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From the Experts

Staying Safe While Voting

This is an important time in America and, if eligible to, you should vote by November 3rd. Less than a week away, many people worry about whether it is safe to vote in-person on election day amidst the COVID-19 pandemic. There are several safe practices to engage in while voting to limit the risk of viral transmission. To reduce the number of people at poll locations on election day and maintain social distancing, voters are not limited to casting ballots in person. Alternative options include early voting, mail-in ballots, and designated drop-off boxes. 

Mail-In Ballot or Drop Off

In Maryland, the last day to request a mail-in ballot was October 20th (Maryland State Board of Elections, 2020). If you are one of the many Americans who requested a ballot through this service, you have two options on how to submit it. You can either send the ballot via mail or drop it off at a designated drop-off box location. Drop off locations are listed on the ballot and available at iwillvote.com, along with nearby voting locations. Make sure to follow all directions carefully when you receive and fill out your ballot so your vote can be counted. This is the safest option for voting because the risk of viral transmission is lowest. Some Americans are choosing one of these two options but others believe that in-person is the best way possible to vote. 

Vote Early

Voting early will likely reduce the risk of transmission due to fewer crowds and lines. In Maryland, anyone who is registered to vote can vote early. States have different rules and dates when it comes to voting early. Visit https://www.usa.gov/election-office to find your official state voting website. For example, Maryland’s State Board of Elections has a website for people to learn how to register to vote, where to vote, and how to check their ballot status (Maryland State Board of Elections, 2020). Voting early is another great option if you are worried about the number of people you will be around on election day. It is still crucial to maintain social distancing of at least six feet whenever possible and to adhere to state and local guidelines for public health precautions (CDC, 2020). 

In-Person

In-person voting carries the risk of COVID-19 transmission but these risks can be mitigated. If you plan to vote in-person, make sure to wear a mask or facial covering. Face shields, while not mandated, can provide extra protection to concerned individuals. Wearing gloves will minimize the risk of viral transmission through touching infected surfaces. Furthermore, it is important to be prepared and to keep your hands clean. Make sure you use hand sanitizer, whether you decide to wear gloves or not (CDC, 2020). Hand sanitizer may also be available at polling stations, along with extra masks and gloves. While voting can be stressful, especially amidst fear about COVID-19, the pandemic should certainly not dissuade anyone from doing so. Taking the proper precautions and evaluating all voting options, the risk of viral transmission can be mitigated and people can feel confident about safely voting. 

References

“Absentee and Early Voting.” USAGov, www.usa.gov/absentee-voting

Elections, Maryland State Board of. Early Voting, elections.maryland.gov/voting/early_voting.html. 

I Will Vote, iwillvote.com/

Mai Tuyet Pho, MD. “How to Stay Safe on Election Day When You’re Voting during a Pandemic.” UChicago Medicine, UChicago Medicine, 13 Oct. 2020, www.uchicagomedicine.org/forefront/coronavirus-disease-covid-19/voting-safety

Tips for Voters to Reduce Spread of COVID-19. (n.d.). Retrieved October 30, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/going-out/voting-tips.html

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From the Experts

Ebola Outbreak in the DRC

On June 25, 2020, the World Health Organization (WHO) officially announced that the Ebola outbreak in the Democratic Republic of the Congo’s (DRC) northeast region, which has been ravaging the region since August of 2018, has officially ended. No new cases have been detected in the northeastern part of the DRC since April 27, 2020. Yet, this extraordinary achievement was overshadowed by the other long-standing health battles in the DRC: the world’s largest measles epidemic, the rising threat of COVID-19, and the new Ebola virus outbreak in the country’s northwest region. Since the outbreak was declared in August 2018, the virus has killed over 2,000 people, making it the world’s second-largest outbreak of Ebola, the first being the 2014–16 West Africa epidemic which killed more than 11,000 people (Maxmen, 2020). The Kivu and Ituri province’s 25 years of war and political unrest in the northeast region added to the health emergency’s complexity. Over the course of the outbreak, more than 70 Ebola patients and Ebola responders were injured in various targeted attacks by armed groups and at least 11 were killed (Maxmen, 2020). 

However, the epidemic did contribute to key victories in vaccination and treatment. This was the first Ebola outbreak in which a vaccine for the virus was widely deployed. Two vaccines, made by Merck and Johnson & Johnson, were distributed to over 300,000 people who had been in close proximity to people with Ebola and their contacts (Kudra Maliro & Larson, 2020). More than 80% of people who were vaccinated were reportedly not infected with Ebola, and those who were infected had relatively mild cases (Maxmen, 2020). A clinical trial conducted by the DRC’s National Institute for Biomedical Research (INRB) also found that two antibody-based drugs, mAB114 and REGN-EB3, reduced deaths dramatically among those hospitalized soon after being infected (Kudra Maliro & Larson, 2020). These were then given to all consenting patients in Ebola treatment centres in northeastern DRC.

First responders hope to replicate these tactics in Équateur, a province in the northwestern part of the country, where 18 people have been reported to be infected with Ebola virus since an outbreak was declared there on June 1, 2020. This is the 11th outbreak of Ebola in the DRC since the virus was first discovered in 1976 (Yeung, 2020). As of June 14, 2020, authorities have reported 14 confirmed infections and 11 deaths in and around the northwestern city of Mbandaka in the province of Équateur. The United Nations has also released $40 million from its Central Emergency Response Fund to help tackle the new outbreak of Ebola and other persistent health crises in the DRC (Yeung, 2020). Ibrahima Socé Fall, the assistant director-general for emergency response at the WHO, says “the region is difficult to reach by automobile which complicates the Ebola responders’ efforts”. He is worried about containing and treating Ebola patients in Équateur because of its inadequate health system and the extreme poverty and mobile nature of its population (Maxmen, 2020).

