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25.03.2021, adminTry to find out their contacts. Lift a fibre to a tip of a straw pillar as well as hang a fibre around twice upon a straw on top of a cruise. In complicated meridiana journeys weren't elementary.
The technique is already well documented in the literature 1. There is some supply of new and used EtO sterilizers on the market, and there may be one in your community. Regional synergy could be achieved. I don't understand why hospitals haven't jumped on this. Two other options: 1. Taking vital signs and initial patient encounters all can be taught relatively rapidly, especially if under continuous medical supervision.
Seek comparable sources of PPE. Half-face construction respirators are obvious, and can be found eg on agricultural and industrial sites still in some stock, but consider also welding respirators. They generally have HEPA filters and are designed to provide continuous positive pressure. Again, truly shocked these haven't been all picked up by now.
Prof Gunachandran, M. It it common for people to panic in reaction to an epidemic outbreak and become more selfish to protect themselves and their loved ones from a possible infection. When PPEs like gloves or masks are available over the counter, such panic buying can not be restricted. However if the equipment were packaged in fewer numbers - for example 5 or 10 instead of 50 or or more -- more stock would be available for others. Bulk packages with or should be supplied only to institutional purchasers and not to individuals.
Also, masks that filter lessor smaller micron particles should be supplied only to health Institutions and needy elderly or ailing people who may be more susceptible to such infection, either on prescription or on establishing their identity. This may help align supply toward a more fair and equitable distribution, especially perhaps for masks which is not a restricted item at present. Stephen Levick, M. University of Pennsylvania School of Medicine. Historically, vital resources have been rationed by governmental bodies when scarce.
With a shared sense of purpose in fighting a common enemy, as with food rationing in the United States in , even an unsophisticated system of allocation was fairly successful. Individuals and families got the food they needed, and hoarding was reduced.
Though many of us are relatively isolated by social distancing directives, all of us, but especially physicians, can convey a shared sense of purpose now: the virus is the enemy to be fought, and we must protect not only ourselves, but those among us most vulnerable to it. In contrast, an adversarial view of certain other countries or people is most unhelpful.
A governmental PPE rationing body must be fair and just, and able to nimbly respond to a rapidly evolving situation. Scientific knowledge of COVID, the prospect of safe and effective treatments, and a vaccine proceed apace. Psychological, social, and economic scientists can help us to better understand and craft policies and messages that mitigate individual and societal fears that fuel PPE hoarding. The varied outcomes of food rationing practices give us food for thought on this vital issue.
Personalized medicine for providers should be a priority, even while providing care in a pandemic. Well-fitting snorkel masks are a brilliant suggestion. They raise and narrow the air intake funnel by 1 Ft, reduce droplet presentation, diminish aerosol exposure, and prevent facial touching and viral transport. Better provider and patient protection will come from this simple form of personalized medicine. Recreate An oversized clear plastic bag covering the face with a respirator N95 mask underneath, secured by gown by tucking the plastic underneath gown at the front leaving a gap behind to allow ventilation, might recreate current protection.
This also allows safer reuse of the mask as it is protected by bag. Robots Robots Both commercial and hospital robots can be utilised to continue providing patient care. Telepresence robots can be utilized for interviewing patients without close contact. During this critical shortage of N95 respirators, we have been working on a method to create your own reusable respirator using only a face mask, an in-line ventilator filter, and two elastic straps.
All for less than 3 dollars! Find instructions, details, and video at childrenshospital. I think one solution is using materials that can be re-sterilized. Cloth masks and cloth aprons that can be put through an autoclave, for example. To be even more thrifty we could use materials that are often discarded in ORs.
For example, sterile blue towels that are often thrown away could be used to cover faces attached via tying with string eg. These could of course be re-sterilized in an autoclave. Gloves could also be re-used if washed while the person is wearing them, eg with alcohol hand sanitizer while still wearing the gloves.
A regional task force could be comprised of representatives of hospitals, outpatient practices including pediatricians , nursing homes and long-term care facilities, EMS providers, and local emergency management command centers. There are many advantages to a planned regional care model. The first advantage is to patients, who will gain the improvement in outcomes from being cared for by experienced staff from the receptionists and housekeepers to the techs to the bedside clinicians in a facility best configured for their needs.
EMS services can be highly effective in transporting patients to the correct facilities as has been shown with previous successes in care for acute myocardial infarction patients and trauma victims. Correct and timely ED triage and coordinated transfer are essential to get self-transporting patients to where they need to be. Coordinated public communications from all providers as to the regional care plan can provide reassuring messages to the public AND reduce confusion and self-transport to the wrong facility.
Effective PPE usage requires staff training including boosters and inventory management that can be more effectively managed at a smaller number of facilities.
Providers may be able to make better use of PPE in bedside care at a regional care center that has been reconfigured especially for COVID treatment. The designated pediatric care center may be different than the adult center s. If transport to farther distant centers will be needed for pediatric patients, the planning process should start now. The new paper in Pediatrics on the child patient experience in China makes very clear that, while the relative risk of severe pediatric cases is lower, USA hospitals should expect a non-zero number of these patients.
Furthermore they will most likely be ages years old, and require specialized PICU supplies and equipment. As the number of patients with COVID peak, more and more health care workers are pulled in and many are newly dealing with an Infectious disease.
The only training they get about PPE is donning and doffing. Emphasis should be made about responsible use of PPE too. In countries like India, where the massive epidemic has not yet set in, we can conserve the remaining PPE in by - Restricting triage; patients don't walk or sit very close to the health care workers.
Only very few who need to examine or do some procedures get closer to patients and they wear PPE. A bell or phone can be arranged for the patient to call for emergency help from the isolation room.
I would like to suggest potentially a two tier protocol where: 1. Disposable PPE are disinfected by wetting with alcohol as much needed 2.
This not only might kill the virus but also evaporate the disinfectant more efficiently. It may be that some research studies could evaluate if only 2 is enough for the purpose. Heating in a hose air oven is probably the easiest we can do this with much less technology requirement.
More studies are needed to confirm these ideas. Geneva: World Health Organization; Annex G, Use of disinfectants: alcohol and bleach. Michele Charest, Retired RN. It is almost impossible to avoid touching one's face.
As the nostrils and mouth are the most likely point of contact and the closest portal of entry for the virus, I am recommending that washing one's face is as important as one's hands when coming in contact with possible sources of contamination.
I would like to have this commonsense measure circulated widely. Michele Charest, Ottawa, Canada. Consideration should be given to placing these in patients with suspected or known COVID to decrease the number of times that additional health care workers e. In an ideal scenario, a patient could have an extended dwell IV placed upon presentation with the hope that it would last them throughout admission for vascular access while also serving as means for phlebotomy. Nurses and physicians could work to time medications, lab collections, vital signs checks, and other care to reduce the amount of times that PPE must be utilized.
Brian Bucher. Consider utilizing either gamma irradiation or e-beam irradiation for sterilizing respirators such as N95s. I am not an expert in any of the relevant fields, so these are simply suggestions with links to some sites and papers Heat sterilization at lowest possible temperature. Boyuan Wang, Ph. Department of Biology, MIT.
So maybe it is worth trying to thermostat PPE at 65 deg C in an oven for 90 minutes before reusing. This obviously would not kill many bacterial pathogens so the mask should go back to the same user to prevent spreading of other diseases. Another potential way to kill COVID without damaging the adsorption ability of the mask is dry-cleaning it using a non-polar solvent. Adsorption of virus to the mask is primarily through polar interactions. Solvents like perchloroethylene 'perc' should not invade these polar structures while likely being sufficient to destroy coronavirus.
Shushovan Chakrabortty, M. Everything should be in "Wartime Mode" for rapid production. The transparent shield can be attached with a headband along with a fastener like Velcro Strap. Michelle Wallace, BS Concerned citizen, inventor, repurposer. Many occupations use hard full face shields, which could be repurposed for medical use. At our hospital, the vast majority of personal protective equipment PPE is used by nursing staff who frequently have to enter patient rooms to provide care.
As part of an attempt to conserve PPE, we looked for opportunities to reduce unnecessary entrances into patient rooms. Rather, medications could often be batched. We worked with pharmacy to create a process where pharmacy would a automatically batch medication administration times when it was clearly safe to do so e.
Sivasubramanium Bhavani, M. University of Chicago. There are several factories in other countries including China that have PPE supplies, and these suppliers are ready to provide the PPE at minimal cost. The problem is the current U. In addition to the lack of connections with suppliers, hospitals are also unable to accurately measure the current need for PPE as the pressure from this need falls directly on providers.
Instead, we need an e-commerce shopify-type open marketplace for personal protective equipment. Unit directors or nursing managers should be able to directly purchase what is required for their units from these international suppliers.
This solution would directly connect the international suppliers with the people who actually need the PPE - providers. Currently there are an estimated , dentists and 71, veterinarians in the U.
One of the main obstacles to charitable giving from these offices include concerns over their ability to maintain their private practices, which operate at a high overhead. The state of Texas alone has over 14, private practices. While many of these offices do not possess N95s, some clinics do. Oral surgery clinics might have their own respirators and equipment. Dentists all possess surgical masks that would certainly provide greater protection than bandanas and makeshift hardware currently used in some hospitals.
I propose the government establish a policy program that encourages these clinics to give their medical supplies in exchange for one of the following: either a direct buyback program at a discounted Medicare rate, or establish a "war bonds" style program that can be federally backed and offer some return on their interest.
Historically, war bonds were debt securities used to raise capital during WWII. The idea was that civilians would purchase these bonds at discounted rates but with a guaranteed maturation value, and since they were backed by the federal government, there was no risk of losing the valuation of the bond. The bonds also controlled for inflation by restricting the amount of deficit spending; the bonds would essentially phase the artificially generated money out of market once they reached maturation.
As many of these offices are operating in the red and still seeing patients to stay afloat, an immediate injection of capital will give them reprieve as small business loan programs roll out and also aid the immediate need for PPE. This buys time for both small offices and hospitals; the latter awaiting a slowly--but surely--snowballing manufacturing effort for medical equipment. Additionally, war bonds have two net benefits. The first being a spirit of patriotism and capturing the urgency of the health care crisis we face.
There are many offices still operating and this offers a meaningful way for members of the private sector to contribute to a public cause. This would also force hesitant private practices to recognize the gravity of the pandemic. Second, war bonds generated a secondary market for their exchange, where individuals in immediate need of capital could sell them to one another. This reduces the overall spending on the part of the government, grants some capital reprieve in the short term for sellers of the bonds, and holders will have extra capital following cessation of the coronavirus outbreak that can return to the market.
I've written an op-ed through Politico that gives some background onto this idea 1. I'm hoping policies that nurture innovative public-private partnerships will result in more collaboration between health care allies to develop a concerted effort in combating the disease. Dentists all possess surgical masks that would certainly provide greater protection that bandanas and makeshift hardware currently used in some hospitals.
Most construction companies use N95 or P respirators that are reusable with disposable filters for painting and handling toxic materials or other activities that require them. These respirators are reusable and can be cleaned with alcohol and probably bleach. There is a very simple, inexpensive and effective way to sterilize and recycle all personal protective equipment against COVID Sterilization using ethylene oxide is used by most surgical units and is readily available.
It takes 12 hours and can be used on masks, gowns, plastics and any delicate equipment. I was horrified when I heard on the news tonight that health care professionals were trying to sterilize their masks by spraying them with lysol spray!
Ethylene oxide sterilization provides ove kill for pathogens and provides indicators that the sterilization was complete. It can be done in bulk and the small ethylene oxide molecules penetrates materials extremely well. Please review the videos below 1,2.
Until we can get the production of PPE up to the levels needed to fight this pandemic, ethylene oxide sterilization can provide a viable method of recycling critical PPE. One solution is placing an ozone generator in the room and blasting the room with ozone. Proper ventilation is required before reentry to the room. We had several tents outside the Emergency Departments in many of our campuses to deal with and screen any potential patients with COVID 19 before they reach the hospital or Emergency Department for potential admission.
At cancer centers with patients at higher risk of complications and even mortality because of their immunocompromised status, we screen every patient or staff member as they enter the cancer center.
We implemented telephone screening for patients the day before their visits to make sure they do have any flu-like symptoms and direct them to the right place for examination or advise them to stay home for isolation as indicated. We also limited the number of visitors. We created a negative pressure room away from the remaining examination rooms with only one provider and one nurse daily to deal with any suspicious COVID 19 cases. Only these providers would require full gear PPE.
N95 face mask can be reused by being placed in a brown bag with their name written on it. We also postponed all elective surgeries andused telephone or WebEx visits for all routine visits to decrease the traffic and exposure to other patients and staff because of shortage of PPE. Reusable gowns for patients in contact isolation have already been deployed at large medical centers 1 , with the primary motivation being an overall reduction in waste and greenhouse gas emissions associated with the manufacture, transportation, and disposal of one time use gowns.
While under normal circumstances implementation of a workflow, especially the laundering process, would take time to carefully plan, there may be opportunities currently to speed this process along. It is likely that commercial laundry facilities with high throughput capabilities, such as those servicing hotels and restaurants, are currently being underutilized and could be called upon to clean reusable gowns. If there is not adequate stock of new gowns currently available, a pattern could be widely disseminated along with yardage of suggested material to allow for speedy production by either citizen volunteers or existing textile manufacturers.
References: 1. Duan, et al, found that dried films of SARS-CoV had rapid inactivation at low temperatures; surfaces "were converted to be non-infectious after , and min exposure at 56 degrees C, at 67 degrees C and at 75 degrees C, respectively.
Additionally, due to the temperature range of degrees C being easily attained in a conventional dry-heat oven commonly found in many parts of the world or wet-steam autoclave commonly found near surgical theaters or clinic procedure rooms and the rapid time to inactivation, this poses an attractive option for translation to underserved health populations.
Duan SM, et al. Accessed Mar WHO Report. Ozone and Microwave Sterilization, Filter Materials. Ozone has been used successfully for sterilization in medical research. I've designed very high concentration ozone generators for semiconductor atomic layer deposition. In high concentrations, ozone can be quite hazardous, but when used in a controlled manner at moderate concentrations, it might prove to be very effective at sterilizing PPE. One of it's benefits is that it penetrates even the smallest spaces.
Here's an example of an ozone generator being used in a medical research lab environment. Microwave energy as delivered by microwave ovens has also been shown to have some efficacy in deactivating viruses 1.
Although N95 respirators often contain one or more metal parts, at least in some cases these do not generate sparking in microwave ovens. The tendency for metal to spark in a microwave oven is highly dependent on the shape of the metal. If such a technique is viable, it will need to be done in a controlled manner accounting for the mask type.
The positioning of the mask in the microwave will be an important factor. The number, volume and placement of masks and other items will also be important factors. It may be wise to use a separate microwave oven for every healthcare worker. Most importantly, the efficacy of the approach will have to be proven beyond a doubt and thoroughly reviewed. N95 respirators are often made from non-woven polypropylene fabrics. Although I don't know of a domestic source yet, here's a Chinese source.
Blisters packs, the clear plastic sheet formed packages often used for electronics and toys among other things, are made with a very simple vacuum process that can be brought on line very quickly.
This approach to thermal forming might yield vented masks to which the N95 filtering material could be applied. A soft foam gasket could be applied to the edge in liquid or paste form, robotically, as a reactive foam. I expect the domestic garment industry in NJ and elsewhere could very quickly produce many surgical style masks if the right materials were available. I also expect that the filter material would hold up well to washing and could be paired with other washable materials.
Certain high quality vacuum cleaner bags are designed to filter out particles in the 0. Those materials and the manufacturers of these bags might be considered as supply chain options.
At ours and many other institutions, a facial mask with an eye shield is worn over the N If N95 was thought not to be contaminated, one. Isolation and treatment centers need to be staffed to the maximum extent possible by people with natural immunity after recovery from COVID who can work without PPE. There are two sources. First are community volunteers who have recovered from infection.
They can be immediately deployed to isolation and treatment centers. Second are young healthy soldiers deployed to isolation and treatment centers, housed in their own hotels with state-of-the-art treatment floors, quarantined from the general community, and with rest, exercise, food and other supports that enhance immune response. They will rapidly constitute a large group of caretakers who do not need PPE. As with war time mobilizations, selected individuals can be provided with training to assume more and more functions.
Recruitment of retired healthcare workers to provide urgent help now is exactly the wrong thing to do. They will require PPE, many will still get infected, spread COVID when they return home, and because of their age be more likely to have severe illness further burdening the delivery system.
Treatment of N95 mask with salt water to allow reuse. I came across an article published in that reports the development of a universal, reusable virus deactivation system by functionalization of the main fibrous filtration unit of surgical mask with sodium chloride salt 1. The salt coating on the fiber surface dissolves upon exposure to virus aerosols and recrystallizes during drying, destroying the pathogens.
The authors found that salt-coated filters proved highly effective in deactivating influenza viruses regardless of subtypes and following storage in harsh environmental conditions. This might allow reuse of the limited masks that we have. We would need validation of this technique to see if it is effective and allows reuse of masks.
Also came across a video on YouTube explaining the technique. Interesting concept but needs further testing and validation! I see an opportunity to reach out to the food canning industry. Biohazard waste handling and transport infrastructure is already in place. The only significant steps to develop are appropriate packaging for reissue and a standardized marking system to indicate previous use and allow discard after a set number of uses. I practice in Grand Island, Nebraska. We have a shortage of N95 masks.
My husband is a farmer and went around to the NAPA stores and hardware stores in surrounding smaller, more rural towns. In the larger towns the public had bought them for themselves. They had industrial N95 masks. I realize that these are not medical grade, but they are a safer option for providers to wear than just a surgical mask.
We contacted local farmers who had boxes of them because they use them on the farm to clean out grain bins. The local ethanol plants and industries and industrial suppliers had some.
Eventus WholeHealth is a medical group of greater than providers of primary care, behavioral medicine, podiatry, audiology, and optometry services for skilled nursing facilities and assisted living facilities in five states. Although skilled nursing facilities have a limited supply of personal protective equipment, assisted living facilities typically do not, yet still provide residential services for populations highly vulnerable to COVID Because traditional PPE suppliers have prioritized their usual customers such as hospitals and ambulatory providers, Eventus has been unable to secure adequate PPE through the usual supply chain.
However, inexpensive disposable plastic rain ponchos have been available via amazon and may be worn in rooms of patients at high risk for the corona virus. Our providers do not perform procedures such as intubations where N95 masks would be necessary. Therefore, we have been able to provide dense-cloth masks to our providers as a results of volunteer seamstresses in our community, providing some droplet protection. We look forward to the supply of PPE expanding, but in the meantime we are grateful to our community volunteers who have allowed us to serve patients in the assisted living facilities and suspect other communities can muster this volunteer resource to assist.
Inpatient eConsults to reduce non-essential patient contact. This communication is documented in the medical record similar to a formal consult. While traditionally this has been used in outpatient settings, this model of care can easily be brought inpatient.
Substituting eConsults for in-person consults reduces the number of PPE used by specialists. It also has the potential added benefit of reducing spread of COVID19 by reducing unnecessary contact. An additional benefit is expanding the capacity of physicians to care for more patients during this surge as eConsults usually require less time than an in-person consult.
NY Presbyterian has just issued this directive: "The use of a surgical mask over the N95 respirator can prevent droplet contamination of the N Thus, if the N95 is covered as above, it can be reused multiple times until visibly soiled, contaminated, or wet or the wearer is unable to pass a fit check.
The same logic would permit a washable cloth mask to cover a surgical mask, permitting the surgical mask to be used many days. The owner of each surgical mask could UV disinfect it by laying it in direct sunlight for a few hours on each side.
Someone with a sewing machine could make 30 masks a day, so community volunteers could produce 60, in 4 days. Separately, I am extremely concerned that some staff and patients are permitted to have uncovered faces within hospitals. The prevalence of infection and transmissibility by asymptomatic persons requires universal droplet precautions. A washable cloth mask would block exhalation of droplets by talking, coughing and sneezing, though it is not as effective as a surgical mask for blocking inhalation of droplets.
A cloth mask should probably be changed every hours since moisture and time could permit droplets to reach the exterior. Under ideal preparedness conditions, what we would need to be ready for something like this: 1.
Modular negative pressure containment units with capacity for unlimited interconnectedness and expansion Neal Stephenson's novel Seveneves has described something similar for space powered by renewable energy and batteries, antechambers between, HEPA filtration. Immediate and swift logistical plans for rapid risk stratification and definitive answers at or close to point of care. Setting these modular units up for testing and treatment as soon as possible. Stockpiles of critical building materials for 2 above reagents, raw materials or the ability to change testing and isolating protocols 5.
Experts in charge scientists, engineers, virologists, logistics experts when an emergency is declared. Unfortunately my understanding from my engineer friends is that is difficult to design a de novo industry producing N95 masks with 0. Everything I have seen during this pandemic from the best of humanity from all over the world; there is no dearth of goodwill, we are not wanting for really great ideas and innovation, but for a unified and coordinated response in the face of what could be a catastrophic event.
The potential for implementing UV decontamination is well discussed in a prior comment. Another way to implement this would be to explore the wavelengths possible with research or even pharmacy hoods.
This would require turning the masks, but has the advantage of using existing UV sources in a setting where airflow can be regulated to be protective. There is existing literature on the use of UV and masks that provides useful data by mask manufacturer length of irradiation which can further guide institutions that chose to explore this approach. Sterilization Methods for Masks and Face Shields.
Simon Mendez, Internal Medicine. All our hospitals likely have vapor, gas, and radiation sterilization equipment in the OR. There are packages and marker tags designed to ensure sterilization of endoscopes, surgical material.
One of these methods can be used to sterilize a pool of masks, goggles, and face shields that are not visibly soiled. Each health care provider can have several surgical masks to use during the day and placed on a bag for decontamination at the end of shift.
The same masks can be given to this provider the next morning. This would depend on testing that sterilization does not deteriorate the physical integrity of the mask. This idea may not apply to the N95 respirators due to the need for a tight fit and filter integrity.
Per information from a WHO publication, one sneeze can release as many as 40, droplets in the 0. A cough releases up to 3, droplets, which is equivalent to an amount released by normal talking for 5 minutes. So even a properly fitted N95 mask does not completely eliminate the risk of illness or death.
High quality air conditioning AC filters work the same way and might be equal to this level of protection. This stands for Minimum Efficiency Reporting Value.
The scale from was designed to represent the worst case performance of a filter handling particles in the range of 0. The higher the MERV rating, Diy Jon Boat Transducer Mount Up the better the particles are captured.
This is equivalent to an N95 mask. I have a 20x25x1 inch AC filter in my house that was made by 3M, purchased at Lowes. It has a MERV rating of Could these filters possibly be taken out of their square cardboard AC filter frames and cut into makeshift masks? Speed up testing, identify necessary staff, triage inpatients, increase virtual visits.
I propose a 4 stage policy for managing shortages 1. Speed up testing- turnaround time should be less than 12 hours possible here in Cleveland, Ohio where we have in-house testing Impact: It will take negative patients out of the system faster and reduce the need for observing them for days. This will single-handedly reduce the need for PPE. Identify necessary staff- Identify a group of people who will work in 8-hour shifts to give emergency care to patients suspected of COVID Impact: It helps to log how much PPE is required for each shift and inflated demands are not made on a particular shift.
It helps in rationing what we have. A principle I have seen to great effect from my service days. Such patients do not need multiple teams visiting them. A virtual monitor can be assigned and a single physician for 20 patients to examine them if need be.
All other teams can have virtual visits. Impact: Lessen the number of physicians and the need for PPE. Strictly follow protocol- Cancel all elective procedures surgical or medical - Insurance companies should stop payments for all elective procedures unless they deal with life-threatening conditions like cancer treatment.
Nothing beats old-style hand washing. Personal hygiene is important. This does not replace PPE but hopefully would reduce transmission. Big companies should step in to start making equipment for the healthcare industry.
Desperate times call for desperate measures. Mark VanDerwater, Ed. Orchard Park High School. The mandatory biology course in the high school where I teach normally does a fetal pig dissection and we offer an anatomy elective. I estimate that we have nearly boxes of latex exam gloves on hand. I imagine this is true for thousands of high schools across the country. Likewise, Science Education suppliers may also stock other basic medical supplies. Brian Lichtenstein, M. Racquetball and other sporting glasses provide significant eye protection and are inexpensive.
Cleaning may be easily performed with soap and water. Clearly masks both disposable surgical and N95 are a precious commodity, both for source control and prevention, which has complicated decision making about use and reuse.
Furthermore, risk of exposure will continue in or communities when our staff return home. Best available research has led all to presume that asymptomatic spread is likely a common mode of transmission.
If so, we should expect all sites of care will have prodromal or asymptomatic staff working who may spread this infection before clinical recognition and isolation from work. To that end, I believe all medical staff should be issued a single mask of any type, to be worn continuously throughout time in high-risk settings, e. Ideally reusable protective eyewear such as sports googles should also be issued. If a mask is visibly soiled or no longer viable due to extended wear, a replacement mask should be provided.
Creating and using cloth masks, made from bandanas, t-shirts, etc. I've included some references below that were previously conducted discussing efficacy of cloth masks and different material.
As other commenters have already noted, multiple templates are available online. Potentially these could be laundered in currently available linen services used by hospitals. Storing N95s immediately after use for future use. Some of my fellow hospitalists and I are preserving N95 masks by removing them and placing them immediately in a brown paper bag instead of throwing them away.
The bag is then labeled with the patient's last name and the date. These bags are then being stored in our locked offices. When a patient's test result returns as negative, the masks used in that patient's room are immediately available to be reused.
If the patient's test comes back positive, then the masks used in their room are reusable a number of days later. Based on the time that the virus can live on surfaces see references below , it should be safe to reuse them again 5 days later. On the conservative side, I am planning on reusing them after 7 days.
This strategy involves having a supply of paper bags, a place to store them, and enough masks to get through a week--this number could vary quite a bit depending on many factors.
Once our hospital switches to Covid-only wards, one mask could be worn an entire shift. My sincere hope is that enough new masks are manufactured and distributed that I never have to reuse the masks I've been storing. See office listings. Latin America. Europe, Middle East, and Africa. Asia Pacific. Recognition has its rewards. Enthusiasm encouraged. Workplace Culture. An authentic lens. Employee Stories. Shape the future of SAS. SSC, www. LAYC, www.
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May 8 � UC Davis Regatta. May � Moore 24 Nationals. TCAW, www. Info, regatta cpyc. Internationally recognized certifications issued through US Sailing, the National Governing Body for the sport of sailing. Ocean-equipped yachts are insured for charters in California coastal and inland waters from Pt. Arena south to the Mexican border for miles offshore. Contact a Club Nautique Membership Director for details. NOW 6 Volt Please send your calendar items by the 10th of the month to calendar latitude No phone-ins!
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In the Tropics Apr. Croix International Regatta. Croix YC, www. Deadline to enter is 5 p. May 12 � Tahiti Pearl Regatta. International fleet racing. Transpac YC, www. July � Tahiti-Moorea Sailing Rendez-vous. Latitude 38 co-sponsors. I have become a regular subscriber to Latitude growing up around sailboats, and crewing for my father on the PC 18 Even Odds.
I would like to request that you please place the enclosed picture in your magazine, to inquire to the PC fleet in San Diego. If it's still around, is it still in good shape? Is it active these days? South Beach Harbor is a great way to experience San Francisco. Boats of all sizes are welcome in our protected harbor.
Bring your boat to South Beach and enjoy all the attractions of the city, including the new Chase Center. Also, I have noticed that Latitude 38 doesn't have too much news about the sailing scene in San Diego. Is there any way you could have more SD news in the magazine? One more thing. The PC fleet is alive and well, with the biggest concentration right there in San Diego. We've never seen a PC up here in the Bay Area, but if you have, readers, please let us know.
To your second question: We are a small staff, and are all located in the Bay Area, where we have a huge sailing scene and a big pile of work. With that said, we're not opposed to a correspondent!
If you don't mind, Timothy, we'll turn this response into a blatant solicitation for SoCal stringers. Submissions are always welcome! The plan was to show up and deal with getting the boat into the water and rigged after the rain quit.
Terry � Those are the good kinds of aches and pains! We hope you get out on your Moore more. Eleven boats went out and raced anyway. You can read about the unofficial Fiasco in Racing Sheet in the March issue of Latitude 38, and read about the official version in the Racing Sheet section of this issue. Manufactured by mariners for mariners Handcrafted custom designs since contact pacificcrestcanvas. Up at a. It was raining through Watsonville, drizzling at the harbor.
I waited until the rain stopped, ended up on the end tie, rushed to get everything rigged, was last to motor out through the narrow slot to the left of the dredge, was 15 minutes late at the unofficial race committee vessel, and hit the start. Since I haven't steered under the kite for 13 months, especially with gusting winds, we did the jib and main only, doublehanded.
Moores are fast even without the chute. The day was awesome, my muscles were sore � upper arms, back, knees, butt � and they're still recovering. These are good aches, if you know what I mean, and give me confidence to continue to get back these inactive muscles. My old Moore, , was second to finish, with Chris Watts aka Biff at the helm and Diy Jon Boat Transducer Mount No a new floating jib-lead system.
This proves old guys can race Moore 24s, as long as they are at the helm. I might have aged out of the foredeck position. The liveaboard owner was rescued by the Coast Guard.
I was raised as an anchor-out, and constantly hear how much sewage, sunken vessels, etc. How much in comparison to all the tens of thousands of homeless people and the taxes it costs to move, police, and clean up after the homeless cities that are now everywhere in the Bay Area and California?
As a kid raised anchored-out, I learned to accept people for their character and not their bank account or clothes or the car they drove. Most of the anchor-outs I was raised around were low- or minimal- income, veterans and hippies, and a lot of people were a little or a lot crazy, but everyone looked after one another, and were quality people you could trust. Living anchored-out gives these few hundred people some responsibility � like not drowning in the.
Face it head-on with the best fabrics for UV protection. These top brands are designed to take a beating and keep on performing, guaranteeing you years of fun in the sun. Get inspired by fresh fabrics, notions, tools and more � plus how-to content and DIY tutorials! My late husband and I had gotten a tour in the '80s after the early restoration.
She was magnificent. The Corliss [steam] engine was mindboggling, and the entire engine room sparkled. We had just been prowling the docks, and while standing next to Suisun admiring her, we were invited aboard. Candy After sinking, the 'Suisun' was eventually raised o. I remember Suisun in her prime in the '80s in the Sausalito Yacht Harbor.
She was gorgeous, and obviously an owner's pride. Over the last few years, it pained me to see her anchored out, wasting away. A sad end for a Grand Dame.
I knew many of the characters, and crewed with Bruce Martens in a couple of offshore deliveries; one was on a ft yacht down to Stillwater Cove for some sort of Playboy magazine shoot. In those days, there were many opportunities to view human anatomy frolicking around. It is indeed heartbreaking to see the Suisun crushed and hauled away.
I am certain there are many keepsakes aboard � things that could be curated. But then there are too few people interested anymore. The wood alone is priceless. Too bad the harbormaster of the Richardson Bay Regional Agency doesn't have the authority to inspect vessels before they chafe their rode, drag their anchor, or sink to the detriment of all concerned.
Doesn't the USCG inspect vessels underway? Isn't it time for preventative inspections rather than just waiting for disaster? Bay by falling in � which I think is much better than what is required to live in a tent or under an overpass. Maybe we should spend a little money to support the anchor-outs to help them get back to living a more responsible life?
Or do we just set up another tent city, like the one I see now set up in Sausalito by Dunphy Park? Sixty thousand miles in the world's toughest oceans with Hood Sails. And you can be sure that each sail we roll out is built by hand, with the same care and craftsmanship that has been the Hood hallmark for 50 years. Stop Your Motor! Contaminated fuel is the most common cause of diesel engine shut-down!
We had the same issues in my home bay of San Diego in the South Bay and it took a major effort on the part of authorities to clear out and reassign many of the vessels to a mooring field near our small bridge as compared to the Golden Gate.
However, the issue seems to come back, with older vessels moving into and out of the bay and anchoring over the weekend, when this activity is allowed. The anchorage near Southwestern Yacht Club and San Diego Yacht Club has regular weekend visitors who can be counted to be in the anchorage from Friday to early Monday morning.
Looking at their vessels, one can speculate that people are living on these older vessels. Where they go during weekdays I can only guess, but I believe they go out past the jetty and anchor near the Strand or in other shallow water. The problem with that is that it is much more open to weather and sea conditions. Plus, their numbers seem to be growing over the last few years.
I love our "Old Salts," but they do not seem to have the revenue needed to maintain their vessels, which will eventually come to the same end as Suisun. It is all very sad. I'm an old guy, and this kind of thing has been going on for longer than I can remember.
Years ago my thought was to 'grandfather' every vessel anchored in Richardson Bay, allowing them to stay in place. At the same time, place restrictions on any new vessels anchoring in the area so as to not perpetuate the problem.
Over time the problem would go away, but the authorities who could make this happen will never do it. Anybody who has anchored at various locations in San Diego knows that the time limits are strictly enforced to the benefit of everyone. Sadly, I'll be dead and buried before any meaningful changes are ever made to the Richardson Bay anchorage.
If they get that far, they then need to have insurance covering the removal of the vessel and damage it may cause if it sinks or damages another vessel. Otherwise it's leave the anchorage or to the dumpster. We need to get real about this issue.
Martin Thomas Latitude Nation Readers � You know it's winter in the Bay Area when you're running a bunch of stories about old boats sinking or running aground. Many readers rightfully have running concerns about anchor-outs, their seamanship, and their financial ability to compensate city and federal officials for recovering damaged or sunken vessels.
This is not a new discussion � it's not even the only time it will appear in this Letters. We'll have a more thorough response in a bit. Please call for all dredging inquiries or email us at: chris lindmarine. His sudden death was a tragic loss for his family and the literary world. How many great books lay unwritten in his pen? Cliff Thornton. Cliff was commenting on an April 13, , 'Lectronic Latitude with the same name as this letter. There was a specific banana that turned the teeth and lips red.
Apparently there is really nothing to do on the island other than drink, as mentioned in the book. Paul Clausen San Diego. The water surrounding the island was crystal-clear, the diving fantastic, and there were limestone sea caves around the perimeter of the island that were spectacular. It's well worth visiting if you can. You don't need to cut all ties with home and people when you leave, just plan a six-month or a yearlong shakedown cruise. Not long after, your plans will begin to take shape.
Come aboard our new Catalina and Bavaria 34, both in-stock at our Alameda location for this event! Enjoy libations, nautical conversation and see the latest models from Catalina and Bavaria! We will be adhering to the state guidelines including social distancing and mask wearing to keep all of our customer as safe as possible. Please RSVP so we can plan ahead and stay within the guidelines. Take the risk with the knowledge that few people will really understand your calling! One difficulty is that the ocean is rather large, and plastic doesn't all accumulate in one handy place for surface skimming.
Plastics are found everywhere we look. The problem has to be solved onshore. They should go to countries where plastic leaves rivers and joins the ocean. Fix the problem there first. It would be much more effective. Kevin Muth. But it has to go hand in hand with controlling the inflow pollution, which is several times harder to achieve. Carlos Bravo The catamaran anta is approximately eet lon with an - t eam. Tim, Carlos and Kevin � We cannot agree more. While we applaud any effort to remove trash from the world's oceans and beaches, we fear that such efforts might lose sight of the crux of the problem.
We've heard some environmentalists go so far as to call ocean cleanups "distractions" from more targeted actions, such as weaning manufacturers, and therefore consumers, off plastics, and preventing plastic waste from going into the water in the first place. Let's not kid ourselves: Short of mobilizing the world's navies to scour the oceans, we can't begin to clean up the plastics currently floating at sea. Let's not forget the incalculable tons of plastic that have disintegrated into micro-fragments and are effectively part of the water column, or the microfibers that have aerosolized, and are part of the air.
Plastic waste is either present, or downright abundant, in the most remote parts of the world. None of this is to say that we shouldn't keep cleaning up where we can. We again applaud SeaCleaners and all the other groups removing not just plastic from the ocean, but all. Gabriel Ley Marina Manager marina marinacostabaja.
We applaud beach cleanups, and the millions of people who pick up trash whenever they're outside � something that we try our best to do. We acknowledge that humanity must fundamentally change its consuming habits to truly undo the impact we've had on the world.
The Far Harbour 39 was conceived by a knowledgeable sailor who commissioned Robert Perry to design a boat that would be a good performer under power and sail. The other main criteria was that it needed to fit into a container that could be shipped anywhere in the world.
Lavish and practical at the same time, Cloud was built by Johanson Boatworks in Maine and her pedigree shows throughout. Perfect for a couple, Cloud is comfortable on deck and down below, and has enough storage and tankage to make cruising dreams in remote places a reality. A Seattle WA facebook. There is a way to do this without ever bringing the stuff to shore. Go to www. Thank the Universe for those who would do this.
How much carbon was released into the atmosphere to build this boat? John John � Fair point, if considered in the vein that much of what humanity does, even when well intentioned, has a negative environmental impact. But some people use this type of logic in the vein of shrugging their shoulders and saying, "Why make any effort at all?
It's a lot of work. That's when men were men. Josef Erlemann The inboard rudder had me thinking it was perhaps a Star, but I've never seen one with a cockpit coaming. Greg Vassilakos It's not a Shields class boat.
Humphrey Bogart died in � the Shields was first built in Gary Green. The boat in the picture is no Santana, but a smaller daysailer. Maybe an S Class or a Michael Roth. I remember seeing Santana on the Bay when I was a kid. Peter Veasey I know Bogie was an avid sailor.
His boat was called Santana. He was among those who launched the Newport to. Whether you strive to improve your Wednesday night race results or win a world championship, North Sails will take your results to the next level. But I don't know exactly what type of boat his Santana was. Joe Saad It's not a , either, which is Thanks to Tom Burden for solving the minor pointy at each mystery o Humphrey Bo art and the case o end.
I was thinkthe unknown vessel. The vessel in question, ing a Clipper, accordin to him is an tlantic a one-desi n - t open-coc pit eel oat daysailer desi ned which is a bigger Mercury. Starling Burgess in It was captained at one point by former Monterey harbormaster Brooks Bowey and visited Monterey Harbor many times.
There's a few people around here who crewed on her before she was sold in The schooner is still in The o t-mentioned-in-this-thread antana in all service � but not her sepia-toned ull-can as lory. Mark Chaffey LocaMotion, Express 37 Monterey Mark � We're not sure if we accidentally plucked your letter from a different thread which sounds like something we'd do , but the boat pictured above is almost certainly Santana and not Te Vega.
Thanks for your insight on the ft gaffrigger, though. Te Vega is truly an awesome vessel. He launched it in '68 or ' It had a blue hull and was very well built, and was once described as amazing workmanship by someone who owned it in the '80s and early '90s. I've been. I remember rounding down in the Circle, then sinking! The water felt warm, everything got quiet, the screaming owner was silenced, and there was peace!
We clung to the mast because boat was on the bottom and made it back to shore in short order. I loved sitting and reputation or sa ety and sta ility. The Columbia Sabre continued the tradition; however, they were not elegant like the 5. Yes, flat-water boats to be sure. When I was a kid, they raced on the Cityfront � quite a lot of them. It's another vanished class. I am missing some '70s � I believe they did go on longer than ' Jennifer Hinckle bought the Italian varnished one that was around, but don't quite know if she still has it.
To write an article like this [a February 17 'Lectronic] is just trying to stir up controversy. There are more important things in life than sailboat racing schedules.
I'd love to find it and take pictures for my dad. Andrea Sommer. They went into lockdown with just three known cases. Oh, if our country had done the same thing a year ago! Let NZ decide what's best for their country.
After all, it is their country. The distance from your slip to the open Bay can be measured in feet, not miles as you simply head west through our fairway and around the break-water to begin your sail. Let the wind take you on your next adventure and carry you home.
Call the Berkeley Marina today to reserve your slip at , or email us at slips cityofberkeley. Boat-in visits up to 4-hours are free. Our team is at the ready to help get you started. Visitors welcome. ACE is the semi-independent organization that runs the Cup, but is still inextricably tied to the host nation. Was this ever a controversy?
Was it only a controversy because we used the word "controversy? So, if a controversy falls in the woods, does it make a noise? Or does it only make a noise if sailing journalists are there to hear it and call it a controversy?
For those of us who follow and report on the Cup, it's easy to see dissension lining the fabric of even the most minor occurrence. But did anyone really expect that schedules wouldn't be affected, at some point, by the harsh and inconvenient realities of COVID? Since the Italians handily defeated INEOS, we hope that everyone can agree that the British team was not the recipient of some kind of advantage.
We hope everyone will take a deep breath and follow the guidelines of a country that has been incredibly successful in squashing the virus. Keep calm, and race on. Perhaps there should be a record for racing boats and a separate one for cargo vessels, or at least vessels that have a comfortable interior which Flying Cloud's captain's quarters certainly provided.
The modern boats are a bit like a Porsche breaking a record set by a semi truck full of cargo. None of the modern boats that broke Flying Cloud's record are in any way comparable � and, the book by David Shaw was great. What a great movie the Creesys' lives and their time aboard Flying Cloud would make! Connie was a dear friend who became a licensed pilot at a time when not a lot of women were.
She passed away a few years ago at 94, and one of my most treasured possessions is her Freiberger yacht sextant. Of course you can't discuss great modern female navigators and sailors without tipping your hat to Jeanne Socrates and Lin Pardey.
Joseph H. Bolero is a Clipper 36 built by Cheoy Lee. It was very foggy that day, and we ran hard aground in Redwood Creek. The tide was falling, and we were soon completely dry. We made pancakes, but we never made it to the Golden Gate that day. Clearly, we needed a woman navigator! Hats off to Eleanor! Bob Wilson South Bay. Some months ago, I strongly recommended to Ryan that he buy Nigel Calder's latest book on diesels.
