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Months into the pandemic, Santa Clara County's hospitals are still falling short on COVID-19 testing

Sutter Health employees direct traffic at the hospital's Palo Alto facility. Photo by Sammy Dallal.

Amid a steep rise in COVID-19 cases in Santa Clara County, local hospitals are reportedly violating a local health order requiring them to provide free tests to residents at higher risk of contracting the virus.

County officials in recent weeks have pressed some of the largest health care providers in the state, notably Kaiser Permanente and Sutter Health, on an apparent failure to ramp up testing several months into the pandemic. Large hospitals have been obligated since June 10 to provide tests to residents who are at increased risk of exposure to the virus -- regardless of whether they show any symptoms -- yet the county has received numerous reports of hospitals flouting the public health mandate.

Hospital leaders say that their hands are tied, and that a chronic shortage of testing supplies and reagents means COVID-19 tests must be triaged only to those who need it most. But county Supervisor Joe Simitian said that's not an excuse, and that more can and must be done to increase testing capacity if there's any hope of controlling the virus.

"What's baffling to me is why this is even a question," Simitian said. "The public health officer issued the order more than two months ago, and yet we continue to get reports and complaints from people who cannot get a test from their provider."

Starting June 10, Santa Clara County's public health officer, Dr. Sara Cody, announced an order requiring that all acute care hospitals in the county provide free COVID-19 testing to a broad range of residents. Anyone who is showing symptoms of COVID-19, has been exposed to someone with a confirmed case, or is "at increased risk of exposure" is entitled to a test.

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It's that third "higher risk" category that vastly expands the eligibility and is causing consternation among hospital officials. It includes those who take public transit, first responders, pharmacy employees, food service workers, grocery store clerks, delivery workers and anyone who has frequent face-to-face interaction with the public.

The county's testing order is asking a lot of hospitals, well above what is required by the California Public Health Department and other counties across the state, said Jo Coffaro, regional vice president of the Hospital Council, a trade organization representing northern and central California hospitals. While there's a desire to expand COVID-19 testing as much as possible, she said there's a "pipeline" problem with testing supplies. Potential sticking points include difficulty in getting swabs, specialized pipettes and reagents.

"We may have two or three of those things on hand, but we don't have one -- maybe a reagent or a testing cartridge -- so the whole test can't be completed," she said.

During the week of Aug. 4, Santa Clara County's own public health system conducted 12,221 COVID-19 tests, vastly outperforming private hospitals including Stanford (3,360), Sutter (1,728), Kaiser (1,457) and El Camino Health (960). Since the start of the pandemic, the county has more than doubled the testing of any private health care provider.

Santa Clara County's COVID-19 testing has largely been done by the county health system, rather than private hospitals.

The test counts are disappointing to Simitian, who has been a staunch advocate for increased testing since March. Simitian said he and other county officials have had repeated conversations to prompt hospitals to voluntarily ramp up COVID-19 testing and comply with the public health order, but he is not optimistic that it's going to happen. Some of these organizations clearly have the scale and the resources to comply but have yet to make it a priority, he said.

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"These are not mom-and-pop operations. Kaiser is the largest HMO in the country, Sutter has 24 hospitals and 200 clinics just in Northern California," Simitian said. "If the county can manage to build it, buy it or pool tests -- and the county has done all three -- I think these organizations can do the same if the will is there."

A push for more tests

In normal times, Dr. Ahmad Kamal is a gastroenterologist with Santa Clara Valley Medical Center. But during the worst global pandemic in more than a century, he shifted gears to become the county's director of health system preparedness, assisting hospitals in safely taking care of COVID-19 patients and coping with the sudden demand for more tests.

While Kamal said he sympathizes with the challenges that private hospitals face, he said there is a clear contrast in the way that private hospitals are responding when compared to Santa Clara County's health system. In July when cases were surging, he recalled a disastrous situation in which the company Hologic, which provides COVID-19 testing equipment, couldn't make a shipment because it was completely tapped out.

To say you have to wait to get sick in order to get a COVID test is absolutely the wrong approach

-Dr. Ahmad Kamal, Santa Clara County director of health system preparedness

County staff began frantically calling testing labs across the country and, within a couple of days, was able to farm out samples to prevent a backlog. Top-of-the-line, premium testing machines that required proprietary reagents were swapped out for open platforms, which Kamal said are more labor intensive and required overtime and additional staffing.

Another strategy used by the county was to "pool" samples, running a COVID-19 test on multiple people's samples batched together. Pooling means limited resources can be stretched much farther -- four or even eight people can be included all in one test. If the pooled test comes back positive, everyone in the group has to be individually retested.

Kamal said the same cannot be said for private hospitals, despite the important public health role they play in controlling the virus. When faced with missing reagents, Kaiser and others simply stop testing large numbers of people, he said, taking the ill-advised approach of testing only those who are showing symptoms.

