Robert T. Babbitt PLLC
Issue 8, Article 1
COVID 19, REMDESIVIR WAS “FIRST THERAPY”, DEXAMETHASONE NOW TESTED FOR COVID-19
Fifty-nine years ago, Dexamethasone was approved for safe use. This generic drug has now been tested as a therapeutic in the treatment of Covid-19. This is a corticosteroid that reduces inflammation and is useful in treatments against arthritis, asthma, allergies and nausea.
In the random testing of 2,104 patients, each received six milligrams of the drug once per day. Compared to 4,321 patients monitored, but not treated, those who received the drug saw improvements. Of those on ventilators, the death rate was 35% lower for those on Dexamethasone. Of those on oxygen only, the fatality rate was 20% lower.
The lead investigators include infectious disease specialist Peter Horby who said: this is “…the first drug to be shown to improve survival in COVID-19.” This comment reflects the greater level of persons tested with this drug than with Remdesivir.
The benefit of this drug in the body’s chemistry is the suppression of the immune system. This disease has various stages including the cytokine storm that can ravage the lungs with an overzealous immune response. USAID infectious disease expert Anthony Fauci said of the unusual end stage storm of immune response: “….it’s usually that you have an aberrant or hyperactive inflammatory response that contributes as much to the morbidity and mortality as any direct viral effect.”
Compared to the promising drug, Remdesivir, this drug offers ease of administration, extremely low cost, and broad availability.
Neither of these drugs prevent Covid-19. But both appear to have a significant impact on the most severe cases. The implication of these findings is that the fatality rate may decline. Remember this does not solve the problem, but it may limit the dangers and the fears that accompany this new disease. It confirms the theory that useful therapeutics will be available before the stringent testing of potential vaccines will be complete.
For more details see: www.nature.com (June 16, 2020)
Issue 8, Article 2
COVID 19, WHAT ARE THE MOST EFFECTIVE STRATEGIES TO AVOID INFECTED EMPLOYEES
Texas transit systems have rapidly adjusted to the new normal of operation during the pandemic. The temporary elimination of fares is ending in many cities. The temporary rear door only policies are ending in some systems. The reduced weekend level service on weekdays is gradually returning to pre-pandemic levels.
We can improve our training with addition of customer service modules instructing how to manage incidents of coughing, sneezing or other dangerous behaviors. Our assignment of operators to runs will need to accommodate the expected extra buses to relieve crowding. Our maintenance and cleaning cycles will need adjustment to clean buses thoroughly more often, and before, our technicians work on preventive or repair tasks.
Some of the strategies that seemed to be solved already include operator barriers that prevent sneeze or cough exposure, deep interior cleaning with safe disinfectants and elimination of physical contact among employees or customers.
We can, in many systems, prepare “fit-for-service” protocols that are critical. We can use thermal imaging or simpler forehead temperature scans for temperature increases. The few employees that appear for normal work shifts without facial coverings can be given masks at the door. And most importantly, each of the few positive cases we experience can be carefully tested and traced to determine the exposure origin and notify each endangered person.
Issue 8, Article 3
COVID 19, IT ACTS LIKE THREE DIFFERENT DISEASES IN THESE PHASES
This disease was a mystery in the winter. During the spring, scientists clarified that the transmission could happen in several methods but almost always is the product of the exhaled, sneezed or coughed particles from an infected person. Very few cases have been traced to outdoor exposures or touching a handle.
The “mystery” that remains is how infectious is the disease before an individual has any symptoms.
For these reasons, facial coverings, hand sanitation, clear sneeze guards and physical distancing must continue while the vaccine race continues.
The therapies are beginning to emerge that are more effective at different points. As different treatments are proven safe and effective, some new combinations of treatments may emerge as the more potent strategies.
Remdesivir and Dexamethasone have a positive impact on many patients in the third phase of the disease. This hyperinflammatory phase is especially dangerous since so many organs may fail because the immune system is working too fast. These two drugs are the most exciting progress to date.
The second phase of the disease is the pulmonary phase. At this point the patient has a persistent cough, low oxygen levels and shortness of breath. In some patients the breathing rate quickens without the individual noticing the change. In others, the act of holding a deep breath is painful. Much of the internal damage at this point is the damage to the alveoli. These tiny air sacs are vital in the oxygen-carbon dioxide transfer from lung to heart. The damage is typically microscopic blood clots. The effective treatments at this phase may be blood thinners like “tPA”. The enzymes responsible for clot breakdowns solve the puzzle of alveoli turning to gel.
