How do we know a pandemic's over?

[The Atheist]

The very simple idea is: Make those billionaires pay for the air purifiers for each and every school and place of work!

I'm quoting that separately just to highlight the extremity of the ignorance.

Maybe it would work in your communist haven of Cuba, but other countries don't allow governments to steal money off rich people just because some complete idiot thinks they should.

 

[dann]

I do care about people amplifying misinformation just because they are annoyed not everyone wants to take the same, 'ignore it', POV.

Fortunately, there are still some people out there who care and who amplify good information:

I love my primary care provider a lot. I can’t describe what a boost this email from them, announcing their masking requirement, gave me yesterday. Check out the facts, the data, the explanations! A+

The Health Center Requiring Masks
We are requiring masks be worn in The Health Center by all staff, except in their private offices, by all patients, and by those who come with patients of the medical, dental, and counseling services. This requirement is in contrast to masking policies in other facilities at present.

We all have COVID fatigue and wish it would go away. But it is surging, not waning: Vermont hospitalizations and positive tests are at new heights and increasing.

The illness is now killing about 1,500 Americans a week. COVID is still, with immunizations having been in use for some three years, about 8 times as lethal as Influenza, with unnecessary deaths, estimated at 40,000 a year, from lack of using Paxlovid when it is diagnosed. Since rapid tests are not reported, health department case counts are substantially lower than the actual number of cases which are occurring.

And COVID, even relatively mild cases, is causing an accumulating number of cases of Long COVID, which can be disabling and has no cure, as yet. This potentially devastating illness is about four times as apt to occur in women, with a peak of unexpected heart attacks in those 25 to 44 years old.

We are a small organization. A couple of cases of COVID in our staff, medical, psych, or dental, substantially reduces our capacity to see patients, while these services are in short supply in our region, as they are nationwide.

So wearing a mask adds protection, for one's self and for others. Not wearing one is not an option. Like the "no shirt / no shoes, no service" policies at some stores and restaurants, this is a condition of entry and of having care here. It is a small price to pay to protect others, even if you think you are invulnerable.

ames (X, Jan 9, 2024)

I wish those guys were in charge of the Danish public health care system instead of the idiots who are currently spreading disinformation about the virus.
Tell Bernie Sanders that Denmark needs to look to Vermont for inspiration in the case of the pandemic. There is nothing to learn here in that respect.

 

[Roger Ramjets]

Well hopefully the latest surge in New Zealand has peaked anyway.

Today's numbers are 1494 cases announced and 439 in hospital as of Dec 31 (down from 483 on Dec 24).

The good news is Hawke's Bay has the lowest reported infection rate in the country with 13/100k, compared to 45/100k for Capital and Coast/Hutt.

 

[dann]

I'm quoting that separately just to highlight the extremity of the ignorance.

Maybe it would work in your communist haven of Cuba, but other countries don't allow governments to steal money off rich people just because some complete idiot thinks they should.

No, other countries allow billionaires to exploit the rest of the population and ruin their health and lives while protecting themselves with #DavosStandard, and complete idiots think that's the way it should be.

Cumulative confirmed COVID-19 deaths per million people


ETA: The much cheaper short-term solution currently used in countries that "don't allow governments to steal money off rich people":

In New Zealand, we use children’s lungs to filter the virus from the air in classrooms.
WicMar (X, Jan 10, 2024)

 

[dann]

If you think suggesting unproven technology as the answer, you're very much mistaken.

As usual.

If The Atheist thinks the technology is unproven - and he probably does because he never looks into anything to find out if it's true or not - he is very much mistaken.
As always!

In fact, he doesn't even look into fairly old information - old in pandemic terms:

An inexpensive type of portable filter efficiently screened SARS-CoV-2 and other disease-causing organisms from hospital air.
Real-world data show that filters clean COVID-causing virus from air (Nature, Oct 6, 2021)

Does he have any other disinformation about this issue?

 

[dann]

Well hopefully the latest surge in New Zealand has peaked anyway.

We hope that it has peaked here too, for now, but it's hard to tell because the numbers tend to be delayed during the Xmas holidays.
And unlike New Zealand, it's not summer in Scandinavia.

 

[icerat]

That's the bit I can't have. The cost would be prohibitive everywhere in the world. Schools in NZ are ventilated by windows and the cost of giving just schools adequate clean air would run into billions of dollars we don't have.

There's ca 800000 school kids in NZ. Assuming less than 30 kids per class, that's about 27000 class rooms.

