Turning Points of History: Kiss of the Spanish Lady

Secret History - Killer Flu In The US.



The 1918 influenza pandemic was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. Although there is not universal consensus regarding where the virus originated, it spread worldwide during 1918-1919.



In the United States, it was first identified in military personnel in spring 1918. It is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States.



https://youtu.be/-UVtlm6BQf0



Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic. While the 1918 H1N1 virus has been synthesized and evaluated, the properties that made it so devastating are not well understood. With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.



Discovering a lost killer.



The 100-year anniversary of the 1918 pandemic and the 10-year anniversary of the 2009 H1N1 pandemic are milestones that provide an opportunity to reflect on the groundbreaking work that led to the discovery, sequencing and reconstruction of the 1918 pandemic flu virus. This collaborative effort advanced understanding of the deadliest flu pandemic in modern history and has helped the global public health community prepare for contemporary pandemics, such as 2009 H1N1, as well as future pandemic threats.



The 1918 H1N1 flu pandemic, sometimes referred to as the “Spanish flu,” killed an estimated 50 million people worldwide, including an estimated 675,000 people in the United States.1,2,3,4 An unusual characteristic of this virus was the high death rate it caused among healthy adults 15 to 34 years of age.3 The pandemic lowered the average life expectancy in the United States by more than 12 years.3 A comparable death rate has not been observed during any of the known flu seasons or pandemics that have occurred either prior to or following the 1918 pandemic.3



The virus’ unique severity puzzled researchers for decades, and prompted several questions, such as “Why was the 1918 virus so deadly?”, “Where did the virus originate from?”, and “What can the public health community learn from the 1918 virus to better prepare for and defend against future pandemics?” These questions drove an expert group of researchers and virus hunters to search for the lost 1918 virus, sequence its genome, recreate the virus in a highly safe and regulated laboratory setting at CDC, and ultimately study its secrets to better prepare for future pandemics. The following is a historical recounting of these efforts, complete with references and descriptions of the contributions made by all of the remarkable men and women involved.



For decades, the 1918 virus was lost to history, a relic of a time when the understanding of infectious pathogens and the tools to study them were still in their infancy. Following the 1918 pandemic, generations of scientists and public health experts were left with only the epidemiological evidence of the 1918 pandemic virus’ lethality and the deleterious impact it had on global populations. A small ocean-side village in Alaska called Brevig Mission would become both testament to this deadly legacy as well as crucial to the 1918 virus’ eventual discovery.



Today, fewer than 400 people live in Brevig Mission, but in the fall of 1918, around 80 adults lived there, mostly Inuit Natives. While different narratives exist as to how the 1918 virus came to reach the small village – whether by traders from a nearby city who traveled via dog-pulled sleds or even by a local mail delivery person – its impact on the village’s population is well documented. During the five-day period from November 15-20, 1918, the 1918 pandemic claimed the lives of 72 of the villages’ 80 adult inhabitants.



Later, at the order of the local government, a mass grave site marked only by small white crosses was created on a hill beside the village – a grim monument to a community all but erased from existence. The grave was frozen in permafrost and left untouched until 1951. That year, Johan Hultin, a 25-year-old Swedish microbiologist and Ph.D. student at the University of Iowa, set out on an expedition to Brevig Mission in the hopes of finding the 1918 virus and in the process unearth new insights and answers. Hultin believed that within that preserved burial ground he might still find traces of the 1918 virus itself, frozen in time within the tissues of the villagers whose lives it had claimed.



In 1951, Hultin successfully obtained permission from the village elders to excavate the Brevig Mission burial site. With the help of several of his university colleagues, Hultin set up a dig site over the grave. The excavation took days, as Hultin had to create campfires to thaw the earth enough to allow for digging. Two days in, Hultin came across the body of a little girl — her body was still preserved wearing a blue dress, and her hair was adorned with red ribbons5. Ultimately, Hultin successfully obtained lung tissue from four additional bodies buried at the site, but logistical and technological limitations of the time period would prove formidable.



https://www.cdc.gov/flu/pandemic-resources/reconstruction-1918-virus.html



:::



Cleaning and Disinfection for Households.



