Give No Fucks

I decided to have that made into business cards and simply pass them out anytime I have an encounter that crosses the line into aggression. I am exhausted trying to please, pretend, ignore or avoid the endless stupidity, rudeness and lack of tolerance by others. This was always a part of society but the pandemic put the accelerator on full when it comes to the issue of public versus private. We can assume that when we are in public settings there are protocols and expectations but those are often not mutually agreed upon, have differences between cultures and can be hard to maintain when again you are not all in agreement about said behaviors and expectations. A good example is walking down the street, it used to be said to walk to the right and watch at corners for crossing lights, traffic etc. The birth of the magical 3×5 card has made that a complete non-existent rule and is why now I see on corners literally pasted on lights, notes on how to cross. Are you fucking kidding me? This is taught in grade school, reinforced by parents and well over time etched into one’s brain. Now I frequently cross against lights but that look both ways guide plays into that and that I boogie regardless, I do not leisurely cross a street, ever.

But today we also have a narc or cancel culture that has crossed the line to obsessiveness. Watching or caring about others behaviors seem to some to be a full time job and I wonder how you are “living in the moment” when you are monitoring everyone else’s behavior. This is why even before the pandemic I rarely subbed in Elementary Schools, the need to tattle to be the hall monitor among the little people is deeply annoying. I know that in fact is a way of reinforcing and cementing what they have learned about expectations and rules but to an Adult who is not in the business of teaching those it is annoying. I was telling the Barista at the coffee shop about how I see children, like annoying co-workers whom I have to tolerate on a daily basis. They just happen to change out like the great resignation where you barely know them and then they quit but a new crew of equally annoying ones are just outside waiting to come in. Kids are annoying and germ carrying and despite all the bullshit about schools being safe, they are not in so many ways when it comes to transmitting disease. Funny how now schools are the lifeblood of the community when a few years ago they were responsible for ignoring bullying and of course violence that became school shootings. Have not heard one single word about that last one? No cause then it cancels the message that schools are safe. Are they? The perpetual conundrum, it is like living in the South where they say one thing, promptly ignore that and do an completely different thing. No it is not hypocrisy to them, it is a way of life. I never got used to it and never will. If anything I am a straight shooter, no pun intended.

Then we have the new Covid protocols and rules which seem to change on a daily basis, thanks to the ineffectual messaging of the CDC. The one thing certain regardless of the Administration in charge, this is one agency determined to remain utterly useless. And yet I hear so many citations and quotes you would think it is Moses come down from the Mount every time Fauci speaks. I have been quite clear in my distaste and distrust of this man since the days of AIDS and he has done little to change my mind. But to white people he seems to be their deity. There are others, you just have to turn off the TV and read some.

So far I have not been wrong yet about Covid. Again this comes from being in schools, teaching seventh-grade science enough you learn a thing or two. Virus have different R Factors and different times of airborne lifespan. In the early days the CDC was certain it was only droplets that led to the spread and that they could travel six feet. I went to a production of Assassins (an oddly prescient musical by Stephen Sondheim that addresses gun violence and the need to be infamous over preserving Democracy…hmmm) and there I could literally see the spit, droplets coming from the mouths of the cast. They flew about a foot. Try spitting let me know. But right there in a small theater for over one hour and half that would have been a close call for superspreader event for all the cast and those sitting in the front row. Again liquid turns into gas that becomes what? Airborne. But the issue is how long does it survive in air? And finally a study was made, it breaks up in about 5 minutes. There is something to know! I was row two and I recalled the Teacher who transmitted Covid, maskless to her students all in the front row during story time. And then the virus (via the now newly infected students) moved literally down row by row. And that again is easy, that happened over the course of the day, through the biggest event of children in a school day – lunch. A table of four children in a cafeteria, one student is pos, the other three will follow. And with this new variant that is a given. 1:4. Old covid 1:3.5 and kids shed faster thanks to smaller nasal passages. And then they go home and share away. One mother in the Washington Post told the story of her son and how he brought home a special treat from school. The entire family of 4 had covid and he was the only one not vaccinated but he like his family were lucky. Note that schools are safe. Sure they are… not.