"To say you have to wait to get sick in order to get a COVID test is absolutely the wrong approach," Kamal said.

There have been some slivers of hope. Kamal said Stanford has been approved for pooling tests by the FDA, and El Camino Hospital is setting up drive-thru testing sites that are easy and convenient. Stanford has also sought help from 3D printing companies to fabricate some of the most sought-after materials. But in the case of Kaiser, he said there have been continued complaints of doctors dissuading residents from getting a test or outright refusing to provide one in violation of the health order.

Signage that directs patients to a testing area in the back of a parking lot in Menlo Park. Photo by Magali Gauthier

When asked for comment, Kaiser officials said they are currently prioritizing residents most in need of tests, including those with symptoms, frontline health workers, first responders and patients prior to undergoing surgeries and certain procedures. Irene Chavez, the vice president and area manager of Kaiser's San Jose Medical Center, said the organization is "marshaling all of the resources and influence we can bring to bear" in order to increase testing capacity.

"We are optimistic that we will be able to double the number of tests we are doing by end of September," Chavez said. "As our capacity grows, we will expand testing to more categories of those at risk of exposure."

Kaiser's website does not say that Santa Clara County residents are entitled to a test if they meet the public health order's criteria. And while there's a clear divergence between which patients are theoretically entitled to a test and which ones are actually getting tested, Coffaro sent a letter to the board of supervisors on July 21 stating that "all hospitals and healthcare systems offer COVID-19 testing to their patients in accordance with this order."

In an interview, Coffaro said the June 10 order is no longer realistic. The spread of the virus and new COVID-19 cases were on the decline when the order was issued, but times have changed and supplies are again running thin. The state's testing requirements have changed significantly since June and have been fluid based on the supply shortage, she said, yet Santa Clara County's have remained constant.

"We want to test every person who needs a test, but in reality it's a matter of availability of supplies, personnel and lab equipment," Coffaro said. "It's very hard to be accountable to something that we just can't get."

Sutter representatives declined to comment, instead referring this reporter to the Santa Clara Medical Association and the Hospital Council. An Aug. 11 letter to the county by the Santa Clara Medical Association suggested that the public health order would lead to "dire consequences" and threatens to divert tests away from those who need it most.

Help from the private sector

Under the public health order, Santa Clara County can start penalizing hospitals for failing to provide tests. On top of civil fines approved last week, violations can also be enforced through the criminal system, carrying a misdemeanor charge.

So far, county officials have taken a softer touch, attempting to work behind the scenes to gain compliance from private hospital systems. A memorandum of understanding (MOU) between the hospitals and the county is currently in the works to determine just how bad the flouting of the public order has to get in order to start incurring fines.

After talking with hospital officials over Zoom on Monday, Simitian said he is not optimistic that the MOU will alleviate the dearth of testing. While nobody wants to go down the route of penalizing hospitals, he said it's essential to get these major health care providers to comply if there is any hope of getting a handle on the virus. Kaiser covers anywhere from 30% to 40% of the county's entire population, he said, while Sutter covers a large portion of his constituents through the Palo Alto Medical Foundation. Both need to step up and do their share, he said.

"Testing is the necessary precondition to working our way out of the condition we're in," Simitian said. "Without testing, you can't do contact tracing, which means you can't ask people to isolate and quarantine, which means people are going to be out there moving the virus around."

Kamal said the county has a symbiotic relationship with these large health care systems, and must rely on them to scale up COVID-19 testing. What's really needed, he said, is for these private hospitals to follow in the footsteps of the county and take emergency measures to ramp up testing capacity, responding to the global health crisis with a commensurate response.

"The mobilization we need to see is the type of mobilization we had during World War II, and that's what we need from our health care partners," Kamal said. "We need them to pitch in and take care of their patients."

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Months into the pandemic, Santa Clara County's hospitals are still falling short on COVID-19 testing

by / Mountain View Voice

Uploaded: Thu, Aug 20, 2020, 1:56 pm

Amid a steep rise in COVID-19 cases in Santa Clara County, local hospitals are reportedly violating a local health order requiring them to provide free tests to residents at higher risk of contracting the virus.

County officials in recent weeks have pressed some of the largest health care providers in the state, notably Kaiser Permanente and Sutter Health, on an apparent failure to ramp up testing several months into the pandemic. Large hospitals have been obligated since June 10 to provide tests to residents who are at increased risk of exposure to the virus -- regardless of whether they show any symptoms -- yet the county has received numerous reports of hospitals flouting the public health mandate.

Hospital leaders say that their hands are tied, and that a chronic shortage of testing supplies and reagents means COVID-19 tests must be triaged only to those who need it most. But county Supervisor Joe Simitian said that's not an excuse, and that more can and must be done to increase testing capacity if there's any hope of controlling the virus.

