Robert T Babbitt PLLC
September 3, 2020
Issue 14, Article 1
COVID 19 HOW DOES IT SPREAD, OR NOT SPREAD, ON TRANSIT?
We learned from Paris and Seoul that community wide tracing studies found cases that caused spreading hotspots at nursing homes, hospitals and other community areas, but none were traced to transit lines.
In contrast, we have learned what not to do from a trip to a Buddhist event in Ningbo, China. The trip included three “test” groups: Bus 1 with 60 passengers, Bus 2 with 68 passengers and 172 other individuals attending the event.
The bus trips were both part of the same organization. Both involved 50-minute one-way trips to Ningbo and 50-minute return trips. Both buses were similarly equipped, with HVAC systems that were set on the recirculation setting.
There was one passenger on Bus 2 that had recently been at a different setting with persons from Wuhan, China where the viral outbreak began. This passenger was seated in the middle of the bus and was asymptomatic at that point. Contact tracing to investigate the outbreak identified 3 of the 4 persons sitting closest were infected by this passenger. But it is important to note that 23 (22 plus the sick person) of the 68 became infected. The implications seem clear that the proximity to the original vector was dangerous for infection, but the seat mapping indicated ten different rows where passengers became infected.
On the surface, this is an obvious connection for the danger of proximity and air recirculation both. But what about the passengers on Bus 1 and those at the event who did not take either bus?
Bus 1 passengers had NO infections resulting from the same trip at the same time to the same event.
Of the 172 other attendees at the event, 7 were infected, or 4.1%. It is important to note that this event was an outdoor event. It is also important to note that in addition to the lack of fresh air in the bus (recirculation mode-HVAC), no passengers wore facial coverings. Contrast these reports with those from Paris and Seoul where all passengers were wearing facial coverings, most trips were fifteen or twenty minutes rather than 50 minutes and riders are encouraged to speak as little as possible.
Those that argue that facial coverings are not needed will point to Bus 1 where no rider became infected. Those that see the need for facial coverings will point to the spread in 50 minutes to almost every row of the Bus 2. Those that realize the lowered risks in outdoor activities will point to the infection rate (4%) at the open-air event among those who did not arrive by bus.
Our riders need our transit services and we need faster testing, facial coverings and safe passenger spacing.
For more details see: JAMA Internal Medicine, September 1, 2020: santepubliquefrance.fr, 4june2020
Issue 14, Article 2
COVID 19 ARE THERE SIMPLE STRATEGIES OUR DOCTORS MAY USE TODAY?
The news of three phases of the Covid-19 has led to changes in the medical treatments. The most striking change is the clearance of inexpensive existing drugs for the late stage prevention of the “cytokine storm”.
It is unusual that the treatments for a disease would use medicines which at one point that could be harmful, yet at another stage can be life saving.
This challenge had scientists concerned. But more clarity has emerged after the publication of three carefully conducted clinical trials: one from France, one from Brazil, and one international team that had a key researcher from the University of Pittsburgh.
In the hospitalized cases that are most serious, the human immune reaction accelerates beyond safe levels. The use of the corticosteroid Dexamethasone to limit this reaction was approved earlier this summer.
The World Health Organization issued another alert this week after the JAMA publication of the three studies that were in progress. These were discontinued as it related to new participants, but the results of safety and efficacy continued to be recorded. Researchers had been concerned that giving these inexpensive drugs too soon in the course of the disease could restrict the body’s immune defense mechanisms. The results from the three studies made it clear that the benefit and safety were substantial. The researchers reached the decisions that the control group that was receiving the placebo could no longer be justified. Each of these candidates needed the benefits of the drugs in the later stages of treatment.
Randomized, controlled studies are the gold standard of research in this type of pursuit. Because the methods were tightly controlled and the results in three different parts of the world could replicate the findings, the earlier guidance on corticosteroids has been strengthened.
“These trials … have strengthened the confidence, further defined the benefit, and shifted usual care of COVID-19-related ARDS to include corticosteroids…”
For more details see: JAMA Editorial September 2, 2020; and WHO/2019-nCoV/Corticosteroids/2020.1; and www.npr.org Sep 2, 2020
Issue 14, Article 3
COVID 19 UNION ADVOCACY FOR SAFETY
There have been union locals that have asked for extra pay and additional personal protective equipment during this pandemic.
Grand Valley Transit in Grand Junction, Colorado is one of the first to push for ultraviolet disinfection process to be installed in the HVAC systems of the transit coaches.
The transit system cleaning crews are using enhanced methods for surface cleaning currently. These include the electrostatic fogging that was not common a year ago. Amalgamated Transit Union Health and Safety Representative, Brian Sherlock is advocating for UVC modifications for the heat and air conditioning systems. He acknowledges that opening the windows is helpful, cleaning surfaces frequently is helpful. A continuous flow of interior air through the UVC filtration is the only apparent solution when an infected rider boards the vehicle. Driver barriers are helpful, but the infected customer is likely to not even know that he or she is ill.
