The virus. PPE. Part 1

Status
Not open for further replies.
Retune said:
Dentistry is a tough one (there was a long discussion about this on a recent This Week in Virology). You can try to keep symptomatic patients away from the surgery, but it's now thought the virus is transmissible for a couple of days before symptoms develop, and it's in saliva. Various standard dental procedures aerosolize whatever is in your mouth. High risk for the dentist, and for the next patient. So more PPE (including face shields) and a dilute hydrogen peroxide mouth wash for the patients to try to get rid of as much virus as possible before the start of the procedure.
Click to expand...

Assuming the required PPE is supplied to dentists (hopefully making them safe), then if a symptomatic patient attended and then exhaled viral particals through an aerosolize procedure, is it not the case that within a short period of time (seconds), the viral particals will drop to a surface? That certainly seems to be what we have been told as to when a person coughs or sneezes. Or does the procedure of aerosolize keep them airbourne longer?
My thoughts were if we could ensure dentists were made safe, then a substantial clean of chairs, equipment etc between patients would hopefully make the area safe again. Maybe I am incorrect in thinking this but surely it can't be much different from nurses and cleaning staff having to attend covid wards?
 
Peter10d said:
Assuming the required PPE is supplied to dentists (hopefully making them safe), then if a symptomatic patient attended and then exhaled viral particals through an aerosolize procedure, is it not the case that within a short period of time (seconds), the viral particals will drop to a surface? That certainly seems to be what we have been told as to when a person coughs or sneezes. Or does the procedure of aerosolize keep them airbourne longer?
My thoughts were if we could ensure dentists were made safe, then a substantial clean of chairs, equipment etc between patients would hopefully make the area safe again. Maybe I am incorrect in thinking this but surely it can't be much different from nurses and cleaning staff having to attend covid wards?
Click to expand...
I gather there's a particular concern about high speed dental instruments generating very fine aerosols of tiny fast-moving virus-laden particles that can potentially go everywhere in the air space, stay airborne longer, and potentially take unconventional transmission routes. It sounds like both good air extraction and disinfection between patients are important. Lots more detail here if you're interested: https://www.microbe.tv/twiv/twiv-611/
 
mikew said:
I noticed a piece of return to work advice today

If you must use public transport try to avoid busy times, if was still working i could go to work and say ime not late just avoiding busy times


They just don't understand
Click to expand...
I'd get there earlier.
 
Retune said:
Dentistry is a tough one (there was a long discussion about this on a recent This Week in Virology). You can try to keep symptomatic patients away from the surgery, but it's now thought the virus is transmissible for a couple of days before symptoms develop, and it's in saliva. Various standard dental procedures aerosolize whatever is in your mouth. High risk for the dentist, and for the next patient. So more PPE (including face shields) and a dilute hydrogen peroxide mouth wash for the patients to try to get rid of as much virus as possible before the start of the procedure.
Click to expand...
It's been a good few years since I went to the dentist and they were face shield then. I would assume it was standard practice.
 
I didn't realise, until Jeremy Hunt said it, but after googling it appears it is true.

SAGE's models did not include a testing and tracing approach. That is truly appalling.
 
Moving from the 'Stay at Home' restrictions we had to what we have now was always going to be difficult but some parts of it do not to have been thought through very well.

If I go outside I can meet(but be no closer than 2m) only one person not from my household but I can go into as many houses as I want owned by people I do not know if I am a prospective buyer or renter -

"Potential buyers and renters will also be allowed to visit show homes and view houses on the market to let or buy. "

Source: - https://www.bbc.co.uk/news/uk-52641373

Dave
 
nilagin said:
I'd get there earlier.
Click to expand...
With every other person that thought the same thing.

I was going to post something about the 2 metre social distancing on public transport but I've seen that's all gone to s*** .."where possible"
Although it will have to happen to move things forward.
 
Last edited:
KitsuneAndy said:
I didn't realise, until Jeremy Hunt said it, but after googling it appears it is true.

SAGE's models did not include a testing and tracing approach. That is truly appalling.
Click to expand...
It doesn’t seem to have been widely reported.
 
dcash29 said:
With every other person that thought the same thing.

I was going to post something about the 2 metre social distancing on public transport but I've seen that's all gone to s*** .."where possible"
Click to expand...
True, and I imagine the government knows that too. The government support for social distances is in name only.
 
