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Those of us who work in IT or who know a little bit about computers, will know that this is a rapidly disappearing technology. Spinning disk drives are being replaced in most consumer devices by Solid State Drives(SSD's).
Bit of a rush shot this week, have been helping eldest daughter with her GCSE work so no time for photography!
Week 12 - Disappearing Technologies
2019 / 2020
Silver gelatin lith print on Slavich Bromexpress-1 (1991)
Kodak D-9
Instagram: www.instagram.com/endingmirage/
Telegram: t.me/dazzlingvisions
My website: endingmirage.com
This is my entry to the Life Sized Accessory category of Space Jam 2019.
The Echo 3 is an item in Borderlands 3 that the Vault Hunter(playable character) always has with them. In the game, this device provides the HUD and menu system for the Vault Hunter, allowing them to keep track of their inventory, view their location on different maps, and document their missions.
The Echo device also has a slot to insert an Echo Cartridge, which the VH often finds scattered around the various worlds, containing valuable information on missions and characters.
I tried to replicate the Echo 3 as accurately as possible, and I think I did a good job. The only details I think I missed were the printed-on parts(like the Dahl logo) and the random bits of tape, which I have no way of producing in lego parts.
I hope you like it!
Today people spending too much time with their high technology devices so it seems like they live not with but "in" their devices.
Device iPhone6. Apps : SlowShutter, Brushstroke, Stackables and Alayer.
I took this photo in a coffèe bar very stylish and knows in Cagliari. The lights at inside are yellow and they contribute to creating a warm and relaxed atmosphere at the club.
PANASONIC Wiring Devices
MODERNLIGHT - JEDDAH - TEL#: 0126059596
#Modernlight, #modernlightJeddah, #modernlightksa
iss068e038127 (Jan. 5, 2023) --- NASA astronaut and Expedition 68 Flight Engineer Josh Cassada checks out and calibrates the mass measurement device that calculates the mass of biological research samples aboard the International Space Station.
I found out that all animals are related to the primal Zodiac so
Mantises have the Sun sign of " Aries " and are born during the Chinese Zodiac´s year of the Snake.
Have a look at the first comment if interested ,,,
Due to the lack of time to go out for shooting this theme´s week, I used this one taken on september /11.
,-)
better on L.
Volume 1 - Origin of Powerhouse: Issue #1
Flicker Fighters
It had been six months since Ben and his Mum had moved to Advent City. It was a big transition in both their lives moving from the Scottish countryside and into the big city. However, with his Mum being CEO of ‘Imagine’ he wasn’t surprised to hear she wanted to manage the company in person. Six months later, and Ben had only made one friend who he really liked, Connie. She was in the same college class as him studying Biomedical Sciences and she was also new to the city. They didn’t really have much in common other than that but, they both had the same personality and enjoyed one another’s company. They could talk about anything and always had a good laugh. Ben contemplated asking her out but he didn’t want to ruin such a good friendship and break the bond that they had, should anything happen. She was a total nerd for mech suits and it just so happened that the new branch opening in ‘Imagine’ was developing some. It was supposed to be kept a secret until their grand unveiling later in the year, but Ben knew Connie wasn’t exactly going to go around telling everyone. Therefore, he arranged to surprise her and set her up for a tour of his Mum’s company. She was more than excited for the day, and Ben struggled not to reveal the surprise. He planned to keep it for the end of the tour and then lead her through the storage facility, where the armoured suits are kept. Ben saw the suits and their designs, half of them were all ready to be showcased. However, his Mum planned to reveal them as a complete set on display once the others had been built. Ben was far too excited to show her the suits, so much so he was going to make her suspect something if he kept smiling like a lunatic.
Ben makes his way through the bustling crowd and is about to check his phone and ask where she is. She was supposed to be outside the main entrance. Although with the way he’s getting bumped about by the city crowd, he figures she got overwhelmed and went inside. She was probably chilling on her phone in a corner, the same thing he’d be doing to avoid the large crowds. He enters the building and there she is, exactly where he thought she’d be. As if she knows he’s watching, she looks up from her phone and smiles waving. They walk towards one another as she slips her phone back into her pocket.
Ben: “You ready for the best tour of your life?”