A Xiaomi Air Purifier 4 would suffice for most classrooms. About $280 ex gst.

https://www.mi-store.co.nz/product/BHR5096GL/Air-Purifier-4-Smart-APP-Control-CADR-Up-to-400m3h

Replacement filters are about $53 ex gst. Recommended change every 6- 12 months, let's say every 3 months, so 4/yr

First year cost $439/classroom, then $212/yr

So total cost less than $12 million in the first year to put one in every classroom - and that's at normal retail (ex tax) price. Sure, some installation and electricity costs, but not even close to "billions" and IMO would *easily* be covered by increased productivity with fewer sick days of kids, teachers, and parents (including days off to look after kids) - not to mention the impact on overall community infection rates.

 

[icerat]

If you think suggesting unproven technology as the answer, you're very much mistaken.

What's unproven about air filters?

 

[sinnikal]

In Spain masks are now mandatory in healthcare settings, e.g. Hospitals, Health Centres etc. I will find out tomorrow whether it is mandatory in Farmacias tomorrow.
Fortunately I have a good stock of FP1's on hand and am fully vaxxed against Covid, Flu and Pneumonia. I guess due to age and ongoing health issues I am in the 'at risk' group. Then again I don't live a particularly sociable life only going out to shops etc. when necessary and I don't meet that many people on the beach.

Spain really doesn't want to end up with the draconian lockdown scenario we had in 20/21.

 

[dann]

I will find out tomorrow whether it is mandatory in Farmacias tomorrow.

It is! See post 457.
(In NZ, Australia and the UK the term Chemist used to refer to pharmacies and pharmacists.)

 

[dann]

What's unproven about air filters?

Well, you know, there's this thing about explanations: Some people don't have the time to try to understand air filtration and how it works.
The Atheist is busy with stuff like this:

I know your English is poor.

Your understanding of English gets worse by the day.

Your understanding of English seems to get worse by the day.

You've proven time and again that your understanding of English is weak, and I do understand that as a second language you probably don't do idiom well, but constantly parroting what I say just gets tedious. ... some people are slow to catch on.

...yet again your English as a second language is holding you back from understanding what the study says? ...For your benefit I'll try to put that into simpler English. ... Feel free to ask for help with any other parts you don't understand.

You just can't expect 'The Grammar Tyrant' to take time off to look into studies about air filtration, can you?
Air Cleaners, HVAC Filters, and Coronavirus (COVID-19) (United States Environmental Protection Agency)
Air Purifiers (Breathing Better NZ Ltd)

 

[FatherLukeduke]

What's unproven about air filters?

There are no good real world studies to show that they reduce the spread of covid, or other infections. The University of East Anglia recently collated the available research and found no effect:

A new study published today reveals that technologies designed to make social interactions safer in indoor spaces are not effective in the real world.

The team studied technologies including air filtration, germicidal lights and ionisers.

They looked at all the available evidence but found little to support hopes that these technologies can make air safe from respiratory or gastrointestinal infections.

“When the Covid pandemic hit, many large companies and governments - including the NHS, the British military, and New York City and regional German governments - investigated installing this type of technology in a bid to reduce airborne virus particles in buildings and small spaces.

“But air treatment technologies can be expensive. So it’s reasonable to weigh up the benefits against costs, and to understand the current capabilities of such technologies.”

The research team studied evidence about whether air cleaning technologies make people safe from catching airborne respiratory or gastrointestinal infections.

They analysed evidence about microbial infections or symptoms in people exposed or not to air treatment technologies in 32 studies, all conducted in real world settings like schools or care homes. So far none of the studies of air treatment started during the Covid era have been published.

Lead researcher Dr Julii Brainard, also from UEA’s Norwich Medical School, said: “The kinds of technologies that we considered included filtration, germicidal lights, ionisers and any other way of safely removing viruses or deactivating them in breathable air.

“In short, we found no strong evidence that air treatment technologies are likely to protect people in real world settings.

https://www.uea.ac.uk/about/news/article/air-cleaners-dont-stop-you-getting-sick-research-shows

It is also interesting in itself that

So far none of the studies of air treatment started during the Covid era have been published.

As we have had years now and, unlike masking, it is relatively straightforward to run a high quality RCTs to test wether filters work. There are also potentially huge profits in it for companies that manufacture these devices. So where are the positive studies? The team at East Anglia seem to say they are left unpublished

“We strongly suspect that there were some relevant studies with very minor or no effect but these were never published.

I did read about what sounded like an interesting RCT conducted in Bradford schools that made initial claims of reducing covid related sick days by 20%, which sounded positive. Yet that was in in October 2023 (the study started in 2021) and nothing has been released yet.

