Better known as "Fauci's Ten Commandments" I think I will edit the previous comment and add this, I like it.

not every one can do this so we need force to ensure that every one apply to this

These can be considered TEN (10) WORST SINS to commit during the war against COVID-19 pandemic!

@ Gary Joseph Ordog

Can you please indicate where or when Dr. Fauci commanded this, and where it was published, before we start making him a bogeyman.

Yes, these are commandments of what NOT to do. cf "Though shall not kill..." I have admired Dr. Fauci all of my career. Now the poor guy and his family are under death threats, what a disgrace. He is a good example of being "perfectly medically ethically correct." Paying the political price for doing that. But he is a great role model for all physicians. I present this list only to honor him with an amalgamated list of his advice over the past few months. God bless Dr. Fauci and his family (and please stop the death threats).

The list is an amalgamation of his recommendations regarding COVID-19 made over the past several months. Because you asked, they are in fact from the following:

1. Newsweek article quotes on May 27, 2020.

2. Washington Post quotes June 30, and July 03, 2020.

3. A speech televised widely on TV on July 21, 2020.

4. NPR quotes in an article on July 01, 2020.

5. PBS Newshour quotes made in April, 2020.

6. Testimony before Senate Committee hearing, May 12 and June 30, 2020.

Again, this is offered with the utmost honor and respect, and intended to be useful information for the COVID-19 Pandemic.

Again, I am sorry that some people are getting confused with this. It is meant to simulate a "Medical" Ten Commandments. Like I said the 10 Commandments list 'things not to do" like "Though shall not kill..." and so his statements and advice are written like that, all negatives as in "what NOT to do." I didn't realize that so much confusion would be created by this list of negatives. Most people are used to positive commandments for advice, it seems. So, it seems that it it time to review the actual "Ten Commandments" to understand this. Sorry for the confusion. Dr. Fauci is a great person, and deserves respect for leading this battle. I for one will heed and follow his advice.

In support of the "Fauci Ten Commandments" and how best to avoid contracting COVID-19, I offer this paragraph on why you want to avoid catching the virus. The best method right now appear to be these rules. That is, until a good vaccine is given:

I cannot recommend herd-immunity at this time for this novel virus, for multiple reasons. First, herd-immunity for this virus is probably not attainable. The immune response to infections appears to be short-lived, possibly in the range of 3 months. Thus re-infection may occur repeatedly, thus no "herd-immunity." Secondly, If the immune response is short-lived with probably re-infection frequent, then there is no real immunity to transfer to the "herd." Thirdly, there appears to be a myriad of complications of the viral infection, both in symptomatic and asymptomatic patients, in the majority of those infected with the virus, no matter the age. This ranges from lung scarring, diminished pulmonary function, lung metaplasia, immune dysfunction, neurological injury, cardiac, and rheumatological injury, etc. Fourthly, the virus may be carcinogenic, combined with the immune suppression of the cancer surveillance system it causes, is worrisome for those who are infected with the virus. (There are many other viruses with similar effects, so this would not be unique.) Fifthly, there are many patients with autoimmune diseases stated to be idiopathic, which in fact, may have been associated with other viral infections, and this new one has the same worries for us. Conclusion: A good vaccine, that offers humoral as well as cellular immunity, even if it is not permanent is a much better way to go, rather than "herd-immunity." Thank you for your support and stay safe. July 31, 2020. Gary Ordog, MD

July 31, 2020: Despite my previous accolades for Dr. Fauci, I was disappointed in his Congressional testimony today. Dr. Fauci, please stick with scientific and medical issues and statements; you were too political today, in my opinion. Thank you.

