Green Legacy

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It's My Dam

It's My Dam




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Universal Masking in Hospitals in the Covid-19 Era

Via The Thinking Housewife

Universal Masking in Hospitals in the Covid-19 Era
May 21, 2020
New England Journal of Medicine 2020; 382:e63

Michael Klompas, M.D., M.P.H., Charles A. Morris, M.D., M.P.H., Julia Sinclair, M.B.A., Madelyn Pearson, D.N.P., R.N., and Erica S. Shenoy, M.D., Ph.D.

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As the SARS-CoV-2 pandemic continues to explode, hospital systems are scrambling to intensify their measures for protecting patients and health care workers from the virus. An increasing number of frontline providers are wondering whether this effort should include universal use of masks by all health care workers. Universal masking is already standard practice in Hong Kong, Singapore, and other parts of Asia and has recently been adopted by a handful of U.S. hospitals.

We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.

The calculus may be different, however, in health care settings. First and foremost, a mask is a core component of the personal protective equipment (PPE) clinicians need when caring for symptomatic patients with respiratory viral infections, in conjunction with gown, gloves, and eye protection. Masking in this context is already part of routine operations for most hospitals. What is less clear is whether a mask offers any further protection in health care settings in which the wearer has no direct interactions with symptomatic patients. There are two scenarios in which there may be possible benefits.

The first is during the care of a patient with unrecognized Covid-19. A mask alone in this setting will reduce risk only slightly, however, since it does not provide protection from droplets that may enter the eyes or from fomites on the patient or in the environment that providers may pick up on their hands and carry to their mucous membranes (particularly given the concern that mask wearers may have an increased tendency to touch their faces).

More compelling is the possibility that wearing a mask may reduce the likelihood of transmission from asymptomatic and minimally symptomatic health care workers with Covid-19 to other providers and patients. This concern increases as Covid-19 becomes more widespread in the community. We face a constant risk that a health care worker with early infection may bring the virus into our facilities and transmit it to others. Transmission from people with asymptomatic infection has been well documented, although it is unclear to what extent such transmission contributes to the overall spread of infection.1-3

More insidious may be the health care worker who comes to work with mild and ambiguous symptoms, such as fatigue or muscle aches, or a scratchy throat and mild nasal congestion, that they attribute to working long hours or stress or seasonal allergies, rather than recognizing that they may have early or mild Covid-19. In our hospitals, we have already seen a number of instances in which staff members either came to work well but developed symptoms of Covid-19 partway through their shifts or worked with mild and ambiguous symptoms that were subsequently diagnosed as Covid-19. These cases have led to large numbers of our patients and staff members being exposed to the virus and a handful of potentially linked infections in health care workers. Masking all providers might limit transmission from these sources by stopping asymptomatic and minimally symptomatic health care workers from spreading virus-laden oral and nasal droplets.

What is clear, however, is that universal masking alone is not a panacea. A mask will not protect providers caring for a patient with active Covid-19 if it’s not accompanied by meticulous hand hygiene, eye protection, gloves, and a gown. A mask alone will not prevent health care workers with early Covid-19 from contaminating their hands and spreading the virus to patients and colleagues. Focusing on universal masking alone may, paradoxically, lead to more transmission of Covid-19 if it diverts attention from implementing more fundamental infection-control measures.

Such measures include vigorous screening of all patients coming to a facility for symptoms of Covid-19 and immediately getting them masked and into a room; early implementation of contact and droplet precautions, including eye protection, for all symptomatic patients and erring on the side of caution when in doubt; rescreening all admitted patients daily for signs and symptoms of Covid-19 in case an infection was incubating on admission or they were exposed to the virus in the hospital; having a low threshold for testing patients with even mild symptoms potentially attributable to a viral respiratory infection (this includes patients with pneumonia, given that a third or more of pneumonias are caused by viruses rather than bacteria); requiring employees to attest that they have no symptoms before starting work each day; being attentive to physical distancing between staff members in all settings (including potentially neglected settings such as elevators, hospital shuttle buses, clinical rounds, and work rooms); restricting and screening visitors; and increasing the frequency and reliability of hand hygiene.

The extent of marginal benefit of universal masking over and above these foundational measures is debatable. It depends on the prevalence of health care workers with asymptomatic and minimally symptomatic infections as well as the relative contribution of this population to the spread of infection. It is informative, in this regard, that the prevalence of Covid-19 among asymptomatic evacuees from Wuhan during the height of the epidemic there was only 1 to 3%.4,5 Modelers assessing the spread of infection in Wuhan have noted the importance of undiagnosed infections in fueling the spread of Covid-19 while also acknowledging that the transmission risk from this population is likely to be lower than the risk of spread from symptomatic patients.3 And then the potential benefits of universal masking need to be balanced against the future risk of running out of masks and thereby exposing clinicians to the much greater risk of caring for symptomatic patients without a mask. Providing each health care worker with one mask per day for extended use, however, may paradoxically improve inventory control by reducing one-time uses and facilitating centralized workflows for allocating masks without risk assessments at the individual-employee level.