Interim Recommendations for U.S. Households with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19)



Summary of Recent Changes.



Revisions were made on 3/26/2020 to reflect the following:



Updated links to EPA-registered disinfectant list

Added guidance for disinfection of electronics

Updated core disinfection/cleaning guidance



Background



There is much to learn about the novel coronavirus (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19). Based on what is currently known about COVID-19, spread from person-to-person of this virus happens most frequently among close contacts (within about 6 feet). This type of transmission occurs via respiratory droplets. On the other hand, transmission of novel coronavirus to persons from surfaces contaminated with the virus has not been documented. Recent studies indicate that people who are infected but do not have symptoms likely also play a role in the spread of COVID-19. Transmission of coronavirus occurs much more commonly through respiratory droplets than through fomites. Current evidence suggests that SARS-CoV-2 may remain viable for hours to days on surfaces made from a variety of materials. Cleaning of visibly dirty surfaces followed by disinfection is a best practice measure for prevention of COVID-19 and other viral respiratory illnesses in households and community settings.



It is unknown how long the air inside a room occupied by someone with confirmed COVID-19 remains potentially infectious. Facilities will need to consider factors such as the size of the room and the ventilation system design (including flowrate [air changes per hour] and location of supply and exhaust vents) when deciding how long to close off rooms or areas used by ill persons before beginning disinfection.  Taking measures to improve ventilation in an area or room where someone was ill or suspected to be ill with COVID-19 will help shorten the time it takes respiratory droplets to be removed from the air.



Purpose



This guidance provides recommendations on the cleaning and disinfection of households where persons under investigation (PUI) or those with confirmed COVID-19 reside or may be in self- isolation. It is aimed at limiting the survival of the virus in the environments. These recommendations will be updated if additional information becomes available.



These guidelines are focused on household settings and are meant for the general public.



Cleaning refers to the removal of germs, dirt, and impurities from surfaces. It does not kill germs, but by removing them, it lowers their numbers and the risk of spreading infection.



Disinfecting refers to using chemicals, for example, EPA-registered disinfectants, to kill germs on surfaces. This process does not necessarily clean dirty surfaces or remove germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection.



General Recommendations for Routine Cleaning and Disinfection of Households

Community members can practice routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks, and electronics (see below for special electronics cleaning and disinfection instructions)) with household cleaners and EPA-registered disinfectants external icon that are appropriate for the surface, following label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product.



For electronics follow the manufacturer’s instructions for all cleaning and disinfection products. Consider use of wipeable covers for electronics. If no manufacturer guidance is available, consider the use of alcohol-based wipes or spray containing at least 70% alcohol to disinfect touch screens. Dry surfaces thoroughly to avoid pooling of liquids.



General Recommendations for Cleaning and Disinfection of Households with People Isolated in Home Care (e.g. Suspected/Confirmed to have COVID-19)

Household members should educate themselves about COVID-19 symptoms and preventing the spread of COVID-19 in homes.



Clean and disinfect high-touch surfaces daily in household common areas (e.g. tables, hard-backed chairs, doorknobs, light switches, phones, tablets, touch screens, remote controls, keyboards, handles, desks, toilets, sinks)



In the bedroom/bathroom dedicated for an ill person: consider reducing cleaning frequency to as-needed (e.g., soiled items and surfaces) to avoid unnecessary contact with the ill person.



As much as possible, an ill person should stay in a specific room and away from other people in their home, following home care guidance.



The caregiver can provide personal cleaning supplies for an ill person’s room and bathroom, unless the room is occupied by child or another person for whom such supplies would not be appropriate. These supplies include tissues, paper towels, cleaners and EPA-registered disinfectants (see examplesexternal icon).



If a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by an ill person. If this is not possible, the caregiver should wait as long as practical after use by an ill person to clean and disinfect the high-touch surfaces.



