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07/14/20

There’s no shortage of controversies surrounding the COVID-19 pandemic, but the controversy over hydroxychloroquine is perhaps one of the most perplexing and frustrating. Doctors and health experts around the world have spoken out both for and against the use of the drug, some reporting spectacular benefits1 while others warn of mortal dangers.2

Game-Changer or Deadly Treatment?

In one international poll3 of 6,227 doctors in 30 countries, 37% rated the antimalaria drug hydroxychloroquine as “the most effective therapy” for COVID-19. The poll was done by Sermo, the world’s largest health care data collection company and social platform for physicians.

In Spain, where the drug was used by 72% of doctors, it was rated “the most effective therapy” by 75% of them. The typical dose used by a majority of doctors was 400 milligrams per day.

French science-prize winning microbiologist and infectious disease expert Didier Raoult, founder and director of the research hospital Institut Hospitalo-Universitaire Méditerranée Infection,4 reported5,6 that a combination of hydroxychloroquine and azithromycin, administered immediately upon diagnosis, led to recovery and “virological cure” — nondetection of SARS-CoV-27 in nasal swabs — in 91.7% of patients.

According to Raoult, the drug combination “avoids worsening and clears virus persistence and contagiosness in most cases.” No cardiac toxicity was observed using a dose of 200 mg three times a day for 10 days, along with 500 mg of azithromycin on Day 1 followed by 250 mg daily for the next four days. The risk of cardiac toxicity was ameliorated by carefully screening patients and performing serial EKGs.

As reported by The Highwire (see video above), July 2, 2020, Raoult is quoted as saying failure to prescribe hydroxychloroquine to a COVID-19 patient “should be grounds for malpractice.” Meanwhile, University of Oxford investigators claim the drug is useless and shouldn’t be prescribed at all in hospitalized patients.8

An interesting website tracking hydroxychloroquine trials is c19study.com.9 It lists more than 40 studies and meta-analyses showing positive results of the drug, compared to nine that have reached a negative conclusion.

The Zelenko Regimen

Dr. Vladimir Zelenko, a primary care physician in Monroe, New York, has also reported excellent results using the drug. He told radio host Sean Hannity he’d had a near-100% success rate using hydroxychloroquine, azithromycin and zinc sulfate for five days. “I’ve seen remarkable results; it really prevents progression of disease, and patients get better,” he told Hannity.

In the video above, Del Bigtree interviews Zelenko about the criticism levied against him for promoting use of the drug. According to Zelenko, hydroxychloroquine deniers “are guilty of mass murder.”

He points out hydroxychloroquine has been used for decades and is safe even for pregnant and nursing women, so he felt very comfortable prescribing it off-label. He prescribed 200 mg of hydroxychloroquine twice a day, 500 mg of azithromycin once a day and 220 mg of zinc once a day, for five days.

The treatment was initiated within the first five days of clinical symptoms of COVID-19, based on “clinical suspicion” of SARS-CoV-2 infection (not lab confirmed testing, as test results took three days and viral load typically explodes by Day 6).

June 30, 2020, Zelenko and two co-authors published a study,10 currently in preprint, which found treating COVID-19 patients who had confirmed positive test results “as early as possible after symptom onset” with zinc, low-dose hydroxychloroquine and azithromycin “was associated with significantly less hospitalizations and five times less all-cause deaths.”

As noted by Zelenko in Bigtree’s interview, the real virus killer in this combination is actually the zinc. The hydroxychloroquine merely acts as a zinc transporter, allowing it to get into the cell. The antibiotic, meanwhile, helps prevent secondary infections.

Concerted Coordinated Effort to Inhibit Use of Effective Drug?

According to Dr. Meryl Nass, the wildly divergent views on hydroxychloroquine appear to have little to do with its safety and effectiveness against COVID-19, and more to do with a concerted and coordinated effort to prevent its use. In the video11 above, Chris Martensen Ph.D., also reviews the “profound lack of integrity” we’re currently seeing when it comes to hydroxychloroquine.

