Robert T. Babbitt PLLC

Issue 9, Article 1

COVID 19, CASES SURGE IN FLORIDA, ARIZONA, TEXAS – BUT SOME PERSPECTIVE NEEDED

There is no doubt that the exuberant return to “normal” activities was ahead of the actual guidance results. It is one thing to allow phased re-openings, it is another to follow or enforce the guidelines designed for our safety.

This week Texas governor Abbott announced closing of bars and other measures. Most large counties in Texas announced mandatory facial coverings when customers enter stores.

Some perspective is important as these critical issues are evaluated. Florida, Arizona, and Texas are the three states with the most serious surge in cases. New York, New Jersey, and Massachusetts are the states with the largest number of fatalities.

According to the data reported at worldometers.info, on Friday (June 26, 2020), Florida reported 8,942 new cases, Texas reported 5,614 new cases and Arizona reported 3,428 new cases. New York had 933 new cases, New Jersey had 413 and Massachusetts had 233. These are dramatic differences.

This is a comparison in which no state wants to perform poorly.

The most vital statistic is the fatality count. New York has had 31,421 including 48 on Friday; New Jersey has had 15,057 including 45 on Friday; Massachusetts has had 8,013 including 50 on Friday. Arizona has had 3,428 with 45 on Friday; Florida has had 3,366 including 37 on Friday; Texas has had 2,367 including 33 on Friday.

The most somber data include the fatalities per one million population.

The USA average is 386; New Jersey has had 1,695; New York 1,615; Massachusetts 1,163. Arizona has had 211; Florida 157; Texas 82,

The data tell us three important things:

              New York, New Jersey, Massachusetts had a far more serious problem than the “Surge” states.

              Arizona, Florida, Texas are accelerating in a dangerous pattern.

              There is no doubt that the distancing measures worked, and the re-opening brought challenges.

Texas continues to experience the lowest fatality rate of any large population state. To keep this trend everyone in our state has an obligation to control the spread. This is a dangerous virus that HAS BEEN PROVEN TO BE CONTROLLABLE BY DISTANCING AND SANITATION.

The problem is complex since it creates a reaction of invulnerability in many. The problem is simple since those that take the required precautions have generally kept their family and friends safe.

Issue 9, Article 2

COVID 19, BREAKTHROUGH NEWS IN UVC TREATMENT

There is no doubt that social distancing and disinfection disrupt the transmission of this disease. But the recent surge in several states points to the need for other strategies as well. To fully open the economy without increasing the spread, vaccines and therapeutic treatments are important.

It would also be of tremendous benefit to have a redundant strategy that could be safely used in places where the public gathers.  

Recent research published by scientists Buonanno, Welch and Brenner offer such a strategy. Many of us have seen reports of ultraviolet UVC light in deep cleaning of rail and bus vehicles. This is effective as a direct approach to inactivate the virus. It works as an antimicrobial approach, normally with UV light emitted from a low-pressure mercury-vapor arc lamp. Typical wavelength of this application is 254 nm.

As useful as this strategy can be, the problem is the danger of its use when persons are in the room or vehicle. Direct exposure to this wavelength causes damage to eye and skin tissues.

A variant is proving to be much safer for humans. Far-UVC light emitting 215 nm has been proven to be effective in the same manner. This short wavelength has extremely limited penetration depth. This penetration is still much larger than the tiny enemy we are fighting but it cannot penetrate the outer dead layer of human skin, the ocular tear layer, nor the cytoplasm of cells. Conventional UVC light does penetrate those.

The testing to date includes how much of this light can be emitted, without damage to people, in public settings. There is a current regulatory limit and the data indicate at that energy level 90% of the viral inactivation takes place in 8 minutes and 99.9% of the viral inactivation requires 25 minutes.

If these results are accepted by the broad scientific review process it will create a rapid solution to reduce the anxiety of travel on vehicles that are equipped for safe operation of the Far-UVC emitter.

It would create a resurgence in transit use to proclaim that the air in our vehicles is safer than the air at home.

The implications for air travel, elevators and offices are promising as well.

For more details see: www.nature.com (June 24, 2020)

And www.scitechdaily.com (June 27, 2020)

Issue 9, Article 3

COVID 19, MANY TRANSIT SYSTEMS HAVE DEALT WITH POSITIVE CASES AMONG EMPLOYEES, FEW HAVE AVOIDED THEM

Houston, Dallas, San Antonio, Austin, and Fort Worth have dealt with employee cases of Covid-19. Many other transit systems may have to deal with this problem before the virus is limited or constrained.

One small transit system in Arkansas made the news recently with the extra steps they have taken. The results are significant. Ozark Regional Transit, like virtually every transit system has had to test employees after exposure to positive cases from riders.

Though all transit systems have increased the intensity and type of interior cleaning, Ozark has added steps. In addition to the nightly detailed cleaning, each employee is temperature checked each time they enter the property.