There may be additional benefits to broad masking policies that extend beyond their technical contribution to reducing pathogen transmission. Masks are visible reminders of an otherwise invisible yet widely prevalent pathogen and may remind people of the importance of social distancing and other infection-control measures.

It is also clear that masks serve symbolic roles. Masks are not only tools, they are also talismans that may help increase health care workers’ perceived sense of safety, well-being, and trust in their hospitals. Although such reactions may not be strictly logical, we are all subject to fear and anxiety, especially during times of crisis. One might argue that fear and anxiety are better countered with data and education than with a marginally beneficial mask, particularly in light of the worldwide mask shortage, but it is difficult to get clinicians to hear this message in the heat of the current crisis. Expanded masking protocols’ greatest contribution may be to reduce the transmission of anxiety, over and above whatever role they may play in reducing transmission of Covid-19. The potential value of universal masking in giving health care workers the confidence to absorb and implement the more foundational infection-prevention practices described above may be its greatest contribution.

Misinforming the American Public

I wrote recently of the cut-and-paste "journalism" that I coined for Steve Sailer's style of writing which I discuss in a longer post here: Ethiopia's Independence and Strength.

The very last comment (#58) in Sailer's article Minnesota is Turning into a Front in the Ethiopian Civil War comments section is by:

stephen 🇬🇧
@LFC_blano
Always Loyal ☆ Fortune Favours The Brave ☆
BRITISH AND PROUD

"stephen" has attached a video with his comment:

Video footage of a 100 strong mob of Ethiopian youths destroying the statue of Emperor Haile Selassie in Cannizaro Park, Wimbledon London https://t.co/O4zTtlfBqr pic.twitter.com/x7b2doJDaO

— stephen 🇬🇧 (@LFC_blano) July 6, 2020

Of course, besides the non-identification of the statue-destroyers, and the pending investigations by the London police, it is TOTALLY reasonable to associate this vandalism with "Ethiopians" (sarcasm alert).

The language that these vandals are speaking is not Amharic, the official and historical language of Ethiopia, but the regional Oromigna. Thus, clearly and unequivocally, these vandals are Oromo, who, like their counterparts in Addis Ababa, simply wish the destruction of the historical Ethiopia.

Steve Sailer has left this piece of twitter in the comments section of his Oromo article (which I have discussed here), adding to more misinformation for the American public.

This, as I have written before, adds to my gathering of proof that American leaders, left or right, are strategizing toward a subdued Ethiopia.

A strong Ethiopia will be difficult to coerce into the various Middle East policies that America, and I am convinced in conjunction with Israel, is currently developing.

As I wrote in my recent post Ethiopia's Independence and Strength about the Grand Ethiopian Renaissance Dam, which is now in its final stages of being filled, a strong and independent Ethiopia is not what these global powers want in northern Africa.

Sailer knows the implications of this, and he left the post and its comments for all to be misinformed.

#Green Footprint From Ethiopia

የሪፐብሊካን ጋርድ አባላት ሀገራቸውን በጽናት ስለማገልገላቸው አመሰግናቸዋለሁ። #አረንጓዴ ዐሻራ

Thank you Republican guard members for serving their country with strength. #Green footprint

Thank you to all members of the country's state of the country for serving them. #Ashaaraamagariisa


#greenlegacy

Earth Day: The COVID-Coincidence?

Spring Landscape Study, Ontario, Canada, April 2020
Edward Burtynsky

(Photograph on Globe and Mail article by Burtynsky, April 22, 2020: "On Earth Day, we must reflect on our duty as stewards of nature."

This photograph is from a new body of work Edward Burtynsky is creating while in isolation, focused on natural landscapes, with proceeds going to support the arts in Canada)

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The global call to action against COVID-19 is a test run for our inevitable fight with climate change – and that time is looming.
Edward Burtynsky

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This is a slightly edited version, for privacy and grammar, of an email I sent a friend after I attended a program organized by the Ryerson Image Centre in April 2019:

That's when I saw the other Ryerson affiliate Ed Burtynsky, sitting quietly in the back row, who takes disaster photographs "aesthetically," now more recently in African countries in order to, I'm sure, destabilize leaders with "Climate Change" and "The Environment" from doing reasonable large scale programs.