Last edited:
jakeblu said:
True, and I imagine the government knows that too. The government support for social distances is in name only.
Click to expand...

Maybe that’s because it’s impossible to social distance all of the time. Also, people are not bothered. I was in m&s today and the checkout girl was chatting to a colleague stood next to her and was almost touching. Chatted for a minute or 2. In reality there was no need for that, they could have stood 2m apart.
 
sphexx said:
It doesn’t seem to have been widely reported.
Click to expand...
It's been mentioned in some articles, e.g. Helen Ward last month:

https://www.theguardian.com/commentisfree/2020/apr/15/uk-government-coronavirus-science-who-advice

'The evidence underpinning the government’s decision appears in a report from 9 March summarising the potential impact of behavioural and social interventions. The report did not consider the impact of case-finding and contact-tracing, but it did suggest that the biggest impact on cases and deaths would come from social distancing and the protection of vulnerable groups.'

You can also see that testing & tracing wasn't considered by reading through the more detailed report from 16 March by Neil Ferguson's group:

https://www.imperial.ac.uk/mrc-glob...covid-19/report-9-impact-of-npis-on-covid-19/

There, it's not one of the modelled scenarios and there's just a line about contact tracing:

'As case numbers fall, it becomes more feasible to adopt intensive testing, contact tracing and quarantine measures akin to the strategies being employed in South Korea today. Technology - such as mobile phone apps that track an individual’s interactions with other people in society - might allow such a policy to be more effective and scalable if the associated privacy concerns can be overcome.'

https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-16-testing/

This is where we are now, but it's still not clear to what extent this sort of policy will be adopted. Here's the same group's report from 23 April:

https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-16-testing/

'Although testing is frequently mentioned in the context of contact tracing (‘test, trace, isolate’), it is not required for contact-tracing and isolation based on symptoms alone –indeed, testing may in fact slow down and limit effectiveness if testing results take time and contacts are not traced until results are available. ... However, at current high COVID-19 incidence rates, testing is likely to be most useful to inform self-isolation among contacts of suspected cases by excluding infection and allowing earlier exit from isolation/quarantine (as for HCWs self-isolating because of a symptomatic household member). One advantage of this it that it might allow recursive contract tracing (i.e. tracing contacts of contacts), which –without testing to confirm infection or release contacts from quarantine –would result in a very high number of people in isolation or quarantine (an ‘epidemic of isolation’).'

But surely 'recursive contact tracing', which testing would allow, should be a central aim of the policy, not a mere 'advantage'? We now think that about half of transmission is pre-symptomatic. So the only way that we can identify many infected and infectious people is to follow the chain of contacts from a symptomatic case, testing as we go. We can start the first level of tracing before the test results are in (to avoid the problem in the first sentence) but we shouldn't stop there, and can only go further with testing (to avoid the problem in the last sentence).
 
Retune said:
It's been mentioned in some articles, e.g. Helen Ward last month:

https://www.theguardian.com/commentisfree/2020/apr/15/uk-government-coronavirus-science-who-advice

'The evidence underpinning the government’s decision appears in a report from 9 March summarising the potential impact of behavioural and social interventions. The report did not consider the impact of case-finding and contact-tracing, but it did suggest that the biggest impact on cases and deaths would come from social distancing and the protection of vulnerable groups.'

You can also see that testing & tracing wasn't considered by reading through the more detailed report from 16 March by Neil Ferguson's group:

https://www.imperial.ac.uk/mrc-glob...covid-19/report-9-impact-of-npis-on-covid-19/

There, it's not one of the modelled scenarios and there's just a line about contact tracing:

'As case numbers fall, it becomes more feasible to adopt intensive testing, contact tracing and quarantine measures akin to the strategies being employed in South Korea today. Technology - such as mobile phone apps that track an individual’s interactions with other people in society - might allow such a policy to be more effective and scalable if the associated privacy concerns can be overcome.'

https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-16-testing/

This is where we are now, but it's still not clear to what extent this sort of policy will be adopted. Here's the same group's report from 23 April:

https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-16-testing/

'Although testing is frequently mentioned in the context of contact tracing (‘test, trace, isolate’), it is not required for contact-tracing and isolation based on symptoms alone –indeed, testing may in fact slow down and limit effectiveness if testing results take time and contacts are not traced until results are available. ... However, at current high COVID-19 incidence rates, testing is likely to be most useful to inform self-isolation among contacts of suspected cases by excluding infection and allowing earlier exit from isolation/quarantine (as for HCWs self-isolating because of a symptomatic household member). One advantage of this it that it might allow recursive contract tracing (i.e. tracing contacts of contacts), which –without testing to confirm infection or release contacts from quarantine –would result in a very high number of people in isolation or quarantine (an ‘epidemic of isolation’).'