Indeed, there are several reasons for why certain individuals and companies might not want an inexpensive generic drug to work against this pandemic illness. (A 14-day supply costs just $2 to manufacture12 and can retail for as little as $20.13)

One of the most obvious reasons is because it might eliminate the need for a vaccine or other antiviral medication currently under development.14 Hundreds of millions of dollars have already been invested, and vaccine makers are hoping for a payday in the billions if not trillions of dollars. In a June 27, 2020, blog post, Nass points out:15

“It is remarkable that a series of events taking place over the past three months produced a unified message about hydroxychloroquine, and produced similar policies about the drug in the U.S., Canada, Australia, NZ and western Europe.16

The message is that generic, inexpensive hydroxychloroquine is dangerous and should not be used to treat a potentially fatal disease, COVID-19, for which there are no (other) reliable treatments.

Hydroxychloroquine has been used safely for 65 years in many millions of patients. And so the message was crafted that the drug is safe for its other uses, but dangerous when used for COVID-19. It doesn’t make sense, but it seems to have worked. Were these acts carefully orchestrated? You decide.

Might these events have been planned to keep the pandemic going? To sell expensive drugs and vaccines to a captive population? Could these acts result in prolonged economic and social hardship, eventually transferring wealth from the middle class to the very rich?”

The fight over hydroxychloroquine may also have political underpinnings. As noted by investigative reporter Sharyl Attkisson in a May 18, 2020, Full Measure report, “never before has a discussion about choices of medicine been so laced with political overtones.”

Trials Undermine Safety and Efficacy by Using Toxic Doses

Nass’ article17 lists what has occurred with regard to hydroxychloroquine so far, the intention being to keep it as a living document that will be added to as time goes on.

Nass says she wrote it in such a way that it might be read as a “to do list … to be carried out by those who pull the strings,” with the intention of suppressing use of the drug. At the time of this writing, Nass’ list18 contains 27 bullet point entries. I highly recommend reading through it, as I will only highlight a select few here.

Several items on Nass’ list detail the various ways in which safe and effective use of the drug were undermined, which allowed for a false narrative of danger to be crafted.

For example, Nass points out that three large, randomized multicenter clinical trials all used excessive dosages known to be toxic.19 These include the following. She also discusses these trials in other in-depth articles:20,21,22

The U.K. Recovery Trial23,24,25  — Funded in part by the Bill & Melinda Gates Foundation, Wellcome Trust and the U.K. government through Oxford University,26 this study randomly assigned patients to usual care or to one of five primary drug treatments: lopinavir-ritonavir; a corticosteroid (low-dose dexamethasone); hydroxychloroquine; tociizumab; or azithromycin. They also used convalescent plasma.

Patients received 2,400 mg of hydroxychloroquine during the first 24 hours — three to six times higher than the daily dosage recommended27 followed by 400 mg every 12 hours for nine more day for a cumulative dose of 9,200 mg over 10 days. The trial ended its hydroxychloroquine arm on June 4, reporting “no benefit.”

The Solidarity Trial28 — Launched by the World Health Organization and funded by 43 countries and 203,000 individuals and organizations,29 this trial also compares standard of care against four drug options, including hydroxychloroquine, among patients in 35 countries.

Strangely, the WHO does not specify the daily dosage used in the trial. However, the registration of the Canadian30 and Norwegian31 portions of the trial lists a dosage of 2,000 mg on the first day, and a cumulative dose of 8,800 mg over 10 days. This is only 400 mg less than the U.K.32 Recovery Trial’s toxic dose.

