Issue No. 3

Welcome to the third issue of COVID Solutions Bulletin. Because of your expertise, you have been chosen part of a select audience to receive this e-mailed publication. Our mission is to educate influential Americans on innovative solutions to the COVID-19 crisis in America. We need to get back to work, to school, to play – to enjoying life. We can’t get there without thwarting the current pandemic and preparing for the possibility of other pathogens to come.

One of our themes is this: Masks, distancing, testing, even vaccines are not enough. Environmental solutions have to be part of the effort – and that means technologies that destroy the COVID virus where it has the best chance to spread and infect – in interior settings. We hope you find this newsletter enlightening and will share your feedback.
In this issue:

• Increase in U.S. death rate highest in history.
• New Biden jobs plan recognizes need to invest in clean, COVID-free air in schools, care facilities.
• New real-life data show vaccines are working. Unvaccinated Americans 50 times more likely to get COVID than vaccinated Americans.
• No evidence vaccinations have contributed to a single death, but 20% of rural Americans still say ‘definitely not’ to getting a COVID shot.
• A German study finds air purifiers work well in classrooms.
• ‘It’s inhalation’: an infected person simply coughing or breathing can make a health worker in a mask sick.
• Dr. Deborah Birx joins ActivePure, Dallas company that makes devices that immediately destroy pathogens like SARS-CoV-2 in interiors.
• Are ventilation systems risky?

COVID 3rd-Leading Cause of Death in 2020, But Data Understate Impact

On Wednesday, the Centers for Disease Control and Prevention (CDC) estimated that the age-adjusted death rate for the United States rose 15.9% last year because of COVID-19, from 715.2 per 100,000 Americans to 828.7. According to our calculations, that is the sharpest calendar-year increase in recorded U.S. history, even greater than during Spanish Influenza epidemic year of 1918, when the rise was 14.1%.

A total of 378,000 COVID deaths were recorded in 2020, ranking the disease third for the year after heart disease and cancer.

The figures, recorded over a calendar year, actually underestimate the impact of COVID. In the first three months of 2020, only about 4,000 COVID deaths occurred; for the first three months of 2021, the total is about 145,000. So for the 12 months from April 1, 2020, to March 31, 2021, the death total from COVID is approximately 520,000. That compares with about 700,000 for heart disease and 600,000 for cancer. 

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New Biden Jobs Plan Includes Improvements to Clear Air of
COVID Virus and Other Pathogens

Also on Wednesday, the White House issued a statement on the details of the President’s proposed American Jobs Plan. It makes the point that “we can’t close the opportunity gap if low-income kids go to schools in building that undermine health and safety.”

So President Biden is calling for “$100 billion to upgrade and build new public schools” – with $50 billion in direct grants and $50 billion through bonds. “These funds,” says the White House statement, “will first go toward making sure our schools are safe and healthy places of learning for our kids and work for teachers and other education professionals, for example by improving indoor air quality and ventilation.”

The plan is clear recognition that clean air is essential in keeping students and teachers healthy, reducing absenteeism and keeping minds focused. The term “ventilation” appears to stand for diverse methods of improving the air. Ventilation itself – the exchange of indoor for outdoor air – is desirable but, of course, does not destroy the pathogens that cause COVID-19 and other illnesses, as we note later in this newsletter.

The American Jobs Plan also calls for modernizing other buildings, including Veterans Administration hospitals, and it allots $400 billion for “care infrastructure,” expanding access to home or community are for people with aging relatives and those with disabilities. These infrastructure improvements as well are ripe for the kind of improvements that will reduce or eliminate the interior flow of pathogens like the virus that causes COVID-19.

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Real-Life Results Show Vaccines Are Working

By the end of March, 29% of Americans had received at least one COVID-19 shot and 16% had received two. Half the population over age 65 is fully vaccinated. We now have early data showing the vaccinations are exceptionally effective and that adverse effects are minimal.

On March 29, the CDC’s Mortality and Morbidity Weekly Report published a study by Mark Thompson, Jefferey Burgess, et al., that looked at nearly 4,000 subjects, mainly health care workers and first responders and found that those who received both vaccinations were 90% less likely to become infected with COVID-19 than the general population; a single vaccination was 80% effective. For vaccinated subjects observed two weeks or more after their second shot, only three came down with COVID, an incidence rate of 0.04 per 1,000 person-days; for unvaccinated subjects, the rate was more than 30 times higher – 1.38 per 1,000 person-days.
 
These findings dovetail with the results cited in a letter by eight California physicians, published by the New England Journal of Medicine (NEJM) on March 23. The researchers found that only seven of 4,167 persons tested 15 or more days after their second vaccination became infected with COVID-19. Out of 7,958 persons who had received just one shot, 57 contracted COVID 15 or more days later.
 
The physicians concluded, “The rarity of positive test results 14 days after administration of the second dose of vaccine is encouraging and suggests that the efficacy of these vaccines is maintained outside the trial setting.” 
 
Another study, reported in a letter from William Daniel and colleagues in the same issue of the NEJM, found that only four out of 8,121 fully vaccinated employees at the University of Texas Southwestern Medical Center in Dallas became infected seven days or more after the second shot. That is just 0.05% of the cohort. By comparison, 2.61% of 6,144 unvaccinated employees became infected, as did 1.82% of those who received only one shot.

