Robert T Babbitt PLLC
Issue 3, Article 1
May 16, 2020
COVID 19, HELP FROM A KNOWN MEDICINE
There is no getting around the unusual nature of this pandemic. It is easy to interrupt the spread with cautious social distancing, rigorous hand washing and disinfecting. It is a minor illness for 80% of positive cases. But, there are dramatic severity issues as well. The 20% who need hospitalization include a small percent that face an unusual mortality risk. Some patients have an acute inflammation that fills the lungs (the alveoli or tiny air sacs) with fluid. This grave condition cannot be cured by mechanical ventilation.
UCI Health in Orange, California will begin a clinical study of the drug, AVIPTADIL. The drug has a 20-year history of use in human clinical trials for lung ailments. It will be the test treatment for a primary cause of COVID 19 deaths: Acute Respiratory Distress Syndrome.
Since it has been previously tested for similar lung problems, the risks are understood. The tests must be given time for accurate assessments. But the logic is clear. AVIPTADIL works in cases of pulmonary fibrosis and pulmonary hypertension. The promising treatment targets inflammatory molecules in the lungs called cytokines. If it works as planned, the worst danger will be avoided: the air sacs that become drenched by the disease in the current pandemic.
For details see: UCI NEWS at news.uci.edu


Issue 3, Article 2
May 16, 2020

COVID 19, LOOKING TO OTHER STATES FOR RATES OF INFECTION, HOSPITALIZATIONS
As Texas cautiously reopens, many states are watching, and we should be watching and learning from the data in other states.
There are alarming numbers in the Texas Panhandle, the Amarillo Public Health area reported 2,731 cases as of today. The cases are rising as we expand the testing rates. But most news accounts are favorable on the careful steps taken in each community to allow a sense of normal while taking extra precautions.
Is it practical to look to other states that have a mix of large urban areas and more rural communities. Maryland is an interesting case to watch. Only ten days ago, the House of Representatives and the Senate were considering extended absence due to the medical community declaration of HOTSPOT for DC and the suburbs of Maryland and Virginia.
In Maryland, the new cases per day jumped to 1,730 on May 1, 2020. The total positive cases reached 36,986 on May 16, 2020. But the anticipated crisis in hospitals was avoided by the social distancing and similar strategies that Texas used. Both have conservative governors who seek to balance the needs of safety and economy.
The rate of Maryland hospitalizations has now hit a 3-week low. As of today, the total hospitalizations are at the lowest point in 22 days. This follows the closing of bars, cafes, gyms and movies on March 16 and shopping malls were closed on March 19. Low risk activities like golf, tennis and boating were allowed to reopen on May 7. Schools were cancelled for the remainder of the academic year. The Preakness was not run, but it is rescheduled.
The pattern is more promising in Texas. Texas total cases are rising, but deaths per million population are 47 in Texas compared to 392 in Maryland as of current counts.
For details see: CBS at baltimore.cbslocal.com; for Amarillo see: newschannel10.com


Issue 3, Article 3
May 16, 2020

COVID 19 , HOW HEALTH INSPECTION PROCESS MAY BECOME A TRANSIT FUNCTION
We are comfortable when we dine at a restaurant, in part, because we know that a city or state health inspector has “graded” the degree to which the café or diner has adhered to a set of health standards. In this case it relates to the precursors of infestations by rodents or insects, common hygiene issues, and quality control of refrigeration and related food preparation issues. Hospitals have promised clean operating rooms and wards for many decades. Now that healthcare associated infections occur in 1 of each 31 patients, the cost of poor hygiene is easier to bring into focus.
Now picture our economy is under a new normal with rigorous testing and tracing. Is it reasonable to assume that new resources will be brought to bear on an awareness level of hygiene that surpasses the levels of our current “normal”?
We have always taken pride in out transit systems cleanliness. But never before have we faced an unseen challenge like the COVID 19 pandemic. Whether we assume the future holds an independent health audit function for transit like that of the restaurants or whether we control the same testing through an internal sanitation audit function is not hard to imagine a new function that calms fears about the vehicle and station condition.
Using the café health inspector model, there are several common-sense issues that would be the foundation of the inspection process:
Vehicle Sanitation
At inspection, the vehicle has no visible sanitation flaws and adenosine triphosphate (ATP) meter detection is clean. Hospitals often use ATP testing.
Station Sanitation
At inspection, the station has no sanitation flaws and ATP meter detection is clean.
Employee Hygiene
How clean are employee hands. SwipeSense is one machine that allows instant hygiene verification at the door of hospital wards or operating rooms. It may be practical to install a combination hand sanitizer dispenser and ATP meter on each bus. Inspectors could use a mobile unit.
Customer Hygiene
Customer hygiene could be randomly tested by inspectors. Hand sanitizers on buses would increase the compliance rates.
Boarding and alighting protocols
The inspectors could easily observe and verify that rear door boarding or other rules are being practiced.