The hydroxychloroquine arm was halted May 25,33 following the publication of the Surgisphere study34 in The Lancet. June 3, after tremendous controversy had been raised over the veracity of the study, and a day before the study was retracted for using fabricated data,35,36 (and this despite having undergone peer-review), the hydroxychloroquine arm was restarted.37

June 17, 2020, the hydroxychloroquine arm was stopped again, this time “based on evidence from the Solidarity trial, U.K.'s Recovery trial and a Cochrane review of other evidence on hydroxychloroquine.”38

The REMAP-CAP Trial (Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia)39 —  Here, patients either received nothing, a combination of lopinavir and ritonavir, or hydroxychloroquine alone or in combination with lopinavir and ritonavir.

REMAP used the same toxic dose as the Recovery Trial but for six days instead of 10. What’s more, only critically ill hospitalized patients were included in this trial. Nass addresses other concerns as well in her June 19 blog40 about this study.

Is Lifesaving Medicine Withheld to Ensure Profits?  

What possessed the study designers and investigators of these three huge clinical trials to use such exaggerated dosages? Hydroxychloroquine has been on the market for 65 years and both toxic and the effective dosages for a variety of ailments are well documented. Doctors who have reported excellent treatment results in the field stayed within the recommended hydroxychloroquine dosages.

Were they trying to purposely sabotage these trials using dosages known to be toxic? Doctors have also reported that best results are observed when the drug is administered early, while symptoms are still mild or moderate, yet in these trials the drug was not given until it was too late.

A July 1, 2020, retrospective analysis41,42,43 of 2,541 patients in the Henry Ford Hospital System in Detroit, Michigan, found use of hydroxychloroquine alone cut mortality by more than half, from 26.4% to 13.5%. (Hydroxychloroquine in combination with azithromycin had a mortality rate of 20.1%, and azithromycin alone had a mortality rate of 22.4%.)

More than 90% of the patients had received the drug or drugs within 48 hours of admission into the hospital. No adverse heart-related events were observed among those given hydroxychloroquine.

All three trials above that used toxic hydroxychloroquine doses — Recovery, Solidarity and REMAP —  also failed to include zinc, which appears to be a key factor. As noted by Zelenko above, the hydroxychloroquine is really only used to drive the zinc in to the cells. Nass observes:44

“The conclusions to be drawn are frightening:

  1. WHO and other national health agencies, universities and charities have conducted large clinical trials that were designed so hydroxychloroquine would fail to show benefit in the treatment of Covid-19, perhaps to advantage much more expensive competitors and vaccines in development.
  2. In so doing, these agencies and charities have de facto conspired to increase the number of deaths in these trials.
  3. In so doing, they have conspired to deprive billions of people from potentially benefiting from a safe and inexpensive drug, when used properly, during a major pandemic. This might contribute to prolongation of the pandemic, massive economic losses and many increased cases and deaths.”

Facets That Need To Be Discussed

Aside from that, there are two additional facets of what’s going on that are not yet being discussed:

1. What we’re seeing happen right now is that patients are being turned into guinea pigs en masse. As of June 16, 2020, the U.S. Food and Drug Administration stated the only way a patient should receive hydroxychloroquine is by enlisting in a clinical trial.45

Similarly, in the U.K., treating physicians have been asked to enroll all hospitalized COVID-19 patients into the Recovery and REMAP trials. As of July 9, 2020, Recovery had enrolled more than 12,000 subjects.46

What this means is that thousands of patients are having their treatment selected via randomization by computer rather than by their own doctors' choice of treatment. The U.K., by the way, has one of the highest COVID-19 death rates in Europe already.47 By removing physician and patient choice of treatment, the death toll might end up being far worse than it needs to be.

Importantly, will this trend continue post-COVID? Now that doctors are being groomed to accept having their patients treated by randomization rather than with the treatment any given doctor believes to be best, will they sign up their future non-COVID patients as subjects just as easily?