"What's baffling to me is why this is even a question," Simitian said. "The public health officer issued the order more than two months ago, and yet we continue to get reports and complaints from people who cannot get a test from their provider."

Starting June 10, Santa Clara County's public health officer, Dr. Sara Cody, announced an order requiring that all acute care hospitals in the county provide free COVID-19 testing to a broad range of residents. Anyone who is showing symptoms of COVID-19, has been exposed to someone with a confirmed case, or is "at increased risk of exposure" is entitled to a test.

It's that third "higher risk" category that vastly expands the eligibility and is causing consternation among hospital officials. It includes those who take public transit, first responders, pharmacy employees, food service workers, grocery store clerks, delivery workers and anyone who has frequent face-to-face interaction with the public.

The county's testing order is asking a lot of hospitals, well above what is required by the California Public Health Department and other counties across the state, said Jo Coffaro, regional vice president of the Hospital Council, a trade organization representing northern and central California hospitals. While there's a desire to expand COVID-19 testing as much as possible, she said there's a "pipeline" problem with testing supplies. Potential sticking points include difficulty in getting swabs, specialized pipettes and reagents.

"We may have two or three of those things on hand, but we don't have one -- maybe a reagent or a testing cartridge -- so the whole test can't be completed," she said.

During the week of Aug. 4, Santa Clara County's own public health system conducted 12,221 COVID-19 tests, vastly outperforming private hospitals including Stanford (3,360), Sutter (1,728), Kaiser (1,457) and El Camino Health (960). Since the start of the pandemic, the county has more than doubled the testing of any private health care provider.

The test counts are disappointing to Simitian, who has been a staunch advocate for increased testing since March. Simitian said he and other county officials have had repeated conversations to prompt hospitals to voluntarily ramp up COVID-19 testing and comply with the public health order, but he is not optimistic that it's going to happen. Some of these organizations clearly have the scale and the resources to comply but have yet to make it a priority, he said.

"These are not mom-and-pop operations. Kaiser is the largest HMO in the country, Sutter has 24 hospitals and 200 clinics just in Northern California," Simitian said. "If the county can manage to build it, buy it or pool tests -- and the county has done all three -- I think these organizations can do the same if the will is there."

A push for more tests

In normal times, Dr. Ahmad Kamal is a gastroenterologist with Santa Clara Valley Medical Center. But during the worst global pandemic in more than a century, he shifted gears to become the county's director of health system preparedness, assisting hospitals in safely taking care of COVID-19 patients and coping with the sudden demand for more tests.

While Kamal said he sympathizes with the challenges that private hospitals face, he said there is a clear contrast in the way that private hospitals are responding when compared to Santa Clara County's health system. In July when cases were surging, he recalled a disastrous situation in which the company Hologic, which provides COVID-19 testing equipment, couldn't make a shipment because it was completely tapped out.

County staff began frantically calling testing labs across the country and, within a couple of days, was able to farm out samples to prevent a backlog. Top-of-the-line, premium testing machines that required proprietary reagents were swapped out for open platforms, which Kamal said are more labor intensive and required overtime and additional staffing.

Another strategy used by the county was to "pool" samples, running a COVID-19 test on multiple people's samples batched together. Pooling means limited resources can be stretched much farther -- four or even eight people can be included all in one test. If the pooled test comes back positive, everyone in the group has to be individually retested.

Kamal said the same cannot be said for private hospitals, despite the important public health role they play in controlling the virus. When faced with missing reagents, Kaiser and others simply stop testing large numbers of people, he said, taking the ill-advised approach of testing only those who are showing symptoms.

"To say you have to wait to get sick in order to get a COVID test is absolutely the wrong approach," Kamal said.

There have been some slivers of hope. Kamal said Stanford has been approved for pooling tests by the FDA, and El Camino Hospital is setting up drive-thru testing sites that are easy and convenient. Stanford has also sought help from 3D printing companies to fabricate some of the most sought-after materials. But in the case of Kaiser, he said there have been continued complaints of doctors dissuading residents from getting a test or outright refusing to provide one in violation of the health order.

When asked for comment, Kaiser officials said they are currently prioritizing residents most in need of tests, including those with symptoms, frontline health workers, first responders and patients prior to undergoing surgeries and certain procedures. Irene Chavez, the vice president and area manager of Kaiser's San Jose Medical Center, said the organization is "marshaling all of the resources and influence we can bring to bear" in order to increase testing capacity.

"We are optimistic that we will be able to double the number of tests we are doing by end of September," Chavez said. "As our capacity grows, we will expand testing to more categories of those at risk of exposure."