 

[dann]

When a team of doctors, scientists and engineers at Addenbrooke’s Hospital and the University of Cambridge placed an air filtration machine in COVID-19 wards, they found that it removed almost all traces of airborne SARS-CoV-2.
(...)
The team installed a High Efficiency Particulate Air (HEPA) air filter/UV steriliser. HEPA filters are made up of thousands of fibres knitted together to form a material that filters out particles above a certain size. The machines were placed in fixed positions and operated continuously for seven days, filtering the full volume of air in each room between five and ten times per hour.

In the surge ward, during the first week prior to the air filter being activated, the researchers were able to detect SARS-CoV-2 on all sampling days. Once the air filter was switched on and run continuously, the team were unable to detect SARS-CoV-2 on any of the five testing days. They then switched off the machine and repeated the sampling – once again, they were able to detect SARS-CoV-2 on three of the five sampling days
Air filter significantly reduces presence of airborne SARS-CoV-2 in COVID-19 wards (University of Cambridge)

The Removal of Airborne Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Other Microbial Bioaerosols by Air Filtration on Coronavirus Disease 2019 (COVID-19) Surge Units (Clinical Infectious Diseases, Volume 75, Issue 1, 1 July 2022)

HEPA filtration is beneficial in reducing bioaerosols, including SARS-CoV-2, as well as other respiratory pathogens in the hospital environment. It should be used in combination with other prevention strategies, including improved ventilation; appropriate isolation; and, during periods of high community transmission, widespread testing and N95 masking.
HEPA filtration reduces transmission of SARS-CoV-2 and prevents nosocomial infection: A call to action (BC Medical Journal, Nov 9, 2023)

In schools, too!
HEPA filters cut covid-19 sick days but we've been slow proving this - Covid-19 sick days were 20 per cent lower in schools with air-cleaning HEPA filter machines, researchers on an eagerly-awaited study have found. (NewScientist, Nov 1, 2023)

The researchers consistently detected salivary and airborne SARS-CoV-2, the virus that causes COVID-19, in air samples and samples from students throughout the study period. However, concentrations of airborne SARS-CoV-2 were, on average, 70% lower with mask mandates and 40% lower with air cleaners. The findings suggest that between 2 and 19 infections could be avoided while masks were mandated.
Masks and portable air cleaners reduced the spread of COVID-19 in schools, study shows (News Medical, May 19,2023)

And there is no reason to assume that air purification won't also help reduce SARS-CoV-2 transmission in offices, gyms, shopping malls, movie theaters, concert halls, churches, on public transport, in people's homes and even in pig barns, which is why I proposed using #PigStandard instead of #DavosStandard.
(But I know how utterly unrealistic such a proposal is. What is the value of ordinary kids' lives nowadays, right?! )

 

[dann]

As we have had years now and, unlike masking, it is relatively straightforward to run a high quality RCTs to test wether filters work.

Tell us more about those high-quality RCTs, please!
What are you going to use as a placebo air purifier? Will you use machines that play recordings of the sound of air purifiers instead of purifying the air? Or will the placebo wards receive air purifiers without the filters? Or will they have filters, but the filters won't be real filters, they'll be placebo filters?

It's particularly important to get those details right if you want to double-blind your testing, which I'm sure you do, because some nosy doctor, nurse or janitor might open one of them to see what's inside, which is usually easy to do because filters have to be changed and/or replaced.
Will some of the staff be working exclusively in air-purified wards and other staff exclusively in placebo wards? Will they be sharing restrooms?

Similar problems arise if you conduct your test at schools: Will some teachers teach exclusively in air-purified classrooms and others in classrooms with 'placebo air'? Will they have two different teachers lounges for between classes?

Science-Based Medicine has had a lot of articles about what some medical professionals refer to as the RCT fetish:

Evidence-based medicine (EBM) has been a very useful paradigm for assessing evidence in medicine. However, like any other framework, it can be misused, particularly when fundamentalist EBM methodolatry leads to its inappropriate application to questions for which it is ill-suited, a misuse that has been weaponized against public health during the pandemic.
(...)
Randomized controlled clinical trials are just that: clinical trials in which subjects are randomized to receive either the intervention or a control (such as a saline placebo) and then followed to determine which group has better outcomes, which are prespecified in the clinical trial protocol. The reason for randomization is to ensure that the two groups being compared resemble each other as closely as possible in characteristics relevant to the outcomes being tested. For example, if you’re testing a drug to treat hypertension, you would want the groups to be matched as closely as possible for, among other characteristics, age, race, sex, severity of hypertension, and relevant risk factors for poor outcomes. Ideally, these RCTs are then double-blinded, so that neither the subjects nor the doctors or medical personnel administering the drugs and assessing outcomes know which group any given subject is in. Double blinding is especially important in clinical trials with more subjective outcomes such as pain, for which placebo effects can be strong, but it’s also important even in trials with “hard” outcomes like tumor progression because it could affect how clinicians interpret tests and radiology studies if they know which group a given patient is in. Moreover, such clinical trials have strict inclusion and exclusion criteria, which ensure that those being treated actually have the disease, do not belong to a group that might be harmed by the drug, and are subjects who are likely to benefit if the drug does have efficacy; i.e., does work.
(...)
Worse, as Dr. Jonathan Howard has pointed out, there is now a whole cadre of physicians demanding RCTs for every COVID-19 intervention, regardless of whether such RCTs are practical or even ethical to carry out.
2023: The year that the evidence-based medicine (EBM) paradigm was weaponized against vaccines and public health (Science-Based Medicine, Jan 1, 2024)