2. Secondly, three recent papers48,49,50 argue that the excessive doses of hydroxychloroquine used in the Recovery Trial were not actually toxic. This creates a serious contradiction that has yet to be addressed. As noted by Nass in an email to me:

“For argument's sake, say they are right, and even high doses are safe. Well then, why are the FDA, European Medicines Agency, pharmacy boards, governors, etc. restricting this drug that is so safe you can even overdose it and be fine?

Either the drug is so toxic at normal doses that it can’t be used for a life-threatening illness, or it is perfectly safe at extremely high doses. You can’t have it both ways.

Zinc Is a Crucial Key

In conclusion, let us circle back to where we started — with the reports of treatment success. A study51 posted on the prepublication server medRxiv, May 8, 2020, compared outcomes in hospitalized COVID-19 patients treated with either hydroxychloroquine and azithromycin alone, or Zelenko’s triplet regimen of hydroxychloroquine, azithromycin and zinc.

While the addition of zinc sulfate had no impact on the length of hospitalization, ICU duration or duration of ventilation, univariate analysis showed it was associated with other positive effects:

  • Increased hospital discharge frequency
  • Decreased the need for ventilation
  • Decreased ICU admission rates
  • Decreased the rate of transfer to hospice for non-ICU patients
  • Decreased mortality

As noted by the authors:52

“After adjusting for the time at which zinc sulfate was added to our protocol, an increased frequency of being discharged home (OR 1.53 …) reduction in mortality or transfer to hospice remained significant (OR 0.449 …). This study provides the first in vivo evidence that zinc sulfate in combination with hydroxychloroquine may play a role in therapeutic management for COVID-19.”

In short, to maximize effectiveness, you need zinc. As explained in “Is Quercetin a Safer Alternative to Hydroxychloroquine?” hydroxychloroquine acts as a zinc ionophore,53,54 meaning it shuttles zinc into your cells, and zinc appears to be a “magic ingredient” required to prevent viral replication.55

If given early, zinc along with a zinc ionophore should, at least theoretically, help lower the viral load and prevent the immune system from becoming overloaded. As noted in the preprint paper, “Does Zinc Supplementation Enhance the Clinical Efficacy of Chloroquine / Hydroxychloroquine to Win Todays Battle Against COVID-19?” published April 8, 2020:56

“Besides direct antiviral effects, CQ/HCQ [chloroquine and hydroxychloroquine] specifically target extracellular zinc to intracellular lysosomes where it interferes with RNA-dependent RNA polymerase activity and coronavirus replication.

As zinc deficiency frequently occurs in elderly patients and in those with cardiovascular disease, chronic pulmonary disease, or diabetes, we hypothesize that CQ/HCQ plus zinc supplementation may be more effective in reducing COVID-19 morbidity and mortality than CQ or HCQ in monotherapy. Therefore, CQ/HCQ in combination with zinc should be considered as additional study arm for COVID-19 clinical trials.”

So far, no major clinical trial has bothered to follow this rather commonsense advice. Unfortunately, due to the corruption and politicization of science on this matter, it’s hard to offer any clear recommendations. In the end, it probably comes down to who you trust.

Quercetin — An All-Natural Safe Home Alternative

That said, if you suspect you’ve contracted COVID-19, it probably wouldn’t hurt to give a version of Zelenko’s regimen a try, at the first sign of symptoms. As explained in “Is Quercetin a Safer Alternative to Hydroxychloroquine?” quercetin is also an ionophore and has the same mechanism of action as hydroxychloroquine — it improves zinc uptake by your cells.

So, you might not need the drug. You could also swap out the antibiotic for a natural antibacterial such as olive leaf or oregano oil. You can find more information about this in “How to Improve Zinc Uptake with Quercetin to Boost Immune Health.”

Personally, I’m taking quercetin and zinc at bedtime as a prophylactic each day. The reason it’s best to take them in the evening, several hours after your last meal, and before the long fast of sleeping, is because quercetin is also a senolytic (i.e., it selectively kills senescent or old, damaged cells) that is activated by fasting. So, why not maximize the timing and use of quercetin?