The first phase is the simplest. Most symptoms feel like a seasonal flu. Many infected persons recover with no therapy except fluids and rest. It is important that any of these phases are treated as infectious. But this first phase is not a frightening experience to most patients. Four in five patients do not require hospitalization and are cured in 14 days.
As transit managers it is important for us to understand the disease, its phases and its transmission methods. We will continually adjust to the new methods of prevention and treatment. The routes and schedules will be adjusted to meet the demands of our customers and the safety needs of our team members.
For more details see: www.thehindu.com (June 14, 2020)
Issue 8, Article 4
COVID 19, WE HAVE MADE PROGRESS, YET DANGER SIGNS ABOUND
New York was the epicenter in the United States and the state is finally able to relax some of the measures that shuttered the economy. Arizona avoided most of the impacts from the disease for months. But on Wednesday this week, Arizona officials reported that, since the reopening of most of the commercial activities, 85% of the hospital beds are in use.
The European Union cases are on decline, but the confirmed cases in Brazil have now exceeded 1 million. Many estimates place the accurate number much higher. On CNBC this week, medical professor Alexandre Barbosa of Sao Paulo State University said: “…. the true number is probably at least 3 million…”
There are two medicines that limit the most severe impacts of the disease in a portion of those serious ill. One is new and one has been used for 59 years. Our communities will soon feel a bit safer, even though the illness is not yet eradicated.
There are nine vaccines, of the dozens under development, that are working through the rigorous safety and efficacy testing.
Transit systems throughout Texas are finding practical ways through the crisis. The issue of facial coverings is a simple strategy for many, yet it has struck a nerve with many others. The mayors of Houston and eight other cities asked Governor Abbott for permission to require masks. Governor Abbott did not argue when Bexar County Judge Nelson Wolff used the governor’s executive order to require businesses to require masks. Several county judges are expected to follow this pattern. Cities that have adopted the “mask” requirement range in size from Houston to Waco.
The political debate over facial coverings reminds us that we remain a nation that innovates and often leads. But we can often become entangled in legitimate “liberty – common safety” debates.
If our transit systems can encourage or require customers to wear facial coverings the issues of six-foot distancing become far less challenging. If our transit systems reach new solutions for touchless fare collection that is fair to those without bank accounts or smartphones, the fear of riding decreases. If every public communication explains the basic health protocols we must follow and the latest adjustments to our service, we will have a balance of health safety, steady return of customers and a community that has a sense of normalcy.
For more details see: www.cnbc.com (June 20, 2020)
Issue 8, Article 5
COVID 19, HOW MANY WILL RETURN AND WHEN
The number of customers that return in the first week, the first month, and the first quarter after normal service is offered will be determined by how many work, school and other trips the community opens up and to how safe the customers feel the transit system experience is.
We have little control over how fast the community economy is reopened but a great deal of control over how safe the customers feel. The subway system in New York hit the lowest ridership in recent history on April 13, 2020 at 366,000. The return to one million daily riders is expected this week. The latest results were over 940,000 per day.
Valley Metro is making the customer feel safe as well. On June 22 facial coverings will be offered at Central Station, Metrocenter, Sunnylslope and Ed Pastor. Facial coverings are “strongly encouraged” at the Metro Mobility Center.
Each of our transit systems is different. In a small Texas city, a few hundred to one thousand daily riders may be normal. New York is at the higher end of daily ridership, but there is a long way to normal from the current 900,000 to the previous 5 million per day.
Many of our transit systems went to free fare or no contact fare. Those that make the no contact approach permanent will see riders return more quickly.
We will each experience a period of few new riders until the previous riders have returned. But as the new riders appear in the new school semester, the health rules must be obvious to all customers to make them feel safe and comfortable and to avoid disagreements among customers and operators.
And in each of our communications, signs and websites we can continue to make the public aware of our new customer friendly attention to their health and the safety of our team. We have proven that transit is essential to the community. Now we must prove that our response to the return of the transit economy respects the inherent dangers of Covid-19 and the simple solutions that prevent the problem.