Connie: “Yeah, I got my camera ready like Peter Parker.”
Ben: “Well I can assure you there’s no radioactive spiders here. I asked my Mum to get some, but apparently it’s a ‘safety hazard’.”
The two shares a laugh and Ben begins to lead her through the tourist exhibits based on all of the new technology. Ben had heard about most of it when talking business with his Mum. Some of the projects were just frivolous crazy things for rich people with far too much money to purchase. Such as nanotechnology paint that allows you to decorate your room with micro robots. They can be remotely controlled to change colour, pattern, and even display images from the internet. Which meant you could paint a wall with these devices and have something different everyday. Then there were more useful pieces of technology for medicinal purposes. The kind of technology which would allow the replication of synthetic tissue and allow it to be ‘filled’ with a false but functional nervous system. It sounded like something from a Sci-Fi show. But that’s why the company was called, Imagine, they create technology that could only have been plucked from wildest of imaginations. Connie was overjoyed as Ben showed her some of the exhibits and the more excited she got the more he felt himself hurrying to show her the grand finale - the mech suits in storage.
Ben: “Come on, I got something cool to show you in the back. My Mum said as long as you keep it a secret and don’t take any pictures it’s okay.”
Connie: “Ooh, something top secret?”
Ben: “For the next year or so, yeah. Now come on, you’re going to love it.”
Ben leads her away from a bustling exhibit, he had to stop himself from pulling her to hurry. He knew she was going to love seeing these suits, she loved that sort of thing. She was a nerd just like him when it came to this stuff. As they are making their way through the crowd Ben turns, beaming a smile. However, someone in the building screams from just down the corridor. The overlapping conversation of the crowds around them fall silent. The scream echoes up the corridor, soon followed by other terrified shrieks. A large crashing sound causes a tremor to quake throughout the exhibit. People begin to murmur amongst themselves and others start to make their way to the exits.
Connie: “What the hell was that?”
Ben: “Um, I’m not sure. We should probably-“
An automated female voice blares from the speakers in the roof, “Emergency! Emergency! Everyone please evacuate the building in a calm and orderly fashion.”
Everyone begins pushing and shoving as they stampede towards the exits. Connie gets shoved to the ground by a larger man who doesn’t bother to look her way as she cries out. Ben yells in protest and struggles to make his way through the sea of panicked people to get to her. He loses sight of her as she’s engulfed by the mob. He knew she was on the floor, probably getting trampled on by all these people. They were scared but so was she, she was probably hurt as well. It was like the videos he had witnessed on Youtube of people going nuts over deals on Black Friday. Doing anything they can to be the first ones in the door - or in this case, out of the door. Eventually, the numbers of the crowd thin out and he sees Connie curled up in a ball on the floor, in a foetal position. Ben rushes towards her as the automated voice continues to repeat the order to evacuate. He kneels beside her and places his hand on her shoulder, she is trembling.
Ben: “Connie, we gotta get out of here.”
She doesn’t say anything and uncurls herself hesitantly. Ben’s heart sinks as he sees boot imprints on her hands and broken finger nails from being trampled on. Her cheek is red and swollen and her lip is busted in the centre. He forces a reassuring smile and lifts her to her feet pulling her towards the exit. Only to feel the building shudder with another tremor. Debris leaks from the ceiling and Ben looks up seeing a crack tear it’s way through the ceiling. His eyes widen and he continues to haul Connie to the exit. The building shakes one last time and the fracture in the ceiling pries apart. Chunks of rubble and debris rain down in front of him crashing against the ground, just inches away from them and blocking the exit. Ben begins to panic but remembers the emergency exit down the corridor. He turns and holds up Connie as she stumbles alongside him. As they make their way down to the corridor he hears something. At first he thinks it’s another tremor but no, it’s more structured with its sound - coordinated. They were footsteps. Loud, thundering footsteps from just one set of feet. Whoever it was, they were big or wearing steel boots and they were heading right for them.