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The COVID-19 pandemic has raised questions about the efficacy of wearing face masks to reduce the transmission of infectious disease. Health agencies are not always in agreement as to who should or should not be wearing masks. The World Health Organization currently states:1

“Medical masks should be worn by health workers and those caring for someone with COVID-19 symptoms, persons aged 60 and over and anyone with preexisting medical conditions as they are at greater risk of developing serious illness, and people who have symptoms suggestive of COVID-19.”

The Centers for Disease Control and Prevention clearly states that medical masks should be reserved for health care professionals and cloth masks should be worn by the public in areas where people congregate:2

“Cover your mouth and nose with a cloth face cover when around others. Do NOT use a facemask meant for a healthcare worker. Currently, surgical masks and N95 respirators are critical supplies that should be reserved for healthcare workers and other first responders.”

The CDC also states a cloth face mask will not prevent the wearer from getting sick but may keep the virus from spreading.3 Many medical and political leaders also support wearing masks in public, such as Dr. Anthony Fauci from the National Institute of Allergy and Infectious Diseases and past acting CDC director Dr. Richard Besser.4

Across the world, countries that have routinely embraced the use of face masks have posted lower numbers of COVID-19 transmissions.5 Whether this means the mask is reducing transmission or encouraging people to maintain social distancing are questions that still need to be answered.

What’s the Research Evidence for Wearing Masks?

Experts were debating the effectiveness of wearing masks to reduce the risk of infection long before COVID-19 came into the picture. Surgical masks were introduced nearly a century ago for the purpose of protecting patients during surgery. Yet, researchers continue to question whether this established routine is necessary.6

In one study published in 2016, scientists found no difference in the infection rates of patients undergoing “clean” surgery, whether the surgical team was masked or unmasked.7 A clean surgery was defined as one in which the lungs, gut, genitals and bladder were not involved.

Researchers have also questioned whether wearing masks during the cold season may cut down on the number of health care professionals who get sick.8 The researchers collected data for 77 consecutive days during cold season and determined whether a cold was present and if participants experienced symptoms based on their reports.

The intervention group wore masks at work and the control group did not. During the study period, one individual in the intervention and one in the control group got a cold. Although the study was small, the researchers felt there was not enough evidence to demonstrate benefits to health care workers in terms of preventing cold symptoms.

Investigations into the effectiveness of masks continued with a study published in BMJ.9 Since the results were released in 2015, the researchers have responded to their data in light of the COVID-19 pandemic. The study was aimed at comparing the effectiveness of cloth masks to that of medical masks in health care workers.

They evaluated 14 secondary and tertiary level hospitals in Hanoi, Vietnam, using 1,607 participants who worked full-time in high-risk units. Their measurement outcome was clinical demonstration of respiratory illness, flu-like illness or laboratory-confirmed respiratory infection.

The researchers found that those who wore cloth masks had a significantly higher rate of flu-like illness and all measured infections as compared to participants using medical masks. They cited moisture retention, reuse and poor filtration as potential reasons for the increased rates of infection.

They wrote, “… cloth masks should not be recommended for HCWs [health care workers], particularly in high-risk situations, and guidelines need to be updated.”10

How Do Cloth Masks Stack Up?

In follow-up comments published in March 2020, the researchers pointed to critical shortages of personal protective equipment and stated that while those wearing cloth masks have a higher rate of infection, they may be better for health care workers than wearing no mask at all.11 They went on to say their research does not excuse health care workers from working unprotected.

Just prior to the pandemic reaching the U.S., a team evaluated the effectiveness of low-cost cloth face masks. The study was published in 2019 and was undertaken since these materials are commonly used in developing countries.12 The team evaluated 20 types of cloth masks and found pore size could range from 80 to 500 nanometers.

