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      On reimagining our post-COVID world

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          Abstract

          “Only a life lived for others is a life worthwhile.” – Albert Einstein, Nobel Laureate in Physics, 1921, quoted in The New York Times, June 20, 1932. Einstein archives 29-041 Sureka et al.[1] modelled a suraksha chakra (safety circle) by designing a new scoring system to protect healthcare workers from COVID. They published the scoring system in the April 2021 issue of the Journal and assessed implementation of the protocol in regular and surprise rounds. What its approach is, is that by constantly nudging our fellow workers, we can motivate them to follow the best practices and hence, in the process, can protect ourselves and those around us. Nevertheless, what we infer by observing [Figures 1 and 2] is that members of the committee have been briefing each other through PowerPoint presentations. While this presentation has its own limitations and challenges,[2] since middle of 2020 various scientists have been underscoring the risk of airborne transmission of SARS-CoV-2 and the resulting higher risk of striking those assembling in enclosed spaces.[3] Thus, we need to make every possible attempt to avoid sharing a common physical environment while the novel Coronavirus 2019 lurks in the air in search of a potential host. While communicating with each other is the need of the hour, in our world, since arrival of the novel Coronavirus, we need to constantly invent or redesign or restructure our surroundings so as not to provide favorable conditions for this virus to spread unabatedly. When we share air in a hall, we would remember that the air we breathe is communal. Since asymptomatic transmission accounts for somewhere from one-third to 59% of all transmissions globally, all of us, especially healthcare workers, should observe all of the COVID-appropriate behaviors at all the times. As evidence is now emerging that enhancing ventilation in buildings secures the health of its occupants, we should make appropriate changes in building designs where scores of occupants constantly breathe common air. Therefore, oral presentation with distribution of pamphlets, or similar or novel methods of information dissemination are needs of the hour in open spaces where currents of outdoor air dissipate the concentration of virus-laden particles in ambient air, subsequently diminishing the possibility of exposure to its occupants. Second, the investigators assess members of its team regarding observation of hand hygiene under a heading ‘H’. Here, we need to inform our fellow workers that practicing this habit not only saves patients from SARS-CoV-2 infection but also from several other diseases,[4] some of which are potentially lethal.[5] So while incidence of fomite-borne transmission can be significantly decreased by frequently washing our hands, it has to be inculcated in our minds that hospital-acquired infections constitute an avoidable burden on our health care system. Several ardent supporters of this practice have shared their experiences, and one common theme among them is that having availability of running water at an accessible distance is a prerequisite to observing this sanitary ritual. Such basic points need to be taken into consideration when designing hospital wards, catering not only to COVID patients but also to non-COVID patients. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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          Ten scientific reasons in support of airborne transmission of SARS-CoV-2