Ben: “Something tells me that isn’t someone coming to help.”
guess who got a new mobile device with a camera?!?!........I did! :-D
after seeing all of the amazing work people were doing with the iPhone, I had to get one. I have officially joined the Hipstamatic (iPhoneography) revolution. I love it...it's great fun! I don't think it'll replace any of my standard photo equipment though...instead I will use it to supplement my arsenal. it's much easier to have with me at all times.
it's also great having a library of pre-made effects, but like with many aspects of my life...I prefer more control. in the meantime, I'm having a lot of fun with the random feature.
below are a few of my favorite iPhoneographers from whom I have drawn inspiration. not only are they great photographers in their own right, but they have proven to me that in proper hands, the iPhone is a legitimate camera and editing device - capable of creating beautiful and compelling photographs.
jq gaines: www.flickr.com/photos/jqgaines/
BLACK EYED SUZY: www.flickr.com/photos/62193851@N07/
that robyn girl: www.flickr.com/photos/thatrobyngirl/
keenemomma: www.flickr.com/photos/58066769@N05/
Over 100 years ago this was a bakery, turned bait shop in the 60s and later becoming a bbq restaurant. The building was built without a bathroom so at some point a bathroom/outhouse was built onto the end of the building (left side of the building).
Night, near full moon, behind heavy cloud cover, 120 second exposure, handheld light producing device set to aquamarine & orange with a large streetlight to camera left.
Click on the image because its best BIG ON BLACK!!!!
"Device to Root out Evil" is a public art sculpture of an upside-down church by Dennis Oppenheim.
For information, visit here:
www.vancouverbiennaleclassroom.com/artists/artist.php?id=12
This sculpture is located in Harbour Green Park facing Coal Harbour in Vancouver.
Visiten micamara.es/isla-de-mallorca/ para conocer la isla de Mallorca
Y otrosos países del mundo en micamara.es/
(Knock! Knock!)
”Who’s there?”
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Walter Newell, an oceanographer and engineer based in New York City. Yeah, New York, the home of every generic and clichéd superhero story. Well guess what? Buckle up as you’re in for the ride of… well… another one of those stories. Walter Newell, like many scientists that have come and pass has begun creating a device that promises to be a “step in the right direction” in his field of science. Have you heard that one before?
Thought so.
Here’s some generic backstory to get you caught up to speed:
All his life, Walter has been fascinated with the ocean. He was intrigued as a young boy by the movies that depicted the creatures that roamed the deep blue abyss. The thing that stood out the most was the fact that there was so much about the ocean that has yet to be discovered. When new findings would emerge he would be jealous of those men and women that were lucky enough to be there. So, he did everything he could to ensure his future as someone that would become famous making new discoveries about the ocean. He read, watched, and studied everything he could about the ocean.
With his head full of, figuratively, everything one could know about the ocean he applied to the best school that had the very program he knew would get him a job with a major company. His goal was a company that stood out to him. This company had shown interest in almost anyone that would show up at their doorstep with an idea to give to them. Well that was if you wanted to make an advancement in technology. Walter had poured over this for the years and years he spent in college.
Now before we get to that, we’ll need to visit a girl. This girl was anything but ordinary. Her name was Diane. She loved the ocean as much as, if not more than, Walter. The two rivaled each other with every assignment they were given. They always had identical test scores and were co-valedictorians as they graduated. In the following months after they’re graduation, they began to date. This moved quickly as Walter asked Diane if she would like to help him with his project. Without hesitation, she said yes. So, they began working on something that would be sure to set them apart from anyone else trying to get a job at…
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
“Advanced Idea Mechanics?” Diane asked.
”Yeah, I’ve heard a lot of great things about them.”
“Alright. Let’s do this!”
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It took them a little over a year to fully develop a reasonable idea. They took their idea to Advanced Idea Mechanics and got enough funding for a prototype. During the building time, Walter proposed to Diane and they were set to marry the next summer. With everything coming up in spades, Walter felt like he was finally making a name for himself. His once rival was now his best friend and fiancé. His passion turned into his job and without his knowing, there was another surprise that Diane was hiding from him until they finished their prototype.
A few months after they had begun, Walter and Diane had a finished prototype of their idea. A suit that would allow divers to go even further than a submarine could. This suit, with modifications they had planned if they got funding to make a second version, would be able to aid the diver in swimming faster and breathing fresh air longer. All of this had the organization’s head, Mister Benton, very intrigued. So much so that he granted them a green light on the project. So with the necessary funding, material, and extra hands, the duo began planning the development of the…
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
“’Project Stingray’.”