This is significantly larger than particulate matter with a diameter of 10 nanometers or less (PM10). They also found that the effectiveness was reduced by 20% after the mask had gone through the fourth cycle of washing and drying. Stretching of the surface altered pore size and washing reduced the number of microfibers within the pores, also altering the effectiveness of the mask.

Finally, the authors of a recently-released preprint study evaluated the effectiveness of reducing airflow in face covers with and without an outlet valve.13 The researchers measured airflow from a person during quiet and heavy breathing and coughing while using different types of face covers.

They found that face covers without an outlet valve reduced the flow of air forward by more than 90%. Individuals using surgical, cloth masks and face shields had intense back and downward flow, which may present a hazard.

What Risks Do Masks Carry for the Wearer?

In the study from Asia in which the symptoms of health care workers who wore face masks were compared to those who did not, researchers asked about headaches, among other things. Participants who wore masks were much more likely to complain of headaches than those who did not wear masks.14

In a more recent study published in the journal Headache, researchers sought to evaluate the factors associated with headaches resulting from the use of personal protection equipment.15

They also wanted to look into workers’ thoughts on how headaches affected their health and performance. The study team surveyed clinicians at a tertiary care hospital where they worked in areas taking care of COVID-19 patients.

Data were gathered from 158 health care workers including nurses, doctors and paramedical staff. During the study, 128 developed headaches associated with their personal protection equipment and 91.3%:16

“… of respondents with pre‐existing headache diagnosis either ‘agreed’ or ‘strongly agreed’ that the increased PPE usage had affected the control of their background headaches, which affected their level of work performance.”

The researchers did not question the origin of the headaches in the participants, but others have asked whether wearing a mask could reduce levels of oxygen or raise CO2 levels, which in turn could produce a headache.

Surgeons Experience Lower Oxygen Saturation

This question was asked in 2008 by a team of researchers from Turkey who evaluated the oxygen saturation of 53 surgeons during surgical procedures.17 The team used a pulse oximeter before the procedure and immediately postoperatively. The results showed the surgeons experienced a decrease in oxygen saturation and a slight increase in pulse rate.

The decrease in oxygen saturation was more significant in surgeons over the age of 35. Due to the design of the study, the researchers were unable to determine whether the changes in oxygen saturation were from the face mask or stress during the surgery. Concerned about the consistent use of face masks, retired neurosurgeon Dr. Russell Blaylock warned that face masks:18

“… fail to protect the healthy from getting sick, but they also create serious health risks to the wearer. The bottom line is that if you are not sick, you should not wear a face mask.”

He expressed some frustration at the wholesale use of face masks for the vulnerable and healthy individuals, pointing out, “When a person has TB we have them wear a mask, not the entire community of noninfected.”

He referenced a study in 2006 in which researchers evaluated the development of headaches in health care workers who were using an N95 face mask.19 Using a survey, they found that 37.3% reported mask-associated headaches and 32.9% said that this happened more than six times per month.

During the study, 59.5% used analgesics for headache pain and 2.1% took preventive medications. The researchers concluded that the N95 face mask could increase the risk of headaches in health care providers and that using them for shorter periods of time could reduce the frequency and severity of their headaches.

Wearing an N95 mask for up to three hours could have also changed nasal function, making it more difficult to breathe after the mask was removed.20 Before Blaylock went on to discuss the new evidence suggesting coronaviruses may enter the brain, he pointed out:21

“There is another danger to wearing these masks on a daily basis, especially if worn for several hours. When a person is infected with a respiratory virus, they will expel some of the virus with each breath.

If they are wearing a mask, especially an N95 mask or other tightly fitting mask, they will be constantly rebreathing the viruses, raising the concentration of the virus in the lungs and the nasal passages. We know that people who have the worst reactions to the coronavirus have the highest concentrations of the virus early on.”