Although some doctors and researchers who were assisting in the northeast relocated to Équateur, many others stayed behind to help fight COVID-19. As of July 13, 2020 there have been at least 8,075 confirmed cases of COVID-19 in the country and 190 deaths (Johns Hopkins University, 2020). There is still a hopeful consensus among those in the region that the damage caused by the coronavirus can be minimal. Fortunately, people in the region are no strangers to the public health practice of social distancing. Schools and places of worship are already fully equipped with hand-washing kits (Kudra Maliro & Larson, 2020). The Ebola outbreak has truly changed these people’s way of life. Things such as not shaking hands is now culturally acceptable, although disrespectful under regular circumstances (Kudra Maliro & Larson, 2020). Now, maintaining good health is of the utmost importance.

References

Johns Hopkins University. (2020, July 13). COVID-19 Map. Retrieved July 13, 2020, from https://coronavirus.jhu.edu/map.html 

Kudra Maliro, A., & Larson, K. (2020, June 25). Congo announces end to 2nd deadliest Ebola outbreak ever. Retrieved July 09, 2020, from https://www.wbtv.com/2020/06/25/congo-announces-end-nd-deadliest-ebola-outbreak-ever/

Maxmen, A. (2020, June 29). World’s Second-Deadliest Ebola Outbreak Ends in Democratic Republic of the Congo. Retrieved July 09, 2020, from https://www.scientificamerican.com/article/worlds-second-deadliest-ebola-outbreak-ends-in-democratic-republic-of-the-congo/

Yeung, P. (2020, June 15). Democratic Republic of the Congo gears up to fight 11th Ebola outbreak. Retrieved July 09, 2020, from https://www.newscientist.com/article/2246095-democratic-republic-of-the-congo-gears-up-to-fight-11th-ebola-outbreak/

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From the Experts

The 1918 Influenza and Coronavirus: Social Revolutions, Racism, and Xenophobia Amidst Pandemics

Throughout the era of COVID-19, people have claimed that society would not be able to sustain itself without the modern technology that many of us enjoy today. In adapting to a world of social distancing, we have altered the way in which we communicate, often remotely. There has been an expansion of mental health care to rural areas without licensed counselors through the improvement of telemedicine. World-renowned scientists have collaborated to invent creative strategies to streamline the testing process in labs across the globe. While pandemics have historically provided technological innovation and societal change, they highlight many inequalities in the status quo.

COVID-19 has exposed health and socioeconomic inequities that have always existed but have failed to be addressed. These inequities stem from a long history of injustice and cause an imbalance of power and privilege, or inequality, that systemically disadvantages minority groups while inherently favoring white people. Racial and ethnic minority groups have disproportionately suffered from the complications arising from COVID-19, resulting in a rate of 92.3 deaths per 100,000 Black people in New York City compared to 45.2 deaths per 100,000 white people (“Coronavirus Disease 2019,” 2020). Several social determinants of health — factors that impact health outcomes — including population density, health care coverage and accessibility, occupation, food insecurity, and chronic stress levels can be attributed to this discrepancy. This pandemic is an opportunity to address the systemic racism ingrained in our society that has engendered these disparities, as members of the Black Lives Matter movement have pointed out following the murder of George Floyd and a long list of others. We must look to previous pandemics and social revolutions to learn from our mistakes and ensure this all-important cultural movement is not undermined by the invisible enemy: COVID-19. Using history, we can learn how to better support one another as we combat social injustice during the age of coronavirus.

The 1918 influenza pandemic

Rewind to 1918. As World War I came to its climax, millions of soldiers traveled to and from international bases while those back at home entered the workforce to be confronted by dismal, crowded working conditions (“1918 Pandemic Influenza Historic Timeline,” 2019). Meanwhile, a different, but formidable threat loomed over humankind. Invisible to the naked eye, this enemy — the 1918 influenza, also called the Spanish flu — would take over two times the number of lives lost during the war. The 1918 influenza was caused by a specific strain of the H1N1 virus — different from the strain causing the Swine Flu outbreak of 2009. (“History of 1918 Flu Pandemic,” 2019). Though the exact origin of the virus is still unknown, the first outbreak was detected at a US Army training camp in Fort Riley, Kansas (“1918 Pandemic Influenza: Three Waves,” 2018). This pandemic is still considered the deadliest flu on record and one of the most lethal pandemics yet, with a total of 50 million deaths worldwide and over 500 million infections by 1920 (“History of 1918 Flu Pandemic,” 2019). However, virus particles were not the only things in the air at the time, as protests, social revolutions, and cultural shifts spread across the globe.

One of the many parallels between the 1918 influenza and COVID-19 includes public revolts against social distancing, lockdown efforts, and masking requirements. As the epicenter of anti-lockdown protests and repeated resurgences of the 1918 influenza, San Francisco took extreme measures early on in its handling of COVID-19 (Kane, 2020). The port city now reflects on its complex history with pandemics, particularly drawing attention to the Anti-Mask League formed by business leaders in January of 1919 after the mayor had periodically enacted and lifted orders requiring face masks in public (Bristow, 2020). Four hundred members of the league were arrested by police for refusing to wear masks, with some even being shot by law enforcement (Bristow, 2020; Clark, 2020). Though many factors contributed to this revolt, historians emphasize that the masking effort entirely collapsed after the mayor and a public health leader were spotted without face coverings (Bristow, 2020). Religious groups across the country simultaneously protested restrictions on mass gatherings, facing similar consequences to the Anti-Mask League with arrests and fines (Clark, 2020). Ultimately, cities where these protests took place experienced resurgences similar to San Francisco, where influenza infections increased from 20,000 at the end of October to 45,000 by the end of spring (Bristow, 2020). 