But regardless of where I sit now in theater I wear a KN95 mask which has a 2.5 hour staying time for infection contraction if NO ONE is wearing masks and the theater require those so I assume they are all garbage and go from there. That is all I need to know and the type of mask and the length of time in presence of an infected person is 15 mins for no mask up to 25 hours in KN95. So if you are running to the store and you are masked even in cloth and the room is varied in type or lack of mask, you have 30 minutes to complete your task. Again type and time matter. That has never changed. In the beginning I went everywhere in a cloth mask with a 30 minute clock to finish the job. And I kept moving. I have changed that now with the theater but the mask has changed. I wear KN95 in schools and I keep windows open as that ventilation issue has not changed either. And now in the gym with others I avoid it but windows if possible or a K95 but frankly working out at three am is fine by me. That has NOT CHANGED.

I am fortunate I don’t live with anyone and my largest risk is where – in the schools. Mask wearing inconsistent, vaccines inconsistent, ventilation inconsistent and the number of bodies roving in and out, constant. And with that being in the public settings. I don’t congregate and find a bar or restaurant where it is me and few others. and yes they exist. I had a Champagne at the Wolfgang Puck’s the other day and it was me and a man seated on the far other end of the bar. That is the way I like it. How long was I there? Less than 30 minutes that much I am certain.

As for New York handling the Covid surge? As they always did, oblivious. Now the spread is rising in the wealthier areas as they believed that rule that they made up that they were impervious to the disease and the vaccine protected them. Sure, whatever. The Cognitive Dissonance exhibited by many New Yorkers, largely the wealthy and white is astounding. They have a sense of entitlement that belies a privilege that enables them to live in one of the world’s expensive cities and regardless of their own net worth they exude an arrogance that Southerner’s would be proud to call their own. They are just missing that level of ignorance that the South has cornered. You cannot live in a major urban city and be that bereft of some intellect but New Yorker’s are not exempt from that at all. That is why the city is often attributed to being the rudest. And yet Southern Hospitality is not all that either but few have lived in both and with that I have this thing called perspective and with that I call it as I see it. So the cards on are on the way and it will save time in trying to have a conversation that leaves me lacking. I recall that from my days in Nashville and I have no desire to repeat them here. For what it is worth I am glad to be living here versus anywhere else.

Fluing around

I have never waivered in my belief that Covid is a stronger version of the Flu mixed in with Whooping Cough. Flu transmits at a 1:1 ratio with Whooping Cough 1:4. Covid 1:2.5 in other words two or in the cases of high viral loads that can extend to a third. So a family of four, that would be the two adults and one child. And the asshole who exposed me that day confirmed it when he made a pit stop for takeout on the way to testing. Thanks for telling me you had asshole. Well you did a year later.

As I look back on the varying reports and studies I stumbled on this about the Flu and I share it with you. Note the date: July 2020. At that point they were starting to accept the belief that it was aerosols (aka your breath via speaking, singing or even heavy breathing) was a transmission factor over that of droplets… the insane notion that led us to wash down packages. Yes if the person handling them had just coughed or sneezed on it, then tossed it to us and we in turn wiped our faces sure. Or worked in say a lab experimenting with viruses and walked out with some RNA on our shoe and then into say a market and walked into blood and that in turn touched an animal or food product that was then consumed. Sure I see that. I like this explanation of how RNA transmission works. Ever wonder how that bat got out the lab, well he might have been Bat Boy versus Batman. Or maybe they let him out for a walk and he got away!

We will never know the origin of Covid-19 and that debate will go on forever. But understanding the Covid virus should enable you to manage your behavior and in turn alter those that put you at risk if you decide to be the anti vaxxed crowd. The issue at hand is how long the virus lasts in the air and here they put the flu at 3 hours. That seems to be again a vague number as if a room is ventilated, air is circulated that may lessen how long it lingers and as Covid is so similar that then Covid is now top 10 on the list of fuck all viruses. To put in into perspective, Measles lingers for 2-3 hours. This is when I go FUCK! But that may explain the tear through Nursing Homes, Meatpacking plants and of course Hospitals. But again this is the issue of viral load and that first 72 hours I again believe is when one sheds the virus. For adults I think it is higher and for children it again is like the Flu, a load of 1:1. So many people don’t think Children get it, they do and they were not tested nor treated in hospitals only the kids who had the random serious kind. Again folks less than 10% of all Covid POS people went to the hospital and they almost all had a preexisting condition – from smoking to being overweight.