”Why Stingray?”
“I’ve always had a love of the creature. They’re very much so like humans. Each has their own personality and their own distinct features. Stingrays are remarkable beings.”
”Alright, let’s do this.”
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The team focused on building one suit to showcase that they could indeed make this thing a reality. While this was going on, Diane let Walter in on a little secret she had kept from him for almost a month. This was the fact that she was pregnant. Walter became overjoyed and ran through the building’s corridors screaming and jumping for joy. He was happier than he had ever been… unfortunately, happier than he would ever be…
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
“The Stingray suit, built to last in the depths of the ocean. The world record for the deepest human dive is just over a thousand feet, and with the aid of this suit you can go double or even triple that. The lightweight material this armor is made of can survive the extreme pressures of the deep blue.” Diane says as she unveils a red and black diving suit. She looks over at her boss and smiled as his mouth was wide open in shock.
“That’s impressive. We know that for sure?” Mister Benton replies with slight concern.
“Well…” Diane begins to speak but is cut off by Walter.
”Well we’ve yet to test it, but there’s a very slim chance that our calculations are off.”
“I want it tested before I pitch this to the board.” Mister Benton turns around and walks out of the lab.
“Alright, let's do... (cough! Cough!)” Diane walks over to a table while suffering a coughing fit.
”Are you okay?” Walter says as he places his hand on his fiancé’s back.
“Yeah, it’s just my... (cough!)”
”We’ve got to get you home.”
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
”So that’s why I’m doing this.” Walter said to his boss with a muffled sigh.
“Doing what?” His boss quickly answered.
”Why I’m leaving.” Walter took a deep breath as he held back tears. ”I’m taking an early leave to be with my wife. She’s dying and I need to be with her.”
“Y’know you can still work here, right?” Benton says as he stands up from his chair and walks over to the side of the desk Walter sits at.
”I know.” Walter looks down at his shoes. ”I just want to be with her right now.”
“I understand. Listen, if… when you want to come back, you’ve got your job.” Mister Benton outreaches his hand and smiles as Walter takes his hand and shakes it firmly.
”Th-thanks.” Walter says as he gets up from his seat and makes his way to the door. He pauses just before the door and turns around as Mister Benson speaks.
“Good-bye, Mister Newell.”
”Good-bye.” Walter opens the door and leaves. He begins his drive back to his house to be with his newborn child and his ill wife. Just as everything began to feel right, it all went wrong…
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
”Take his wife. That’ll give him reason enough to continue his work.”
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
(NOTES:)
"Who the heck is Stingray?" You may be asking. Well, that's a fair question. I'll tell ya who he is.
He's a character that I think doesn't get as much love as he could. Sure he showed up in Deadpool's "heroes for money" run, but I wanted to show him some real good love. Perfect explanation, right? Thought so...
I actually planned to introduce him in Deadpool but since I dropped Deadpool I decided I would make him my new role (hopefully).
So I hope y'all enjoy this and I hope I get the role. :D
Occupying a prominent position overlooking the Solent at the entrance to Southampton Water, Calshot Castle is an artillery fort
(a Device Fort) constructed by Henry VIII on Calshot Spit, Hampshire, England, between 1539 and 1540, suspected to have been constructed using stone from the recently dissolved Beaulieu and Netley Abbeys.
The castle finally closed in 1961 after a variety of uses, and is now cared for by English Heritage.
The window openings give an idea of the thickness of the walls.
2Jan2025
Visiten micamara.es/isla-de-mallorca/ para conocer la isla de Mallorca
Y otrosos países del mundo en micamara.es/
History: A product of the pride of the Predecessors, Project: Avalon is the first successful attempt at creating a synthetic life form. Unit-7 was built by the Predecessors to wield the Distortion Engine, a device that can bend the fabric of reality. Avalon, as she prefers to be called, was programmed to serve Diaa in the Predecessor-Conduit war on Okoto. Following Diaa's fall, Avalon was temporarily deactivated, but Diaa reactivated her once he returned to Okoto. Now, she works for Diaa as he seeks revenge on Okoto.