But surely 'recursive contact tracing', which testing would allow, should be a central aim of the policy, not a mere 'advantage'? We now think that about half of transmission is pre-symptomatic. So the only way that we can identify many infected and infectious people is to follow the chain of contacts from a symptomatic case, testing as we go. We can start the first level of tracing before the test results are in (to avoid the problem in the first sentence) but we shouldn't stop there, and can only go further with testing (to avoid the problem in the last sentence).
Click to expand...
Thanks for that. I must say I’m puzzled by the lack of consideration of contact tracking :(. I suppose they are looking for cheap alternatives (apps) that sound good but probably aren’t.
 
jakeblu said:
True, and I imagine the government knows that too. The government support for social distances is in name only.
Click to expand...
The social distancing on public transport is down to the operators, not the government.
I keep seeing people moaning about the safety of the drivers. When, I was a kid we had old routemaster buses, the driver sat in his own little cab. The last time I used a bus, the driver was still separated from the passengers by a perspex screen. London buses are now free, and people have to use the central doors not the front door to get on. Assuming the driver still has the perspex screen, how the hell are they getting infected?
 
Just watched some of PMQ's and I have to say that Johnson's response to Starmer's question about the slide of international comparisons being dropped from daily press conferences was just feeble bluster.

I think Starmer has a point about the comparison being dropped now that it doesn't look favourable for the UK.

Surely if you're going to adopt a metric to give context to the UK's outbreak you should stick with it?
 
nilagin said:
The social distancing on public transport is down to the operators, not the government.
I keep seeing people moaning about the safety of the drivers. When, I was a kid we had old routemaster buses, the driver sat in his own little cab. The last time I used a bus, the driver was still separated from the passengers by a perspex screen. London buses are now free, and people have to use the central doors not the front door to get on. Assuming the driver still has the perspex screen, how the hell are they getting infected?
Click to expand...
No driver screens on buses here usually & only a door at the front :(.
 
A quick follow up, to my post above re PMQ's.

Starmer questioned Johnson re Care Homes. It seems that Johnson's reply was far from accurate. Starmer has written to Johnson to asking him to return to the house to correct the record :


"At this time of national crisis, it is more important than ever that government ministers are accurate in the information they give.

Given this, I expect you to come to the House of Commons at the earliest opportunity to correct the record and to recognise that this was official government guidance regarding care homes."

More here:


https://www.theguardian.com/politic...urn-to-work-pmqs-covid-19-latest-news-updates

Scroll down to 'PMQ's Snap Verdict'
 
Uncle Fester said:
Just watched some of PMQ's and I have to say that Johnson's response to Starmer's question about the slide of international comparisons being dropped from daily press conferences was just feeble bluster.

I think Starmer has a point about the comparison being dropped now that it doesn't look favourable for the UK.

Surely if you're going to adopt a metric to give context to the UK's outbreak you should stick with it?
Click to expand...

Under Starmer's cross-examination Johnson is looking exposed without his supporting chorus in a sparsely populated chamber.
(Edit: Which is exactly what that Snap Verdict says, now I've read it).

Starmer made Spiegelhalter's point well, that we need to be learning lessons from other countries now. 'League tables' may be problematic with current uncertainties about the numbers, but I'm sure that's not why they've been dropped from the press conferences as we started to top the tables. It may not be possible to say whether the UK, Italy or Span has suffered the worst, but it's pretty clear that Germany is doing better and incredibly clear that South Korea is.

View: https://BANNED/d_spiegel/status/1258087627003179009
 
Last edited:
Uncle Fester said:
A quick follow up, to my post above re PMQ's.

Starmer questioned Johnson re Care Homes. It seems that Johnson's reply was far from accurate. Starmer has written to Johnson to asking him to return to the house to correct the record :


"At this time of national crisis, it is more important than ever that government ministers are accurate in the information they give.

Given this, I expect you to come to the House of Commons at the earliest opportunity to correct the record and to recognise that this was official government guidance regarding care homes."
Click to expand...