So expect another uptick in POS tests post Memorial Day as the two twains shall meet. The anti and the pro vaxxer and there will be some crossover as the variants and the sheer lack of coverage by the J&J folk. Good luck and have fun on that picnic.

The Flu May Linger in the Air, Just Like the Coronavirus

As scientists race to understand how coronavirus aerosols may spread indoors, a new study on influenza offers some clues.

The New York Times July 14, 2020 By Katherine Wu

The coronavirus is not the flu. But the two viruses have something crucial in common: Both have been described as spreading primarily through close contact with symptomatic people or the surfaces they’ve touched.

Mounting evidence may be starting to turn the tide on that message. Last week, the World Health Organization modified its stance on coronavirus transmission, acknowledging that the virus may also hop from person to person by lingering in the air, trapped inside tiny aerosols that can traverse the length of room.

A wealth of evidence has shown the same is true of flu viruses, which also attack cells in the human airway. Researchers have even isolated infectious flu viruses from exhaled breath. But examining the relative contributions of different modes of transmission — whether through contaminated surfaces; tiny aerosols; or large, liquid-laden droplets expelled by coughs or sneezes — remains a daunting task for experts in the field.

“We’ve been studying the flu for 102 years and still don’t know for sure how it’s transmitted,” said Dr. Don Milton, an environmental health researcher and aerosol transmission expert at the University of Maryland.

A new study from Dr. Milton and his team, published Monday in PLoS Pathogens, contains some of the latest data supporting an aerosol route for the flu. The researchers deliberately infected 52 volunteers with a strain of influenza, a setup called a human challenge trial. They then had these “donors” mix and socialize with 75 healthy “recipients” for four days to test how often the virus got passed to others.

Under these conditions, Dr. Milton and his colleagues expected the virus to spread to several of the recipients. That was certainly the case when his colleagues, also authors on the new paper, ran a pilot study in another group of volunteers under similar conditions in 2009: After just two days of bunking up, about 8 percent of the recipients were infected.

In this new experiment, the researchers doubled the number of days the study participants were allowed to mingle. But they found only one new case of flu among the 75 volunteers who hadn’t been intentionally dosed with the virus — an infection rate of just 1.3 percent.

The biggest difference between the two experiments, Dr. Milton said, was their backdrop. In its first iteration, the study took place in poorly ventilated hotel rooms; in its second, the researchers housed their participants in a research facility with much improved air flow. In the new study, “we had at least seven times more ventilation per person,” he said.

A multitude of factors, such as past exposures to infection, can influence a person’s vulnerability to a virus. But “the fact that they only had one transmission event, compared to what the pilot study suggested, indicates that ventilation is important,” said Linsey Marr, an aerosols expert at Virginia Tech who wasn’t involved in the study.

Editors’ Picks

While good ventilation can dilute aerosols, it is far less effective against droplets, which are much wider and heavier — in the same way that a passing breeze would perturb the trajectory of a Ping-Pong ball, but not a cannonball.The Coronavirus Outbreak ›

The study points to a more “important role” for aerosolized flu transmission than some might assume, Dr. Marr said.

Determining the exact size of that role, however, is another matter entirely. “It’s very hard to conduct these human challenge studies and separate the different modes of transmission,” Dr. Marr said. That problem applies across respiratory viruses, including the coronavirus.

Part of the problem is the continuum on which aerosols and droplets exist. Though they go by different names, the two categories really belong to the same group: globs of fluid that come in varying sizes. Blobs less than five micrometers in diameter are termed aerosols, which can exit the airway at the slightest breath and waft away; anything larger is a droplet, hefty enough to fall to the ground within a few feet of its source. The boundary between them is somewhat arbitrary, though generally speaking, the smaller the particle, the farther it travels.

When people expel fluid from their airway, it tends to manifest in a mixture, some bigger, some smaller and everything in between, said Seema Lakdawala, who studies influenza transmission at the University of Pittsburgh.

Even after they exit an individual, these fluidic blobs remain dynamic. Large droplets, for instance, can disperse or evaporate into little aerosols in midair. Others might scatter onto a surface or a hand, lingering for minutes or hours before encountering someone new. And the rates at which all these events occur can shift, depending on the force with which someone, maybe a loud talker, expels these droplets or the amount of air flow in an area, Dr. Lakdawala said.