Kaiser's website does not say that Santa Clara County residents are entitled to a test if they meet the public health order's criteria. And while there's a clear divergence between which patients are theoretically entitled to a test and which ones are actually getting tested, Coffaro sent a letter to the board of supervisors on July 21 stating that "all hospitals and healthcare systems offer COVID-19 testing to their patients in accordance with this order."

In an interview, Coffaro said the June 10 order is no longer realistic. The spread of the virus and new COVID-19 cases were on the decline when the order was issued, but times have changed and supplies are again running thin. The state's testing requirements have changed significantly since June and have been fluid based on the supply shortage, she said, yet Santa Clara County's have remained constant.

"We want to test every person who needs a test, but in reality it's a matter of availability of supplies, personnel and lab equipment," Coffaro said. "It's very hard to be accountable to something that we just can't get."

Sutter representatives declined to comment, instead referring this reporter to the Santa Clara Medical Association and the Hospital Council. An Aug. 11 letter to the county by the Santa Clara Medical Association suggested that the public health order would lead to "dire consequences" and threatens to divert tests away from those who need it most.

Help from the private sector

Under the public health order, Santa Clara County can start penalizing hospitals for failing to provide tests. On top of civil fines approved last week, violations can also be enforced through the criminal system, carrying a misdemeanor charge.

So far, county officials have taken a softer touch, attempting to work behind the scenes to gain compliance from private hospital systems. A memorandum of understanding (MOU) between the hospitals and the county is currently in the works to determine just how bad the flouting of the public order has to get in order to start incurring fines.

After talking with hospital officials over Zoom on Monday, Simitian said he is not optimistic that the MOU will alleviate the dearth of testing. While nobody wants to go down the route of penalizing hospitals, he said it's essential to get these major health care providers to comply if there is any hope of getting a handle on the virus. Kaiser covers anywhere from 30% to 40% of the county's entire population, he said, while Sutter covers a large portion of his constituents through the Palo Alto Medical Foundation. Both need to step up and do their share, he said.

"Testing is the necessary precondition to working our way out of the condition we're in," Simitian said. "Without testing, you can't do contact tracing, which means you can't ask people to isolate and quarantine, which means people are going to be out there moving the virus around."

Kamal said the county has a symbiotic relationship with these large health care systems, and must rely on them to scale up COVID-19 testing. What's really needed, he said, is for these private hospitals to follow in the footsteps of the county and take emergency measures to ramp up testing capacity, responding to the global health crisis with a commensurate response.

"The mobilization we need to see is the type of mobilization we had during World War II, and that's what we need from our health care partners," Kamal said. "We need them to pitch in and take care of their patients."

Comments

Seriously
Registered user
Martens-Carmelita
on Aug 20, 2020 at 3:14 pm
Seriously, Martens-Carmelita
Registered user
on Aug 20, 2020 at 3:14 pm

I had my "free" Covid test at the end of July at El Camino Hospital. After 15 days of waiting and leaving two phone messages, I was finally directed to the ECH myCare page and eventually retrieved my (negative) result. I understand the need for community-wide testing and I was pleased to contribute, but individual test results are important too. Since ECH took my private health insurance information, and most likely billed them, I am not at all happy with their "free testing".


Steven Goldstein
Registered user
Old Mountain View
on Aug 20, 2020 at 8:34 pm
Steven Goldstein, Old Mountain View
Registered user
on Aug 20, 2020 at 8:34 pm

I completely concur.

This response as a whole has been a disaster feeding event.

Joe Biden just said it, "COVID must be controlled before anything can be restored"

In effect the "Just In Time" management of medicine has broken the country worse than anything.

It is the most cost efficient way of medical care (thus most profitable), but it also has proven to leave us all in danger because of COVID.

We need to learn this lesson real good, "WE CAN"T EVER BE IN THIS POSITION AGAIN."


Julia
Registered user
Another Mountain View Neighborhood
on Aug 23, 2020 at 9:24 am
Julia, Another Mountain View Neighborhood
Registered user
on Aug 23, 2020 at 9:24 am

Testing turnaround has to be so much shorter. Compare the experience of family in Australia with test results texted to them in 16 hrs.
This delay in testing here means staff at open businesses aren't getting results in a timely way which means spread continues. Compare finding out in East Palo Alto Sun today finding out there are 30 plus covid cases in employees at local Ikea! In Australia if there is one covid case of an employee or customer anywhere information is put out by the health department with details of where person worked or has been and the times and for anyone at the store at the time to urgently get tested. We are so far behind here!


Steven Goldstein
Registered user
Old Mountain View
on Aug 23, 2020 at 11:32 am
Steven Goldstein, Old Mountain View
Registered user
on Aug 23, 2020 at 11:32 am

Add on top of this now, the smoke caused by the fires in the area are another severe public health risk.

It looks like this area can't get any luck except bad.