It is difficult to compare small transit systems with large transit systems, the dangers of community spread are much different. But transit workers are generally hard workers who have, for years, pushed through minor congestion or other symptoms. This is not a time to allow any employee to “push through” an illness unless they prove the symptoms are not related to Covid-19.

It may be difficult to temperature check each employee each time they enter the work environment, but it is important and practical in the current environment. The riders notice the extra effort. The May results indicate ORT ridership was back to 48% of the same month in 2019.

We are adjusting to a work environment that includes sending a “healthy” employee home for three to fourteen days due to a limited contact with a positive case. This is a problem, but it is far better than allowing an unknown case to spread.

This virus is unique in the ability to spread before a person knows they have been infected. One Tyson Food facility in Springdale, Arkansas tested all employees. Of the 1,102 employees, 198 were positive and displayed no symptoms. Only one tested positive that had any symptom.

For more details see: www.wattagnet.com (June 12, 2020)

Issue 9, Article 4

COVID 19, AS OUR CITIES OPEN MANY BUSINESSES, ARE THERE CLEAR RULES TO REDUCE RISKS?

Dr. Emily Landon, University of Chicago Medicine infectious disease specialists reminds workers if they are returning to a small office or a 50-story high rise with cramped elevators, the simple rules apply:

CHOOSE

              Outdoor over indoor

              Masking over not masking

              More space over cramped space

              Fewer person meeting over many persons meeting

With these tendencies it is easy to forecast that the central business district of many cities will “re-open” gradually, and the new normal will be a slight reduction in overall trips. In the larger cities, high rise elevators will require new spacing. This may bring needs to spread the commuting worker demand over two hours of starting times.

In large shopping centers and malls in many cities, the shopping trips may be transformed to “shop by internet, pickup at store”. This could mean quicker return trips that impact those transit fares that are valid for two hours, reducing the need for the customer to pay for the return trip.

In the case of trips to hospitals, we can expect a prolonged period of anxiety among riders. Of course the trips by medical workers will continue, but many will be exposed for several more weeks to unusual risks all day and may therefore be reluctant to share a transit trip for thirty minutes with others who might carry the virus unknowingly.  

Many high schools and colleges will offer a fall schedule of mixed classes, some in-person courses will be supplemented by some remote learning. This will change the pattern of trips to and from some of our larger trip generators.

In our transit systems that are requiring masks on-board, one of the more common issues of concern might be the after-school trip home if teens take off masks and speak loudly or yell at one another. It will only be a matter of hours until we receive complaints from the parents of students who demand we enforce the rules for the safety of their student.

This may prove to be the most challenging period of regaining customers since the oil shortage ended three decades ago. Transit managers will need to measure, adapt and modify at a rapid pace.

Issue 9, Article 5

COVID 19, NATIONAL RURAL TRANSIT ASSISTANCE PROGRAM – ADVICE FROM CLINICIANS

How do we prepare our team members that test positive? It can be a frightening experience due to the few extreme cases.

First, consider the positive test itself. There is a chance to take the test and receive a FALSE positive. There is little an employee can do; the employer must treat the case as positive until proof of the error and confirmation of a new test.

False negative tests are a different concern. In the example of 100 employees tested, 30 negative tests could be errors. The best available nasal swab testing may gradually improve in accuracy, but for current safe precautions, this error rate is a significant problem.

Physicians also rely on confirmations through symptoms. Fever, fatigue, chills, headache and muscle aches are Covid-19 symptoms, but these also could be symptoms of something as simple as strep throat.

Loss of smell, dry cough, shortness of breath and rapid shallow breathing are symptoms that probably fit the diagnosis of Covid-19 rather than other illnesses. The unusual pattern of this infection is the high number of positive cases that exhibit no symptoms. The estimates range from 20% to 50% of these asymptomatic cases. But they are dangerous in terms of infecting others at work or home, just the same.

Often the only “treatment” is rest, fluids and quarantine isolation. In those that do not require hospital stays, the home quarantine period must be carefully guarded so that household members are not infected. In the 20% of cases that require hospital stays, care may include intravenous fluids, antibiotics (which only help with some effects), sedation and oxygen.

The most dangerous cases are treated in the Intensive Care Units of larger hospitals. In these instances, one of the more debilitating issues is the isolation. The hospital rules will eliminate virtually all visits in the ICU for these dangerously ill patients. The nurses and doctors report a variety of sad and humbling stories of human suffering in these small percent of cases.      

In the case of those serious patients that enter the critical “cytokine storm” phase, there may be an opportunity to receive one of two therapeutics that offer promise. Dexamethasone has been in use for other illnesses for 59 years, Remdesivir is a new drug. Both have shown significant improvement for patients in this serious stage of the infection.

We do not want to frighten any employee, but it is important that the accurate picture of the dangers and warning signs are clear to all our team members.

For more details see: www.nationalrtap.org (June 2020)

Weekly Update: Issue 9, Week of June 29-July 5, 2020: Perspective Needed For Surge In Cases, Breakthrough News In UVC Treatment, and more

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