Issue 3, Article 4
May 16, 2020

COVID 19, WHAT DOES THE TRANSIT RESTART LOOK LIKE AROUND THE STATE
Governor Abbott has directed the phased opening of many commercial establishments. There will be some reporters who focus on the best elements of the move back to a type of normal and those reporters who focus on the negative elements. What we all hope for is a cure and, until a cure is ready, a great deal of caution.
VIA announced it is returning to the fare structure on June 1, 2020. Pass sales are available on-line. Sales at ticket windows will return on May 20, 2020. Enhanced cleaning is in place. Safe spacing capacity is limited to 16 passengers on the bus. VIA will continue to require non-exempt customers age 10 or older to wear face coverings. Operators and staff will wear face coverings also. All employees of VIA will have a temperature check as they enter the building. The Essential Service Schedule that went into effect on April 27, 2020 will continue. It is based on a Sunday schedule with added frequency on routes with high ridership.
Houston METRO will resume limited Park and Ride service on May 18, 2020. Downtown destinations will be served from 5am to 9am inbound and 3pm to 7pm outbound. Service frequency on these routes will be 15 minutes for most routes. Customers should prepare for longer travel time due to added stops. Routes serving the Texas Medical Center will operate on a regular weekday schedule. Local buses will operate on a modified Saturday schedule each day of the week. Extra buses will be added on routes to allow social distancing. METRORail will serve the Red Line on 12-minute frequency and the Purple and Green lines on 18-minute frequency.
DART will continue the modified service at this point. The light rail services will operate on 20-minute frequency. The full set of bus routes will have service on weekdays except that frequencies are limited. All customers are encouraged to keep an open seat between themselves and other riders and to avoid handshakes or other touching. DART, like other transit operators has enhanced cleaning processes in place. Interior stations and the DART lobby remain closed at this point.


Issue 3, Article 5
May 16, 2020

COVID 19, BUS OPERATORS PAY HIGH PRICE IN DUTIES
We are reminded that most Covid 19 cases are not dangerous. Those that are dangerous end in a hospital stay. Only a small portion end in fatal complications. But the fatality rate remains the focal point of all prevention efforts.
Bus operators have died from Covid 19 in New York city, Boston, Chicago, Saint Louis, Detroit, Seattle, Newark, Richmond, Washington DC, New Orleans and Dover NJ. The most reviewed case on social media was the case of Jason Hargrove, a Detroit operator. The posting showed a video of a rider coughing but not covering her mouth. Eleven days later Hargrove passed away. Face coverings do a little to prevent you from receiving the virus. Face coverings do a great deal to limit how far you might accidently transmit the virus through a cough or sneeze.
What can transit managers do to prevent this. Many have installed plastic clear barriers at the driver position. Most are requiring rear door boarding. Some are dispensing to each operator a face mask each day. Some allow surgical gloves. Most are encouraging immediate removal form duty on any symptoms. Many are checking temperatures regularly. Virtually all transit systems have switched their deep cleaning to a higher frequency. Several are wiping down frequently touched surfaces like stanchions every hour.
We will see progress on one of several vaccines soon. We have already seen progress on existing therapeutic medicines that were tested for other diseases being repurposed and fine tuned to prevent the worst outcomes from Covid 19.
In the meantime, cautious reopening of our transit systems will follow the pattern of business openings. It is vital that we protect our most important asset: our value team members.
For details see: theguardian.com

Weekly Updates: Issue 3, Week of May 18-24, 2020: AVIPTADIL, Health Inspection and Transit, Transit Restart in Texas, and more

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