You and The Atheist should read the whole thing, FatherLukeduke!

 

[Lithrael]

The meta study is interesting but their 'control' data, I don't understand the choice. "Expelling indoor air and replacing it with outdoor air was the ideal comparator." Isn't that exactly what would have the greatest possible impact on airborne diseases, over filtration of recirculated indoor air? Like, wouldn't we EXPECT that to lead to outcomes at least as good as indoor air cleaning efforts? Wouldn't that naturally lead to filtration looking 'meh' in comparison?

 

[The Atheist]

Well hopefully the latest surge in New Zealand has peaked anyway.

How many people under 90 died?

No, other countries allow billionaires to exploit the rest of the population...

Ok, I finally get it.

You're jealous of successful people and want to bring them down to your level because they have more money than you.

What a sad way to live your life.

A Xiaomi Air Purifier 4 would suffice for most classrooms.

Which would be throwing money away for no good purpose, as others have helpfully noted:

There are no good real world studies to show that they reduce the spread of covid, or other infections.

The meta study is interesting but their 'control' data, I don't understand the choice. "Expelling indoor air and replacing it with outdoor air was the ideal comparator." Isn't that exactly what would have the greatest possible impact on airborne diseases, over filtration of recirculated indoor air? Like, wouldn't we EXPECT that to lead to outcomes at least as good as indoor air cleaning efforts? Wouldn't that naturally lead to filtration looking 'meh' in comparison?

Absolutely spot on.

Purifiers are a joke, but it's nice some people think one purifier can somehow stop kids getting infected by someone sitting next to them 3 metres from the purifier.

I suggest the purifier chat could be split off to a new thread. Humor looks like the ideal home for it.

 

[FatherLukeduke]

In schools, too!
HEPA filters cut covid-19 sick days but we've been slow proving this - Covid-19 sick days were 20 per cent lower in schools with air-cleaning HEPA filter machines, researchers on an eagerly-awaited study have found. (NewScientist, Nov 1, 2023)

That is literally the promising Bradford study I referred to in my post. However they haven't published yet, so we will have to wait and see.

Tell us more about those high-quality RCTs, please!

They haven't published any, which was my point, however you just linked to a high quality one that is being carried out now....just not yet published. They have explicitly said they are conducting it to shape future government policy, so if they get positive results for air filtration then we will see some investment.

I'm really not sure what the rest of your rambling on double-blind protocols or RCTs in general is about really, but there is lot of information out there on how they work and why they are the gold standard for research, if you are interested.

 

[Lithrael]

Purifiers are a joke

My point was not that purifiers are a joke, but that it seems obvious that purified air will certainly not be better than fresh outdoor air for pathogen density etc.

I don't see why, or compelling evidence so far that, appropriately designed air purifiers should have next to no effect in situations where you are already are using/have no choice but to use recirculated air in your building.

Yet that meta study calls outdoor air exchange the ideal control group.

OTOH if you're saying, where the climate allows for it, instead of fancy air filters we should just get box fans and open windows, yeah, absolutely.

 

[TragicMonkey]

My point was not that purifiers are a joke, but that it seems obvious that purified air will certainly not be better than fresh outdoor air for pathogen density etc.

One man's "seems obvious" is five other people's "gee, I never thought of that". The pandemic taught me more than any other event in my lifetime that a large percentage of the population just can't think sensibly about things, examining them and reasoning out causes, effects, consequences, and risks.

 

[icerat]

There are no good real world studies to show that they reduce the spread of covid, or other infections. The University of East Anglia recently collated the available research and found no effect:

Found no effect is not the same as is no effect.

As we have had years now and, unlike masking, it is relatively straightforward to run a high quality RCTs to test wether filters work.

No, it's not relatively straight forward at all. How do you control for transmission outside of the place where the filter is?

It's the same flaw as many supposed mask studies - all they usually do is prove that masks don't work when you're not wearing them.

A "high quality RCT" for HEPA - or masks - would require isolating participants from all other potential sources of infection for an extended period - months I would suggest.