing symptoms, their skin turning blue and their lungs filling with fluid that caused them to suffocate. There was no treatment, no vaccine, no cure. Thanks to WW1 (BTW – the Spanish flu killed more soldiers than died in battle in WW1), there was also a shortage of doctors and nurses back home. And no one, no place was immune. Even President Woodrow Wilson got it in early 1919 while negotiating the Treaty of Versailles in Europe. (Link)

It's hard not to believe that it was the Spanish Flu's return in October, 1918 that got Anna to writing things down. Not that she knew it, but that month was the peak – but not the end – of the pestilence. But she was well aware that men were coming home from the war, some of them sick, some of them dying. That people all around her were sick, dying, but also marrying and giving birth. And that's what she writes about.

1918

Camp Funston Hospital Ward for Soldiers sick with Influenza

Oct. 14th – Hans Oswood seriously ill at Camp Funston of the Fluenza.
Oct. 15th – Alfred Nelson gassed in France in August and has been at the hospital since.
Emil Sanders sick of the Fluenza in Camp Dodge.
School closed in Pierpont Oct. 14th on account of the Flu.
Dr. Murphy sick of the Flu.
Mrs. Eddie Kamestad died in the evening Oct. 14th.
Luther Hofstad wounded severely in France Oct. 14th.
Edwin Ronshaugen died in Camp Funston of the Flu., Oct. 14th.
Kristian Mjolsness was married to Lina Likus Oct. 18th.
Anna Rindahl was married to Mr. Jensen November 3rd.
Mr. and Mrs. Monk Osby are the proud parents of a baby boy, born Oct. 3rd.
Rudolph Baukol lost in action [in pencil].
Magnus Brindenuven died of wounds received in France.
Oscar Nymauen died of the Fluenza in Camp grand.
My Note: "On Oct. 16, 1918, the South Dakota State Board of Health ordered everything closed: Schools, houses of amusement, sporting events, speeches, everything. The order was enforced by police and the Home Guard, a quasi-military force that patrolled cities looking for violations." (Argus Leader)

SD Historical Archives

Mrs. Martin Jacobson died of the Influenza in November at Nigdahl Minn.
The oldest boy of Rev. Danielson died of the Flu at Langford.
Ole Jacobson’s little baby boy died of the Flu Sunday evening 28th of Dec.
Henry was married to Jennie Eggen the 4th of Dec. at New Effington.
Alma Gunderson was married to Dennie Holland in December.
Selma Liknis was married to Synerk Anderson in October.
Josie Oswood was married to Boyd Vikers in August at Camp Lewis, Washington.
Enok Liknis was home in a furlough in Oct.
The soldiers who came home for Xmas is as following –
Earl Hutenburg
Hans Oswood
Gust Johnson
Mat Johnson
Harry Nerheim
Rev. Husley from France [in pencil – Y.M.C.A.]
Adolph Eikaness
Martin Midland - -
Mathilda Hanson was married to Mr. Olson
Howard and Marie spent Xmas with us.
A cablegram from the battlefields of France last week Thursday, conveyed the heartbreaking news of the first sacrifice made by one who spent his childhood days in Farmington, and lived here in the adjoined vicinity on the north, the greater part of his life.

Henry O. Osness in company with his brother Chester departed from Langford April 26, 1918, with the Marshall County soldier boys of that date, who were sent to Camp Funston, Kansas.

WW1 Soldiers Returning Home

A sorrowful group of half-sisters and brothers mourn his loss, also a number of other relatives.
He is survived by his two sister, Misses Josephine and Anna, and by three brothers, Chester, his comrade, and Theodore and Selmer.
Three years ago, Henry enlisted in the navy, but was honorably discharged on account of physical disability. He appeared well and was of a happy, jolly disposition. The selective draft admitted him, and he went to death bravely fighting for his glorious country. “Over the top” was his motto, and t’was there he payed the supreme sacrifice.After only a brief time, they were called “over there” and on July 11th Henry gave his life nobly in this great crisis, which the United States was suddenly thrust into and from which nearly the entire world is so grandly, so nobly extricating itself. Henry was the son of Mr. and Mrs. Christian Osness and was born in Newport township, Marshall Co., June 10, 1889. The family resided in Farmington a number of years, during which the children were left orphans by the death of both parents.

O’er the sea there came a cable message from the battlefields of France.The golden star in their service flag appeals with honor and sadness to Henry’s countless friends here.
Henry is gone, never hereafter to wake nor to weep.
Sleep, soldier, sleep.
Ne’er more the bugle shall call you, call you to fight fierce and long.
Yours is calm rest. We your memory sacred will keep.
Sleep, soldier, sleep.
We gaze at a star turned to golden. That shortly in deep blue did shine. O that in heaven, your soul is in keep.
Sleep, soldier, sleep.
“Chester’s Tale”
Henry was blown to pieces. Half of the body were all that they could find to bury. There’s a little white cross somewhere in France that now marks his grave.

Aerial photograph of Pierpont,
Aerial view of Pierpont, SD.
Pierpont Quasquicentennial - Pierpont SD Facebook page

1919

January

Walter Sletten and Bernt Norland arrived from Camp Dodge Jan. 3.
School opened again January 6th – met Bernt at the Ladies Aid at Synert Sampson January 9thTheodore Roswell died in January
Old Mr. Brookings was buried January 9th.
Born to Mr. and Mrs. Boyd Vikers a baby in January.

Boyd Vikers and Christ Oswood return home from camp.
Charly Paulson has been home on furlough.
Meeting in Falness [Lutheran Church, Langford, SD] Jan. 19 – also to Y P.M. in the evening.
Mr. Knut Syvertson and Mrs. Dahl was married this month.
Was at John Enstad Sunday the 12th in the evening.