September 1, 2020 Fascinating Study! Gary Ordog, MD, DABEM, DABMT | County of Los Angeles, Department of Health Services, (retired) First to answer the previous question, I believe it is stated in the article that no one was wearing masks, as a COVID-19 outbreak had not been identified at that time. My point here is that you have a fascinating article, that was extremely well done. Thank you and congratulations. I would like to see the next phase of a similar study using PPE. We already know that health care workers have a higher risk of infection despite using PPE. But it obviously helps. You study confirms the proverbial "sardine can" analogy, avoid buses, trains, planes and indoor restaurants in this time of COVID-19. Again, excellent study! Original Investigation September 1, 2020 Community Outbreak Investigation of SARS-CoV-2 Transmission Among Bus Riders in Eastern China Ye Shen, PhD1; Changwei Li, PhD1,2; Hongjun Dong, MD3; et alZhen Wang, MD4; Leonardo Martinez, PhD5; Zhou Sun, MD6; Andreas Handel, PhD1,7,8; Zhiping Chen, MD4; Enfu Chen, MD4; Mark H. Ebell, MD, MS1; Fan Wang, MA9,10; Bo Yi, MD3; Haibin Wang, MD11; Xiaoxiao Wang, MD4; Aihong Wang, MD3; Bingbing Chen, MD11; Yanling Qi, PhD12; Lirong Liang, MD, PhD13; Yang Li, PhD9,10,14; Feng Ling, MD4; Junfang Chen, MD6; Guozhang Xu, MD3 Author Affiliations Article Information JAMA Intern Med. Published online September 1, 2020. doi:10.1001/jamainternmed.2020.5225 Key Points Question Is airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a potential mean of spreading coronavirus disease 2019 (COVID-19)? Findings In this cohort study of 128 individuals who rode 1 of 2 buses and attended a worship event in Eastern China, those who rode a bus with air recirculation and with a patient with COVID-19 had an increased risk of SARS-CoV-2 infection compared with those who rode a different bus. Airborne transmission may partially explain the increased risk of SARS-CoV-2 infection among these bus riders. Meaning These results suggest that future efforts at prevention and control must consider the potential for airborne spread of SARS-CoV-2, which is a highly transmissible pathogen in closed environments with air recirculation. Abstract Importance Evidence of whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), can be transmitted as an aerosol (ie, airborne) has substantial public health implications...

Here, add eye protection to #2 facemasks for the Ten Commandments. See my publication in the JAMA Ophthalmology today for more details:

Comment Journal of the American Medical Association Ophthalmology September 19, 2020 Eye Protection as an Essential Part of PPE. Gary Ordog, MD, DABEM, DABMT | County of Los Angeles, Department of Health Services, (retired) Thank you for the informative study. First, in response to a previous question, the methodology is stated to include direct questioning about eyeglasses, also in my experience, the direct questioning of patients upon hospital admission includes the use of eyeglasses, dentures, prostheses, pacemakers, etc. which would make this information readily available on admission documents. So this set of data seems plausible. The validity of matching of the experimental with the control group is more questionable. Nevertheless, the results show a very strong association in the protective action of eyeglasses against SARS-CoV-2, and in conclusion would support the use of eye protection in PPE use. The preferred PPE should have eye protection that prevents "touching" and direct air flow to the eyes. Also, there may be other confounding variables that are causing this strong association, for example: 'further investigation could show that eyeglass users frequently clean the glasses with sterilizing wipe, thus presenting a chemical shield to the virus.' Again, thank you for your work, and as usual, further study is required. Stay safe with eye protection. CONFLICT OF INTEREST: None Reported Brief Report September 16, 2020 Association of Daily Wear of Eyeglasses With Susceptibility to Coronavirus Disease 2019 Infection Weibiao Zeng, MS1; Xiaolin Wang, MS2; Junyu Li, MS3; et alYong Yang, MS2; Xingting Qiu, MS4; Pinhong Song, MS2; Jianjun Xu, MD, PhD1; Yiping Wei, MD, PhD1 Author Affiliations Article Information JAMA Ophthalmol. Published online September 16, 2020. doi:10.1001/jamaophthalmol.2020.3906 COVID-19 Resource Center editorial comment icon Editorial Comment Key Points Question What is the association between the daily wear of eyeglasses and susceptibility to coronavirus disease 2019 (COVID-19)? Findings In this cohort of 276 patients hospitalized with COVID-19 in Suizhou, China, the proportion of daily wearers of eyeglasses was lower than that of the local population (5.8% vs 31.5%). Meaning These findings suggest that daily wearers of eyeglasses may be less likely to be infected with COVID-19. Abstract Importance The proportion of daily wearers of eyeglasses among patients with coronavirus disease 2019 (COVID-19) is small, and the association between daily wear of eyeglasses and COVID-19 susceptibility has not been reported. Objective To study the association between the daily wearing of eyeglasses and the susceptibility to COVID-19. Design, Setting, and Participants This cohort study enrolled all inpatients with COVID-19 in Suizhou Zengdu Hospital, Suizhou, China, a designated hospital for COVID-19 treatment in the area, from January 27 to March 13, 2020. COVID-19 was diagnosed according to the fifth edition of Chinese COVID-19 diagnostic guidelines. The proportion of persons with myopia who wore eyeglasses in Hubei province was based on data from a previous study. Exposures Daily wearing of eyeglasses for more than 8 hours. Main Outcomes and Measures The main outcomes were the proportions of daily wearers of eyeglasses among patients admitted to the hospital with COVID-19 and among the local population. Data on exposure history, clinical symptoms, underlying diseases, duration of wearing glasses, and myopia status and the proportion of people with myopia who wore eyeglasses in Hubei province were collected. People who wore glasses for more than 8 hours a day were defined as long-term wearers. Results A total of 276 patients with COVID-19 were enrolled. Of these, 155 (56.2%) were male, and the median age was 51 (interquartile range, 41-58) years. All those who wore glasses for more than 8 hours a day had myopia and included 16 of 276 patients (5.8%; 95% CI, 3.04%-8.55%). The proportion of people with myopia in Hubei province, based on a previous study, was 31.5%, which was much higher than the proportion of patients with COVID-19 who had myopia in this sample. Conclusions and Relevance In this cohort study of patients hospitalized with COVID-19 in Suizhou, China, the proportion of inpatients with COVID-19 who wore glasses for extended daily periods (>8 h/d) was smaller than that in the general population, suggesting that daily wearers of eyeglasses may be less susceptible to COVID-19. Introduction Coronavirus disease 2019 (COVID-19), the pathogen of which is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly infectious disease that broke out in Wuhan, China, in December 2019 and has spread to more than 200 countries.1 COVID-19 has been proven to be transmitted mainly through droplets and contact.2 The eye is also considered an important route of infection. According to reports published in recent years, the prevalence of myopia in China is now more than 80% of the population. Wearing of eyeglasses is common among Chinese individuals of all ages.3 However, since the outbreak of COVID-19 in Wuhan in December 2019, we observed that few patients with eyeglasses were admitted in the hospital ward. Therefore, we collected information on the wearing of eyeglasses from all inpatients with COVID-19 as part of their medical history and used the data to examine the association between wearing eyeglasses and COVID-19 infection. Methods This cohort study was approved by the ethics committee of Suizhou Zengdu Hospital, Suizhou, China, and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. Patients signed written informed consent and were not provided with any incentive or compensation to participate in the study. The study enrolled patients admitted to the hospital from January 27 to March 13, 2020, with the admission criteria of a diagnosis of COVID-19. The diagnostics and clinical classification of COVID-19 were based on the fifth edition of Chinese COVID-19 diagnostic guidelines.4 Throat swab samples were obtained from patients at admission and tested using real-time reverse transcriptase–polymerase chain reaction assays to identify COVID-19 infection. Patients were specifically asked about the reason they wore eyeglasses, the length of time that they wore eyeglasses during daily activities, and whether they wore contact lenses or had ever undergone refractive surgery. This information was recorded by the patients’ treating physicians while taking their medical history, starting February 4, 2020. Information on exposure history and clinical symptoms was extracted from the medical records. People who wore eyeglasses for more than 8 hours a day were defined as long-term wearers, and these people were considered to wear eyeglasses when socializing. To estimate the population myopia rate, we extracted data from the Research on Chinese Student Physique and Health Study,5 which recorded data from a survey about the physical and health status of Chinese students, organized by state educational institutions and the Ministry of Health of China in 1985. We used descriptive statistics to characterize the study sample. Results As shown in the Table, a total of 276 patients with COVID-19 were enrolled in the study. The median age was 51 (interquartile range, 41-58) years; 155 patients (56.2%) were male and 121 (43.8%) were female. Most patients with COVID-19 were moderately ill, with 14 (5.1%) severely ill. Common symptoms were fever (227 [82.2%]), cough (218 [79.0%]), and fatigue (141 [51.1%]). Underlying disease was present in 88 patients (31.9%), with hypertension the most common, accounting for 47 (17.0%) of all admitted patients. Thirty patients with COVID-19 wore eyeglasses (10.9%), including 16 cases of myopia and 14 cases of presbyopia. None of the patients in this study wore contact lenses or underwent refractive surgery. All 16 patients with COVID-19 who wore glasses for more than 8 hours per day had myopia, accounting for 5.8% (95% CI, 3.0%-8.6%), and the median age was 33 years. Their symptoms, underlying disease, and COVID-19 severity were not significantly different from those of other patients. The results from previous research5 showed that the mean rate of myopia among students aged 7 to 22 years in Hubei province was 31.5%. By 2020, these students were aged 42 to 57 years, which is close to the median age of our patients with COVID-19. The myopia rate of 31.5% is higher than the 5.8% among our patients with COVID-19. Discussion At the time of writing, this study was the only research, to our knowledge, to assess the association between wearing eyeglasses and COVID-19 infection. Our main finding was that patients with COVID-19 who wear eyeglasses for an extended period (>8 h/d) every day were relatively uncommon, which could be preliminary evidence that daily wearers of eyeglasses are less susceptible to COVID-19. Considering the prevalence of COVID-19, conducting a sample survey among the local population would have been difficult. Instead, we used data from a previous survey for approximate reference and comparison, although the age, region, and educational level of the students in that survey had some differences compared with our study population. We hypothesized that eyeglasses prevent or discourage wearers from touching their eyes, thus avoiding transferring the virus from the hands to the eyes.6 Studies have shown that normal people will involuntarily touch their eyes about 10 times per hour.7 Eyes usually lack protection, and an abundance of the SARS-CoV-2 receptor angiotensin-converting enzyme 2 has been found on the ocular surface,8 through which SARS-CoV-2 can enter the human body. SARS-CoV-2 may also be transported to the nasal and nasopharyngeal mucosa through continuous tear irrigation of the lacrimal duct, causing respiratory infection.9 According to available statistics, nearly 1% to 12% of patients with COVID-19 have ocular manifestations,10,11 SARS-CoV-2 was detected in tears or the conjunctival sacs of patients with COVID-19,12 and some ophthalmologists were reported to be infected during routine treatment.13 Therefore, the eyes are considered an important channel for SARS-CoV-2 to enter the human body.11 For daily wearers of eyeglasses, who usually wear eyeglasses on social occasions, wearing eyeglasses may become a protective factor, reducing the risk of virus transfer to the eyes and leading to long-term daily wearers of eyeglasses being rarely infected with COVID-19. Presently, many COVID-19 guidelines state the need to pay attention to preventing infections through the eyes,14 but most people only focus on wearing masks and home isolation, ignoring recommendations such as washing hands frequently and avoiding touching the eyes with the hands.15 The results of this study can be used as evidence of the importance of these 2 recommendations. Limitations Our study had some notable limitations. First, it was a single-center study with a small sample size. The numbers of patients who wear eyeglasses and long-term wearers were limited, which