Another important point to know is that the dubbing of the 1918 influenza pandemic as the Spanish flu stems from a misconception. As previously mentioned, the first outbreak was traced back to an Army camp in Kansas. Understandably, many people believed that Spain was the origin of the virus given its nickname (Andrews, 2020). Spain was one of the few neutral countries during World War I and did not experience media blackouts as compared to America, Germany, and the United Kingdom, where much of the news was censored for either propaganda or morale purposes (Andrews, 2020). Virus coverage increased when Spain’s King Alfonso XIII had been infected (Andrews, 2020). Seemingly overnight, the pandemic was dubbed the Spanish flu (Andrews, 2020). This misleading label propagated the illusion that the virus came from a foreign enemy with the intent to sabotage, inciting fear, and facilitating the circulation of xenophobic ideals. The prejudiced name also underscores the false belief that simply closing borders would resolve pandemics and is reflective of countries’ instincts to disregard vulnerable minority communities when developing medical countermeasures (Parmet & Rothstein, 2018). The US government was negligent in its treatment of minority groups, resulting in unfettered spread throughout these densely-populated communities. There was a 35% higher influenza mortality rate in Black populations than in white populations, and further stigmatization and scapegoating minority groups subsequently followed (Hutchins et al., 2009).

A stark, grim contrast

Fast forward to 2020. Once again crowds are protesting the lockdown, gathering without proper personal protective equipment with some defying orders to wear masks in part because some government officials refuse to do so themselves. These parallels between the 1918 influenza and COVID-19 are clear as day but it is equally important to discuss the contrasts between these pandemics, specifically surrounding law enforcement’s responses to public demonstrations. During the 1918 influenza pandemic, police arrested and even fired bullets at protesters for refusing to wear masks or act in accordance with public health measures. Now, for the large part, officers are not arresting anti-lockdown demonstrators but are instead using excessive violence against peaceful protesters demanding racial justice. In the wake of the murder of George Floyd, the Black Lives Matter movement is faced with teargas, rubber bullets, and unwarranted arrests. Attacks on public health are deemed permissible while advocacy for racial equality — a mission that, at its core, is inherently uncontroversial and should not be political — is criminalized.

Lessons to be learned

COVID-19 has disproportionately affected minority groups just as the 1918 influenza impacted Black Americans. In order to reverse this trend, we must first recognize racism as a public health issue. According to a study conducted by the Proceedings of the National Academy of Science, police violence is the sixth leading cause of death for all men in America, and Black men are 2.5 times more likely to be killed by the police than white men (Edwards et al., 2019)  These numbers tie into the fact that average life expectancy was 3.5 years shorter for Black populations than for white populations in 2017 — a record low for this death gap in the US (Arias & Xu, 2019). Police brutality is just one of many ways that institutional racism has directly promoted health inequities and widened the disparity between life expectancy of Black and white Americans. Bottom line, racism is causing a public health crisis.

Racial discrimination is so deeply ingrained in our society that microaggressions — subtle slights or insults that deliver hostile messages to members of marginalized groups — occur far too frequently and often go unchecked. These negative interactions can range from the claim that one “does not see color” — which can be interpreted as ignoring the struggles of Black people — to the act of a business owner following a person of color around their store. Microaggressions are essentially a social determinant of health, as they have lasting impacts on the physical wellbeing of the targeted individual. These slights and insults are stress-inducing and provoke a “fight or flight” response — a physiological reaction to a perceived threat or harmful event (Mays et al., 2007). The neuroendocrine system consequently releases high levels of epinephrine which increases heart rate, causes a spike in blood pressure, and triggers the secretion of cortisol alongside other stress hormones and inflammatory-promoting factors (Ansell, 2017). The cumulative effect of this response is called allostatic load — the weathering of the body due to repeated cycles of stress (Mays et al., 2007). Allostatic load greatly increases the likelihood of developing hypertension, metabolic syndrome, and cardiovascular disease (Mays et al., 2007). These chronic conditions put individuals at higher risk of experiencing severe illness or death from COVID-19 (Schiffrin et al., 2020). As this field of research expands, ongoing studies suggest the relationship between racism and allostatic load contributes to the higher prevalence of life-threatening diseases in Black Americans, and thus, increased vulnerability to diseases like COVID-19 (Mays et al., 2007). Microaggressions are only one example of several stressful circumstances, along with food insecurity and domestic violence, that disproportionately impact members of minority groups on a daily basis. 

Health disparities caused by racism and prejudice do not stop at the US border. The xenophobic rhetoric of 1918 has manifested in intolerant accusations, hysteria, and bigoted conspiracy theories about the coronavirus. It is critical that these attitudes do not result in the exclusion of marginalized groups from medical care, which will require addressing the gap in treatment of COVID-19 between people of developed and developing nations. Poverty, lack of modern sanitation, and lack of access to medical countermeasures were partial reasons for why mortality rates in Asia, Sub-Saharan Africa, and Latin America were significantly higher than those in Europe and North America during the 1918 influenza pandemic (Oshitani et al., 2008). As a leading global power, we cannot repeat our mistakes. Simply closing our borders off and neglecting the rest of the world will not do.