Yes but we all know, because we have been told often enough Boris is not a details person more a broad strokes kind off person. just what you need at a time like this, someone who cannot get the facts right or on occasion blurts out the wrong things, a bit like the other day when he said about detecting the infection in the water supply.
 
nilagin said:
. When, I was a kid we had old routemaster buses, the driver sat in his own little cab.
Click to expand...
Conductor didn't though, they stood in a recess under the stairs :)

Lots of buses only have a front door, people get up and stand next to the driver waiting to get off.
Overheard a young girl jokingly ask her friend if the Perspex was there because the driver bites.
Bit like dirty old Guy the Gorilla in London Zoo, think he did a bit more than bite though
 
tijuana taxi said:
Conductor didn't though, they stood in a recess under the stairs :)

Lots of buses only have a front door, people get up and stand next to the driver waiting to get off.
Overheard a young girl jokingly ask her friend if the Perspex was there because the driver bites.
Bit like dirty old Guy the Gorilla in London Zoo, think he did a bit more than bite though
Click to expand...
The only single door buses we have had around here after the routemaster were retired, was small hopper buses which were just glorified minibuses. All the rest have had two doors, and that dates back to the 70's.
 
nilagin said:
The only single door buses we have had around here after the routemaster were retired, was small hopper buses which were just glorified minibuses. All the rest have had two doors, and that dates back to the 70's.
Click to expand...

Was thinking more countrywide than just London Transport
 
There are lots of single door buses around (the last time I got on a bus outside London was in South Wales, and they had them there). But in any case the front passengers are very near the driver in most buses, and a plastic screen is not an airlock (though it probably reduces the risk).
 
Retune said:
There are lots of single door buses around (the last time I got on a bus outside London was in South Wales, and they had them there). But in any case the front passengers are very near the driver in most buses, and a plastic screen is not an airlock (though it probably reduces the risk).
Click to expand...

tijuana taxi said:
They do in Cambridge and surrounding areas
Click to expand...
Both the back end of beyond, probably wasn't all that long ago they moved on from horses and carriages
;)
 
Uncle Fester said:
A quick follow up, to my post above re PMQ's.

Starmer questioned Johnson re Care Homes. It seems that Johnson's reply was far from accurate. Starmer has written to Johnson to asking him to return to the house to correct the record :


"At this time of national crisis, it is more important than ever that government ministers are accurate in the information they give.

Given this, I expect you to come to the House of Commons at the earliest opportunity to correct the record and to recognise that this was official government guidance regarding care homes."

More here:


https://www.theguardian.com/politic...urn-to-work-pmqs-covid-19-latest-news-updates

Scroll down to 'PMQ's Snap Verdict'
Click to expand...
Pathetic response to this from No 10. From the Guardian thread:

'A source said that Starmer had “inaccurately and selectively” quoted from the document, and that therefore the PM was right to say what Starmer said was not correct. The source said that in his question Starmer talked about it remaining the case that people in care were unlikely to be infected (the document does not use the word “remains” at that point) and the source said the full quote (see above) made it clear that this assurance covered a period where there was no community transmission. Starmer did not include the word “therefore”, the source said. The source signalled that Johnson would not be retracting what he said.'

The 'source' has obviously just quickly searched the relevant document and tried to find an excuse:

https://www.gov.uk/government/publi...ity-care-and-residential-settings-on-covid-19

But there are actually two statements about care homes, and (as someone just pointed out in that thread) Starmer was quoting the second:

'This guidance is intended for the current position in the UK where there is currently no transmission of COVID-19 in the community. It is therefore very unlikely that anyone receiving care in a care home or the community will become infected. This is the latest information and will be updated shortly.'

...

'During normal day-to-day activities facemasks do not provide protection from respiratory viruses, such as COVID-19 and do not need to be worn by staff in any of these settings. Facemasks are only recommended to be worn by infected individuals when advised by a healthcare worker, to reduce the risk of transmitting the infection to other people. It remains very unlikely that people receiving care in a care home or the community will become infected.'

A credible response would have been to apologise that out of date information was still in the official government advice on 12 March. Both quotes were clearly dangerously misleading well before the document was withdrawn.

Edit: Andrew Sparrow in the Guardian: "To be fair, the Labour spokesman who sent out the quote to journalist as PMQs was happening sent out the section 1 version, not the section 7 version. But Starmer was quoted from the section 7 version."
 