Household members should follow home care guidance when interacting with persons with suspected/confirmed COVID-19 and their isolation rooms/bathrooms.



How to clean and disinfect:



Hard (Non-porous) Surfaces



Wear disposable gloves when cleaning and disinfecting surfaces. Gloves should be discarded after each cleaning. If reusable gloves are used, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other purposes. Consult the manufacturer’s instructions for cleaning and disinfection products used. Clean hands immediately after gloves are removed.



If surfaces are dirty, they should be cleaned using a detergent or soap and water prior to disinfection.



For disinfection, most common EPA-registered household disinfectants should be effective.



A list of products that are EPA-approved for use against the virus that causes COVID-19 is available here pdf icon external icon. Follow manufacturer’s instructions for all cleaning and disinfection products for (concentration, application method and contact time, etc.).



Additionally, diluted household bleach solutions (at least 1000ppm sodium hypochlorite) can be used if appropriate for the surface. Follow manufacturer’s instructions for application, ensuring a contact time of at least 1 minute, and allowing proper ventilation during and after application. Check to ensure the product is not past its expiration date. Never mix household bleach with ammonia or any other cleanser. Unexpired household bleach will be effective against coronaviruses when properly diluted.



Prepare a bleach solution by mixing:



5 tablespoons (1/3rd cup) bleach per gallon of water or

4 teaspoons bleach per quart of water



Soft (Porous) Surfaces



For soft (porous) surfaces such as carpeted floor, rugs, and drapes, remove visible contamination if present and clean with appropriate cleaners indicated for use on these surfaces. After cleaning:



Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely.



Otherwise, use products that are EPA-approved for use against the virus that causes COVID-19 pdf icon external icon and that are suitable for porous surfaces.



Electronics



For electronics such as cell phones, tablets, touch screens, remote controls, and keyboards, remove visible contamination if present.



Follow the manufacturer’s instructions for all cleaning and disinfection products.

Consider use of wipeable covers for electronics.



If no manufacturer guidance is available, consider the use of alcohol-based wipes or sprays containing at least 70% alcohol to disinfect touch screens. Dry surfaces thoroughly to avoid pooling of liquids.



Linens, clothing, and other items that go in the laundry



Wear disposable gloves when handling dirty laundry from an ill person and then discard after each use. If using reusable gloves, those gloves should be dedicated for cleaning and disinfection of surfaces for COVID-19 and should not be used for other household purposes. Clean hands immediately after gloves are removed.



If no gloves are used when handling dirty laundry, be sure to wash hands afterwards.



If possible, do not shake dirty laundry. This will minimize the possibility of dispersing virus through the air.



Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry from an ill person can be washed with other people’s items.



Clean and disinfect clothes hampers according to guidance above for surfaces. If possible, consider placing a bag liner that is either disposable (can be thrown away) or can be laundered.



Hand hygiene and other preventive measures



Household members should clean hands often, including immediately after removing gloves and after contact with an ill person, by washing hands with soap and water for 20 seconds. If soap and water are not available and hands are not visibly dirty, an alcohol-based hand sanitizer that contains at least 60% alcohol may be used. However, if hands are visibly dirty, always wash hands with soap and water.



Household members should follow normal preventive actions while at work and home including recommended hand hygiene and avoiding touching eyes, nose, or mouth with unwashed hands.



Additional key times to clean hands include:



After blowing one’s nose, coughing, or sneezing



After using the restroom



Before eating or preparing food



After contact with animals or pets



Before and after providing routine care for another person who needs assistance (e.g. a child)



Other considerations



The ill person should eat/be fed in their room if possible. Non-disposable food service items used should be handled with gloves and washed with hot water or in a dishwasher. Clean hands after handling used food service items.



If possible, dedicate a lined trash can for the ill person. Use gloves when removing garbage bags, handling, and disposing of trash. Wash hands after handling or disposing of trash.