There will never be a clear, singular solution to institutional racism, especially as a public health issue, but there are steps that we can take now. It is essential that the Black Lives Matter movement continues to receive the public attention that it rightfully deserves. Looking forward, however, we must keep in mind that we are still in the midst of a pandemic despite states reopening and media coverage shifting its focus. Do not give in to the illusion that coronavirus is no longer among us, as we have learned that prematurely letting our guard down only leads to resurgences. Hold your community accountable to ensure we do not make the same mistakes as the Anti-Mask League in San Francisco. Most importantly, educate yourself on racism as a public health issue, seek concrete solutions from trusted sources, and adamantly commit to protecting the health of yourself and others. Public health is more than a mechanism to mitigate the spread of coronavirus. It is a tool to learn about and navigate the multitude of disparities caused by institutional racism. It is a reminder of how your interactions with marginalized groups may cause a cascade of physiological events that lead to increments of change in health inequities. Public health, if used in its full capacity, can be a driving force behind the fight against racial discrimination. 

References:

1918 Pandemic Influenza Historic Timeline | Pandemic Influenza (Flu) | CDC. (2019, April 18). Retrieved June 18, 2020, from https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/pandemic-timeline-1918.htm

1918 Pandemic Influenza: Three Waves | Pandemic Influenza (Flu) | CDC. (2018, November 29). Retrieved June 18, 2020, from https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/three-waves.htm

Andrews, E. (n.d.). Why Was It Called the “Spanish Flu?” Retrieved June 18, 2020, from https://www.history.com/news/why-was-it-called-the-spanish-flu

Ansell, D. A. (2017). The death gap: how inequality kills. Chicago ; London: The University of Chicago Press.

Arias, E., & Xu J. (2019). United States life tables, 2017. National Vital Statistics Reports, 68(7), https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_07-508.pdf 

Bristow, N. (2020, May 1). Loosening Public-Health Restrictions Too Early Can Cost Lives. Just Look What Happened During the 1918 Flu Pandemic. (n.d.). Retrieved June 18, 2020, from https://time.com/5830265/1918-flu-reopening-coronavirus/

CDC. (2020, February 11). Coronavirus Disease 2019 (COVID-19). Retrieved June 18, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html

Clark, D. (2020, May 11). “A breaking point”: Anti-lockdown efforts during Spanish flu offer a cautionary tale for coronavirus. (n.d.). Retrieved June 18, 2020, from https://www.nbcnews.com/politics/politics-news/breaking-point-anti-lockdown-efforts-during-spanish-flu-offer-cautionary-n1202111

Edwards, F., Lee, H., & Esposito, M. (2019). Risk of being killed by police use of force in the United States by age, race–ethnicity, and sex. Proceedings of the National Academy of Sciences, 116(34), 16793–16798. https://doi.org/10.1073/pnas.1821204116

History of 1918 Flu Pandemic | Pandemic Influenza (Flu) | CDC. (2019, January 22). Retrieved June 18, 2020, from https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/1918-pandemic-history.htm

Hutchins, S. S., Fiscella, K., Levine, R. S., Ompad, D. C., & McDonald, M. (2009). Protection of Racial/Ethnic Minority Populations During an Influenza Pandemic. American Journal of Public Health, 99(S2), S261–S270. https://doi.org/10.2105/AJPH.2009.161505

Kane, P. L. (2020, April 29). The Anti-Mask League: lockdown protests draw parallels to 1918 pandemic. The Guardian. Retrieved from https://www.theguardian.com/world/2020/apr/29/coronavirus-pandemic-1918-protests-california

Mays, V. M., Cochran, S. D., & Barnes, N. W. (2007). Race, Race-Based Discrimination, and Health Outcomes Among African Americans. Annual Review of Psychology, 58(1), 201–225. https://doi.org/10.1146/annurev.psych.57.102904.190212

Oshitani, H., Kamigaki, T., & Suzuki, A. (2008). Major Issues and Challenges of Influenza Pandemic Preparedness in Developing Countries. Emerging Infectious Diseases, 14(6), 875–880. https://doi.org/10.3201/eid1406.070839

Parmet, W. E., & Rothstein, M. A. (2018). The 1918 Influenza Pandemic: Lessons Learned and Not—Introduction to the Special Section. American Journal of Public Health, 108(11), 1435–1436. https://doi.org/10.2105/AJPH.2018.304695

Schiffrin, E. L., Flack, J. M., Ito, S., Muntner, P., & Webb, R. C. (2020). Hypertension and COVID-19. American Journal of Hypertension, 33(5), 373–374. https://doi.org/10.1093/ajh/hpaa057

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From the Experts

The Cleaning Boom of 2020

Every single day healthcare workers are risking their health in order to save lives. We often forget about the other unsung heroes risking their lives every time they show up to do their job; essential workers.  Essential workers risk their health to get a paycheck and provide us with the ability to feel safe, eat, get essential items, etc. 

A particularly vulnerable population of essential workers is the cleaner industry. This includes housekeepers, cleaning services, janitors, and anyone who’s job involves providing cleaning and restoration services.  The demand cleaner industry has skyrocketed as a result of the COVID-19 pandemic, with sales growing by 195% within the first couple of months (prnewswire.com). This spike in demand has left workers scrambling to meet the needs of this growing market. In the coming months, this trend will likely continue and as cleaners adjust to the growing demand, a “cleaning boom” will ensue. This is positive for the cleaner industry as it is one of the few industries being beneficially affected by the pandemic. However, while the economic benefits of a cleaning boom are positive, it is important to remember the obvious negatives involved with such a large demand for cleaning services. The negative being cleaners put at high risk of being exposed to the virus. In general, the cleaner industry has done an excellent job taking the needed precautions in reaction to the COVID-19 pandemic, however, that does not mean they are completely immune from being affected by the virus, and this increased exposure to illness. 