Neurological Infections May Enter Through the Nose

Based on past evidence,22 Blaylock questions whether wearing a mask could also reintroduce exhaled viruses deep into the nasal cavity, driving up the amount of virus in the upper respiratory tract and increasing the potential to enter the olfactory nerves and travel into the brain.23

Blaylock is not the only expert to react to the widespread use of masks. One group of experts writing in the New England Journal of Medicine said:24

“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.”

They go on to describe why masks may be critical to protect health care workers in close proximity to patients with active and symptomatic COVID-19. For those working in close quarters with health care workers who may be asymptomatic or who have a mild disease, a mask may at least lessen the risk for patients and other employees to get sick.

The authors of a paper published in the Journal of the American Medical Association agree that face masks should only be used by “individuals who have symptoms of respiratory infection such as coughing, sneezing, or, in some cases, fever.”25 The authors go on to say there's no evidence masks used by healthy people can prevent others from becoming sick.

If You Wear a Mask Use These Guidelines

Ultimately, the goal is to reduce transmission of infectious disease, including COVID-19. It’s apparent scientific evidence supporting or debunking face masks is far from conclusive. If you do choose to wear a face mask, here are strategies from the WHO for reducing the potential of infecting yourself:26

  • Before putting on a mask, clean your hands with soap and water.
  • Cover your mouth and nose with the mask and make sure there are no gaps between your face and the mask.
  • Avoid touching the mask while using it; if you have to, try to clean your hands with alcohol-based hand rub or soap and water before doing so.
  • Replace the mask with a new one as soon as it is damp. Do not reuse single-use masks.
  • To take off the mask: Remove it from behind (do not touch the front of the mask); discard it immediately in a closed bin; and clean your hands with alcohol-based hand rub or soap and water.


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Propagate light through any kind of medium -- be it free space or biological tissue -- and light will scatter. Robustness to scattering is a common requirement for communications and for imaging systems. Structured light, with its use of projected patterns, is resistant to scattering, and has therefore emerged as a versatile tool. In particular, modes of structured light carrying orbital angular momentum (OAM) have attracted significant attention for applications in biomedical imaging.

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People wrongfully accused of a crime often wait years -- if ever -- to be exonerated. Many of these wrongfully accused cases stem from unreliable eyewitness testimony. Now, scientists have identified a new way of presenting a lineup to an eyewitness that could improve the likelihood that the correct suspect is identified and reduce the number of innocent people sentenced to jail.

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A new study finds that the technical interviews currently used in hiring for many software engineering positions test whether a job candidate has performance anxiety rather than whether the candidate is competent at coding. The interviews may also be used to exclude groups or favor specific job candidates.

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Medicated chewing gum has been recognized as a new advanced drug delivery method but currently there is no gold standard for testing drug release from chewing gum in vitro. New research has shown a chewing robot with built-in humanoid jaws could provide opportunities for pharmaceutical companies to develop medicated chewing gum.

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Researchers argue that cognitive studies in comparative psychology often wrongly take an anthropocentric approach, resulting in an over-valuation of human-like abilities and the assumption that cognitive skills cluster in animals as they do in humans. The authors advocate for philosophical and procedural changes to the discipline that would lead to a better understanding of animal minds and the evolution of multiple forms of cognition.

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Given the choice between using a public bathroom and doing anything else, some people will always choose the latter. Regardless of the urgency or however pristine it’s reported to be, the space comes with an ick factor, says Dr. John Ross, who practices hospital medicine at Brigham and Women’s Hospital in Boston and is board-certified in infectious diseases.

That image is hard to shake even in normal times, but COVID-19 has done nothing to make public bathrooms more appealing, as they come with high-touch surfaces and often lidless toilets. Ross says that it’s easy to see them as hotbeds of infection and avoid them in the name of safety. But not using them has caused people to reorganize their days, figuring out how many errands can be done in one trip, when to stop drinking water, and preventing the possibility of socially-distant visits with friends and relatives.

