There's evidence that masks don't work, overview on the disease

There is increasing evidence that the SARS-2 coronavirus is transmitted, at least in indoor settings, not only by droplets but also by smaller aerosols. However, due to their large pore size and poor fit, cloth masks cannot filter out aerosols (see video analysis below): over 90% of aerosols penetrate or bypass the mask and fill a medium-sized room within minutes.

After mandatory mask orders, the cases go up. Are Face Masks Effective? The Evidence. – Swiss Policy Research (swprs.org)

Overview

Lethality: According to the latest immunological studies, the overall infection fatality rate (IFR) of covid-19 in the general population is about 0.1% to 0.5% in most countries, which is comparable to the medium influenza pandemics of 1957 and 1968.

Treatment: For people at high risk or high exposure, early or prophylactic treatment is essential to prevent progression of the disease and avoid hospitalization.

Age profile: The median age of covid deaths is over 80 years in most countries and only about 5% of the deceased had no serious preconditions. In contrast to pandemic influenza, the age and risk profile of covid mortality is thus comparable to normal mortality and increases it proportionally.

Nursing homes: In many Western countries, up to two thirds of all covid deaths have occurred in nursing homes, which require targeted and humane protection. In some cases it is not clear whether the residents really died of covid or of weeks of stress and isolation.

Excess mortality: Up to 30% of all additional deaths may have been caused not by covid, but by the effects of lockdowns, panic and fear. For example, the treatment of heart attacks and strokes decreased by up to 40% because many patients no longer dared to go to hospital.

Antibodies: By summer 2020, global hotspots such as New York City and Bergamo had reached antibody levels of approximately 25%. Capital cities such as Madrid, London and Stockholm were around 15%. Large parts of Europe and the US, however, were still below 5%.

Symptoms: Up to 40% of all infected persons show no symptoms, about 80% show at most mild symptoms, and about 95% show at most moderate symptoms and do not require hospitalization. Mild cases may be due to protective T-cells from earlier common cold coronavirus infections.

Long covid: About 10% of symptomatic people report post-acute or long covid, i.e. symptoms that last for several weeks or months. This also affects younger and previously healthy people with a strong immune response. The post-viral syndrome is known from severe influenza, too.

Transmission: According to current knowledge, the main routes of transmission of the virus are indoor aerosols and droplets produced when speaking or coughing, while outdoor aerosols as well as most object surfaces appear to play a minor role.

Masks: There is still little to no scientific evidence for the effectiveness of cloth face masks in the general population, and the introduction of mandatory masks couldn’t contain or slow the epidemic in most countries. If used improperly, masks may increase the risk of infection.

Children and schools: In contrast to influenza, the risk of disease and transmission in children is very low in the case of covid. There was and is therefore no medical reason for the closure of elementary schools or other measures specifically aimed at children.

Contact tracing: A WHO study of 2019 on measures against influenza pandemics concluded that from a medical perspective, contact tracing is “not recommended in any circumstances”. Contact tracing apps on cell phones have also failed in most countries.

PCR tests: The virus test kits used internationally may in some cases produce false positive and false negative results or react to non-infectious virus fragments from a previous infection. In this regard, the so-called cycle threshold or ct value is an important parameter.

Medical mismanagement: In the US and some other countries, fatal medical mismanagement of some covid patients occurred due to questionable financial incentives and inappropriate protocols. In most countries, covid in-hospital mortality has since decreased significantly.

Lockdowns: The WHO warned that lockdowns have caused a “terrible global catastrophe”. According to the UN, lockdowns may put the livelihood of 1.6 billion people at acute risk and may push an additional 150 million children into poverty. Unemployment, bankruptcies and psychological problems have reached record levels worldwide.

Sweden: In Sweden, total mortality without lockdown has so far been in the range of a strong influenza season. 70% of Swedish deaths occurred in nursing homes that were not protected quickly enough. The median age of the Swedish covid deaths is 84 years.

Media: The reporting of many media has been unprofessional, has maximized fear and panic in the population and has led to a massive overestimation of the lethality and mortality of covid. Some media even used manipulative pictures and videos to dramatize the situation.