Consider consulting with your local health department about trash disposal guidance if available.



Additional Resources



https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html



:::



Covid-19: How long does the coronavirus last on surfaces?



We can pick up the Covid-19 by touching surfaces contaminated with the new coronavirus, but it is only just becoming clear how long the virus can survive outside the human body.



As Covid-19 has spread, so has our fear of surfaces. There are now some familiar scenes in public places around the world – people trying to open doors with their elbows, commuters studiously surfing their way through train journeys to avoid grabbing a handle, office workers rubbing down their desks each morning.



In the areas worst hit by the new coronavirus, teams of workers in protective clothing have been dispatched to spray a fog of disinfectant in plazas, parks and public streets. Cleaning regimes in offices, hospitals, shops and restaurants have been increased. In some cities, well-meaning volunteers even venture out at night to scrub the keypads of cash machines.



Like many respiratory viruses, including flu, Covid-19 can be spread in tiny droplets released from the nose and mouth of an infected person as they cough. A single cough can produce up to 3,000 droplets. These particles can land on other people, clothing and surfaces around them, but some of the smaller particles can remain in the air. There is also some evidence that the virus is also shed for longer in faecal matter, so anyone not washing their hands thoroughly after visiting the toilet could contaminate anything they touch.



It is worth noting that, according to the Centers for Disease Control and Prevention, touching a surface or object with the virus and then touching one's own face "is not thought to be the main way the virus spreads". Even so, the CDC, the World Health Organization and others health authorities, have emphasised that both washing one's hands and cleaning and disinfecting frequently touched surfaces daily are key in preventing Covid-19's spread. So although we still don't know exactly how many cases are being caused directly by contaminated surfaces, experts advise exercising caution.



You might also like:



The lessons we can learn from Spanish Flu



https://www.bbc.com/future/article/20200302-coronavirus-what-can-we-learn-from-the-spanish-flu



Why panic buying is irrational



https://www.bbc.com/worklife/article/20200304-coronavirus-covid-19-update-why-people-are-stockpiling



One aspect that has been unclear is exactly how long Sars-CoV-2, the name of the virus that causes the disease Covid-19, can survive outside the human body. Some studies on other coronaviruses, including Sars and Mers, found they can survive on metal, glass and plastic for as long as nine days, unless they are properly disinfected. Some can even hang around for up to 28 days in low temperatures.



Coronaviruses are well known to be particularly resilient in terms of where they can survive. And researchers are now beginning to understand more about how this affects the spread of the new coronavirus. (Read more about the global fight against Covid-19.)



https://www.bbc.com/future/article/20200317-covid-19-how-long-does-the-coronavirus-last-on-surfaces



:::



Will hot weather stop Covid-19 from spreading?



Some people hope that outbreaks of the new coronavirus will wane as temperatures rise, but pandemics often don’t behave in the same way as seasonal outbreaks. BBC Future looks at what we know.



Many infectious diseases wax and wane with the seasons. Flu typically arrives with the colder winter months, as does the norovirus vomiting bug. Others, such as typhoid, tend to peak during the summer. Measles cases drop during the summer in temperate climates, while in tropical regions they peak in the dry season.



Perhaps unsurprisingly, many people are now asking whether we can expect similar seasonality with Covid-19. Since it first emerged in China around mid-December, the virus has spread quickly, with the number of cases now rising most sharply in Europe and the US.



Many of the largest outbreaks have been in regions where the weather is cooler, leading to speculation that the disease might begin to tail off with the arrival of summer. Many experts, however, have already cautioned against banking too much on the virus dying down over the summer.



You might also like:



● Drinking water will not kill the coronavirus



https://www.bbc.com/future/article/20200319-covid-19-will-drinking-water-keep-you-safe-from-coronavirus



● Does sunshine kill the coronavirus?



https://www.bbc.com/future/article/20200327-can-you-kill-coronavirus-with-uv-light



And they are right to be cautious. The virus that causes Covid-19 – which has been officially named SARS-CoV-2 – is too new to have any firm data on how cases will change with the seasons. The closely related Sars virus that spread in 2003 was contained quickly, meaning there is little information about how it was affected by the seasons.