Personality:
Although she was programmed to be an emotionless killing machine, Avalon possesses a pure soul. Even after years of being used as a living weapon, she is naive and innocent at heart. She is not particularly evil; she has merely been misguided by Diaa. She has even showed the capacity to care for eithers, as is exemplified by her friendship with her partner, Ryylem. The disparity between her soul and her intended nature and her inability to fully tap into the Distortion Engine's power led her creators to build her siblings, Unit-8 Echelon and Unit-9 Paragon.
Abilities: Avalon is an incredibly capable fighter, able to defeat even Ahi and Gaxello in combat. Her synthetic body is quite strong, and her programming gives her a proprensity for tactics and strategy. Her levitation gear gear grants her great mobility and agility on the ground and in the air. The Caliburn blades are versatile weapons that can be mounted on her shoulders as guns, or can be used as katanas. Her most useful tool is her Distortion Engine which she carries on her back. She can use this device to bend reality around her, allowing her to deflect attacks. She can also use her engine offensively by combining it with her Caliburn blades to form Excalibur, the Distortion Blade.
Note: The only known individual to defeat Avalon is Krona.
Phonsavan, Laos 2008
Laos has the dubious distinction of being the world's most heavily bombed nation. During the period of the American Vietnam War, over half a million American bombing missions dropped more than 2 million tons of ordnance on Laos, most of it anti-personnel cluster bombs.[32] Each cluster bomb shell contained hundreds of individual bomblets, "bombies", about the size of a tennis ball. An estimated 30% of these munitions did not detonate. Ten of the 18 Laotian provinces have been described as "severely contaminated" with artillery and mortar shells, mines, rockets, grenades, and other devices from various countries of origin. These munitions pose a continuing obstacle to agriculture and a special threat to children, who are attracted by the toylike devices.
Some 288 million cluster munitions and about 75 million unexploded bombs were left across Laos after the war ended. From 1996-2009, more than 1 million items of UXO were destroyed, freeing up 23,000 hectares of land. Between 1999 and 2008, there were 2,184 casualties (including 834 deaths) from UXO incidents. - Wikipedia
First York operated battery-electric Wrightbus StreetDeck Electroliner MF23 ZWJ - 36520 - is pictured Not in Service at York Railway Station waiting for its next duty.
This vehicle wears the new First Ultraviolet livery with pink front and multicoloured stripes for the University of York and is one of 10 buses to carry this branding out of a total of 29 of the type in the fleet. This is the odd one out of the batch in that it's the only University branded one on a 23 plate, the other 9 are all on 73 plates.
Date Taken: October 19th, 2023
Device Used: iPhone 12 Pro Max
Date Uploaded: April 17th, 2025
Upload Number: 1303
Interested in seeing some bus videos? You'll find buses both real and virtual on my YouTube channel, as well as other cool bus-themed stuff too! - www.youtube.com/@ZZ9sTransport
© ZZ9's Transport Photography (ZZ9 Productions). All Rights Reserved. Modification, redistribution, reuploading and the like is prohibited without prior written permission from myself.
Macromondays: Theme is Smallest Devices
Fear - A device used to control other people. Couldn't get this one as I had thought of it. Never mind..... decided to re-add it to the pool anyway.
There are many different germs and infections inside and outside of the healthcare setting. Despite the variety of viruses and bacteria, germs spread from person to person through a common series of events. Therefore, to prevent germs from infecting more people, we must break the chain of infection. No matter the germ, there are six points at which the chain can
be broken and a germ can be stopped from infecting another person. The six links include: the infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, and susceptible host.
• Infectious agent is the pathogen (germ) that causes diseases
• Reservoir includes places in the environment where the pathogen lives (this includes people,
animals and insects, medical equipment, and soil and water)
• Portal of exit is the way the infectious agent leaves the reservoir (through open wounds, aerosols, and splatter of body fluids including coughing, sneezing, and saliva)
• Mode of transmission is the way the infectious agent can be passed on (through direct or indirect contact, ingestion, or inhalation)
• Portal of entry is the way the infectious agent can enter a new host (through broken skin, the respiratory tract, mucous membranes, and catheters and tubes)
• Susceptible host can be any person (the most vulnerable of whom are receiving healthcare, are immunocompromised, or have invasive medical devices including lines, devices, and airways)
The way to stop germs from spreading is by interrupting this chain at any link. Break the chain by cleaning your hands frequently, staying up to date on your vaccines (including the flu shot), covering coughs and sneezes and staying home when sick, following the rules for standard and contact isolation, using personal protective equipment the right way, cleaning and disinfecting the environment, sterilizing medical instruments and equipment, following safe injection practices, and using antibiotics wisely to prevent antibiotic resistance.