With the rise of science and medicine, public health professionals forgot about the socioeconomic determinants of health. Cleaning roles are mostly filled by members of minority communities, which have higher rates of pre-existing conditions, and are therefore more susceptible to contracting and dying from COVID-19. Most cleaners are underpaid and uninsured with minimal job security despite cleaning being an essential, hazardous, and low paying job that requires skill. These workers deserve greater training, hazard pay, job assurance, and economic security, which will result in a change in societal views and safer stores, restaurants, and gyms. 

History shows us that cleaners during pandemics are seen as public health experts trained with a specific skill. Cleaning specialists have always been essential and now more than ever society is recognizing that. BioPrep Solutions is here to help you ensure cleaning is at the forefront of your business, your employees are trained to follow guidelines and know they are valued, and customers know they are safe.

Next time you are in contact with a member industry, consider giving them a kind nod of appreciation or thank them as they are risking their health every day for the safety of others.

 Resources:

https://www.prnewswire.com/news-releases/impact-of-covid-19-on-the-household-cleaners-industry-sales-grow-by-195—leading-manufacturers-working-to-meet-the-unprecedented-demand-for-their-cleaning-products-301050100.html

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From the Experts

What We Can Learn from Response to Typhoid Mary

Once the germ was discovered and researchers discovered its origin was not related to dirt, looking through microscopes replaced sanitation and other systemic approaches to public health. Street cleaning and garbage removal stopped and focus shifted to individuals who carry germs. Citizens were encouraged to avoid germs, self-isolate, and vaccinate. 

Typhoid fever is a bacterial infection that causes GI distress. Historically, it struck cities that sent untreated water through pipes. This highlighted the need for cities to provide clean water. Once the water systems were in place, typhoid fever did not disappear completely. Healthy persons, who either recovered from the disease or never exhibited any symptoms, continued to carry the bacteria and transmit it to others.

Mary Mallon, or Typhoid Mary, a chef in New York in the 1900s, was stuck in isolation for over 25 years for carrying typhoid and endangering other people. Mary was not sick, however, managed to transmit the bacteria through the food she cooked. She was identified as a carrier after an epidemiologist traced a series of typhoid fever outbreaks in 9 families that previously employed her. 

Once tracked down, Typhoid Mary was removed from society and placed in an isolation cottage. Officials believed this was the best way to protect the health of the public. Mary’s data was gathered during her long stay and she was determined to be an intermittent carrier, meaning sometimes she tested positive, and sometimes she did not.

Mary interpreted this treatment to mean that the doctors did not know what they were doing. When she was able to leave isolation for a short period of time, she continued infecting people with her cooking. The one question nobody asked was, how could Mary stop transmitting the disease to others? Her life may have benefited from education in areas of proper sanitation or finding a career with less direct customer contact. 

Looking back, it’s known that 100% isolation is not a realistic approach to controlling an epidemic. New York State began governing the behavior of carriers, finding them jobs outside of the food industry, and even subsidizing their income in special circumstances. Restriction of certain activities was deemed sufficient. Carriers were no longer removed from society because their economic contribution to their family was acknowledged. Ultimately, the New York State Health Department forbade people sick with infectious diseases from handling food. Cooks needed to prove they were free from infectious diseases before gaining employment. 

Additionally, the government kept records of people who were infected with typhoid and monitored them post-recovery to keep data of healthy typhoid carriers. The healthy carriers were required to have satisfactory home environments and carry out the rules of public health. Many behaved in the public’s best interest, unlike Mary Mallon, who did not listen to medical advice and continued to cook food, proving there are multiple determinants of disease outcomes.

Typhoid is a bacteria and COVID-19 is a virus. Both are infectious. Even though Typhoid Mary’s experience began in 1907 and COVID-19 didn’t appear until 2019, many lessons can be learned from Mary.

Key takeaways:

  • Testing is critical 
  • Education is necessary  
  • Clean environments are the safest environments 
  • Asymptomatic people can be carriers of disease 
  • Wash hands 
  • Do not touch the face
  • Treat others with respect and empathy
  • Mentally prepare for the new normal
  • Social norms change
  • Restriction of certain activities work
  • Quarantine and isolation work
  • Buildings need to be reconstructed to promote health
  • Government surveillance works
  • Government intervention is necessary
  • Economic subsidies are necessary
  • Learning new skill or trade-in the new normal might be necessary
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From the Experts

What We Know: Immunity

Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is the key agent of the novel ongoing pandemic, Coronavirus 2019 (COVID-19). Though there are still many unknowns, we have learned about immunity regarding SARS-CoV-1(the virus that first appeared in 2003). Researchers have presented studies, showing what immunity of the Coronavirus in the current pandemic could look like.

From the Fall of 2016 to 2018, a group of researchers at Columbia University in Manhattan conducted a study to see if the immunity of the Coronavirus protected patients from getting infected multiple times. Researchers collected nasal swabs from first responders, educators, and 191 children. The participants were asked to document symptoms including a sore throat and sneezing. This study showed that the individuals were consistently re-infected with the same Coronavirus, many cases relapsing in the same year. The report also indicated that one of the participants had tested positive again only four weeks after initial recovery. In conclusion, it is fair to say that the immunity of the Coronavirus SARS-CoV-1diminishes rapidly.

The World Health Organization (WHO) is currently measuring the antibodies specific to COVID-19. Antibodies are proteins in the blood that bind to and recognize foreign substances such as bacteria or viruses and produce a response in order for the immune system to clear the virus. Usually, the cells that create antibodies called B lymphocytes also create memory cells. These memory cells remember foreign substances in order to respond and decrease the time of antibody production in future infections. The WHO suggests this is not true. According to the WHO, when they looked at the antibody response of SARS-CoV-2 the agent of COVID-19, they noticed that some individuals showed levels of antibodies for the virus in their system, but others had only small amounts. In late April 2020, the WHO released a scientific brief making it clear that “there is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.”