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Adverse Events from Vaccines Rare, But Hesitance Still High
 
As for adverse events, the CDC on March 22 reported that anaphylaxis – a type of severe allergic reaction – after getting a COVID-10 was “rare and occurred in approximately 2 to 5 per million vaccinated” in the United States. The reaction almost always happens within 30 minutes after getting a shot. The data come from the robust Vaccine Adverse Event Reporting System (VAERS), a project of the U.S. Department of Health and Human Services.
 
At the time of the CDC report, 126 million doses had been administered, and VAERS had been informed of 2,216 deaths among people who had received a shot. But don’t be alarmed. That’s about one of every 60,000 of people vaccinated, and in the U.S. roughly one in every 1,200 people die every month from all causes.
 
Says the Centers for Disease Control and Prevention: “CDC and FDA physicians review each case report of death as soon as notified and CDC requests medical records to further assess reports. A review of available clinical information including death certificates, autopsy, and medical records revealed no evidence that vaccination contributed to patient deaths.”
 
The vaccines are working. The bigger problem is getting enough people to be vaccinated. Now that supply in the U.S. is increasing briskly – 1% of Americans are getting shots each day – we are coming face to face with vaccination hesitancy, that is, fears unjustified by the data.
 
The Kaiser Family Foundation finds that, when asked if they will get vaccinated 13% of Americans say “definitely not,” 7% say “only if required,” and 17% want to “wait and see.” Among the definitely-nots, the rate is 15% for whites and 10% for blacks; 29% for Republicans and 5% for Democrats; 20% for people in rural areas and 10% for urban.

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Air Purifiers Practical Solutions for Classrooms, Says German Study
 
A peer-reviewed study in the journal Aerosol Science and Technology, published March 1, concludes that “the operation of mobile air purifiers in classrooms seems feasible as a practical measure that can be quickly implemented during an epidemic.” Joachim Curtius, professor of experimental research at the Institute for Atmospheric and Environmental Sciences at the Goethe University in Frankfurt, Germany, and two of his colleagues also wrote:
 
In order to reduce the risks of aerosol transmission for SARS-CoV-2 [the cause of COVID-19], air purifiers can form an important additional measure of precaution, especially in cases where no fixed ventilation systems are installed and when windows cannot be opened properly.
 
The study found that “staying for 2 h[ours] in a closed room with a highly infective person, we estimate that the inhaled dose is reduced by a factor of six when using air purifiers.” Also, “in times when classes were conducted with windows and door closed, the aerosol concentration was reduced by more than 90% within less than 30 min when running the purifiers.”
 
The researchers write that “air purifiers can reduce the aerosol load in a classroom in a fast, efficient and homogeneous way” and that the costs of implementation and maintenance “need to be compared to the substantial advantages of reducing the amount of infections and COVID-19 cases.”
 
We learned about the Curtius study from an approving Tweet by Joseph Allen, assistant professor of exposure assessment science at the Department of Environmental Health at the Harvard T.H. Chan School of Public Health. Dr. Allen wrote that he and Richard Corsi, the Joe J. King Chair Emeritus of Engineering at the University of Texas at Austin, “did a little back of the envelope” calculation and found that it would cost “only $1B to get one of these in every classroom.” Another calculation he did came to $10 per student per year.

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A Plain Cough Is More Dangerous Than Intubating a COVID Patient
 
A year ago, a young anesthesiologist named Cory Deburghgraeve, who worked at the state hospital of the University of Illinois in Chicago, described to a Washington Post reporter what it was like to intubate patients in the ICU with COVID-19:

My mask and hood can get covered in fluid. Usually it’s tiny droplets. Aerosolized virus can float around. You’re basically right next to the nuclear reactor. I go in confident and fast, because if you miss on the first try, you have to do it again, and then you’re bringing out a ton more virus.
 
But in October, a paper in the journal Anaesthesia by J. Brown of the North Bristol (U.K.) National Health Service Trust and colleagues found that a simple cough produces about 20 more particles than the procedure of intubating a patient. The number of particles detected per cough was actually higher with ventilation on than with ventilation off. Or, as the headline on a CNN.com article on March 12 put it, “Cough more hazardous to Covid-19 medical workers than intubation, research suggests.”
 
The same particles of SARS-CoV-2, the virus that causes COVID-19, that harmed the medical workers in the Brown study are emitted not just in health care and nursing home settings but in interiors anywhere, including offices, schools, stores, restaurants, and gyms. And in some of settings, masks come off when people are eating, drinking or exercising.
 
As the CNN article stated: “Other new studies show that patients with COVID simply talking or breathing, even in a well-ventilated room, could make workers sick in [a] CDC-sanctioned mask.” The piece also cited “the growing body of studies showing aerosol spread of COVID-19 during choir practice, on a bus, in a restaurant and at gyms.”
 