One can expect many more transit systems that work with ATU members to pursue this line of defense for their members – your employees.
Ultraviolet light in the C part of the spectrum has been proven effective in destroying the virus by damaging the DNA of the microbes, making them inert. The use on buses is relatively new, yet the basic process of fighting bacteria this way was discovered over 100 years ago.
Though ATU officer Sherlock recently referred to this as $50 air filter, recent sales by one vendor (Apache Safespace) include a room model that has both UVC disinfecting and High Efficiency Particulate Air filtration for $1,850 per unit. This unit processes 175 cubic feet of air per minute. A typical bus has under 2,400 cubic feet of interior space.
The room version of the PuraShield500 claims many benefits for $1,300. The airflow it can accommodate is claimed to be once every 10 minutes in a 4,000 cubic foot room. This unit claims it removes 99.99% of the aerosols carrying viruses without UVC, though the Covid-19 virus has not been conclusively tested in this product.
For more details see: www.westernslopenow.com Sep 3, 2020
Issue 14, Article 4
COVID 19 OCTOBER SURPRISE?
We are all anxious for a complete, safe victory in the battle against Covid-19. And none of us want our family at home or team at work to be late to receive the vaccine. But we also do not want the safety and efficacy of the vaccine to be inconclusive.
On September 2, 2020 the national media reported the August 27, 2020 letter from the Center for Disease Control to the nation’s governors to begin preparations for distribution of the vaccine by November 1, 2020. Election Day is November 3, 2020.
There is clear and present need to have an approved vaccine; to have manufacturers produce the approved drug in mass quantities and for the distribution to be conducted smoothly and quickly.
The letter describes the contractor role in the distribution:
“…the U.S. CDC has contracted with McKesson Corporation … to distribute these vaccines to state and local health departments, medical facilities, doctor offices and other vaccine providers…. The normal time required to obtain these permits presents a significant barrier to the success of this urgent public health program…. CDC urgently requests your assistance in expediting applications for these distribution facilities…. The requirements you may be asked to waive in order to expedite vaccine distribution will not compromise the safety or integrity of the products being distributed.”
The date so close to the election caused many reporters to ask questions.
Doctor Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases clarified that if the clinical trial data is overwhelmingly positive, scientists would have a moral obligation to offer the vaccine to all participants, including those that had been receiving the placebo.
Be prepared for questions from your team members on the timing and effectiveness of these important developments.
There are three clinical trials that will soon report Phase 3 Preliminary findings. It will be data based on several weeks of results from 10,000 to 20,000 participants in all probability. It may be possible that scientists from around the globe can rescue us from the virus and our own faults in the first months of the pandemic.
We are finding many solutions each day to the strategies that allow our “normal” life to return while we keep the risks lower than before. But this virus does not care about our feelings or our politics. If the vaccine is close to the timing suggested in the letter, be prepared for ridership patterns to change quickly.
Issue 14, Article 5
COVID 19 WHAT CHANGES MIGHT REMAIN AFTER THE CRISIS ENDS?
There are many transit operations that have been modified during the last four months. And now that many cities are opening most businesses and schools under modified rules, most transit systems are reopening the front doors of buses and requiring fare collection from the customers.
Even though solutions such as plastic barriers at the bus operator platform have been developed, the farebox interaction is the point of great concern.
The need for contactless payment methods has created new solutions. Cubic recently acquired Delerrok, the provider of cloud-hosted on-board readers that recognize most forms of magnetic and electronic fare media. The Delerrok platform has been a solution for many small and mid-sized transit systems. Some readers were installed in the last two years for under $4,000 per unit.
The Token Transit validators provide another low capital-cost solution for contact free or reduced contact fare recognition. Token Transit has offered a no capital-cost solution to the transit systems for several years. The company keeps a percentage of each fare used. If your system gains new riders from the added convenience, the company suggests this is a win-win accomplishment. The fare in these cases is displayed by a smart phone screen. In some cases, the operator needs to hold the phone or steady the phone while being held by the customer to determine the fare “picture” validity. The pandemic put a premium on low or no-contact interactions at the farebox. Token Transit began offering the validator to eliminate the operator need to read the phone screen.
The small unit can mount on the top of many existing farebox chassis with little cost. The small self-contained unit looks a bit like a small, flat smoke alarm. It uses a self-contained battery also. This same box could be mounted on the stanchion or panel at the back door. A small blue light is activated when the valid fare is transmitted or read from the phone.
Please consider the implications of these solutions or any permanent modification. There are valid reasons for making changes of this nature. There will remain many of our customers who do not use a smart phone, or that share one phone for two users. There will remain several of our customers who do not usually use a bank checking account. Those issues seem minor to some, but we face equity issues and Title VI questions if we implement these changes and customers are impacted. The processes to avoid, minimize or mitigate these issues must be documented. Often the banking issues has been resolved by a hybrid approach that allows those who are not using a bank to add value to the farecard at a convenience or grocery store using cash.