Vaccines: Several medical experts warned that express coronavirus vaccines may be risky. Indeed, the vaccine against the so-called swine flu of 2009, for example, led to cases of severe neurological damage and lawsuits in the millions. In the testing of new coronavirus vaccines, too, serious complications and failures have already been reported.

Virus origin: The origin of the new corona virus remains unclear, but the best evidence currently points to a covid-like pneumonia incident in a Chinese mine in 2012, whose virus samples were collected, stored and researched by the Virology Institute in Wuhan (WIV).

Surveillance: NSA whistleblower Edward Snowden warned that the covid pandemic may be used to permanently expand global surveillance. In several parts of the world, the population is being monitored by drones and facing serious police overreach during lockdowns.

Facts about Covid-19 – Swiss Policy Research (swprs.org)

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It takes a village to take care of mom

“If you have an aging loved one — grandparent, parent, aunt, uncle, or family friend – living in a senior nursing community or being cared for at home by a home health organization, the people performing the most menial-sounding jobs may be the most important people in their lives. They are the van driver who takes them for a day out to the mall or to the clinic for dialysis; the laundry worker who picks up their dirty clothes every morning and brings them back clean and carefully hung or folded; the activities director who brings music, art and crafts to engage their minds, bodies and hearts; the housekeeper who cleans the floor no matter what mess s/he encounters. They also are the groundskeeper who mows the lawn and manicures the flower beds; the custodian who hangs a new memento on the wall; the hairdresser who keeps them neatly groomed.

My mother spent the final eight years of her life in a nursing facility. That became her permanent home, and almost everyone treated her as if she owned the place. She knew most of the staff by name and would share with me her interactions with them. It became clear after a few months that she only spoke in detail about the employees that I mentioned in the first paragraph. The nurses and aides, of course, were giving her the physical caring she needed to stay healthy, yet the non-clinical staff were the people she told me about. She knew about their marital status and family life, what they did on their non-working time, and their favorite hobbies. Mom didn’t get to know the clinical staff on the same personal level; they had many residents who demanded their expertise, and her interactions with clinical staff were focused on medical needs.

The next time you visit your aging loved one living in a senior community, pay attention to the staff:  not only those who are giving the meds or changing bedpans, but also those working behind the scenes to make life more comfortable for the residents.” by Myra Wilson, u.osu.edu/alber/2018/10/15/elder-care-it-takes-a-village/?

Family

I got the newsletter from Pinecrest Community yesterday--a Church of the Brethren facility that began in the 19th c. as a home for the destitute aged and orphans. There are independent apartments and small houses; assisted care, nursing care, and memory care. When I was a little girl, I'd go with other children to sing for them, or take presents we had made. Now I can visit some of my classmates there! Over the years, I've visited parents of my friends, my aunts and uncles, eventually my parents, and now a sibling. At one time both my father and his uncle Orville were living there, and I thought that was rare, however, there was only about 2-3 years difference in their ages. But I saw a story I'd never seen: Wally Brooks and his mother Ruth Linger both live there! He is 85 and she's 107!! In the photo, they look terrific.

Dementia is a leading cause of death in the U.S.

That sounds really scary unless you realize that our research and technology have extended the lives of people who would have died of different diseases, and safer roads and automobiles have prevented thousands of deaths. Dick Cheney and Bill Clinton for instance have both been saved several times of dying of a heart attack. All that means is you live long enough to die of something else. Deaths from heart disease, stroke, prostate and breast cancer all decreased between 2000 and 2006, but Alzheimer's (about 70% of dementia cases) was up 47% in the same time period. And I doubt that too many actually die from dementia, but from something related like pressure sores, kidney infections, or pneumonia from aspirating food.