The smoke can cause long term lung damage because the particles are so small. The particles are defined as PM 2.5 PM, and they are so small they are 5 times smaller than the width of a human hair. They get lodged inside the lung aerolas, the places where the air we breath passes through a membrane to oxygenate the blood and expire the carbon dioxide.

I suffered from severe respiratory distress syndrome after birth, so I am very sensitive to this problem.

If people go put without a mask to help filter these particles, they will be stuck with these particles for as long as it takes to breath clean air enough to exhale these particles, which can take weeks.

Now these kinds of masks are very hard to get and also very expensive. But if this our new normal regarding climate change, the government may have to issue us this protection during these events.

And you can be exposed without being consciously aware of it. A level can occur that you cannot detect with smell. It is accumulative so that it collects in the lungs until the are is "clean" enough for the body to exhale them

We can't get a break can't we?


Agree
Registered user
another community
on Aug 23, 2020 at 12:09 pm
Agree, another community
Registered user
on Aug 23, 2020 at 12:09 pm

I was feeling horrible (cough, aches) and called to get a covid test from Sutter Health. Even though their website says if you have any of the listed symptoms, you could get a test. When I called I was told I couldn't be tested unless I had vomiting and diarrhea. So disappointing as a patient of Sutter Health.


Gary
Registered user
Sylvan Park
on Aug 23, 2020 at 10:48 pm
Gary, Sylvan Park
Registered user
on Aug 23, 2020 at 10:48 pm

Sunday, President Trump announced that the FDA had gotten out of the way in authorizing use of blood plasma from Covid-19 survivors to infectees who want to survive. Does it work or even help? Maybe yes. Maybe not. But the important point is that it could help Donald Trump's re-election bid. If this treatment does not help (the campaign), there will be others. We all remember Trump's last big idea about how to curb the pandemic: spraying lungs with a disinfectant!


Monte Wright
Registered user
Blossom Valley
on Aug 24, 2020 at 12:48 pm
Monte Wright, Blossom Valley
Registered user
on Aug 24, 2020 at 12:48 pm

I'm a registered nurse at Kaiser San Jose. To date staff has not been tested in compliance with the mandate. In fact covid+ staff are told to come to work if they are asymptomatic. This causes safety concerns as there are times when we can't be six feet apart.


Ken M.
Registered user
Cuesta Park
on Aug 25, 2020 at 2:41 pm
Ken M. , Cuesta Park
Registered user
on Aug 25, 2020 at 2:41 pm

In a pinch, you can sneeze onto an over-the-counter pregnancy test for at-home results.


Steven Goldstein
Registered user
Old Mountain View
on Aug 25, 2020 at 3:05 pm
Steven Goldstein, Old Mountain View
Registered user
on Aug 25, 2020 at 3:05 pm

Ken M.

WOW what does a pregnancy test have related to COVID?

I hope your being sarcastic.

I suffer from kleptomania sometimes and thus I don't understand SARCASM:

Kleptomaniacs take EVERYTHING literally.

I remember when I visited my doctor and he told me to take a seat.

It is now in my living room.


LisaR
Registered user
Rex Manor
on Aug 28, 2020 at 7:20 am
LisaR, Rex Manor
Registered user
on Aug 28, 2020 at 7:20 am

More evidence that the profit motive in health care doesn’t serve us well. Can anyone still claim we have the best health care system in the world? Are we all still so happy with the current system that we will resist changing it? Time for a single payer system!


Steven Goldstein
Registered user
Old Mountain View
on Aug 31, 2020 at 10:09 am
Steven Goldstein, Old Mountain View
Registered user
on Aug 31, 2020 at 10:09 am

OMG,

The U.S. just confirmed the first reinfections after recovery.

When are the doctors going to get this thing under control other than isolating ourselves?

REINFECTION means that if you get reinfected say 10 times in the next 5 years you increase your chances of death by 1000%

We are so screwed.


Justin Case
Registered user
Another Mountain View Neighborhood
on Aug 31, 2020 at 11:43 am
Justin Case, Another Mountain View Neighborhood
Registered user
on Aug 31, 2020 at 11:43 am

> In a pinch, you can sneeze onto an over-the-counter pregnancy test for at-home results.

^ Covid-19 also appears as specks in human feces so evaluating a stool sample via home testing or lab analysis might also suffice.


Steven Goldstein
Registered user
Old Mountain View
on Aug 31, 2020 at 1:16 pm
Steven Goldstein, Old Mountain View
Registered user
on Aug 31, 2020 at 1:16 pm

Justin Case,

PLEASE say your joking? Again I have been accused of being a kleptomaniac.

Kleptomaniacs have no sarcasm be cause we take EVERYTHING literally.

If you are actually serious, OMG.