limits the extension of the results to a larger population, so our results need to be verified by large-sample multicenter studies. Second, the proportion of wearers of eyeglasses was based on data from previous literature and was not calculated from current local populations. Third, the myopia rate obtained in previous studies included a small number of people with myopia who did not wear eyeglasses. Information on these people was lacking and partly affected the integrity and validity of our data. Fourth, none of our research participants wore contact lenses, so the association between wearing contact lenses and susceptibility to COVID-19 remains to be studied. In addition, further studies are needed to clarify the reasons that wearing eyeglasses may decrease susceptibility to COVID-19. Conclusions Our study found that the proportion of inpatients with COVID-19 who wear eyeglasses for extended daily periods was lower than that of the general population, suggesting that daily wear of eyeglasses is associated with less susceptibility to COVID-19 infection. These findings suggest that the eye may be an important infection route for COVID-19, and more attention should be paid to preventive measures such as frequent hand washing and avoiding touching the eyes. Back to top Article Information Accepted for Publication: July 28, 2020. Corresponding Author: Yiping Wei, MD, PhD ([email protected]), and Jianjun Xu, MD, PhD ([email protected]), Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Min De Road, Nanchang 330006, China. Published Online: September 16, 2020. doi:10.1001/jamaophthalmol.2020.3906 Author Contributions: Drs Wei and Xu had full access to the study data and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Xu, Yiping. Acquisition, analysis, or interpretation of data: Zeng, Xiaolin, Junyu, Qiu, Yong, Song, Yiping. Drafting of the manuscript: Zeng, Xiaolin, Junyu, Qiu, Song, Yiping. Critical revision of the manuscript for important intellectual content: Zeng, Yong, Xu, Yiping. Statistical analysis: All authors. Obtained funding: Zeng, Xu, Yiping. Administrative, technical, or material support: Zeng, Junyu, Yong, Xu, Yiping. Supervision: Yong, Xu, Yiping. Conflict of Interest Disclosures: None reported. Additional Contributions: We thank the physicians who supported Suizhou Zengdu Hospital, Suizhou, China, in the fight against coronavirus disease 2019 for their contribution to patient management and data collection for this study. References 1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.  JAMA. 2020. doi:10.1001/jama.2020.2648 ArticlePubMedGoogle Scholar 2. Pongpirul WA, Pongpirul K, Ratnarathon AC, Prasithsirikul W. Journey of a Thai taxi driver and novel coronavirus.  N Engl J Med. 2020;382(11):1067-1068. doi:10.1056/NEJMc2001621PubMedGoogle ScholarCrossref 3. Chen M, Wu A, Zhang L, et al. The increasing prevalence of myopia and high myopia among high school students in Fenghua City, eastern China: a 15-year population-based survey.  BMC Ophthalmol. 2018;18(1):159. doi:10.1186/s12886-018-0829-8PubMedGoogle ScholarCrossref 4. General Office of National Health Commission. Diagnosis and treatment protocols for novel coronavirus pneumonia (trial version 5, revised) [in Chinese]. Published February 4, 2020. Accessed March 15, 2020. http://www.gov.cn/zhengce/zhengceku/2020-02/09/content_5476407.htm 5. Chinese Student Physique and Health Research Group. Research on Chinese Students' Physique and Health [in Chinese]. People's Education Press; 1987. 6. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1.  N Engl J Med. 2020;382(16):1564-1567. doi:10.1056/NEJMc2004973PubMedGoogle ScholarCrossref 7. Kwok YL, Gralton J, McLaws ML. Face touching: a frequent habit that has implications for hand hygiene.  Am J Infect Control. 2015;43(2):112-114. doi:10.1016/j.ajic.2014.10.015PubMedGoogle ScholarCrossref 8. Holappa M, Vapaatalo H, Vaajanen A. Many faces of renin-angiotensin system—focus on eye.  Open Ophthalmol J. 2017;11:122-142. doi:10.2174/1874364101711010122PubMedGoogle ScholarCrossref 9. Xiao X, Chakraborti S, Dimitrov AS, Gramatikoff K, Dimitrov DS. The SARS-CoV S glycoprotein: expression and functional characterization.  Biochem Biophys Res Commun. 2003;312(4):1159-1164. doi:10.1016/j.bbrc.2003.11.054PubMedGoogle ScholarCrossref 10. Guan WJ, Ni ZY, Hu Y, et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China.  N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032PubMedGoogle ScholarCrossref 11. Wu P, Duan F, Luo C, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China.  JAMA Ophthalmol. 2020;138(5):575-578. doi:10.1001/jamaophthalmol.2020.1291 ArticlePubMedGoogle ScholarCrossref 12. Seah IYJ, Anderson DE, Kang AEZ, et al. Assessing viral shedding and infectivity of tears in coronavirus disease 2019 (COVID-19) patients.  Ophthalmology. 2020;127(7):977-979. doi:10.1016/j.ophtha.2020.03.026PubMedGoogle ScholarCrossref 13. Lu CW, Liu XF, Jia ZF. 2019-nCoV transmission through the ocular surface must not be ignored.  Lancet. 2020;395(10224):e39. doi:10.1016/S0140-6736(20)30313-5PubMedGoogle Scholar 14. World Health Organization. Coronavirus disease (COVID-19) advice for the public. Updated June 4, 2020. Accessed April 1, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public 15. Machida M, Nakamura I, Saito R, et al. Adoption of personal protective measures by ordinary citizens during the COVID-19 outbreak in Japan.  Int J Infect Dis. 2020;94:139-144. doi:10.1016/j.ijid.2020.04.014PubMedGoogle ScholarCrossref