The February 10 issue of JAMA has an article on using feeding tubes with nursing home residents with "advanced cognitive impairment" i.e., dementia [Hospital characteristics associated with feeding tube placement in nursing home residents with advanced cognitive impairment," vol 303, no.6, p.544-550]. Using feeding tubes in patients with advanced dementia does not improve survival. So why is it done and why do the rates vary from hospital to hospital? That's what this study was supposed to explain. I'm not sure I understood all the details, but I did see that only 5.8% of hospitalized nursing home residents had an order to forego artificial hydration and nutrition despite the fact most nursing home residents say they would rather die than live in dementia with a feeding tube. (I'm not referring to people like Terri Schiavo who didn't actually need a feeding tube and wasn't dying--she was inconvenient for a husband who had received a very large monetary settlement and had started another family.) Also, I didn't see a distinction between hydration and feeding in this article. (Dehydration is an extremely painful death.) Also, it appears that feeding tubes don't solve any of the problems like pneumonia or pressure sores, which actually are the cause of death. The research also demonstrated that practices vary widely among hospitals and that black and Hispanic nursing home residents were more likely to undergo a feeding tube insertion. So is that more aggressive care or a reflection of how indigent people are treated?

As the authors of this study comment, the results raise more questions than they answered. For instance, the rates decreased during the 8 year study. But one thing I know, conservatives unhappy with Obamacare shouldn't use reluctance to use feeding tubes or counseling about preferences as a sign of an attempt to dispatch the elderly. There doesn't seem to be any evidence that feeding tubes help those suffering the end stages of dementia.

Are you looking at retirement homes?

We're not, but we thoroughly enjoyed visiting the new Willow Brook at Delaware Run in Delaware, Ohio yesterday. If you or your parents are at a stage where you're starting to think about this, I'd certainly schedule a visit. We visited our former neighbors, had a personal tour with them, and ate in the lovely dining room, The Water's Edge Restaurant, which incidentally has a French chef and is open to the public. The food was as good or better than any restaurant I've enjoyed recently.

Although this is not my favorite architectural style, nothing has been overlooked on the inside for tasteful decor and comfort of the residents. This facility just opened, so these owners/residents got to pick cabinet finishes, and extra features. A number of residents already had plans for the Erickson facility in Hilliard that went into bankruptcy, so there were some last minutes changes, and fortunately they got their money back. As I understand the plans, the area you see in this photo will eventually have buildings all around the little lake. Our friends' apartment faces the highway and a residential neighborhood (not all that close), which they just love because there is so much to look at from their large windows or balcony. They have an alcove in the living room which accomodates their grand piano--so you can see these are not small units.

At this time Willow Brook has 1 and 2 bedroom apartments and twin singles, and our friends also had a study so they were using the 2nd bedroom as a TV room. On the 3rd floor they have vaulted ceilings with gives a nice feeling of openess. There is an assisted care wing and a "memory care" wing on the first floor. There's a lovely library in the balcony area over the lobby, and we stopped by and chatted with the volunteers who were working to get the shelves stocked under the supervision of a retired librarian. There's an artists' workshop, an underground garage, exercise facilities with the latest in equipment, a chapel (not much there yet except chairs despite all the retired preachers), and a very large activity/banquet room.

We met a number of the pleasant staff including Larry Harris, CEO, and the chef, and some of the residents, many retired pastors and professors and business people. Willow Brook is part of Christian Communities (Church of Christ). There is also a Willow Brook Christian Village (about 20 years old) and Willow Brook Christian Home (skilled nursing and rehab).

So if you're starting to look, or you have a parent thinking of moving closer to the children, this facility is about a 45 minute drive from Arlington if you use Rt 33 and about 35 using Rt 315 (we tried both). Delaware is a college town with a nice business district--however, I'm sure there are so many activities planned for the residents they don't have much time to take in the local sights. We heard only two very mild complaints from two couples we know there--they haven't found a local church and haven't changed doctors, dentists, hair dressers, etc., and are still driving back to Columbus.

Visit a Nursing Home Week in Ohio

It's official. Our governor wants us to visit a nursing home this week.

"The department [of aging] created "Visit a Nursing Home Week" to encourage people to look at nursing home residents not as patients with conditions that need care, but as individuals with thoughts and feelings, some of them isolated from the ones they love, who might appreciate some fellowship, particularly during the holidays. With the help of the Office of the State Long-term Care Ombudsman, the department also encourages facilities to design special events during the week to welcome visitors.