What is really also scary is that the FDA is bending over backwards and forgoing any safety protocols to get ANY vaccine out there. The Medical Community is going nuts over it.

Many Doctors and others are raising the specter of the first generation vaccines either not working or worse causing negative health impact after the vaccine is given, because no safety checking for long term health is being done.

We can't just use anything, it must be proven safe first, and proven to really work.

Again, we are not doing what we did during Polio. We have to use our tools wisely and effectively.

But back then we had in effect a socialized healthcare systems, thus we had a army working together.

The current situation appears like the private labs are not coordinated.

This reminds me of Paul Tsongus that made the following observation:

The World is in a Crew Boat Race against COVID 19.

All the other countries have their crew manager saying "stroke, Stroke" and the rowers are in sync using the oars. Thus they are doing a better job at controlling the spreads

Our boat manger is saying "stroke, stroke" but our rowers are using the oars to beat each other to a pulp. Dr. Fauci is the boat manger, but Donald Trump is a rower. NOT the other way around. Donald Trump is NOT a Doctor or trained in Epidemiology

Like Donald Trump saying all the states are on their own. Donald Trump saying I am not responsible for anything, criticize the other guys. Like Donald Trump NOT listening to any MEDICAL professionals except those he has some financial ties to. Like hydroxychloroguine?

We are ALL screwed.


Justin Case
Registered user
Another Mountain View Neighborhood
on Aug 31, 2020 at 3:56 pm
Justin Case, Another Mountain View Neighborhood
Registered user
on Aug 31, 2020 at 3:56 pm

> PLEASE say your joking?

^ Not according to medical researchers. WebMD also has an article on this...it has something to do with Covid-19 RNA traces in human stool samples.

A DIY stool test could provide at home screening for the coronavirus....until there is a cure.

"Many COVID patients shed virus in feces, even without GI symptoms | MDedge Infectious Disease" Web Link


Justin Case
Registered user
Another Mountain View Neighborhood
on Aug 31, 2020 at 4:02 pm
Justin Case, Another Mountain View Neighborhood
Registered user
on Aug 31, 2020 at 4:02 pm

@ Mr. Goldstein

Here is the WebMD article. It mentions that Covid-19 particles could even be spread as aerosol from a flushing toilet or by hands that come in contact with an infected person's poop.

"COVID-19 Virus Found in Stool May Be Infectious" Web Link


Steven Goldstein
Registered user
Old Mountain View
on Aug 31, 2020 at 5:12 pm
Steven Goldstein, Old Mountain View
Registered user
on Aug 31, 2020 at 5:12 pm

Justin Case:

Yes, if someone coughs into a toilet and it is not cleaned it can spread COVID 19.

But you neglected to demonstrate that the "fecal" matter is not the original infections source.

Yes it has been detected in fecal matter as far as genetic material for detection. So far the evidence isn't indicating stat fecal matter is infectious.

Those tests are "genetic" thus require most likely PCR processing in order to detect it. The genetic material needs to be replicated in a lab. That testing can take days to process. There is no way to create a genetic test that people can perform either at work or at home to achieve this.

Please be safe EVERYONE?


Justin Case
Registered user
Another Mountain View Neighborhood
on Aug 31, 2020 at 7:39 pm
Justin Case, Another Mountain View Neighborhood
Registered user
on Aug 31, 2020 at 7:39 pm

> Yes, if someone coughs into a toilet and it is not cleaned it can spread COVID 19.

But you neglected to demonstrate that the "fecal" matter is not the original infections source.

Yes it has been detected in fecal matter as far as genetic material for detection. So far the evidence isn't indicating stat fecal matter is infectious.

^ Perhaps best to err on the side of precaution.

Covid-19 residual poop particles going airborne during the flushing process is what the researchers were referring to as there are countless public restrooms where others have neglected to flush after going.

Wearing a face mask curtails the
possibility of inhaling noxious fecal particles from an infected individual.

As far as infectious sources go, it's probably advisable to avoid eating bats as well.


Steven Goldstein
Registered user
Old Mountain View
on Aug 31, 2020 at 9:08 pm
Steven Goldstein, Old Mountain View
Registered user
on Aug 31, 2020 at 9:08 pm

JUstin Case,

Ozzy Osbourne had Bat as a diet. He seems fine.

As far as public bathrooms, they should have lids, to keep a bathroom clean you should flush the toilet with the cover down. The flow of water creates a vacuum, so the bacteria and viruses are sucked down the drain. On top of that, there should be bleach added to the water to kill infections.


Public bathrooms are extremely dirty unless cleaned every 3 to 4 hours.

Also, I know it sounds strange, but men should urinate sitting down to prevent spills and minimize aeration of urine carrying diseases. It also keeps bathrooms cleaner.

And don't get me started on urinals, they are the worst.