“Everyone thinks transmission is a very binary concept,” she added. “The reality is that there is a continuum of aerosols.”

Still, researchers have come up with some truly innovative experiments to investigate transmission for certain viruses in the past, Dr. Marr said.

In the 1980s, researchers in Wisconsin dosed a group of male volunteers with rhinovirus, which causes the common cold, and sat them down for 12 hours of poker with their healthy counterparts. Some of the recipients, who were susceptible to new infections, were given large, plastic collars or arm restraints that kept them from touching their faces. In this setting, aerosols and droplets were likely to have been the most feasible route of transmission, Dr. Marr said. Though the study was small, its participants seemed to be infected at similar rates, regardless of whether they’d been restrained.

That experiment probably couldn’t be conducted today, Dr. Marr said. But perhaps a variant of it could help tease out some of the dynamics of flu or coronavirus transmission.

These studies grow more pressing as researchers home in on how long the coronavirus can persist while adrift in the air. In March, a study in the New England Journal of Medicine suggested that, under ideal laboratory conditions, the virus remained viable for up to three hours in aerosols; a more recent study, led by Chad Roy of Tulane University, found the germ’s longevity might be even more impressive.

There’s still a long way to go before scientists fully understand exactly how and when the coronavirus most easily spreads, Dr. Marr said. But recent events appear to have breathed new life into the study of aerosol transmission.

“I’ve been studying this for more than a decade,” she said. “In the last four months, I’ve seen a greater willingness to consider the importance of aerosols than I’ve seen in the last 12 years.”

Try Try Again

Funny once again I read and with reading comes knowledge and knowledge is power.  Today I looked at the Flu of 2017-18 and it killed more people than the current Covid pandemic. Again these numbers are fluid as we have no fucking clue if Covid killed them or that they died of another illness but due to Covid and the crush in hospitals, the lack of a consistent medical examination post mortem we may never know the true numbers.

CDC estimates that the burden of illness during the 2017–2018 season was also high with an estimated 48.8 million people getting sick with influenza, 22.7 million people going to a health care provider, 959,000 hospitalizations, and 79,400 deaths from influenza. For Covid that is 57,640 and of course is fluid.

I want a 9/11 commission on this whole Covid crisis as again I have never understood the numbers, the reality behind the White House denials, the ever changing landscape of protocols, the hysteria and fear mongering and of course when they knew and why they did nothing and still are actually doing nothing.

At my coffee shop this morning the discussion is always Covid and today I found out the owner of a local liquor store had Covid came in after having a few days off, felt better but was certainly not tested to insure he was negative, had no protective gear on to prevent transmission and staff went nuts.  Some quit and some filed complaints. What that means is nothing but okay then.  Who was his Doctor and did he not explain that the virus sheds until you are negative, not when you feel well?

And if we do in fact actually turn into a military state with regards to tracking, testing and tracing the hardest hit communities are the ones currently being hit, Black and Brown ones.  The absurdity of this is the new drug wars and of course education and information does not provide the resources that cash fines and jails do.  Good luck with this one.

Then we have the stupid, and by those I mean medical professionals who have decided for some nutty reason to come to New York and “volunteer” on the front lines and then go home with a souvenir of Covid.  Again nothing in Tennessee shocks me anymore.  So was anyone on the plane with him contacted? I doubt it.

Then my Barista told me another story of his friend in Cincinnati who has not left her home in over three weeks because she is afraid.  She lives across the street from a park and there have been endless playdates, basketball games and the like, no one socially distancing and wearing masks and is afraid. So much for Mike DeWine the forefather for this bullshit clearly he is like the rest of the Covid Brigade, full of shit.  But I do wonder why she has not left her home, is she going to the park? Well if the answer is no then what is the problem?  And it was like my fight with the idiot here in charge of Health Services who informed me that her neighborhood she had people congregating on the stoops not practicing social distancing and that is why the parks are closed.  Really what has that got to do with parks and there is already an ordinance in place that permits you to call Police to shut that down as affecting egress or public safety.  Did she get back to me on that? No.

So we are sure that Covid is flying around the air waiting to land on an unsuspecting victim to literally squeeze the life out of you. Well in some situations yes ask that Doctor about that and his seat mate or his wife. Did he hug and kiss her and the kids when he got home.  My favorite about that was he had never been home alone in his entire life for four whole days. WOW just WOW.