"Many nursing home residents have family and friends who visit them regularly," said Strickland. "Others seldom have visitors and some have no one to visit them. Visitors help residents stay connected to the world around them and give them a sense of friendship and belonging. And that's why this week is so important.""

In the 80s when I returned to Illinois to visit my parents, I'd usually drive to Oregon and visit my grandparents at the nursing home. Anyone would have taken in grandma (despite what you read, most frail elderly are cared for by relatives), but grandpa had dementia, and after 70 years of marriage, she thought it best to go with him.

I don't know any churches who don't have volunteers who regularly visit nursing home residents. All levels of government in developing their social programs take their ideas from the churches, whether it's the penitentiaries or the Peace Corps or universities and colleges. In fact, the volunteers are essential for keeping staff and management on their toes because they might notice things (sores, urinary tract infections, missing glasses, wrong dentures, etc.) that staff miss, although it is usually a family member who spots this first. One time when I was volunteering with Kay, a member of our church who'd had an aneurysm at 18, I heard something that sounded like a bird chirping in the next room. Thinking there might be a trapped animal, I went to investigate. It was an elderly woman left alone strangling in the restraints of her wheelchair. I desperately tried to free her, but couldn't lift her, so I ran to get help. The staff didn't seem any too concerned and just ambled down the hall.

But if you do visit, you need a special heart. Ignore the odors; ignore their desire that you be someone else, perhaps long deceased; ignore your own frailties. Also ignore their forgetfulness that makes them believe and say, "no one comes to visit." You probably passed their daughter or spouse or niece in the hall, and they've already forgotten. Twenty-five years ago, I never heard anyone crying out for "daddy," it was always "mommy." Maybe that will be different 20-30 years from now.

When I was in elementary school, one big event of the season was walking over to "the Brethren old folks home" (now Pinecrest, with apartments, duplexes, nursing care and dementia care) to sing Christmas carols. My friend Lynne includes that in her Christmas story at the class reunion blog.

Let's ruin long term care

We've had a "long term care" policy for over 10 years. It isn't cheap, but even a month in a nursing home costs more than a year's cost for the policy. It's like any insurance--we've never gotten anything out of our auto insurance either--thank goodness--but have been buying it for almost 50 years. But Obama-Biden licking their chops over the money that's in it already? Oh no! Link.

Visit a Nursing Home Week

"Governor Ted Strickland, the Ohio Department of Aging and the Office of the State Long-term Care Ombudsman invite all Ohioans to share their holiday celebration, fellowship and compassion with nursing home residents during the state's third annual Visit a Nursing Home Week, December 24-31, 2008."

I'll observe Nursing Home Week by sending a contribution to the Good Samaritan Fund at Pinecrest Community in Mt. Morris, Illinois. According to the letter below, half of their 123 residents rely on state assistance, and although the letter doesn't say why the state of Illinois can't support them, the total payment Pinecrest receives from Medicaid and the cost to provide the care means Pinecrest loses $4200 per day.

Click to read
Pinecrest was established by the Church of the Brethren, the first building begun in 1891 and finished in 1893. It wasn't called that when I was growing up--we just called it "The Old Folks' Home." Long before anyone had heard of Medicaid or Social Security, the Brethren were concerned about the elderly and orphans who had no family to care for them and voted in 1890 to raise funds for a shelter to care for both. The first building I remember was a brick, 2 story--although it was old by the time we elementary school children would walk there to sing at Christmas, or for a special Sunday afternoon program performed the church junior choir. It's a mystery to me how they managed that with the infirm, sick and elderly--installing toilets in 1902! It had 21 residents in 1905 ranging in age from 51 to 86, only 7 men, and all were Brethren. The residents helped grow their food with a rather large garden on site. Children, infants to teens, were cared for in a separate building across from the current building on Brayton Rd. from 1912 through 1923. A new facility was built in 1963 with an FHA approved loan--the Rockford paper said it resembled an ultra-modern luxury motel! After the old brick building, I'm sure the new facility with room for 100 residents was quite a change. Then later independent living apartments were built in 1974 and 1988, Pinecrest Village, where my parents lived their last years. An Alzheimers unit was added in the 90s called Pinecrest Terrace. [Details from Pinecrest Community; our 100th year 1893-1993]