Many studies have proven that the statement released by the WHO claiming that there is no evidence that antibodies are protective, is false. Cold Spring Harbor Laboratory, bioRXiv, conducted a study in which healthy monkeys were exposed to the virus and tested positive, and were exposed to the virus again after recovery. Results demonstrated that when the monkeys were challenged with the SARS-CoV-2 strain after recovering the first time, their immune system was not overtaken by the virus. Although some research has proven that antibodies help fight against recurrent infections, it is stressed that this does not mean that individuals should ignore public health advice and assume they are not at risk for a second infection.

Bottom Line Up Front:
● Our immune system reacts differently to COVID-19 than other viruses.
● There is a risk of a second infection.

Resources
“Immunity passports” in the context of COVID-19. World Health Organization. https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19. Accessed April 29, 2020.

Regalado A. What if immunity to covid-19 doesn’t last? MIT Technology Review. https://www.technologyreview.com/2020/04/27/1000569/how-long-are-people-immune-to-covid-19/. Published April 27, 2020. Accessed April 29, 2020.

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From the Experts

Seasonality of COVID-19

Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) is the key agent of the novel ongoing pandemic, Coronavirus 2019 (COVID-19). Though there are still many unknowns, we have learned about immunity regarding SARS-CoV-1(the virus that first appeared in 2003). Researchers have presented studies, showing what immunity of the Coronavirus in the current pandemic could look like.

From the Fall of 2016 to 2018, a group of researchers at Columbia University in Manhattan conducted a study to see if the immunity of the Coronavirus protected patients from getting infected multiple times. Researchers collected nasal swabs from first responders, educators, and 191 children. The participants were asked to document symptoms including a sore throat and sneezing. This study showed that the individuals were consistently re-infected with the same Coronavirus, many cases relapsing in the same year. The report also indicated that one of the participants had tested positive again only four weeks after initial recovery. In conclusion, it is fair to say that the immunity of the Coronavirus SARS-CoV-1diminishes rapidly.

The World Health Organization (WHO) is currently measuring the antibodies specific to COVID-19. Antibodies are proteins in the blood that bind to and recognize foreign substances such as bacteria or viruses and produce a response in order for the immune system to clear the virus. Usually, the cells that create antibodies called B lymphocytes also create memory cells. These memory cells remember foreign substances in order to respond and decrease the time of antibody production in future infections. The WHO suggests this is not true. According to the WHO, when they looked at the antibody response of SARS-CoV-2 the agent of COVID-19, they noticed that some individuals showed levels of antibodies for the virus in their system, but others had only small amounts. In late April 2020, the WHO released a scientific brief making it clear that “there is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.”

Many studies have proven that the statement released by the WHO claiming that there is no evidence that antibodies are protective, is false. Cold Spring Harbor Laboratory, bioRXiv, conducted a study in which healthy monkeys were exposed to the virus and tested positive, and were exposed to the virus again after recovery. Results demonstrated that when the monkeys were challenged with the SARS-CoV-2 strain after recovering the first time, their immune system was not overtaken by the virus. Although some research has proven that antibodies help fight against recurrent infections, it is stressed that this does not mean that individuals should ignore public health advice and assume they are not at risk for a second infection.

Bottom Line Up Front:
● Our immune system reacts differently to COVID-19 than other viruses.
● There is a risk of a second infection.

Resources
“Immunity passports” in the context of COVID-19. World Health Organization. https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19. Accessed April 29, 2020.

Regalado A. What if immunity to covid-19 doesn’t last? MIT Technology Review. https://www.technologyreview.com/2020/04/27/1000569/how-long-are-people-immune-to-covid-19/. Published April 27, 2020. Accessed April 29, 2020.

Categories
From the Experts Medical

Remdesivir – What We Know

As COVID-19 sweeps across the country and over one million people in the U.S. have been diagnosed with the virus, researchers have been anxiously trying to find a treatment. In April 2020, news broke that the clinical trials for Remdesivir have shown modest benefits against the virus. Remdesivir is a nucleotide analog, meaning it prevents the replication of the virus in the body. This means that it inhibits viral RNA polymerase from operating. 

Amino acids make proteins through two processes: translation and transcription. Amino acids are used by living organisms to make proteins, which serve many functions to keep us alive. The type of proteins made depends on the sequence of an amino acid chain. About 1/5 of our body is made out of proteins and all cellular components in our body use proteins to execute functions. The two major steps in making a protein include transcription and translation.

During transcription, a cell makes a copy of its DNA, called RNA. The difference between RNA and DNA is that DNA contains the sugar deoxyribose, while RNA contains the sugar ribose. Translation is the process of converting RNA into a sequence of amino acids, which makes up the protein. 

In both transcription and translation, different molecules are responsible for adding and removing nucleotides. The key factor for the conversion of DNA to RNA during transcription is a molecule called RNA polymerase. As noted earlier, Remdesivir inhibits this viral RNA polymerase, so that no RNA can be made. SARS-CoV-2 is made from RNA, so as a summary, Remdesivir prevents the virus from being created. 