21st - has been very lovely weather now for the last days. Today it is foggy.
23rd – Henry Fossum returned home from Camp Lewis. Oscar Brandly also is home from Washington.Olaf Syre returned home from camp.

Lillie’s partner was Clarence, my partner was Emil Erickson – we had a very nice time talking and laughing. Played games and so on. Shook hands with Olaf Syre. Hobart Syre and Joseph Nygaard came home today.23rd – very nice weather, social in Hainess school house tonite. Quite a few there. The sum paid for Baskets $72.74.
28th – had our first trip in the Overland to Pierpoint. Sawsa Brandle’s a baby in January

My Note The Overland was a "runabout", and the Overland Automobile was produced from 1903-1926. Pa's new vehicle was probably Model 83:

Overland automobile
Overland automobile (Wikipedia)
February

My Summation: February was cold, snowy, with more running about in the Overland. Alma Asdland died on the 10th and was buried on the 13th, which means the ground wasn't frozen solid. (Not always true in a South Dakota February.) There were meetings, cleaning, crocheting, and an oyster supper, along with one day when it was warm enough to play croquet, and more days when it was bitter cold with snow.

March, 1919 - the flu returns - the Third Wave

1st – Sat. – Enstad’s – washed the floors and baked was what Hattie did, and I tried to help her along. Snap’d our pictures.
2nd – Sun. – kind of nice today. Rudolph came over after dinner. We made up a poem. In the evening we were discussing different things. Told our fortunes, and had a little lunch. Rudolph stayed over night. (In pencil on the side, Mrs. Ole Enstad died this morning.)
3rd – Mon. – very mild and nice this morning. Rudolph went to Lee’s and then he came back for me. We had a Dakota blizzard going home.
4th – Tue. – Mr. and Mrs. Carl Sampson a boy. Cold, but clear. Have not been doing very much. 5th – Wed. – washing clothes today, nicer weather.
6th – Thurs. – Ironed. Jennie baked cookies, I washed upstairs.
8th – Sat. – Doing the Sat. work in the forenoon and in the afternoon we four girls went to Bakke’s but only Selmer at home. In the evening, Julian and Hattie came over.7th – Fri. – Washed the floors. In the afternoon we went to town. Talked to Chris L. Oswood. Myrtle & Lillie went with us home.

11th – Tue. – Rud sick of the flu. Very nice weather. Not doing very much.
13th – Thurs. – Ironing. Colder. Feeling punk tonight. Uncle and Selmer is here.
14th – Fri. – Sick in bed today of the fluenza.
15th – Sat. – Sunshine again today. Been up this afternoon. Last year today we sure had a nice time this evening but now it is only memorys.
16th – Sun. – Home all day. Have the “flu”.
17th – Mon. – Feel better today.
18th – Tue. – Pa has the flu today – nice weather.
19th – Wed. – Nice weather. We are all feeling fine after the flu. Mrs. Huxley died of the flu.

And then it's done - the Spanish Influenza is over.

Wikipedia - Chitrapa - Own work

On Thursday, May 22nd, Anna and the family went "to Pierpont, had a reception there for the soldiers. First time I seen Chester in uniform. The soldiers were seated on the stage. Had Annie Sparks duet and a quartet. Drawed number on a Red Cross quilt and Chester won it. had ice cream and cake. Only one vacant chair and that was Henry Osness." (Whose death, as you'll remember, Anna recorded in the first part of her diary.)
23rd – Fri. – Lillie and I have been home alone today. The folks been in town. In the evening we went to Pierpoint to take in “The Birth of a Nation”.

A few more months, barely three pages more, and Anna's diary came to an end.
My Note: Anna mentions 14 cases of the flu, 6 of them in October, 3 in November-December, and 5 in March. In the whole diary, 12 people die - 3 in October, 3 in Nov-Dec., and the rest in Jan, March, May, two at least of whom died of the flu. Not a lot, right? But in a community of 380 people, where everyone knows everyone else and has since they were born, that's a lot.
Six cases of flu in October, including the doctor, would have frightened everyone. The whole family coming down with the flu in March would have everyone scared.
And those 12 people dead - they would leave a hole in the community, from the newborn to the soldiers who never came back. Small towns are tight-knit, and memories are long. Weddings and funerals, births and deaths, all get talked about for years, if not generations. The proof is that we know the rest of Anna's story, because it's still being talked about, in Allyson's family, and now here. Anna continued to live on the farm until she was married. She was an older bride: she and Bernt were married in 1931, when she was 32.

Lace or floral wedding dresses
https://vintagedancer.com/vintage/1930s-wedding-history/

But marriage isn't the end of the story, no matter how happy it was. And while I wish her story had a happier ending, it doesn't: Anna died in 1933, in childbirth, at the age of 34. As you can see from the photo of her in the casket, she was buried in her wedding dress, a custom of the time. The baby died as well.




Written On The Back Fly-Leaves of her Diary:

Could we but draw back the curtains that surround each other’s lives, see the naked heart and spirit. Know what spur the action gives. Often we would find it better, purer then we judge we should, we should love each other better. If we only understood.
I’m getting tired of dreaming. Dreaming of you all day. I’m getting tired of sceming [sic]. Hope I shall get you some day.
I envy the dimples that hide and go seek, and play with the roses that bloom on your cheek.
Our eyes have met.
Our lips not yet
But O you kid
I’ll get you yet
Smile, and the world smiles with you.
Weep, and you weep alone.

Anna Eneboe

Stay well, stay safe, stay  HOME.

PS - for Anna's entire diary, go here.

PPS - Other sources for information of the 1918 Spanish Influenza Pandemic in South Dakota include these article: