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Masks
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PLee
Joined: 08 Dec 2003
Posts: 3671
Location: Brooklyn, NY

4/16/20 3:27 PM

Masks

Well, New York is finally requiring face masks in public where social distancing is difficult. I might try running with a mask again. It'll be like running at altitude with reduced oxygen, right? . . .

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Steve B.
Joined: 19 Jan 2004
Posts: 754
Location: Long Island, NY

4/16/20 6:20 PM

You donít need a mask unless you canít keep a 6ft. difference. Iíd be running wherever there are the least amount of people, which is how Iím cycling. No paths, MUTs, etc....

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Sparky
Joined: 08 Dec 2003
Posts: 17730
Location: Portland, OR

4/16/20 6:35 PM

" Iíd be running wherever there are the least amount of people"

Upwind or downwind?

Mask will help others from you more than visa versa I believe...

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KerryIrons
Joined: 12 Jan 2004
Posts: 3057
Location: Midland, MI

4/18/20 9:31 AM

Protection

Yup. Unless you're wearing surgical grade stuff, the mask serves mostly to protect everyone else rather than to protect you. But given the long latency period for this virus you can be a carrier for days before you show symptoms, so protecting others makes sense.

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Sparky
Joined: 08 Dec 2003
Posts: 17730
Location: Portland, OR

4/18/20 10:18 AM

Seems drinking hot fluids frequently is a good thing to do.

The idea being the heat breaking the fat around the protein and you swallow where in digestive acids the protein does not survive. Hopefully the more times you swallow hot stuff down, you lower the odds the protein emerges from the fat and you breath it into your lungs, etc. If I understand it correctly.

With all the beautiful air, the trees seem so happy as to be more prolific in shedding pollen like I have not seen since here. So rides net a nice scratchy throat and lungs from elevated respiratory rates. Just what your imagination needs to process now.

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Sparky
Joined: 08 Dec 2003
Posts: 17730
Location: Portland, OR

4/18/20 12:19 PM

Did you run wearing the ask yet? Curious as to the result.

This pollen here is killing me. And I have no allergy per se, it is just the particulate matter irritation. It rained a little last night, so the ample ground cover of pollen to blow around should be better for a few days going forward [I pray].

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PLee
Joined: 08 Dec 2003
Posts: 3671
Location: Brooklyn, NY

4/18/20 1:31 PM

Did it this morning with a surgical mask. It was horrible, but I can put up with it. The biggest issue is having the fabric get sucked into my lips whenever I inhale; it's uncomfortable and annoying. I have an N95 mask that I can try next time.

As for the 6 ft rule, some recent studies are saying more like 10 to 15 feet, especially behind runners or bicyclists or, as has been pointed out, downwind.

And I know my personal alert sirens now go off whenever I see someone else not wearing a mask; it's only fair and courteous for me to wear one outside. I'm also the designated errand runner in my household, I may very well be an asymptomatic carrier.

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dan emery
Joined: 11 Jan 2004
Posts: 6375
Location: Maine

4/18/20 2:13 PM

6 foot rule

As I posted in another thread, data from Belgium/Netherlands suggests that, for riding directly behind another cyclist at speed, itís 20 yards. I believe it so Iím only riding solo. And the corollary is, to pass you pull out 20 yards back and stay well to the side. I executed my first such pass yesterday, as someone riding slow turned onto the route in front of me. I donít wear a mask cycling as I see few others, but I wear one when going anywhere around other people. My office weíre covering in 1 person shifts. Iím guessing running in Brooklyn gets a little cramped.

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Steve B.
Joined: 19 Jan 2004
Posts: 754
Location: Long Island, NY

4/18/20 8:54 PM

Iím essentially doing it how Dan does, I give a lot of room if Iím coming up on another cyclist. I also move to the center of the road to give runners and walkers room. Iíve stopped cycling with my buddies. I do run into other stopped cyclists and hikers in the woods, I never stop, just keep rolling.

Some news I read tonight that they think sunlight breaks down the virus very quickly, Iím thinking maybe the UV. That might be a game changer if UV is effective as itís very easy manufacture and rig UV lamps. Weíll see where that goes.

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lrzipris
Joined: 04 Mar 2004
Posts: 494
Location: Doylestown, PA

4/19/20 7:36 AM

"I give a lot of room if Iím coming up on another cyclist." This is not really a problem for me, as I'm usually the passee, not the passer.

"I also move to the center of the road to give runners and walkers room." Where safe to do so, I always did this even before. Or slow down until passing widely is safe.

Riding with a mask is, for me, problematic. During the winter, riding with a balaclava, I find breathing difficult and my glasses fog up.

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Steve B.
Joined: 19 Jan 2004
Posts: 754
Location: Long Island, NY

4/19/20 8:04 AM

"This is not really a problem for me, as I'm usually the passee, not the passer."

I've been finding there's a new influx of folks taking up cycling again as newbies or resurrecting bikes that have been sitting dormant. Thus more cyclists, especially on the MUT's which I now avoid. AS well on other cycling forums we are seeing a lot of questions from folks getting back into the activity asking the usual "how to: questions.

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KerryIrons
Joined: 12 Jan 2004
Posts: 3057
Location: Midland, MI

4/20/20 7:04 AM


quote:
Seems drinking hot fluids frequently is a good thing to do.


Sounds like an excuse cooked up by tea drinkers in the UK. :) And of course a good reason to drink more coffee.

Like a study I read back in the '70s where an English physicist tried to pin tornadoes on the fact that we drive on the right in the US, inducing the swirl of air into a funnel cloud. No explicit statement that "driving on the left" was better, but you could read between the lines.

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henoch
Joined: 12 Jan 2004
Posts: 1672

4/20/20 8:32 AM

Any excuse to drink more coffee :)

I am using one of those neck gaiters that you can pull up over your mouth nose.

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Jesus Saves
Joined: 16 Jun 2005
Posts: 1149
Location: South of Heaven

4/20/20 4:57 PM

Fear the droplets or not

The Belgian "study" is a theoretical one, with emphasis on theoretical, that assumes one will consume infectious "droplets". From my experience cycling the past few weeks, I am more concerned about the risk posed by encountering many inexperienced cyclists and the risk of physical injury whereby I will be surrounded by covids in the hospital than the risk of getting hit by an infected's snot rocket or riding in the slipstream of daffy duck.

Go ahead and read the "study" yourself and decide its merits. Below is a small excerpt from such. Note some of the study's parameters....

"....aerodynamics study investigates whether a first person moving nearby a second person at 1.5 m distance or beyond could cause droplet transfer to this second person. CFD simulations, previously validated with wind tunnel measurements of droplet movement and evaporation and of airflow around a runner, are performed of the movement of droplets emitted by an exhaling walking or running person nearby another walking or running person. External wind was considered absent .." [/b]

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Steve B.
Joined: 19 Jan 2004
Posts: 754
Location: Long Island, NY

4/21/20 11:40 AM

Good article in the NY Times this morning.

Richard Levitan, an emergency physician in Littleton, N.H., is president of Airway Cam Technologies, a company that teaches courses in intubation and airway management.

I have been practicing emergency medicine for 30 years. In 1994 I invented an imaging system for teaching intubation, the procedure of inserting breathing tubes. This led me to perform research into this procedure, and subsequently teach airway procedure courses to physicians worldwide for the last two decades.

So at the end of March, as a crush of Covid-19 patients began overwhelming hospitals in New York City, I volunteered to spend 10 days at Bellevue, helping at the hospital where I trained. Over those days, I realized that we are not detecting the deadly pneumonia the virus causes early enough and that we could be doing more to keep patients off ventilators ó and alive.

On the long drive to New York from my home in New Hampshire, I called my friend Nick Caputo, an emergency physician in the Bronx, who was already in the thick of it. I wanted to know what I was facing, how to stay safe and about his insights into airway management with this disease. ďRich,Ē he said, ďitís like nothing Iíve ever seen before.Ē

He was right. Pneumonia caused by the coronavirus has had a stunning impact on the cityís hospital system. Normally an E.R. has a mix of patients with conditions ranging from the serious, such as heart attacks, strokes and traumatic injuries, to the nonlife-threatening, such as minor lacerations, intoxication, orthopedic injuries and migraine headaches.

During my recent time at Bellevue, though, almost all the E.R. patients had Covid pneumonia. Within the first hour of my first shift I inserted breathing tubes into two patients.

Even patients without respiratory complaints had Covid pneumonia. The patient stabbed in the shoulder, whom we X-rayed because we worried he had a collapsed lung, actually had Covid pneumonia. In patients on whom we did CT scans because they were injured in falls, we coincidentally found Covid pneumonia. Elderly patients who had passed out for unknown reasons and a number of diabetic patients were found to have it.

And here is what really surprised us: These patients did not report any sensation of breathing problems, even though their chest X-rays showed diffuse pneumonia and their oxygen was below normal. How could this be?

We are just beginning to recognize that Covid pneumonia initially causes a form of oxygen deprivation we call ďsilent hypoxiaĒ ó ďsilentĒ because of its insidious, hard-to-detect nature.

Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients donít feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 percent to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.

To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.

In emergency departments we insert breathing tubes in critically ill patients for a variety of reasons. In my 30 years of practice, however, most patients requiring emergency intubation are in shock, have altered mental status or are grunting to breathe. Patients requiring intubation because of acute hypoxia are often unconscious or using every muscle they can to take a breath. They are in extreme duress. Covid pneumonia cases are very different.

A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage ó seemingly incompatible with life ó but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.

We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain ďcompliant,Ē not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide ó and without a buildup of carbon dioxide, patients do not feel short of breath.

Share Your Stories From the Front Lines We want to hear from doctors, nurses and health care workers around the world.

Patients compensate for the low oxygen in their blood by breathing faster and deeper ó and this happens without their realizing it. This silent hypoxia, and the patientís physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until oxygen levels plummet. In effect, patients are injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure.

By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator.

Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath. (It appears that most Covid-19 patients experience relatively mild symptoms and get over the illness in a week or two without treatment.)

A major reason this pandemic is straining our health system is the alarming severity of lung injury patients have when they arrive in emergency rooms. Covid-19 overwhelmingly kills through the lungs. And because so many patients are not going to the hospital until their pneumonia is already well advanced, many wind up on ventilators, causing shortages of the machines. And once on ventilators, many die.

Avoiding the use of a ventilator is a huge win for both patient and the health care system. The resources needed for patients on ventilators are staggering. Vented patients require multiple sedatives so that they donít buck the vent or accidentally remove their breathing tubes; they need intravenous and arterial lines, IV medicines and IV pumps. In addition to a tube in the trachea, they have tubes in their stomach and bladder. Teams of people are required to move each patient, turning them on their stomach and then their back, twice a day to improve lung function.

There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively ó and it would not require waiting for a coronavirus test at a hospital or doctorís office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.

Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.

Pulse oximeters helped save the lives of two emergency physicians I know, alerting them early on to the need for treatment. When they noticed their oxygen levels declining, both went to the hospital and recovered (though one waited longer and required more treatment). Detection of hypoxia, early treatment and close monitoring apparently also worked for Boris Johnson, the British prime minister.

Widespread pulse oximetry screening for Covid pneumonia ó whether people check themselves on home devices or go to clinics or doctorsí offices ó could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.

People using the devices at home would want to consult with their doctors to reduce the number of people who come to the E.R. unnecessarily because they misinterpret their device. There also may be some patients who have unrecognized chronic lung problems and have borderline or slightly low oxygen saturations unrelated to Covid-19.

All patients who have tested positive for the coronavirus should have pulse oximetry monitoring for two weeks, the period during which Covid pneumonia typically develops. All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate. A vast majority of Americans who have been exposed to the virus donít know it.

There are other things we can do as well to avoid immediately resorting to intubation and a ventilator. Patient positioning maneuvers (having patients lie on their stomach and sides) opens up the lower and posterior lungs most affected in Covid pneumonia. Oxygenation and positioning helped patients breathe easier and seemed to prevent progression of the disease in many cases. In a preliminary study by Dr. Caputo, this strategy helped keep three out of four patients with advanced Covid pneumonia from needing a ventilator in the first 24 hours.

To date, Covid-19 has killed more than 40,600 people nationwide ó more than 10,000 in New York State alone. Oximeters are not 100 percent accurate, and they are not a panacea. There will be deaths and bad outcomes that are not preventable. We donít fully understand why certain patients get so sick, or why some go on to develop multi-organ failure. Many elderly people, already weak with chronic illness, and those with underlying lung disease do very poorly with Covid pneumonia, despite aggressive treatment.

But we can do better. Right now, many emergency rooms are either being crushed by this one disease or waiting for it to hit. We must direct resources to identifying and treating the initial phase of Covid pneumonia earlier by screening for silent hypoxia.

Itís time to get ahead of this virus instead of chasing it.

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Sparky
Joined: 08 Dec 2003
Posts: 17730
Location: Portland, OR

4/21/20 12:13 PM

I usually cringe upon seeing monster posts, or copy/paste posts in thread of this magnitude.

Thanks for that, VG read...

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Steve B.
Joined: 19 Jan 2004
Posts: 754
Location: Long Island, NY

4/21/20 12:45 PM

Sorry for the length, the Times is picky about sharing and copying. Some stuff you can share the link to the actual article.

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Sparky
Joined: 08 Dec 2003
Posts: 17730
Location: Portland, OR

4/21/20 1:19 PM

Probably cool in this time and place/space I'd say. ;)

I am just happy a little rain washed down the unreal pollen accumulations here. Yesterdays ride was the first in over a week I did not feel like a had aggregate in my chest after the ride. Just what I want to feel with ample paranoia present...

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lrzipris
Joined: 04 Mar 2004
Posts: 494
Location: Doylestown, PA

4/21/20 2:27 PM

Not so coincidentally, huffpost just published an article about the best face mask materials, looking at filtration and breathability:

https://www.huffpost.com/entry/best-...b6a92100e63129

I can't imagine cycling with a denim mask.

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Tom Price
Joined: 11 Jan 2004
Posts: 451
Location: Rochester, NY

4/21/20 6:26 PM

Steve B. thanks for the article. My brother tested positive. He had a mild fever for a day and he mentioned a slight decrease in lung function. I sent him the article and suggested he get an oximeter and/or talk to his doctor.

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PLee
Joined: 08 Dec 2003
Posts: 3671
Location: Brooklyn, NY

4/22/20 9:11 AM

My Samsung Galaxy S9 has a pulse oximetry sensor accessible through the Samsung Health app. Reading the article reminded me of it. Pulse rate 55 and oxygen saturation 98%. Phew.

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PLee
Joined: 08 Dec 2003
Posts: 3671
Location: Brooklyn, NY

4/22/20 9:15 AM

Tried running with an N95 mask yesterday. Decidedly better than with a surgical face mask. Only a little bit of each side would collapse inward when I inhaled. Much less annoying than with the surgical mask. I might be able to fix that by gluing a piece of paper clip to the mask.

The N95 still restricted airflow a bit. I had to slow to a jog to compensate. Not ideal, but the jog/run is good for the mental health, not to mention physical well-being. Now if the temps could only get and stay above 50 . . .

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Sparky
Joined: 08 Dec 2003
Posts: 17730
Location: Portland, OR

4/22/20 11:16 AM

I grabbed a pulse oximeter when I went to the store yesterday.

I did not think to look at my Galaxy...

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Steve B.
Joined: 19 Jan 2004
Posts: 754
Location: Long Island, NY

4/22/20 6:08 PM

I just Googled a device for an iPhone. They run between $49 and $249.

OR

A model at CVS is $39.

This is hard......

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Andy M-S
Joined: 11 Jan 2004
Posts: 3219
Location: Hamden (greater New Haven) CT

4/22/20 6:39 PM

Anther pulse oximeter purchaser here, on account of that article. Both T and I have been feeling tight in the chest, figured it was probably due to stress rather than COVID, but to be on the safe side...

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