But there are some clues from other coronaviruses that infect humans as to whether Covid-19 might eventually become seasonal.



https://www.bbc.com/future/article/20200323-coronavirus-will-hot-weather-kill-covid-19



:::



Up to 25% of people with COVID-19 may not show symptoms

By Rachael Rettner - Senior Writer.



The data is prompting the CDC to reconsider who should wear face masks.



https://www.livescience.com/coronavirus-asymptomatic-spread.html



:::



Coronavirus (COVID-19): What patients and families need to know before coming to SickKids. Current as of: April 1, 2020, 4:30 p.m.



SickKids is closely monitoring the novel coronavirus (COVID-19) situation. Please check this page often for the latest updates on clinical services, access to the hospital, and how we are keeping our patients, families and staff safe. Families, friends and members of the public: please avoid coming to SickKids if your presence is not essential to the care of a patient who is currently at the hospital.



http://www.sickkids.ca/skmobile/infection--prevention-and-control/index.html



:::



Most Kids Only Get Mildly Sick From Covid-19—but Not All.



New studies suggest that children still fare better than adults. But  babies, toddlers, and kids with other conditions remain at risk.



https://www.wired.com/story/most-kids-only-get-mildly-sick-from-covid-19-but-not-all/



:::



Scientists seek reason why coronavirus has less impact on children.



In Sars also, the young were susceptible to infection but their illnesses were milder.



The children of China provided the first clue that Covid-19 does not spread its ill-effects equitably across the generations. The young, except those with underlying health conditions, appear to be escaping the worst of this pandemic.



One early study showed that, of more than 700 children known to have close contact with a confirmed case or to live in a recently affected household, only 10 tested positive. Of those children, all under 15 years old, none needed respiratory support or intensive care. A study in the journal Paediatrics, released early and subject to revision, noted one death in more than 2,000 confirmed and suspected child cases.



Now attention is turning to the scientific reasons for the age discrepancy. One UK academic hopes to start a study into whether young lungs lack an appropriate “lock” that can be picked by the virus to gain entry into the body’s respiratory machinery.



Covid-19 is not the first coronavirus disease to home in on older people: age was also a risk factor in the 2002-03 Sars epidemic. While children and adolescents seemed susceptible to infection, showing symptoms such as fever, cough and vomiting, their illnesses tended to be milder and shorter with, as one paper asserts, no child deaths.



In order to infect an animal or a person, a virus must hijack cell machinery so it can start replicating. That means finding an entry point into cells in the first place. The coronaviruses that cause Sars and Covid-19 share an important feature: they use the same “keyhole” to enter cells, called the ACE2 receptor. The receptors are primed to latch on to the ACE2 protein, which helps to regulate heart and kidney function as well as lung development (remdesivir, a Sars antiviral that targets ACE2 receptors, is being trialled as a Covid-19 treatment).



Calum Semple, professor of child health and outbreak medicine at Liverpool University, theorises that ACE2 receptors in children’s lungs provide a poor fit for this viral key: “We know that lung development doesn’t finish until the teenage years. My hypothesis, and it is just that, is that ACE2 is highly regulated in lung development. Because of this regulation, the ‘lock’ might be expressed differently in kids’ lungs.”



These cellular locks might also look different in children’s upper and lower airways, and explain why they become infected — and able to transmit Covid-19 — but do not show the same progression to severe symptoms. The virus can only descend so far before being barred.



Prof Semple, who heads the UK’s clinical studies response to emerging infections, has recruited more than 2,500 adult and child Covid-19 patients to test this hypothesis, among others. Studies will also examine other crucial aspects of the pandemic: which treatments work best; why people with underlying health conditions fare poorly; and why men outnumber women in Covid-19 hospital admissions.