In early April, The New England Journal of Medicine released a study on the use of Remdesivir in fifty-three patients with severe clinical manifestation of COVID-19. Patients involved in the study were from many different countries, including the United States, Japan, Italy, Austria, France, Germany, Neverlands, Spain, and Canada. Fourteen of the participants were men and thirteen were women. Many of the patients were over 60 years old and had pre-existing health conditions. The results showed that 68% of the individuals improved while 15% did worse. Out of the 8 participants that experienced a decline in health, 7 of them died. Thirty-two patients (60%) reported adverse events during the trial. These side effects include things like: diarrhea, rash, kidney injuries, and failure renal impairment, low blood pressure, acute kidney injury, and septic shock. Also, four of the patients had to stop using Remdesivir due to how intensively the drug was developing multi-organ failures. The research stressed that the patients who were chosen for this study were severely ill and had a high mortality rate, including 64% being on invasive ventilation. Also, many of the patients chosen were males over the age of sixty and had coexisting conditions. 

Gilead Sciences, an American biopharmaceutical company that researches, develops, and commercializes drugs and performed their own study, also came out with a report. Gilead suggests that patients are responding positively to the treatment. The study looked at 125 patients at the University of Chicago; 113 of the individuals were in critical condition. The data showed that two individuals died after being given Rremdesivir, and most patients were discharged from the hospital after only six days, significantly lower than the average ten days. 

In a “normal” scenario, once a drug is believed to improve the care of patients during preclinical research, it goes through 5 clinical trials, also known as phases. 

● In Phase 0, researchers try to collect data on how the drug affects a test group of around ten people. 

● If the data is positive, then Phase I occurs. Health administrators will try to determine the safest dosage for a patient. This phase of the trial also only includes a small group of people. Each patient is given a low dose to start, and then the dose is increased until one of two things happen: The desired results are demonstrated or the side effects are too severe. 

● Phase II: More patients enter the trial. This phase aims to further examine the safety and efficiency[1] of the drug.

● Next, in Phase III: The drug being researched is compared to the standard-of-care drug using two groups. One group is given the new drug and the second group is given the current standard-of-care currently being used in the market. In order to decrease confounding variables, these trials are randomized, meaning that the groups are randomly assigned, usually by a computer program. Doctors and researchers are not told which patients are being treated with which drug, to decrease bias. 

● Lastly, in Phase IV, the FDA approves the new drug. There are strict guidelines for a drug to be approved. For example, a large sample size is needed to prove that the drug is both safe and effective. 

The drug trial for Rremdesivir has recently finished Phase III, evaluating efficacy and safety. Currently, 6 studies are being done on the drug. Beginning in March 2020, approximately one thousand individuals were tested with the drug, but mainly in countries with the highest prevalence of the pandemic. In China, researchers are conducting a study to compare how hospitalized patients with and without supplemental oxygen are responding to the drug. The 2 studies examine how patients are responding to the drug based on the severity of their illnesses. For example, patients hospitalized that need supplemental oxygen versus patients who are hospitalized and do not need supplemental oxygen. Besides China, the National Institute of Allergy and Infectious Diseases (NIAID) in the United States and the National Institute for Health and Medical Research (INSERM) in France are in the midst of conducting their own research on Rremdesivir. 

The reporting of Remdesivir has given many a sense of optimism. While Gilead has not shared their data yet, many medical professionals are not able to assess the drug’s risks and benefits. The studies that Gilead has released are uncontrolled studies; patients taking Remdesivir were not compared to patients not taking Remdesivir or people who are either taking a different treatment or no treatment. 

Bottom line upfront:

● The studies of Remdesivir with optimistic results were not completed under Food and Drug Administration testing protocols

● Data has not been provided to medical professionals so they are unable to assess risks and benefits of Remdesivir as a treatment for COVID-19

● Further study, including clinical trials as detailed in this paper, need to occur before medical professionals can say Remdesivir is a treatment for COVID-19

Resources

Grein J, Ohmagari N, Shin D, et al. Compassionate Use of Remdesivir for Patients with Severe Covid-19. New England Journal of Medicine. October 2020. DOI:10.1056/nejmoa2007016.

Kolata G. Gilead Claims ‘Positive Data’ to Come From N.I.H. Trial of Remdesivir. The New York Times. https://www.nytimes.com/2020/04/29/health/gilead-remdesivir-coronavirus.html. Published April 29, 2020. Accessed April 30, 2020.

National Comprehensive Cancer Network. Phases of clinical trials. https://www.nccn.org/patients/resources/clinical_trials/phases.aspx. Accessed April 30, 2020.

Remdesivir Clinical Trials. Gilead Creating Possible. https://www.gilead.com/purpose/advancing-global-health/covid-19/remdesivir-clinical-trials. Accessed April 30, 2020.

Categories
Finance Small Business

The Impact of the Cares Act on Your Small Business

~Michael Derouin

 

The Coronavirus Aid, Relief and Economic Security (CARES) Act, and the Families First Coronavirus Response Act include provisions to help businesses cover critical operating costs and provide tax relief as a result of the coronavirus pandemic. We have summarized the important points of the CARES Act and compiled key resources for your business.

 

Paycheck Protection Program

The CARES Act provides federally guaranteed loans to small businesses to cover business operating costs for eight weeks. These loans may be fully forgiven (including interest) if the small business uses the loan proceeds for payroll costs (including benefits), mortgage interest, rent and/or utilities while maintaining their payroll during the crisis. Small businesses interested in this program should contact their local Small Business Administration lender, federally insured depository institution, or federally insured credit union to get more detailed information. 

 

Employee Retention Tax Credit

The CARES Act provides a refundable payroll tax credit up to $5,000 per eligible employee for businesses impacted by COVID-19. 

The credit is available to employers whose:

  • Operations were fully or partially suspended due to a COVID-19-related shutdown order. 