Comment Journal of the American Medical Association Ophthalmology September 19, 2020 Eye Protection as an Essential Part of PPE. Gary Ordog, MD, DABEM, DABMT | County of Los Angeles, Department of Health Services, (retired) Thank you for the informative study. First, in response to a previous question, the methodology is stated to include direct questioning about eyeglasses, also in my experience, the direct questioning of patients upon hospital admission includes the use of eyeglasses, dentures, prostheses, pacemakers, etc. which would make this information readily available on admission documents. So this set of data seems plausible. The validity of matching of the experimental with the control group is more questionable. Nevertheless, the results show a very strong association in the protective action of eyeglasses against SARS-CoV-2, and in conclusion would support the use of eye protection in PPE use. The preferred PPE should have eye protection that prevents "touching" and direct air flow to the eyes. Also, there may be other confounding variables that are causing this strong association, for example: 'further investigation could show that eyeglass users frequently clean the glasses with sterilizing wipe, thus presenting a chemical shield to the virus.' Again, thank you for your work, and as usual, further study is required. Stay safe with eye protection. CONFLICT OF INTEREST: None Reported

Thank you and stay safe. Thank you for your support. Gary Ordog, MD.

Update on Dr. Fauci's advice on September 22, 2020:

Gary Joseph Ordog added a reply:

September 22, 2020 Latest Dr. Fauci Update: Anthony Fauci calls 200,000 pandemic death toll 'sobering, and in some respects, stunning' CNN WASHINGTON, DC - JUNE 30: Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, testifies at a hearing of the Senate Health, Education, Labor and Pensions Committee on June 30, 2020 in Washington, DC. The committee is examining efforts to contain the Covid-19 pandemic while putting people back to work and kids back in school. Dr. Anthony Fauci on Tuesday said the US reaching 200,000 coronavirus deaths is "very sobering, and in some respects, stunning," while adding that Americans should trust medical experts despite at times conflicting signals from the highest levels of government. "The idea of 200,000 deaths is really very sobering, and in some respects, stunning," the nation's top infectious doctor told CNN's Sanjay Gupta during the Citizen by CNN conference shortly before the US reached the grim milestone late Tuesday morning. "We do have within our capability -- even before we get a vaccine, which we will get reasonably soon -- we have the capability by doing things that we have been speaking about for so long, Sanjay, that could prevent the transmission, and by preventing transmission, ultimately preventing the morbidity and mortality that we see." He mentioned measures such as frequent hand washing and mask wearing. Fauci said he is concerned about the country not having control of the virus' spread ahead of the winter season that could exacerbate it. "And depending upon your own social situation, indoors for you or another person may mean poor ventilation, poor air flow. And difficulty getting the kind of removal of anything that would lead to spread," adding that he'd like to see the US go into the fall and winter months "at such a low level that when you have the inevitable cases, you can handle them." "I don't want to really make this kind of a dark thing that 'oh, my goodness, it's inevitable that we are going to get into serious trouble,'" he continued. "We can't throw our hands up and say, 'It's hopeless, it's going to happen anyway.' That is unacceptable to take that approach. On the other hand, it's not acceptable to not realize that we are entering into a risk period and we've got to act accordingly as we enter into that risk period." President Donald Trump had praised his administration's response to the pandemic on Monday, telling "Fox & Friends" that "we've done a phenomenal job" and giving himself an "A+" on how he has handled the virus. Fauci, answering a question Tuesday from a viewer on what grade he would give Trump's pandemic response, said, "Take a look at the numbers and make up your own mind." "I mean, you know, we don't need a sound bite from me. Take a look at the numbers," he said. On Monday, the US Centers for Disease Control and Prevention abruptly reverted to its previous guidance about how coronavirus is transmitted, removing language about airborne transmission it had posted days earlier. The move added to confusion about the virus spurred by mixed messaging from the White House on preventative measures and mask wearing. Many doctors and researchers have also cautioned for months that the virus can be transmitted through small airborne viral particles. Asked where people should get trusted information about the virus, Fauci said Tuesday, "they need to get it by following the scientific data and the scientific evidence." "The fact is you've got to go with the scientific data," he said. "One of the things that the public needs to understand is that this is an evolving situation and the people who say, 'Well, how can I trust anybody because things change,' what changes is the fact that we are in an evolving outbreak. And the things that we did not know a few months ago allowed us to at the time use the scientific information to make recommendations that were appropriate at the time and because the data were telling us at the same time. As we learned more, things changed. It's appropriate to make changes in recommendations based on the additional knowledge that you know." He (Dr. Fauci) also said one can assume "that some aspect of transmission can be and is by aerosol" and said "it doesn't change anything that we have been saying: It means wear your mask." This story has been updated with additional comments from Dr. Anthony Fauci.