But your cell phone has been identified as a major sanitary problem, they should be cleaned at least once an hour

I was once learning to be an occupational therapist, so I was taught to analyze common tasks, and going to the bathroom is called an activity of daily living. Activity analysis can get so detailed you can write a 10 page analysis on daily grooming and bathroom activities double sided.


Justin Case
Registered user
Another Mountain View Neighborhood
on Sep 1, 2020 at 8:22 am
Justin Case, Another Mountain View Neighborhood
Registered user
on Sep 1, 2020 at 8:22 am

> And don't get me started on urinals, they are the worst.

^ Especially on the floor in front of the urinals...a lot of dribblers leave their mark for others to step in. Some public urinals have rubber mats but these only act as sponges...same after effect.

> ...men should urinate sitting down to prevent spills and minimize aeration of urine carrying diseases. It also keeps bathrooms cleaner.

^ Another suggestion...bidets.
They save on toilet paper and actually clean your behind rather than smearing the poop all over. Bidets are very popular in Europe, Japan & Muslim countries (where it is haram & considered unsanitary to use toilet paper).

Bidets are difficult to implement in rural outhouses because of the mobility factor...when the outhouse hole is filled, the outhouse is simply moved to a new location. Perhaps Manefest Destiny & the Homestead Act prevented bidets from becoming a valid part of American society & culture

> But your cell phone has been identified as a major sanitary problem, they should be cleaned at least once an hour.

^ Laying a cell phone down on unsanitary surfaces is the prime culprit.

Any suggestions for the safe handling of coinage & currency?
Money is probably the dirtiest of all...both figuratively & literally


Steven Goldstein
Registered user
Old Mountain View
on Sep 1, 2020 at 3:35 pm
Steven Goldstein, Old Mountain View
Registered user
on Sep 1, 2020 at 3:35 pm

Justin Case,

I went to the toilet and instead of finding toilet paper I see these 3 sea shells.

Sound familiar?

I agree that bidets are more sanitary, I used then when I worked in France the summer after I graduated high school.

There are retrofit kits that can be installed on home toilets.

They also should be installed with a "mild" soap cartridge to really clean.

But just understand that all public restrooms should be assumed to have fecal matter on all surfaces.

Especially if the bathroom have no towels, air dryers spread it around. The idea that air dryers are more sanitary is false.

I also remember that one approach is to install strong UV sanitation lights that work automatically if the door closes and is not locked, and signage is used to prepare the users. The UV can kill bacteria and viruses without chemicals. In fact many hospitals use UV air sanitization devices to clean the operating room air


Steven Goldstein
Registered user
Old Mountain View
on Sep 1, 2020 at 6:42 pm
Steven Goldstein, Old Mountain View
Registered user
on Sep 1, 2020 at 6:42 pm

OMG, The NIH just pulled convalescent plasma as a treatment for COVID.

OMG, when are we going to get ANY real hope against COVID?

No treatment, no herd immunity, and potential of constant reinfection?

Now my anxiety is surpassed critical and is reaching terminal condition.

COVID 19 is getting to be like HIV, and they NEVER got a vaccine for it.


Justin Case
Registered user
Another Mountain View Neighborhood
on Sep 6, 2020 at 9:33 am
Justin Case, Another Mountain View Neighborhood
Registered user
on Sep 6, 2020 at 9:33 am

> "COVID 19 is getting to be like HIV, and they NEVER got a vaccine for it."

^ And so all practical & precautionary measures against Covid-19 must be maintained & practiced as a whole.

Incidentally...the wearing of face masks, safe distancing & no touching during sex have been advised by various public health agencies to prevent the spread of Covid-19.


Justin Case
Registered user
Another Mountain View Neighborhood
on Sep 6, 2020 at 9:38 am
Justin Case, Another Mountain View Neighborhood
Registered user
on Sep 6, 2020 at 9:38 am

Addendum/reference/FYI:

Web Link


Steven Goldstein
Registered user
Old Mountain View
on Sep 6, 2020 at 10:41 am
Steven Goldstein, Old Mountain View
Registered user
on Sep 6, 2020 at 10:41 am

Justin,

Of course any kissing or close breathing can spread COVID.

Yes, it means that for the last 6 plus months intimate contact is a risk factor.

And YES, this is why college students are furious and revolting regarding social isolation.

Only those who you know are negative, or have been isolating themselves for at least 2 weeks prior should you consider getting into that kind of activities.

This has been the unspoken real pain regarding this time. This is why we need mental health support at a level never heard of in the general population. Even "healthy" psychologically classed people are suffering because of this.


Justin Case
Registered user
Another Mountain View Neighborhood
on Sep 6, 2020 at 11:56 am
Justin Case, Another Mountain View Neighborhood
Registered user
on Sep 6, 2020 at 11:56 am

> "..this is why college students are furious and revolting regarding social isolation.'