Burtynksy is must be very wealthy, and has projects/books/tv documentaries/lectureships all over the place, all the time. (I've attached a photo from his facebook/instagram page on his visit to a school: "So fun engaging with aspiring artists and sharing stories...What a special opportunity letting them play with some of the things they're working on an avara media [Burtynsky is part of this also] and hearing their unique, intelligent perspectives..." Comment: valeriedurantvancouver: Shaping young minds for the future. So important...)

Catch them while they're young.

I continue

He [Burtynsky] is very impressive. But my admiration was short-lived. He is part of the elite global leftist artists whose mandate is to show how terrible the world is: Global Warming/Climate Change/Environmental Destruction. Of course they are not incorrect, where our civilizational responsibility is to use the world in a Godly manner, but we USE the world and its resources, not let them stew useless in their quarries.

And

[T]hese elitist Western photographers and professional artists dictate the course of "global" culture through their disaster imagery.

COVID must be a godsend for the likes of Burtynsky, especially since it coincides with Earth Day (which was April 22, by the way).

It feels a little surreal to be commemorating the 50th anniversary of Earth Day in the middle of this unprecedented global crisis...

writes Burtynsky, in an April 22 article for the Globe and Mail, which is also available here, and which I've posted below.

He continues:

My first trip to China in 2002 took me to Wuhan en route to photograph along the Yangtze River, where entire cities and landscapes were being commandeered and flattened to make way for the building of the Three Gorges Dam. So, when the pictures first emerged of the coronavirus lockdown in Wuhan months ago, never did I imagine seeing cities being shut down in this new and devastating way – or that we would soon experience this contagion all over the world.

Finally, his China disaster photographs and world apocalypse have conjoined, and given him a re-invigorated mission, where

...isolated at home, with a new pathogen determined to wreak global havoc...[m]y hope is that during this time in isolation I am able to create a suite of images looking at nature, with proceeds going directly to support the arts sector in Canada.

The government is tanking because of a fake emergency, people are set to lose everything, home, job, savings, and his contribution is to print a few prints and sell them for the proceeds for those "starving" artists.

One has to conclude that even these elites realize that the COVID is a big scam. A couple of prints from Ed, and all will be well! What's wrong with that picture?

The future of life on this planet rests in our hands...

doom talks Burtynsky. What a lofty ordeal!

Below is the article, which Burtynsky wrote for the Globe and Mail (available here, and a version of it here), on COVID-19, and for Earth Day. He writes, and prints his charity photographs, from the comfort of his "cottage," his rural home by a lake and in the woods, somewhere in northern Ontario, far away from the urban apocalypse that ordinary folk are experiencing.

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On Earth Day, we must reflect on our duty as stewards of nature

It feels a little surreal to be commemorating the 50th anniversary of Earth Day in the middle of this unprecedented global crisis. Admittedly, I had envisioned this day much differently, yet with COVID-19 forcing us all into isolation, the message of Earth Day seems more urgent than ever.

My 40-year career as an artist has taken me on a journey around our planet in search of the largest examples of human systems expressed upon the land and sea. I have been to many places that very few of us have any reason to go – the places where we wrest out the things we need from nature to propel our human destiny. My first trip to China in 2002 took me to Wuhan en route to photograph along the Yangtze River, where entire cities and landscapes were being commandeered and flattened to make way for the building of the Three Gorges Dam. So, when the pictures first emerged of the coronavirus lockdown in Wuhan months ago, never did I imagine seeing cities being shut down in this new and devastating way – or that we would soon experience this contagion all over the world.

There’s no doubt that the ravenous human appetite to conquer nature has compelled us to encroach on natural habitats and biodiversity in an ever-expanding way, and that this has led us to where we are today – isolated at home, with a new pathogen determined to wreak global havoc. It seems the paradigm has shifted: Where humans once had our collective boot on nature’s neck, we now find ourselves with nature’s boot firmly pressed against ours.

On this 50th anniversary of Earth Day, I find myself in northern Ontario. This familiar landscape has become hugely important to my career. It’s the place where I recalibrate and consider nature, and where I first came to understand that we do not own this land – we merely serve as its steward, taking care of it and passing it on to the next generation. It has become an inflection point for me, a stark reference for when I’m able to go out into the world and see humanity shaping nature at scale through industry, urban sprawl and the sheer impact of the nearly eight-billion-large human population dominating our planet.



Rural Canada has taught me many things, and as I reflect on humanity’s impact on the planet, the most profound lesson now is that our reach into nature has gone too far. The global call to action against this virus is a test run for our inevitable fight against climate change. And that time is looming.