Please also consider this:

Update: Proof that PPE, including masks, works in the hospital among healthcare workers, with nosocomial COVID-19.

This partly answers the question. PPE in hospital works.

September 25, 2020

What Is the Incidence of Nosocomial COVID-19?

Carlos del Rio, MD reviewing Rhee C et al. JAMA Netw Open 2020 Sep 9

With rigorous infection control measures implemented, nosocomial COVID-19 is a rare event.

During the height of the pandemic in Boston, hundreds of patients were admitted to hospitals for COVID-19. Investigators studied patients at one Boston hospital who were diagnosed with COVID-19 on hospital day 3 or later or within 14 days after discharge to assess the risk for nosocomial acquisition of SARS-CoV-2. Measures implemented for infection control evolved over time but included screening for symptoms; testing for SARS-CoV-2; dedicated COVID-19 units with airborne isolation rooms; personal protective equipment; universal masking of staff and, later, patients; and visitor restriction.

Between March 7 and May 30, 2020, of the 9149 patients admitted, 697 (7.6%) were diagnosed with their first episode of COVID-19. Median length of stay was 7 days. Of the 697 patients, 12 (1.7%) were first diagnosed on hospital day 3 or later. The median time from admission to diagnosis was 4 days. After review of their records, the investigators classified these 12 patients as definitely community acquired (4), likely community acquired (7), or definitely hospital acquired (1). Among the 8370 patients discharged from the hospital during the study period for non-COVID conditions, 11 (0.1%) tested positive for SARS-CoV-2 within 14 days after discharge. Of these, only one case was thought to be hospital acquired.

COMMENT

Multiple studies have raised the alarm about nosocomial transmission of COVID-19. This study demonstrates that a well-implemented infection control program — one that includes routine testing of all admissions, serial testing of patients with clinical syndromes suspicious of COVID-19, universal masking of staff and patients, and limiting visitors — is effective in making hospital-acquired SARS-CoV-2 a rare event. For the foreseeable future, hospitals should continue to make these interventions part of their standard of care, much like universal precautions became standard of care after the emergence of HIV in the 1980s, and work with employees so that “battle-weary” staff don't let their guard down, as recently occurred at the exact same hospital where this study took place. Such incidents notwithstanding, patients need to be reassured that contracting COVID-19 is unlikely in a hospital or clinic where infection control measures are enforced.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Carlos del Rio, MD at time of publication

Consultant/Advisory BoardInfectious Diseases Society of AmericaGrant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug AbuseEditorial BoardsClinical Infectious Diseases; JAIDS: Journal of Acquired Immune Deficiency SyndromesLeadership Positions in Professional SocietiesInternational Antiviral Society–USA (Board of Directors); American Conference for the Treatment of HIV (Board of Directors)

CITATION(S):

Rhee C et al. Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. JAMA Netw Open 2020 Sep 9; 3:e2020498. (https://doi.org/10.1001/jamanetworkopen.2020.20498)

Carlos del Rio, MD

So this would imply that as there are very low nosocomial COVID-19 infections, that the staff are getting infected outside of the hospital. Again, speaking for better protection outside of the hospital, in the staffs' personal lives, to decrease the infection rate in hospital workers. Thank you and stay safe, Gary Ordog, MD