For other ways to protect patients, visit
It takes a chain reaction of events for infections to spread to others. The way to stop germs from spreading is by interrupting the chain. When you go into a hospital or other healthcare setting to receive care, you become vulnerable to catching infections. But the good news is that patients, their families, and visitors can take steps to prevent infections by simply knowing the top infection prevention basics!
Are you a healthcare professional? Learn how you can break the chain of infection in healthcare settings.
The best way to stay healthy while visiting the hospital is to speak up for your care. Don’t be shy. After all, we’re talking about your health. Your doctors, your nurses, and other members of your care team want you to have a voice in your care.
So ask questions, voice concerns, and make sure you’re comfortable with the care you are getting while in the hospital or other healthcare facility.
Keeping your hands clean is the number one way to prevent the spread of infection. Clean your hands after using the bathroom; after sneezing, blowing your nose, or coughing; before eating; when visiting someone who is sick; or whenever your hands are dirty.
Make sure that everyone around you, including your healthcare providers and your visitors, do too. Did you see them clean their hands? If not, it’s okay to ask them to clean their hands!
Ask about safe injection practices. Safe injection practices are steps that your healthcare providers should follow when they give injections. For example, not using the same needle or syringe on more than one patient.
Remember: One needle, one syringe, only one time.
Ask to have your room or equipment cleaned. Keeping healthcare facilities clean is extremely important. It’s very easy for germs to be passed from the surfaces to the hands and to other people.
So speak up and ask to have your room or equipment cleaned if they appear dirty or dusty.
Ask questions about the medications that are prescribed to you. Know what they are for, how to take them, how long you should take them, and how often you should take them. If you are taking antibiotics, take them exactly as prescribed, even if you start to feel better.
Using antibiotics the wrong way can cause bacteria to grow into superbugs.
Ask about vaccines you need to stay healthy. The majority of Americans who die each year from vaccine-preventable diseases are adults. Vaccines are a very effective way to prevent the suffering (and costs) associated with vaccine-preventable infections.
Vaccines are among the safest medical products available. The potential risks associated with the diseases these vaccines prevent are much greater than the potential risks associated with the vaccines themselves.
Know about infection preventionists. These germ sleuths work every day to protect you. Your safety is their #1 priority. They strive to keep you, visitors, volunteers, employees, and healthcare providers safe from infection.
Infection preventionists partner with your healthcare team to make sure everyone is doing the right things to keep you safe from healthcare-associated infections.
Become familiar with healthcare-associated infections. Healthcare-associated infections (HAIs) are infections that patients can get while receiving treatment for medical or surgical conditions. No matter where you are—in a hospital, a long-term care facility, outpatient surgery center, dialysis center, doctor’s office, or elsewhere—you are at risk for infections.
These kinds of infections are often preventable.
professionals.site.apic.org/infection-prevention-basics/b...
Evidence always plays a major role in devising a strategy for any global health crisis – it becomes even more important when the circumstances of that crisis continuously evolve. With the total count of Coronavirus patients exceeding 885,000 across more than 170 countries, it is clear that COVID-19 is a once-in-a-lifetime pandemic and a crisis of unprecedented magnitude.Italy and Spain now have over 100,000 confirmed cases of the virus, while the US will soon pass the 200,000 mark. The lesson from these developments is clear: we must abandon the assumptions that COVID-19 will be contained without drastic public health interventions. On 16 March, researchers from Imperial College of London announced a searing report on the impact of an uncontrolled pandemic, that describes the cost of inaction: approximately 510,000 deaths in the UK and 2.2 million in the US. The report highlighted that infections would peak by the middle of June and, without effective policies in place, could lead to as many as 55,000 deaths on the worst day. This scenario is corroborated by emerging evidence suggesting that younger adults, who were previously thought to be less affected – are also prone to developing severe forms of the coronavirus infection. Upon publication of the report, the UK government changed its previous policy of “building herd immunity” and the US reinforced its approach to adopt stricter measures towards containing the spread of the infection.While the numbers in the report are sobering, it does provide guidance on how to develop a global health strategy for containing COVID-19. To be successful, all major countries around the world must act now.