Another study, conducted by Harvard and Tulane researchers, published in the Proceedings of the National Academy of Sciences on Feb. 23, found that super-spreaders infected with COVID, mainly older or obese people, emit three times more aerosol particles than younger, healthier people. “The upshot is that it’s inhalation” of tiny airborne particles that leads to infection, says Donald Milton of the University of Maryland School of Public Health.
 
If schools are to reopen safely and Americans are to get back to something close to normal, a different approach is clearly needed to defeat COVID indoors. Ventilation, which simply exchanges old air for new but doesn’t destroy the virus itself, is obviously insufficient. Virus particles have to arrive at filters, a slow and inefficient process. Ultraviolet light is dangerous to humans and animals, and wearing an N95 mask at all times is, for nearly everyone, is an impossibility.
 
In solving the problem of airborne spread of SARS-CoV-2 indoors, scientists and policy experts are looking increasingly at technologies that blast out sub-microscopic particles that neutralize SARS-CoV-2 and other pathogens immediately in the air as well as on surfaces. Such technologies also have the advantage of quick installation. They don’t require expensive changes to HVAC systems – or the installation of brand-new systems in schools and older buildings that lack them.
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Dr. Birx Joins Maker of Devices That Destroy Interior Pathogens
 
In the latest indication of the importance of battling the COVID-19 virus in interior spaces, Deborah Birx – the high-profile scientific researcher, physician, and former public official – on March 15 joined a leading U.S. manufacturer of scientifically advanced infection-prevention devices.
 
MarketWatch described Dr. Birx as “a world-renowned global health official and a retired U.S. Army physician who was instrumental in HIV/AIDS vaccine research, and whose career has spanned three decades.” She was appointed by President Obama in 2014 to head the fight against the global HIV/AIDS epidemic and then last year by President Trump as response coordinator for the COVID-19 epidemic in this country.

Birx, who left government last month, became Chief Medical and Scientific Advisor to ActivePure Technologies, a Dallas-based company that makes a variety of devices that quickly and safely destroy viruses, bacteria and other pathogens in the air and on surfaces. The story of Birx’s move was first reported by Reuters on March 12.

Also on March 12, the George W. Bush Institute announced that Dr. Birx would join the organization as a Senior Fellow. “In the role,” said a press release from the George W. Bush Presidential Center in Dallas, “she will leverage her significant expertise in global health, pandemic response, and health systems to support the Bush Institute’s portfolio of work. She will also take on policy initiatives on how to better position our country to tackle health disparities in the future based off the lessons learned from the COVID-19 pandemic.”
 
ABC News reported that Birx said ActivePure “could help people get back indoors in a way that is safe.” ABC added that Birx….
 
…said ActivePure, which develops air purification technology for indoor spaces, could help people get back indoors in a way that is safe. "While I was out across the country listening to communities, the number one thing that everyone asked me was when will we get back to normal," Birx said.
 
ActivePure sells products used against other pathogens in the air and is in the process of applying for Food and Drug Administration approval of its technology to fight the novel coronavirus, as well. "It's about COVID-19 now, but I think it's going to be about aerosolized and respiratory viruses in the future," Birx said. "I think we'll all look at our indoor space in a much more critical way."
 
In 2014, President Obama appointed Birx as Global AIDS Coordinator at the State Department, heading the President’s Emergency Plan for AIDS Relief, or PEPFAR, the largest global health effort by a single nation in history.
 
PEPFAR was launched by President George W. Bush in 2003 with overwhelming bipartisan congressional support. To date, the program has invested more than $90 billion fighting the AIDS epidemic and has saved more than 18 million lives, mainly in Africa. Birx was the longest-serving AIDS Coordinator when she was asked a year ago by President Trump to take on the additional job of coordinating the response to the COVID-19 pandemic.
 
Serving in the U.S. Army, she achieved the rank of colonel and headed research efforts on contagious diseases at Walter Reed National Military Medical Center and at the Centers for Disease Control before going to the State Department. She has been author or co-author on more than 200 papers published in peer-reviewed journals.

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CDC Says ‘Risk of Spreading’ COVID Virus by Ventilation Systems Still Unclear
 
The Centers for Disease Control (CDC) has been somewhat ambivalent about the value of ventilation systems, as opposed to systems that actively destroy pathogens in the air. It’s worth quoting CDC guidance updated March 23:
 
The risk of spreading SARS-CoV-2, the virus that causes COVID-19, through ventilation systems is not clear at this time. Viral RNA has reportedly been found on return air grilles, in return air ducts, and on heating, ventilation, and air conditioning (HVAC) filters, but detecting viral RNA alone does not imply that the virus was capable of transmitting disease.
 
One research group reported that the use of a new air-sampling method allowed them to find viable viral particles within a COVID-19 patient’s hospital room with good ventilation, filtration and ultraviolet (UV) disinfection (at distances as far as 16 feet from the patient). However, the concentration of viable virus detected was believed to be too low to cause disease transmission. There may be some implications for HVAC systems associated with these findings, but it is too early to conclude that with certainty.

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Revealing Classroom Animation
 
The New York Times recently posted this excellent animation with a headline about opening windows being the key to opening schools – though, as the Times itself demonstrated, it’s not as simple as that. The best answer (see Scenario 3) was a fan plus a portable air-cleaning unit.
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