The first chaplain at Pinecrest Manor, as the nursing home was named, was Foster B. Statler, who baptized me when he was the pastor of the local Brethren Church. He was followed by John I Masterson, father of my childhood friend and college roommate, and former Superintendent of Forreston schools. I've had a lot of relatives at Pinecrest over the years, most recently my Aunt Betty and Aunt Ada, but also many now deceased like Uncle John, Uncle Orville, and my grandmother after a surgery, who got excellent care as their lives became more limited.

I think the key is the location--a small town--with excellent, caring staff. My mother was a volunteer at Pinecrest for 30 years--one of hundreds--beginning in 1963 when her mother died, and when you have townspeople so closely involved in the care, you know someone is keeping an eye on things. Although I haven't lived in Mt. Morris for over 50 years, I recognize the names of many people who participated as volunteers, auxiliary, staff or Board members--Edna Neher, Harold Hoff, Bill Powers, Marj Powers, Vernon Hohnadel, Alma Fridley, Kenny Zellers, Rev. Carl Myers (who married us), Stan James, Harold Ross, Ralph Zickuhr, Eldo Henricks, Bob Martin, LaVerne Edwards, Art Hunn, Richard Park, Dale Henricks, Arman Stover, Robert Urish, Bill Clark, J.R. Worley, Albert Avey, Warren Reckmeyer, Dick Noser, Donna Ritchey Martin, Mary Ann Watt, Gary Montel, and others (I'm using an old list). So its development over the years was really a community effort.

Nursing homes all over the country are probably in need of help this Christmas--charitable giving is down, and endowments are suffering losses and states are struggling to meet their Medicaid obligations. If you have one close to you emotionally or geographically, now might be the time to remember them, to become a Good Samaritan.

Caring for Aunt Ann

Michelle and I have known each other for several years, but during Advent we were both on the same communion team and chatted a bit while waiting for others to arrive. She told me about her aunt, and the frustration she was experiencing with nursing home staff. I asked her if she'd like to be my guest blogger, and she agreed. In the few months since we talked, her aunt died.

My aunt died January 4 after her last urinary tract infection led to the kidney failure, to hospital treatment, to hospice and three weeks waiting for her wish to be fulfilled - to join her family in heaven.

For the past five years, I had to be a strong advocate for her, fighting for what I consider good treatment. You need to understand, Ann was in a "good" nursing home. But she and many other patients who could not get about by themselves, were wheeled to their rooms and left there without an attempt to give them their push cords to call for assistance. Staff or volunteers would wheel a cart by and put ice and water in their pitchers. That was good, but many couldn't lift the pitcher after it was filled. I never saw anyone put any water in a cup that the resident could take by himself/herself. I asked several to do it and, while they didn't say, "That's not my job," I never saw them do it in other rooms where they were filling pitchers. Often the pitchers were on the tables and way out of reach of the residents. (Lack of water increases potential for urinary tract infections and kidney failure with change in mental status.)

When busy, staff would put Ann on the toilet where she could sit for more than a half hour at times. Ann would sit there scratching previously inaccessible areas but the staff would haul them off the toilet, wipe their bottoms, restore them to their wheelchairs and bring back out into the room. I would protest that Ann's hands needed washed, and they said "We wiped her." I explained about her scratching and showed them her fingernails and the dead skin, etc., under them. Staff would wheel her back in bathroom and help her wash. That gradually became wheeling her to the sink and leaving her there to care for someone else -- but Ann couldn't reach the faucet or handles from her wheelchair.

I discovered that oral care (tooth brushing) was asking "Do you want to brush your teeth?" (not asked nightly) at the end of the day. So longing for their beds, the elderly would say "no." Weeks would go by that no toothbrush would be used. I tested once by bringing in my own toothbrush to use on Ann and winding a couple of Ann's hairs in the tooth brush. After two weeks unchanged, I reported it to the director and head nurse.