          Heneghan and colleagues' systematic review, funded by WHO, published in March, 2021, as a preprint, states: “The lack of recoverable viral culture samples of SARS-CoV-2 prevents firm conclusions to be drawn about airborne transmission”. 1 This conclusion, and the wide circulation of the review's findings, is concerning because of the public health implications. If an infectious virus spreads predominantly through large respiratory droplets that fall quickly, the key control measures are reducing direct contact, cleaning surfaces, physical barriers, physical distancing, use of masks within droplet distance, respiratory hygiene, and wearing high-grade protection only for so-called aerosol-generating health-care procedures. Such policies need not distinguish between indoors and outdoors, since a gravity-driven mechanism for transmission would be similar for both settings. But if an infectious virus is mainly airborne, an individual could potentially be infected when they inhale aerosols produced when an infected person exhales, speaks, shouts, sings, sneezes, or coughs. Reducing airborne transmission of virus requires measures to avoid inhalation of infectious aerosols, including ventilation, air filtration, reducing crowding and time spent indoors, use of masks whenever indoors, attention to mask quality and fit, and higher-grade protection for health-care staff and front-line workers. 2 Airborne transmission of respiratory viruses is difficult to demonstrate directly. 3 Mixed findings from studies that seek to detect viable pathogen in air are therefore insufficient grounds for concluding that a pathogen is not airborne if the totality of scientific evidence indicates otherwise. Decades of painstaking research, which did not include capturing live pathogens in the air, showed that diseases once considered to be spread by droplets are airborne. 4 Ten streams of evidence collectively support the hypothesis that SARS-CoV-2 is transmitted primarily by the airborne route. 5 First, superspreading events account for substantial SARS-CoV-2 transmission; indeed, such events may be the pandemic's primary drivers. 6 Detailed analyses of human behaviours and interactions, room sizes, ventilation, and other variables in choir concerts, cruise ships, slaughterhouses, care homes, and correctional facilities, among other settings, have shown patterns—eg, long-range transmission and overdispersion of the basic reproduction number (R0), discussed below—consistent with airborne spread of SARS-CoV-2 that cannot be adequately explained by droplets or fomites. 6 The high incidence of such events strongly suggests the dominance of aerosol transmission. Second, long-range transmission of SARS-CoV-2 between people in adjacent rooms but never in each other's presence has been documented in quarantine hotels. 7 Historically, it was possible to prove long-range transmission only in the complete absence of community transmission. 4 Third, asymptomatic or presymptomatic transmission of SARS-CoV-2 from people who are not coughing or sneezing is likely to account for at least a third, and perhaps up to 59%, of all transmission globally and is a key way SARS-CoV-2 has spread around the world, 8 supportive of a predominantly airborne mode of transmission. Direct measurements show that speaking produces thousands of aerosol particles and few large droplets, 9 which supports the airborne route. Fourth, transmission of SARS-CoV-2 is higher indoors than outdoors 10 and is substantially reduced by indoor ventilation. 5 Both observations support a predominantly airborne route of transmission. Fifth, nosocomial infections have been documented in health-care organisations, where there have been strict contact-and-droplet precautions and use of personal protective equipment (PPE) designed to protect against droplet but not aerosol exposure. 11 Sixth, viable SARS-CoV-2 has been detected in the air. In laboratory experiments, SARS-CoV-2 stayed infectious in the air for up to 3 h with a half-life of 1·1 h. 12 Viable SARS-CoV-2 was identified in air samples from rooms occupied by COVID-19 patients in the absence of aerosol-generating health-care procedures 13 and in air samples from an infected person's car. 14 Although other studies have failed to capture viable SARS-CoV-2 in air samples, this is to be expected. Sampling of airborne virus is technically challenging for several reasons, including limited effectiveness of some sampling methods for collecting fine particles, viral dehydration during collection, viral damage due to impact forces (leading to loss of viability), reaerosolisation of virus during collection, and viral retention in the sampling equipment. 3 Measles and tuberculosis, two primarily airborne diseases, have never been cultivated from room air. 15 Seventh, SARS-CoV-2 has been identified in air filters and building ducts in hospitals with COVID-19 patients; such locations could be reached only by aerosols. 16 Eighth, studies involving infected caged animals that were connected to separately caged uninfected animals via an air duct have shown transmission of SARS-CoV-2 that can be adequately explained only by aerosols. 17 Ninth, no study to our knowledge has provided strong or consistent evidence to refute the hypothesis of airborne SARS-CoV-2 transmission. Some people have avoided SARS-CoV-2 infection when they have shared air with infected people, but this situation could be explained by a combination of factors, including variation in the amount of viral shedding between infectious individuals by several orders of magnitude and different environmental (especially ventilation) conditions. 18 Individual and environmental variation means that a minority of primary cases (notably, individuals shedding high levels of virus in indoor, crowded settings with poor ventilation) account for a majority of secondary infections, which is supported by high-quality contact tracing data from several countries.19, 20 Wide variation in respiratory viral load of SARS-CoV-2 counters arguments that SARS-CoV-2 cannot be airborne because the virus has a lower R0 (estimated at around 2·5) 21 than measles (estimated at around 15), 22 especially since R0, which is an average, does not account for the fact that only a minority of infectious individuals shed high amounts of virus. Overdispersion of R0 is well documented in COVID-19. 23 Tenth, there is limited evidence to support other dominant routes of transmission—ie, respiratory droplet or fomite.9, 24 Ease of infection between people in close proximity to each other has been cited as proof of respiratory droplet transmission of SARS-CoV-2. However, close-proximity transmission in most cases along with distant infection for a few when sharing air is more likely to be explained by dilution of exhaled aerosols with distance from an infected person. 9 The flawed assumption that transmission through close proximity implies large respiratory droplets or fomites was historically used for decades to deny the airborne transmission of tuberculosis and measles.15, 25 This became medical dogma, ignoring direct measurements of aerosols and droplets which reveal flaws such as the overwhelming number of aerosols produced in respiratory activities and the arbitrary boundary in particle size of 5 μm between aerosols and droplets, instead of the correct boundary of 100 μm.15, 25 It is sometimes argued that since respiratory droplets are larger than aerosols, they must contain more viruses. However, in diseases where pathogen concentrations have been quantified by particle size, smaller aerosols showed higher pathogen concentrations than droplets when both were measured. 15 In conclusion, we propose that it is a scientific error to use lack of direct evidence of SARS-CoV-2 in some air samples to cast doubt on airborne transmission while overlooking the quality and strength of the overall evidence base. There is consistent, strong evidence that SARS-CoV-2 spreads by airborne transmission. Although other routes can contribute, we believe that the airborne route is likely to be dominant. The public health community should act accordingly and without further delay. © 2021 Ap Garo/Phanie/Science Photo Library 2021
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            Does a presentation’s medium affect its message? PowerPoint, Prezi, and oral presentations