     OR 

  • Gross receipts declined by more than 50% when compared to the same quarter in the prior calendar year.

If there are fewer than 100 full-time employees, the business may claim the tax credit on the wages of all employees.

 

Economic Injury Disaster Loans (EIDL)

The CARES Act expands eligibility for access to Economic Injury Disaster Loans to include Tribal businesses, cooperatives, and ESOPs with fewer than 500 employees, or any individual operating as a sole proprietor or an independent contractor during the covered period (Jan. 31, 2020 to Dec. 31, 2020). For eligible businesses that have applied for an EIDL loan due to COVID-19, the Act also establishes an Emergency Grant enabling the business to request up to a $10,000 advance of that loan. This can be forgiven if used to:

  • Provide paid sick leave to employees
  • Maintain payroll Meet increased material costs
  • Make rent or mortgage payments Repay obligations that cannot be met due to revenue losses

 

Sick and Family Leave Tax Credits

  • The Families First Coronavirus Response Act establishes credits for sick and family leave costs for businesses with fewer than 500 employees.
  •  Businesses are eligible to receive refundable tax credits to help offset the costs associated with providing sick and family leave. Refundable credits are also available for businesses with no employees (e.g., sole proprietors).

 

Understanding Which Benefits Your Business Can Use

It’s important to note that certain provisions described above cannot be used in conjunction with others. Some considerations when determining which programs to use:

  •  The same wages cannot qualify for both the sick and family leave tax credits and the Paycheck Protection Program. 
  • The same business costs cannot be covered by both the Paycheck Protection Program and Economic Disaster Loans. 
  • The same wages cannot qualify for both the sick and family leave tax credits and the employee retention tax credit. 
  • You must choose between the Paycheck Protection Program or the employee retention tax credit and deferral of payment of employer payroll taxes – you may not choose both.

Benefits generally limited to employers with up to 499 employees (also for self-employed individuals):

  •  Sick and family leave tax credits. 
  • The Paycheck Protection Program. 
  • Economic Injury Disaster Loans (EIDL). 

Benefits not limited by employer size (generally also available to self-employed individuals) include:

  • An employee retention tax credit. 
  • The deferral of payment of employer payroll taxes.

 

Categories
Retail Small Business

What does Reopening of American Small Business Look Like?

Living in an Alternate Reality

How will small retail businesses survive the COVID-19 pandemic?

If three months ago small retail owners were told they would lose virtually all their customers overnight and it may take up to a year or more to get these customers back, they would not have believed it. They would have said that their business would be forced to close if this was the case.

Yet this is the current reality.  

Most retail operates are on razor-thin profit margins when times are good. How can they hope to survive the new normal? The answer lies in how quickly they can regain customers as the country begins to “reopen.” Simply hoping that customers will come back is not the answer.

Today, most small retail businesses are closed and those fortunate enough to be considered “essential” are facing a significant drop in customers. Once busy restaurants are trying to survive on delivery and take-out, others are attempting to retain customers by implementing social distancing measures (limiting the number of customers that can come inside, placing tape on the floor six feet apart for customers to stand on when in line, putting up barriers between employees and customers, etc.). 

The U.S. is being told by the government that these measures are temporary. But what does this timeline really look like? Information obtained from a simple internet search shows the obvious problems with reopening retail. Let’s address some of these issues:

  • Vaccine – There are many different vaccines in the works, but medical experts are still 12-18 months away from a viable vaccine.
  • Cure – There are promising drugs, but no magic bullet yet.  If that magic happens, it is still likely 12-18 months away.  
  • Herd immunity – This requires enough of the population to be infected and recover so the virus cannot spread any more. We are many months, potentially over a year away from this best-case scenario. Moreover, it is unknown if recovered individuals are immune.
  • Testing – COVID-19 testing to see who is currently infected and antibody testing to see who has recovered and is hopefully now immune. This is the most realistic solution to reopen the country.  We are nowhere near having this level of testing readily available.  It also relies upon the unproven assumption that these COVID-19 survivors are immune to reinfection.   

It is not palatable to think about, but when small business retail is finally allowed to reopen, likely at some point during the summer of 2020, COVID-19 will still be around and impacting us for another 12-18 months minimum.  For this reason, businesses not prepared to protect customers and employees from an active pandemic are likely to fail. This is particularly true of small retail.

 

How does small retail adapt and succeed in the midst of a global pandemic? 

Customers willing to venture out and brave the new world are going to have different expectations of safety and cleanliness than they did in a pre-COVID-19 world. However, satisfying these customers alone will not be enough to keep small retail in business. 

There will undoubtedly be a larger group of former customers that will not be back, at least not initially. The primary reason for this is that they will have found new ways to get what they want (think online) and need without engaging in the risky behavior of in-person retail.  Businesses that do not find a way to attract these former customers or to find new customers are destined to fail.  There are no simple solutions. But, here are a few ideas that can help. 

  1. Ensure customers are safe and “feel safe”.
  2. Message your existing customer base to ensure they know the measures you have taken for your safety and the safety of your employees.  You want to reassure your customers that you have gone above and beyond competitors.
  3. Make sure you have a product, service, or need that people are willing to come out for. 
  4. Take advantage of all online opportunities to sell your product.
  5. Concerted advertising, including optimization of social media.
  6. Take advantage of ALL government programs.
  7. Anticipate inflation/deflation, supply chain disruptions, and plan this uncertainty into your product costs.   
  8. Make connections with your customers and sell experiences (you can’t get that online).  People will be hungry for those.  Stand out. 

As with any retail crisis, there will be new opportunities. People always find new ways to succeed where others fail. That is a topic for another day.  

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