^ Preoccupation with sex, partying and alcohol consumption (though widely practiced), is not a sound reason for attending a college or university let alone unnecessary risk-taking.

As the URL suggested, there are other alternatives towards addressing one's imminent 'needs' and they should be considered...regardless of one's age.


Steven Goldstein
Registered user
Old Mountain View
on Sep 6, 2020 at 2:05 pm
Steven Goldstein, Old Mountain View
Registered user
on Sep 6, 2020 at 2:05 pm

Justin,

I apologize if I was "pigeon holing" that only college students were being impacted.

You are correct, everyone with any romantic needs are being impacted of any kind.


Justin Case
Registered user
Another Mountain View Neighborhood
on Sep 7, 2020 at 12:25 pm
Justin Case, Another Mountain View Neighborhood
Registered user
on Sep 7, 2020 at 12:25 pm

> "everyone with any romantic needs are being impacted of any kind."

^ The same can be said of those with certain 'non-romantic needs' (i.e. purely biological/hormonal and/or sociopathic ones) as well.

No sympathy here for them.


Steven Goldstein
Registered user
Old Mountain View
on Sep 7, 2020 at 2:33 pm
Steven Goldstein, Old Mountain View
Registered user
on Sep 7, 2020 at 2:33 pm

Justin,

The link you shared was about "intimate" relations. Yes there are other problems also occurring. But you brought up that particular infection vector.

Be safe


Justin Case
Registered user
Another Mountain View Neighborhood
on Sep 9, 2020 at 1:40 pm
Justin Case, Another Mountain View Neighborhood
Registered user
on Sep 9, 2020 at 1:40 pm

> "Even "healthy" psychologically classed people are suffering because of this."

^ As far as adapting to SIP mandates, safe distancing advisements & overcoming an ongoing sense of restlessness, recreational vehicle and boats sales & slip rentals are up.

What better way to pass the time than to set sail on the open waters or to hit the road and see America...whatever's left of it.

Beats staying home and feeling sorry for oneself.




Steven Goldstein
Registered user
Old Mountain View
on Sep 9, 2020 at 2:07 pm
Steven Goldstein, Old Mountain View
Registered user
on Sep 9, 2020 at 2:07 pm

Justin,

NOW Bob Woodward discloses that Donald Trump KNEW the disease was dangerous and infectious BUT said the opposite all during the pandemic.

If he was up front with us in the beginning, and took all the steps the medical professionals wanted to in the beginning, we would be in far better shape today.

The facts are thousands of people have died, and jobs are lost because he wanted to "prevent panic"

A freeze on cash markets and providing free shelter, energy, food, telecommunications from the beginning would have been the right action. Employment would be on "holiday" thus no increase in job loss would have happened. And the cost of taking out loans to prop up stocks again would have been saved.

The Vaccine front is getting a reality check from the Oxford vaccine study, and it has impacts on the rest of the vaccine research.

We are so not out of the woods yet.


Steven Goldstein
Registered user
Old Mountain View
on Sep 14, 2020 at 12:17 am
Steven Goldstein, Old Mountain View
Registered user
on Sep 14, 2020 at 12:17 am

Please also understand that it appears your twice as likely to contract COVID when going to eat even outdoors. Te report is found here (Web Link)

The CDC is in effect saying it doesn't matter whether you eat indoors or outdoors regarding this report.

In fact this study used California as a data source.

It specifically stated:
"Asked about the CDC report, Dr. Wafaa El-Sadr, a professor of epidemiology at the Mailman School of Public Health at Columbia University, said, “It is not surprising that dining at a restaurant was found to be associated with a positive test. This is likely due to the fact that eating and drinking, two activities intrinsic to visiting a restaurant, require removal of face covering."

From what I understand, the following states in the study prohibited indoor dining:

California, Colorado, Massachusetts, and Minnesota appears to have no indoor dining. Maryland, North Carolina and Tennessee has restricted indoor dining. Ohio, Utah, and Washington only recently allowed indoor dining with restrictions. During the study they were closed. So out of the 10 states at least 7 had no indoor dining at all during the study, and 3 did with restrictions.

To me that seems pretty clear, the findings are mostly counting infections from outdoor dining as a source. I know I didn’t point this out a clearly as I should. But it really appears that outdoor dining is just not safe given that it increases your infection probability by 100%.

Maybe this makes it more clear to the readers too.

By the way, even though we have seen a reduction in infections in Santa Clara County, it is due to the fact that the air quality is so bad that people are not going to eat outdoors for the last 3 or more weeks. So do not assume that the improved numbers we have now are a good sample or predictors. The reality is that once we allowed outdoor dining as an option our infections increased significantly if you look at the history.

This is REAL science, we need to consider this information at least?


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