            Despite the prevalence of PowerPoint in professional and educational presentations, surprisingly little is known about how effective such presentations are. All else being equal, are PowerPoint presentations better than purely oral presentations or those that use alternative software tools? To address this question we recreated a real-world business scenario in which individuals presented to a corporate board. Participants (playing the role of the presenter) were randomly assigned to create PowerPoint, Prezi, or oral presentations, and then actually delivered the presentation live to other participants (playing the role of corporate executives). Across two experiments and on a variety of dimensions, participants evaluated PowerPoint presentations comparably to oral presentations, but evaluated Prezi presentations more favorably than both PowerPoint and oral presentations. There was some evidence that participants who viewed different types of presentations came to different conclusions about the business scenario, but no evidence that they remembered or comprehended the scenario differently. We conclude that the observed effects of presentation format are not merely the result of novelty, bias, experimenter-, or software-specific characteristics, but instead reveal a communication preference for using the panning-and-zooming animations that characterize Prezi presentations.
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              Ignaz Semmelweis: “The Savior of Mothers” On the 200th Anniversary of the Birth

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                Author and article information

                Journal
                J Family Med Prim Care
                J Family Med Prim Care
                JFMPC
                J Family Med Prim Care
                Journal of Family Medicine and Primary Care
                Wolters Kluwer - Medknow (India )
                2249-4863
                2278-7135
                September 2022
                14 October 2022
                : 11
                : 9
                : 5718-5719
                Affiliations
                [1] Department of Medicine, KG’s Medical University, Lucknow, Uttar Pradesh, India
                Author notes
                Address for correspondence: Dr. Harish Gupta, Department of Medicine, KG’s Medical University, Lucknow -226 003, Uttar Pradesh, India. E-mail: harishgupta@ 123456kgmcindia.edu
                Article
                JFMPC-11-5718
                10.4103/jfmpc.jfmpc_853_21
                9731070
                36505525
                5bbd79d6-6dff-4f6e-83c1-83a16813a6a3
                Copyright: © 2022 Journal of Family Medicine and Primary Care

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 10 May 2021
                : 15 May 2022
                : 27 May 2022
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