I went on rampage after rampage in the winter when the heat was up and I would walk through the halls, stopping in various rooms where I had made friends and offering water. No one refused and no one drank less than 6 ounces of water. Most drank at least 12 ounces. When I told the facility I had offered to find a new place for Ann to live but she told me "No, I have friends here. And the other place will be the same or worse" - it got the director out of her office daily to walk the halls and survey who didn't have their call cords in their hands, offering water to patients, checking to see if water was available for those who couldn't pour. She did this for nearly two months during the heating season -- and guess what?? People were healthier when appropriately hydrated, were less listless and more interactive per my observations However, when the director stopped her daily walks, things went back to the way they were before.

Ann had numerous urinary tract infections (UTI) over the years, sometimes two or three in a row before they were conquered. She also contracted an MRSA (methacillin-resistant Staphylococcus aureus) infection and had to be moved from her nursing home to a sister facility to share a room with someone else with MRSA. This is highly contagious and challenging to treat. However, with any infection and the elderly, using a new, powerful antibiotic is very hard on their systems, often resulting in yeast infections, stomach irritation and other side effects.

Keep watch and an open ear to your loved one's condition -- seek to discover if they are feeling unwell while under antibiotic treatment. Good aides will notify the nurses. Good nurses will respond quickly to the aides comments about a change in condition (stomach upset, not wanting to eat, yeast discoloration, redness in genital area). Sorry to say, not all aides and nurses respond appropriately or quickly. If you are able and the resident is willing, ask to see the condition yourself.

During those years, as I struggled to get attention for many of the nursing home residents and did some of the things they needed done on my own. I had a phone conversation with a doctor who cared for Ann there. He told me that my expectations for what the aides could provide in care was "unrealistic." (i.e., forget keeping their teeth clean, forget them getting body lotion immediately after a shower, offering water when they entered her room to serve her). He explained that during an eight hour shift, with the number of patients an aide had, the charting, showering, serving food, assisting in needs, it was his thought that I could not expect any more than 30 minutes of care per shift by an aide for my loved one. If I were lucky, or her need was more severe than other patients, perhaps 45 minutes. I was stunned into silence with that. But I did tell him, I would not be able to accept that what he was proposing was an acceptable level of care for any of the patients. And, you can probably guess that cantankerous and challenging patients that don't offer warm fuzzies with staff have a slightly decreased opportunity for his/her "number of minutes."

Knowing the suffering that Ann had endured over 5-6 years (Ann still had her mental capacity to protect herself and demand certain care, but also hesitated to do too much in fear of making staff angry with her. Those with dementia may not always be able to seek appropriate care.

While Ann wanted to "go home to the Lord" for some 10 years before her death, Ann was so amazingly happy to "be back home" after a hospital stay, it shocked me. She rejoiced in our visits, but did acknowledge that the times in between weren't so great for her, but I would watch her interact with staff, and the staff and Ann would each tell me their versions of stories when they shared fun and happiness together. I saw that interaction as being moments of quality that she appreciated. I found this contrasting with the desire to be done with her life on earth and sometimes challenging to reconcile.

Hospice nurses have told me that pneumonia can be a gentle opportunity to escape from life. So, there is an option that can be written and added to health directives:
1) that a patient who is debilitated can ask not to be treated for pneumonia.
2) That should breathing difficulties and pneumonia symptoms appear, patient and family can request NO transfer to the hospital for treatment and implement hospice treatment (care centers or specialty hospice groups can provide that.)
3) It is my understanding that the pneumonia process gradually lessens the patient's responsiveness and she succumbs to death reasonably easily.
4) This peaceful death is with pain medication appropriate for condition.
5) Ann might have been granted release from nursing home a few years earlier had she and I implemented this plan together. It's not an easy choice, but one that deserves conversation.

Thank you, Michelle--this is better than I could have hoped for, and I'm so thankful that Ann had a loving, Christian niece to help her through difficult times. In part 2, Michelle will share her experience with a 90 year old neighbor who needed emergency care.