Over the past few weeks, I have been inspired to go back to my origins of photographing in these natural landscapes – viewing nature as a kind of painting. Looking at abstract expressionism and trying to find that place through photography. Going back to the shrubs and bushes of the forest. Going back to my home, nature.

My hope is that during this time in isolation I am able to create a suite of images looking at nature, with proceeds going directly to support the arts sector in Canada. The arts have taken an oversized hit during these times and will continue to suffer enormously because of this crisis. And yet, it is the artists, musicians, filmmakers and performers to whom we are all turning for catharsis, relaxation, distraction, entertainment and, perhaps most importantly, hope. As the great artist Gerhard Richter once said, “Art is the highest form of hope.” Artists now need our support as much as we need theirs.

There will be a lot of pain felt out there over the next months, as we regroup, as we try to gather in spaces and share them together again. I don’t know what those next few months will bring, but in this time of isolation and contemplation, I can be assured of one very important thing: The future of life on this planet rests in our hands. There might one day soon be a vaccine for this virus, but there’s no vaccine for climate change.


Landscape Study #4, Ontario, Canada, 1981
Edward Burtynsky
(Photograph on Globe and Mail article by Burtynsky, April 22, 2020: On Earth Day, we must reflect on our duty as stewards of nature)

New York in a Week Part III: The Cloisters

I visited the Cloisters during my August trip. It is the third time I've been there. Below are my previous posts on the Cloisters:

- Flowers of the Unicorn Tapestry
September 9, 2012
- A Road Less Taken
August 12, 2012
- The Luck of the Unicorns
September 8, 2010

And here is a published article (in the Botanical Artists of Canada Newsletter) where I discuss the flowers and plants in the Unicorn Tapestries:
- Botanical Art and the Decorative Arts
Botanical Artists of Canada Newsletter
Summer 2007
Pp3-4

This time, I wanted to take better photographs of the New Jersey Palisades, and of the exterior of the museum. Also, there is a special exhibition on the 75th anniversary of the Cloisters, which a special emphasis on the items (documents and objects) relating to the Unicorn.

Here is a description of the exhibition:

Given by John D. Rockefeller Jr. in time for the opening of The Cloisters in 1938, the Unicorn Tapestries are its best-known masterpieces; yet, seventy-five years later, their history and meaning remain elusive. They have been seen both as complicated metaphors for Christ and as emblems of matrimony, and they are beloved as quaint indications of medieval notions about the natural world. This exhibition of some forty works of art drawn from the collections of the Metropolitan, sister institutions, and private collections invites audiences to see the Unicorn Tapestries anew, as the finest expression of a subject widely treated across cultures, and in both European art and science, from the Middle Ages, through the Renaissance.

I will post more on the exhibition, and the notes I took, in an upcoming posting.

The Cloisters are not very far from New York. The city's M4 bus goes there, traveling through the Bronx to get there in about a 45-minute ride. The bus goes through the Bronx, with some beautiful wrought iron balconies and fire escapes on old New York buildings. (The friend I write about is Larry Auster, who was a constant companion during my recent visits in New York). I wrote about the buildings and the iron work here in New York Fire Escapes.

Below are the photographs I took during this trip. The Cloisters, only a short distance from New York City, feel like another place, far away both geographically and spiritually. Magical is another word I would use to describe them, and their location.

I have posted my photographs from my last trip at the Cloisters in August 2012 at the end of the 2013 photographs.


Cloisters entrance
[Photo by KPA, August 2013]


View of the George Washington Bridge from the Cloisters
[Photo by KPA, August 2013]


View of The New Jersey Palisades from the Cloisters
[Photo by KPA, August 2013]

The New Jersey Palisades (above), which were protected through land claims by Rockefeller, are now battling to prevent high rise constructions.

An information pamphlet, An American Landmark is at Risk, was provided at the museum. There is a link at www.protectThePalisades.org for online information.


Garden in the Cloisters
Discussed in: Garden Guide: New York City pp. 33-37
Cloisters Flowers
[Photo by KPA, August 2012]


Standing Virgin and Child
Attributed to Nikolaus Gerhaert van Leiden
(North Netherlandish, active in Strasbourg, 1460–1473)
Date: ca. 1470
Medium: Boxwood, tinted lips and eyes
Dimensions: 13 1/4 x 5 1/8 x 3 9/16 in.
[Photo by KPA, August 2012]




Periwinkles in the Cloisters
Discussed in Garden Guide: New York City pp. 33-37
Periwinkle Label:
Common Periwinkle, Myrtle
Vinca minor
[Photo by KPA, August 2012]
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Posted By: Kidist P. Asrat
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