So once again this falls to personal responsibility, having knowledge, common sense and some way of tracking, tracing and knowing your contacts.   That is a challenge but if you are aware you can be proactive and still leave the house.   So I leave you with this before I go out to enjoy the day. Just be safe! Whatever that fucking means. How about be proactive and take care of yourself and respect yourself by modeling that and in turn respecting others by giving them space, boundaries and letting them do their thing out of your airspace.

Is the coronavirus airborne? Experts can’t agree
The World Health Organization says the evidence is not compelling, but scientists warn that gathering sufficient data could take years and cost lives.

Dyani Lewis
Nature
April 2 2020

Since early reports revealed that a new coronavirus was spreading rapidly between people, researchers have been trying to pin down whether it can travel through the air. Health officials say the virus is transported only through droplets that are coughed or sneezed out — either directly, or on objects. But some scientists say there is preliminary evidence that airborne transmission — in which the disease spreads in the much smaller particles from exhaled air, known as aerosols — is occurring, and that precautions, such as increasing ventilation indoors, should be recommended to reduce the risk of infection.

Covert coronavirus infections could be seeding new outbreaks

In a scientific brief posted to its website on 27 March, the World Health Organization said that there is not sufficient evidence to suggest that SARS-CoV-2 is airborne, except in a handful of medical contexts, such as when intubating an infected patient.

But experts that work on airborne respiratory illnesses and aerosols say that gathering unequivocal evidence for airborne transmission could take years and cost lives. We shouldn’t “let perfect be the enemy of convincing”, says Michael Osterholm, an infectious-disease epidemiologist at the University of Minnesota in Minneapolis.

“In the mind of scientists working on this, there’s absolutely no doubt that the virus spreads in the air,” says aerosol scientist Lidia Morawska at the Queensland University of Technology in Brisbane, Australia. “This is a no-brainer.”
Confusing definitions

When public health officials say there isn’t sufficient evidence to say that SARS-CoV-2 is airborne, they specifically mean transported in virus-laden aerosols smaller than 5 micrometres in diameter. Compared with droplets, which are heftier and thought to travel only short distances after someone coughs or sneezes before falling to the floor or onto other surfaces, aerosols can linger in the air for longer and travel further.

Most transmission occurs at close range, says Ben Cowling, an epidemiologist at the University of Hong Kong. But the distinction between droplets and aerosols is unhelpful because “the particles that come out with virus can be a wide range of sizes. Very, very large ones right down to aerosols”, he says.

And if SARS-CoV-2 is transmitting in aerosols, it is possible that virus particles can build up over time in enclosed spaces or be transmitted over greater distances.

Coronavirus tests: researchers chase new diagnostics to fight the pandemic

Aerosols are also more likely to be produced by talking and breathing, which might even constitute a bigger risk than sneezing and coughing, says virologist Julian Tang at the University of Leicester, UK. “When someone’s coughing, they turn away, and when they’re sneezing, they turn away,” he says. That’s not the case when we talk and breathe.

A study of people with influenza found that 39% of people exhaled infectious aerosols. As long as we are sharing an airspace with someone else, breathing in the air that they exhale, airborne transmission is possible, says Tang. *what kind of airspace, outdoors or indoors? ***What is the radius or square foot transmission rate, three or six feet, or no feet just sharing airspace in the world? 

The evidence so far

Evidence from preliminary studies and field reports that SARS-CoV-2 is spreading in aerosols is mixed. At the height of the coronavirus outbreak in Wuhan, China, virologist Ke Lan at Wuhan University collected samples of aerosols in and around hospitals treating people with COVID-19, as well as at the busy entrances of two department stores.

In an unreviewed preprint1, Lan and his colleagues report finding viral RNA from SARS-CoV-2 in a number of locations, including the department stores.

The study doesn’t ascertain whether the aerosols collected were able to infect cells. But, in an e-mail to Nature, Lan says the work demonstrates that “during breathing or talking, SARS-CoV-2 aerosol transmission might occur and impact people both near and far from the source”. As a precaution, the general public should avoid crowds, he writes, and should also wear masks, “to reduce the risk of airborne virus exposure”.  **in other words you are responsible for yourself and be smart and proactive or paranoid whatever works.