It's a wonderfully written book and an invaluable reference for everything related to marine diesel engines. I bet Ryan would gladly credit his success with his engine repairs to Mr. As to Ryan and his wife Cyn having to await the high tide to float off that shoal, the almost-sure way to tow a sailboat off a 'mild' grounding is to have the tow boat pull so as to heel the boat over, which raises the keel off the bottom so that the vessel can move forward off the shallow area with her own engine.
Use the best masthead halyard available. It doesn't take a 'real' tow boat to accomplish this feat; a good-size Whaler or inflatable with a good outboard motor should do the trick for a footer. I've seen this work a dozen times on my own boats and others. Fred Huffman Marina del Rey.
The boat was a marvel of marine engineering, but the complexities of the systems aboard made me shake my head in awe. It was an easier boat to maneuver than my ft cutter with the computer control of the engines and thrusters.
But, you had to wonder what would happen if there was a glitch in the software. Maarten, and lost control of her steerin. Unlike aircraft that are fly-by-wire, the testing of yachts is much, much less stringent than required by the FAA.
Expect more interesting videos like this, and good on L38 for telling us the rest of the story. By the way, having read the. With gratitude to all the local businesses working tirelessly to serve us under these difficult conditions �we salute you! Bravo to him, and here is a toast to the K. Joseph DiMatteo His second letter this Letters.
I am a firm believer in "what can go wrong, will go wrong. Westlawn Enabling our students and alumni to achieve their dreams of becoming successful yacht designers. However, the biggest environmental hazard was omitted again by the council and the media. The entire area was built on fill. Many structures are literally sinking, and as they sink, they break the private sewer lateral pipe connecting the property to the sewer main. Because this occurs underground, it is possibly unnoticed.
The effluent will occasionally flow into streets when the ground is saturated from rains or high tides. Sausalito has no routine inspection of the laterals until a property is sold, which rarely happens for commercial property. Meanwhile, the sewage leaches into the Bay. At high tides, seawater inflows into the main-line side of the broken lateral and the saltwater flows to the sewage treatment plant in the south part of Sausalito, near Cavallo Point, causing early corrosion and premature failure of the entire pipe system at the treatment plant.
This has led to numerous breakdowns and spills into the Bay. The Marinship zone, as it exists now and would be realized under the new General Plan, is an environmental disaster.
Building housing there, regardless of the motive, only adds to the problem. It will be a shame to lose that historic marine area to commercial greed. Just what Sausalito needs is a bunch of ugly condos Diy Jon Boat Transducer Mount Rate and more traffic. The Marinship is not a thin "sliver" of land; it consists of over acres. It is not all landfill.
Among other things, it includes the bedrock of the former Pine Point neighborhood that was demolished and dynamited to create most of the landfill that was used in other areas of the Marinship. There may be some toxic residue in this large area, but there are no specific known toxic hot spots, and several parcels have multiple clean soil tests showing no toxic materials.
Enjoy tax savings. Feathering Profile Blade. New Symmetric high-tech Gawn Profile blade. The City of Sausalito convened a forum on the future of the Marinship in September , which was attended by over people.
The outcome of that forum was overwhelming support for both protecting the maritime industrial waterfront and for creating new housing, especially along the Bridgeway Boulevard street front, which has no industrial activity and no known toxic issues, and is not susceptible to flooding.
Bob Silvestri does not live in Sausalito and is a professional housing opponent. I am an affordable-housing advocate with no potential financial benefit from the creation of affordable or senior housing.
Ron Albert Sausalito Ron � We respectfully disagree that any of the articles referenced in the March 5 'Lectronic are inaccurate, but perhaps "sliver" isn't the best term to describe the Marinship.
We were referring to the working waterfront's overall size when compared with the totality of Sausalito, including the hills. We try to rise above simple labels such as calling someone "anti-housing," because this language lacks the nuance that characterizes a fruitful debate over sustainable housing and development.
While we can't speak for all of Bob Silvestri's points of view, we don't believe he is a "professional housing opponent. Regarding the many forums on the Marinship: Please keep in mind that there were several unanimous votes by the Sausalito City Council, Planning Commission and General Plan Working Group, "all of whom decided that there should be no land-based housing east of Bridgeway," unless there was appropriate analysis, Silvestri wrote in the Marin Post.
He added that Vice Mayor Janelle Kellman said that ignoring those previous votes would render years of community engagement meaningless. Sea Frost Welcome to the cold! The modern-day arinship is more than ust a thri in wor in waterfront, it's also an historical landmark. During World War II, Sausalito was home to a monumental war effort that mobilized the nation's workforce and produced some ships. Let's forget about housing for a moment. We're a sailing magazine, after all, and not Urban-Planning Monthly.
Yes, there is overwhelming support for Sausalito's working waterfront, but what is anyone actually doing to help marine businesses in the Marinship, many of which are forced to operate on month-to-month leases? This uncertainty robs owners of incentive to invest in infrastructure or make improvements. What does that say about the value placed on these. Serving the West coast with professional, quality work and consultations. Since Contact us today. His pure tight skin was an excellent fit; and closely wrapped up in it.
Starbuck seemed prepared to endure for long ages to come, and to endure always, as now; for be it Polar snow or torrid sun, like a patent chronometer, his interior vitality was warranted to do well in all climates.
I was near Point Conception one day when a mayday came across from an anchored boater who had just had an onboard explosion.
They Meet up with other young adult sailors, rig up a boat and get out on the water! The boat was considered See where the Bay winds take you and your mates! But this looks like just another chapter in the sad tale of Richardson Bay and the fleet of derelict boats that are a blight to the area. The inability of local authorities to get rid of the derelict boats, and their irresponsible owners, is the saddest part of this tale.
DiMatteo His third letter this Letters. Well said, Joe. Guess we'll just have to wait until all the derelict boats blow up or sink due to storms. The environmental consequences are the worst part. Visual blight is one thing; toxins in the Bay have consequences for innocent birds and marine mammals. We all have a duty to protect the environment.
The Raccoon is waiting to be put into action against the derelict 'boats'. Aren't registered? Can't pass the Coast Guard inspection?
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25.03.2021 at 19:23:50 House system on a sunny day and I really are safe what.
25.03.2021 at 10:26:32 Method when the plan construction is something.