The report described two major approaches available for containing COVID-19. One is mitigation: slowing down the spread of the epidemic but not interrupting the transmission completely, while ensuring the healthcare needs for those who are at risk of developing serious forms of the infection are met. This approach, which includes “social distancing” along with isolation and quarantining of cases, is unlikely to contain the pandemic and may result in the death of thousands of patients while severely burdening health systems, especially available intensive care units. As such, the researchers recommend the second approach, suppression, as more optimal. Suppression refers to a reversal of epidemic spread by reducing the infectivity of the coronavirus and continued maintenance of this approach for up to 18 months. A reversal of spread can be achieved by the implementation of non-pharmaceutical interventions (NPI). These include strict lockdown measures – social distancing in entire populations, the closure of schools and community spaces – and extending these measures until vaccines can be developed. Infectivity of COVID-19 is determined by its reproduction number, or R0 (pronounced R naught), which current epidemiological estimates suggest lies between 1.5 to 3. This means that every COVID-19 patient can infect up to three other people on average. The suppression strategy will require the elimination of human-to-human transmission by lowering the R0 to less than one, which is postulated to halt the spread of the infection. Mitigation strategies, the researchers observe, are unlikely to reduce R0 to less than one. To achieve these metrics, the first step would be to test as many individuals as possible even the ones who may not exhibit symptoms. This is important because coronavirus infection has a longer incubation period of 1-14 days (compared to 1-4 days in flu) and emerging evidence suggests that people with mild or no symptoms may be responsible for the rapid spread of the infection. This approach was also underscored by the Director-General of the World Health Organization), Dr Tedros Ghebreyesus, who highlighted the importance of “breaking the chains of transmission”. This identification of infected individuals by rapid and reliable testing will be crucial to building an effective approach to impede the spread of the infection. The next critical step will be case isolation and voluntary home quarantines. These NPIs should be supplemented by strict social distancing with people maintaining almost six feet of distance along with the closure of schools, universities, bars, and other areas of social gatherings. This is especially important because recent investigation suggests that coronavirus is viable in aerosols for hours and on surfaces for days. The suppression strategy will also ensure that healthcare systems are not overburdened and capacity for critical care is preserved – a practice that has come to be known as “flattening the curve”. Failure to suppress the transmission of infection in countries like Italy has been responsible for the decimation of its healthcare systems leading to thousands of deaths. The implementation of these suppression strategies is also the reason that countries in Asia, such as Singapore, Hong Kong SAR and Taiwan, China, have succeeded in maintaining low case counts of COVID-19. Learning from the experiences of the Severe Acute Respiratory Syndrome (SARS) epidemic of 2003 and swine flu of 2009, these countries instituted strict travel controls and rapid screening and contact tracing of infected individuals. To develop resilient response systems that can halt the transmission, these countries also escalated the production of tests for COVID-19 soon after the genetic sequence of the virus became available. Singapore even enacted mandatory quarantines with criminal penalties for violators. Although some experts have highlighted the limited applicability of complete lockdown measures in developing economies, such countries can still benefit from implementing strict mitigation strategies.With a case fatality rate of up to 3.4% and up to 60% of the global population at risk, many of these measures may seem drastic, but they are also necessary to halt the transmission of this deadly pathogen. It may even seem an overreaction to an epidemic that is not well understood and where comprehensive data is missing. However, given the trajectory of the infection in Italy and the rapid collapse of its entire health system, it is prudent to exercise extreme caution to prevent other countries from trailing that path. In moments of extreme uncertainty, the judgement of leaders is as important as evidence. To combat the pandemic of COVID-19, we will need to sacrifice short-term comforts for long-term gains. More than evidence, this will require courage on the part of national leaders; their next step will become a part of their legacy.
www.weforum.org/agenda/2020/04/covid-19-containment-suppr...