Another study failed to find evidence of SARS-CoV-2 in air samples in isolation rooms at an outbreak centre dedicated to treating people with COVID-19 in Singapore. Surface samples from an air outlet fan did return a positive result2, but two of the authors — Kalisvar Marimuthu and Oon Tek Ng at the National Centre for Infectious Diseases in Singapore — told Nature in an e-mail that the outlet was close enough to a person with COVID-19 that it could have been contaminated by respiratory droplets from a cough or sneeze.

A similar study by researchers in Nebraska found viral RNA in nearly two-thirds of air samples collected in isolation rooms in a hospital treating people with severe COVID-19 and in a quarantine facility housing those with mild infections3. Surfaces in ventilation grates also tested positive. None of the air samples was infectious in cell culture, but the data suggest that “viral aerosol particles are produced by individuals that have the COVID-19 disease, even in the absence of cough”, the authors write.**meaning that in a confined space there is a higher liklihood of transmission you know like hospital rooms, old folks rooms and jail cells.. or cabins on cruise ships, same diff. 

The WHO writes in its latest scientific brief that the evidence of viral RNA “is not indicative of viable virus that could be transmissible”. The brief also points to its own analysis of more than 75,000 COVID-19 cases in China that did not report finding airborne transmission. But Ben Cowling says that “there wasn’t a lot of evidence put forward to support the assessment” and, an absence of evidence does not mean SARS-CoV-2 is not airborne. The WHO did not respond to Nature’s questions about the evidence in time for publication.

Scientists in the United States have shown in the laboratory that the virus can survive in an aerosol and remain infectious for at least 3 hours. Although the conditions in the study were “highly artificial”, there is probably “a non-zero risk of longer-range spread through the air”, says co-author Jamie Lloyd-Smith, an infectious-diseases researcher at the University of California, Los Angeles.  *meaning we fuck all don’t know but hey that closed in idea applies like airplanes

Gaps to fill

Leo Poon, a virologist at the University of Hong Kong, doesn’t think there’s enough evidence yet to say SARS-CoV-2 is airborne. He’d like to see experiments showing that the virus is infectious in droplets of different sizes.

Whether people with COVID-19 produce enough virus-laden aerosols to constitute a risk is also unknown, says Lloyd-Smith. Air sampling from people when they talk, breathe, cough and sneeze — and testing for viable virus in those samples — “would be another big part of the puzzle”, he says. One such study failed to detect viral RNA in air collected 10 centimetres in front of one person with COVID-19 who was breathing, speaking and coughing, but the authors didn’t rule out airborne transmission entirely6.

Another crucial unknown is the infectious dose: the number of SARS-CoV-2 particles necessary to cause an infection, says Lloyd-Smith. “If you’re breathing aerosolized virus, we don’t know what the infectious dose is that gives a significant chance of being infected,” he says. An experiment to get at that number — deliberately exposing people and measuring the infection rate at different doses — would be unethical given the disease’s severity.

Whatever the infectious dose, length of exposure is probably an important factor too, says Tang. Each breath might not produce much virus, he says, but “if you’re standing beside [someone who’s infected], sharing the same airspace with them for 45 minutes, you’re going to inhale enough virus to cause infection”.

But capturing those small concentrations of aerosols that, given the right combination of airflow, humidity and temperature, might build to an infectious dose over time, is “extremely difficult”, says Morawska. “We could say that we need more data, but then we should acknowledge the difficulty of collecting the data,” she says.

Cautious approach

The assumption should be that airborne transmission is possible unless experimental evidence rules it out, not the other way around, says Tang. That way people can take precautions to protect themselves, he says.

Increasing ventilation indoors and not recirculating air can go some way to ensuring that infectious aerosols are diluted and flushed out, says Morawska. Indoor meetings should be banned just in case, she says.

Meanwhile, Lan and others are calling for the public to wear masks to reduce transmission. Masks are ubiquitous in many countries in Asia. In the United States and some European countries, however, health officials have discouraged people from wearing them, in part because supplies are low and health-care workers need them. The Czech Republic and Slovakia, however, have made it mandatory for people to wear masks outside the home. Tang thinks those countries have taken the right approach. “They are following the southeast Asia approach. If everyone can mask, it is double, two-way protection,” he says.

But Cowling thinks masks should be recommended for the public only after supplies have been secured for health-care workers, people with symptoms, and vulnerable populations such as the elderly.