Last edited:
Retune said:
Pathetic response to this from No 10. From the Guardian thread:

'A source said that Starmer had “inaccurately and selectively” quoted from the document, and that therefore the PM was right to say what Starmer said was not correct. The source said that in his question Starmer talked about it remaining the case that people in care were unlikely to be infected (the document does not use the word “remains” at that point) and the source said the full quote (see above) made it clear that this assurance covered a period where there was no community transmission. Starmer did not include the word “therefore”, the source said. The source signalled that Johnson would not be retracting what he said.'

The 'source' has obviously just quickly searched the relevant document and tried to find an excuse:

https://www.gov.uk/government/publi...ity-care-and-residential-settings-on-covid-19

But there are actually two statements about care homes, and (as someone just pointed out in that thread) Starmer was quoting the second:

'This guidance is intended for the current position in the UK where there is currently no transmission of COVID-19 in the community. It is therefore very unlikely that anyone receiving care in a care home or the community will become infected. This is the latest information and will be updated shortly.'

...

'During normal day-to-day activities facemasks do not provide protection from respiratory viruses, such as COVID-19 and do not need to be worn by staff in any of these settings. Facemasks are only recommended to be worn by infected individuals when advised by a healthcare worker, to reduce the risk of transmitting the infection to other people. It remains very unlikely that people receiving care in a care home or the community will become infected.'

A credible response would have been to apologise that out of date information was still in the official government advice on 12 March. Both quotes were clearly dangerously misleading well before the document was withdrawn.

Edit: Andrew Sparrow in the Guardian: "To be fair, the Labour spokesman who sent out the quote to journalist as PMQs was happening sent out the section 1 version, not the section 7 version. But Starmer was quoted from the section 7 version."
Click to expand...
Starmer is a barrister, I always understood the ”rule” was “never ask a question to which you don’t know the answer” :).
 
sphexx said:
Starmer is a barrister, I always understood the ”rule” was “never ask a question to which you don’t know the answer” :).
Click to expand...

.... Ah, but which is the correct answer to a question being asked? < That is doubtless an endless debate and depends on, or is fundamentally influenced by, your political persuasion.

I like Starmer but that's because he is a barrister and presents in the style of a barrister and nothing to do with the political party he represents.
 
sphexx said:
Starmer is a barrister, I always understood the ”rule” was “never ask a question to which you don’t know the answer” :).
Click to expand...
Johnson and his team should really have taken this on board by now. BJ's instinct was to give a flat-out denial about advice in a document he might well never have read (or at least remembered), which isn't going to end well when you're answering a well-briefed QC. I wonder if the noises Rees-Mogg has been making about getting Parliament back in full session next month are at least partly motivated by the thought of seeing a naked PM exposed like this for another few weeks without a braying gallery to play to?
 
cambsno said:
Exactly, pubs are needed NOW!!!

I thought I saw someone at Tesco opticians the other day getting something done?
Click to expand...

my neighbours are optician’s and still go to work. If you have an emergency eg your glasses break or you are having vision problems then you can go see an optician. But no ’normal‘ sight tests.
 
The man on the podium just said corvid patient numbers in hospital has gone down since yesterday, just a daft thought but could the 495 that have died since yesterday have anything to do with that.
 
RedRobin said:
.... Ah, but which is the correct answer to a question being asked? < That is doubtless an endless debate and depends on, or is fundamentally influenced by, your political persuasion.

I like Starmer but that's because he is a barrister and presents in the style of a barrister and nothing to do with the political party he represents.
Click to expand...
I think the correct answer is that the document was left in its original form for a couple of weeks too long. Community transmission was first noticed at the end of February, invalidating this advice, and in reality must have been happening for some time prior to that, before the advice was even issued on 25th Feb. Neil Ferguson's group had published a report on the 21st Feb that concluded 2/3 cases exported from China were probably going undetected, which should have rung alarm bells.
 
mikew said:
The man on the podium just said corvid patient numbers in hospital has gone down since yesterday, just a daft thought but could the 495 that have died since yesterday have anything to do with that.
Click to expand...

"corvid patient numbers" .................. probably nothing to crow about ........:exit:
 
98081114_10157325762950814_5692648601574965248_o.jpg
 
Status
Not open for further replies.
Back
Top