Healthcare, Rural Living

Remember When ‘Fresh Air’ Was A Good Thing? I Do.

wind-blowingJournal of Public Health, written in 2015, and titled “The Open-Air Treatment of PANDEMIC INFLUENZA.” (No, I’m not shouting, the term is capitalized in the article title.) The authors seem competent, literate, rational and sane, and the details presented are many and compelling. Sources are painstakingly referenced and footnoted. It recapitulates the history, and efforts to control and treat, several global pandemics, including the 1918 flu outbreak. The concluding paragraph:

However, more might be gained by introducing high levels of natural ventilation or, indeed, by encouraging the public to spend as much time outdoors as possible. It might also be prudent to stockpile tents and beds, because hospitals in the United Kingdom, the United States, and elsewhere are not prepared for a severe pandemic. Temporary accommodation would be required to deal with the most seriously ill, just as it was in 1918. The Camp Brooks Open Air Hospital might serve as a useful model.

Over the course of the late eighteenth, and the nineteenth century, a collection of brave pioneers, both men and women, revolutionized medicine, and greatly improved outcomes, by introducing antiseptics, infection control procedures, cleanliness, and freshness to medicine, and by opening up hospitals and institutions to the concepts of “light” and “air.” And this, among several other common-sense ideas, is the model favored in the article, and recommended for the treatment of future respiratory-spread pandemics.

Somewhere in the last fifty or sixty years, in the interests of climate control, cost control, energy efficiency, and “safety,” that last innovation has gone away, and the environment in most hospitals (and other large buildings such as group homes and communal living facilities and office buildings where we live and work on top of one another) resembles nothing so much as an expanded version of the recirculating germ-fest of an airplane cabin, one where windows cannot be opened and the air goes round and round, blown through a series of filters that are changed, one hopes, as often as they should be, which, even if they are, probably isn’t nearly often enough.

The Abstract of the article reads as follows:

The H1N1 “Spanish flu” outbreak of 1918–1919 was the most devastating pandemic on record, killing between 50 million and 100 million people. Should the next influenza pandemic prove equally virulent, there could be more than 300 million deaths globally. The conventional view is that little could have been done to prevent the H1N1 virus from spreading or to treat those infected; however, there is evidence to the contrary. Records from an “open-air” hospital in Boston, Massachusetts, suggest that some patients and staff were spared the worst of the outbreak. A combination of fresh air, sunlight, scrupulous standards of hygiene, and reusable face masks appears to have substantially reduced deaths among some patients and infections among medical staff. We argue that temporary hospitals should be a priority in emergency planning. Equally, other measures adopted during the 1918 pandemic merit more attention than they currently receive.

A recent report on a local television station, Beaver County Nursing Home Presuming All 800 Residents And Staff Have Coronavirus, speaks of a home where about ten percent of the residents, and (at the time of writing) ten of the 300 staff, have tested positive, but they are treating the entire facility as if everyone has it. The result — total lockdown and isolation. Stay inside. Do not go outdoors. Do not pass “Go.” Perhaps the federal government will send you your $200. If you’re still alive, that is.

We seem to be going backward. And I wonder, when all is said and done, if anyone will have the bravery, the insight, and the honesty to admit that the closed and germy buildings we live in, particularly those we work in, and those many of us age in and die in, and even those we’re sent to for care when we are ill, have done more than their fair share to contribute to the misery we’re living through right now, as many of the establishments we trust to care for ourselves and our elders actually turn, pretty quickly, into cesspits of infection and disease. (Perhaps, another 100 years or so from now, someone will write an article making that point, looking at infection rates and viral spread among different populations in different parts of the country, and comparing outcomes from the field hospitals now being set up against those from the bricks-and-mortar establishments which were already in place. Perhaps.)

It’s disheartening enough to think in these terms. It’s truly depressing to read about snitches turning in their neighbors who are sunbathing in their backyards, or going for a walk by themselves or with a family member (it’s now a criminal offense to “exercise” outside the home more than once a day in Scotland–and there are guidelines as to what that means, and how long you’re allowed to be outside– a “walk of about an hour” seems to be the maximum permitted. Go out again, or stay out for longer, and you could be fined or jailed). I can’t wait to read about the first woman to call the police on the people living next door because they’re endangering their neighbors by opening their living room windows (when that happens, remember you read it here first).

What a stupid time we live in. That’s not my normal view of the world, but sometimes, one just has to acknowledge that stubborn fact.

I’m going for a walk. Outside. See you when I get back. I’ll decide when that is.

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