Weighing the risks compared to other indoor activities

There’s no clear-cut answer. The coronavirus requires each person to asses each situation, says Dr. Todd Ellerin, director of infectious diseases and vice chairman of the department of medicine at South Shore Hospital in Weymouth, Massachusetts, and an instructor in medicine at Harvard Medical School.

Ross says that as an indoor space, a public bathroom is not necessarily a safe environment, but it’s also on par with other indoor spaces. In some ways, it’s a lower-level risk in comparison, but it comes down to the components. One area of concern is the air. A flush creates an aerosol spray (the toilet plume), and the virus exists in feces. Taken together, and since the virus enters the body through mucus membranes, that would seem worrisome, but Ross and Ellerin say the research suggests otherwise.

A recent study of two hospitals in Wuhan, China, found that the highest aerosol concentration was in a bathroom, although it noted that it was a temporary, single-toilet room with no ventilation. The study also found that sanitization and ventilation effectively limited the virus’s concentration in aerosols. Another recent study that analyzed samples from patients hospitalized with COVID-19 found that attempts to isolate the virus from stool samples were never successful, and that existing fragments were not infectious.

Ross adds that the flush is a one-time event, and any direct plume is from a person’s own feces; if the virus was present, that person would already be infected. “Our own fecal plume poses no risk to us,” he says. If someone else in the bathroom happens to flush, there are barriers blocking direct contact. “The risk of bathroom exposure is largely theoretical — possible, but not proven,” he says.

There are other elements in play that make the bathroom less risky than it might seem. Your exposure time is a factor with transmission. Ellerin says that if an unmasked interaction within six feet lasts under 15 minutes and doesn’t include coughing or sneezing, the transmission risk is still low. Since most bathroom visits will probably be shorter, “time is on your side,” he says. “Save the long visits for your home.”

The number of people you’ll be around is another factor. Ross says that more than the plume, being coughed on is a bigger concern. Wearing a mask provides a needed layer to anything in the air. The barriers in the bathroom also keep people separate, making less chance for face-to-face contact. “That’s also in your favor,” Ellerin says.

Ross says that other indoor activities, which are more socially acceptable, can offer a greater risk, such going to bars, weddings, religious services, and indoor parties. They all can be tightly packed. Music might be playing, causing people to lean in and speak to each other. Alcohol can make people relax and forget about distancing, and when there’s singing, breaths are forcibly ejected into the air. In many of these settings, masks might not be required and might not be worn, further encouraging the spread.

So what’s the best way use a public bathroom?

The fundamental steps are: Put a mask on before you enter. Wash your hands immediately after. You can also wear glasses to protect your eyes. There are a number of high-touch surfaces, and the virus, along with bacteria, can exist on them. It’s good to minimize contact by using your foot or toilet paper when lifting, turning, or pulling anything, Ross says.

Contact before going to the bathroom isn’t as important, since you’ll be washing your hands, but even if you touch a surface, Ross says that the virus won’t go through your skin. The main thing is to not touch your face, specifically your mouth, nose, or eyes, before washing. And before you leave, use your foot, elbow (if possible), or a paper towel to open the door, and once outside, spray your hands with a sanitizer.

Ellerin says don’t overlook cleaning your glasses and cell phone. “Is your iPhone a major risk? Probably not, but it could be a potential source for some individuals,” he says. “That’s the thing with COVID-19. We don’t know, so it’s good to disinfect high-touch areas. Some people will take their own extra steps with cleaning, because it provides a greater sense of psychological confidence, since there’s still much uncertainty.”

But doing what’s known, such as washing hands, wearing a mask, and minimizing close contact, while it doesn’t guarantee safety, can help people consider options and re-engage with lost activities. “When it comes to the bathroom,” Ellerin says, “follow the basic hygiene, get in and out, and you’re probably in a low-risk group.”

For more information about the coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center.

The post How risky is using a public bathroom during the pandemic? appeared first on Harvard Health Blog.



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