Other researchers suggest children may enjoy some immunity to Covid-19 via cross-exposure to other coronaviruses associated with common colds. Prof Semple disagrees, saying in that case babies, with no prior immunity, would be especially at risk of severe illness, as they are with influenza and respiratory syncytial virus (RSV puts an estimated 3m under-fives in hospital annually). That is not borne out clinically.



While babies and children are not succumbing to the same degree as adults, it is a mistake to think they are invincible. The Paediatrics study noted that nearly 6 per cent of child patients in China became severely or critically ill, despite only one death being recorded. The US has reported the first death of an infant with Covid-19, although the exact cause of death has not been confirmed.



Even if they are rarely victims, children are still generous spreaders. While so much remains unknown about Covid-19, particularly long-term health outcomes, the precautionary principle should continue to govern our response.



https://www.ft.com/content/2d616ea0-7281-11ea-90ce-5fb6c07a27f2



:::



As Virus Reaches War Zones, UN Chief Calls for Global Cease-Fire



Guterres says ‘it is time to put armed conflict on lockdown’

He cites infections now being reported in Syria and Gaza



We’re tracking the latest on the coronavirus outbreak and the global response. Sign up here for our daily newsletter on what you need to know.



United Nations Secretary-General Antonio Guterres said the spread of the coronavirus demands a global cease-fire in war zones so nations can focus on the pandemic as their true enemy.



With infections now reported in Syria and Gaza, Guterres said that weak health-care systems mean civilian populations face the “highest risk of suffering devastating losses.” Refugees and others displaced by violent conflict are “doubly vulnerable,” he said, calling for “an immediate global cease-fire in all corners of the world.”



“It is time to put armed conflict on lockdown and focus together on the true fight of our lives,” he told reporters on Monday.



Millions of civilians in crowded refugee camps from Syria to Yemen to Myanmar lack basic requirements deployed in richer countries to fight the spread of the epidemic, from clean water and soap to enough space to keep a safe distance from one another. The UN is seeking $2 billion from wealthier countries as part of a global humanitarian plan to help poor countries combat the virus, he added.



While wealthy countries are trying to develop stimulus plans to buttress their healthcare systems and economies as global equity markets sink, Guterres said coordination is needed so that “not only the developed countries can respond effectively to the disease but that there is massive support to the developing world not to let the disease spread like wildfire in the developing world.”



He said an aid package will need to keep households and businesses in poorer countries afloat “and this will require a double‑digit GDP support in the developed world” and the “creation of new facilities” through the IMF to enable swaps among central banks.



By David Wainer. March 23, 2020, 12:20 PM EDT Updated on March 23, 2020, 4:32 PM EDT.



https://www.bloomberg.com/news/articles/2020-03-23/as-virus-reaches-war-zones-un-chief-calls-for-global-cease-fire



https://www.dailymail.co.uk/sciencetech/article-4453666/The-world-war-Interactive-map-reveals-conflicts.html



https://towardsdatascience.com/cord-19-the-data-science-response-to-covid-19-46d57ab811f3



:::



2020: WASHINGTON — President Trump on Wednesday defended his increasingly frequent practice of calling the coronavirus the “Chinese Virus,” ignoring a growing chorus of criticism that it is racist and anti-Chinese.



“It’s not racist at all,” Mr. Trump said, explaining his rationale. “It comes from China, that’s why.”



But the term has angered Chinese officials and a wide range of critics, and China experts say labeling the virus that way will only ratchet up tensions between the two countries, while resulting in the kind of xenophobia that American leaders should discourage. Asian-Americans have reported incidents of racial slurs and physical abuse because of the erroneous perception that China is the cause of the virus.



“The use of this term is not only corrosive vis-à-vis a global audience, including here at home, it is also fueling a narrative in China about a broader American hatred and fear of not just the Chinese Communist Party but of China and Chinese people in general,” said Scott Kennedy, a China expert at the Center for Strategic and International Studies.



https://www.nytimes.com/2020/03/18/us/politics/china-virus.html



:::