LA homeless sites ‘overwhelmed’ by COVID-19

 

A tent at Union Rescue Mission became an impromptu triage center as Housing for Health struggled to respond to a sudden surge in the spread of COVID-19 cases through the homeless shelter system.

(Irfan Khan / Los Angeles Times)

The day after Christmas, Dr. Heidi Behforouz, medical director for L.A. County’s Housing for Health program, sent out a call of distress.

People living in skid row shelters were being diagnosed with dozens of new cases of COVID-19, and Behforouz needed a place to send them quickly to isolate.

The call went to the Rev. Andrew J. Bales, chief executive of the Union Rescue Mission, which before the pandemic had erected a large tent behind its five-story building on skid row to make room for more people without a home.

“We were able to make yet 1 more chess move against this Monster Genius Covid,” Bales said in an email to The Times. “We moved our men inside to 2nd floor and handed over keys last Sunday.”

The tent at Union Rescue Mission became an impromptu triage center as Housing for Health struggled to respond to a sudden surge in the spread of the disease through the homeless shelter system.

Though infections among the homeless have generally lagged slightly below the county’s per capita rate, belying early predictions of devastating outbreaks in shelters and encampments, the December surge has brought a spike in the homeless numbers as well, further straining the overstretched services system.

After averaging about 60 new cases each week through the fall, infections of homeless people doubled in the week after Thanksgiving and have since continued to climb sharply. On Tuesday, the Department of Public Health’s latest report showed 547 new cases in the previous week.

“The unexplainable protection that people who are homeless have had from COVID is disappearing,” Bales said. “All of skid row and many agencies/missions are hot spots. All are overwhelmed.”

The outbreaks have hit skid row especially hard, forcing the county to improvise.

“We saw there were a few shelters having outbreaks in skid row,” said Cheri Todoroff, director of Housing for Health. “We wanted to move very quickly.”

The Union Rescue Mission, which had worked closely with the county Department of Health Services after a COVID outbreak there in March, was ideal because of its central location.

“We could just walk the clients over, make them comfortable and do clinical assessments,” Todoroff said Thursday. “We have been using that way only since this weekend.”

Housing for Health, a Department of Health Services program that provides housing for medically vulnerable homeless people, runs the county’s coronavirus isolation and quarantine system.

To keep up with the upsurge in cases, the agency opened four new isolation/quarantine sites in December, more than doubling the available beds.

The rapid response was partly assisted by the state’s Project Homekey program through which the county has purchased 10 motels and hotels for homeless housing. Most are being used as interim housing before being converted into permanent homes. Two have been converted temporarily into medical isolation/quarantine sites.

A third site was set up in a motel that was phased out of Project Roomkey, the program to house medically vulnerable homeless people during the pandemic. A nonprofit provided the fourth site on a property it had acquired for a future project.

The sites are being staffed by several nonprofits, including PATH, Exodus, The People Concern and JWCH Institute, with clinical services shared by Holliday’s Helping Hands and the Department of Health Services.

“Staffing has been one of the biggest challenges throughout COVID, not just in Housing for Health, across homeless services sector and healthcare and hospital field,” Todoroff said.

The sites were opened quickly with just a few beds and expanded as staff came on board, she said.

“It’s been an amazing effort to stand up this kind of operation,” Todoroff said. “We haven’t done anything like this before. We have so many partners. Everybody always shows up.”

Even as it was catching up with the new beds, now numbering 820, Housing for Health has had to restrict admissions for the first time.

“Throughout summer and fall we did have beds available pretty much most days,” Todoroff said. Through that period, about two-thirds of those in isolation or quarantine were homeless. The remainder were people being discharged from hospitals and those with housing conditions that made isolation impossible.

“When the surge started in December, we had certain days when we may not be able to accept referrals,” Todoroff said.

As a result, the sites are now predominantly occupied by homeless people, she said.

The clients, who have to stay isolated for up to two weeks, are not sent back to the street. Housing for Health finds placements, generally in shelters or recuperative care centers, and transports them.

“It’s hard,” Todoroff said, adding that the entire shelter system is being hit now.

Early in the pandemic, homeless services and healthcare providers worked desperately to slow the transmission in homeless populations.

Shelters across the county removed beds to achieve the social spacing recommended by the federal Centers for Disease Control and Prevention.

After the March outbreak, the Union Rescue Mission reduced its capacity by more than half. The tent, initially for women, became what Bales called a MASH unit for men who tested positive.

“We moved all of our ladies inside to 5th floor dorms,” he said.

On the streets, city and county officials sent out more toilets and hand washing stations. Beefed-up outreach teams urged camp dwellers to isolate in their tents. L.A. city suspended cleanups at encampment that forced dwellers to leave the tents where health officials were advising them to isolate.

Housing for Health deployed 30 teams to engage homeless people. They have conducted 76,000 tests in shelters and 17,000 in encampments, Todoroff said.

By and large, the measures worked. The infection rate within the homeless population has generally tracked slightly below that of the county and never exceeded it. About 60% of the 4,059 cumulative homeless cases reported last week occurred in shelters.

But recently, the Los Angeles City Council authorized cleanups to resume at some sites, drawing criticism from homeless activists.

“There is simply no public health justification for continuing the displacement of unhoused residents at this time,” Shayla Myers, an attorney for the Legal Aid Foundation of Los Angeles, wrote in a Dec. 21 letter to Mayor Eric Garcetti. “Doing so places unhoused residents and the community at significant, unnecessary and foreseeable risk.”

On Thursday, Bales said he was alarmed to learn that there were 90 new cases overnight, including a hot spot at a park near Union Rescue Mission.

“We aren’t winning, just barely holding our own,” Bales said. “These are the toughest times in my career, life, and in the 130-year history of Union Rescue Mission.”

https://www.latimes.com/homeless-housing/story/2021-01-03/homeless-shelters-coronavirus-surge-hospitals

Russia & Cuba Working Closely With Iran To Procure COVID-19 Vaccine

 In late 2019 into early 2020 Iran was among the first countries outside of China to be hit hard by the coronavirus pandemic (alongside Italy). Due to its international isolation and the crippling US-led sanctions on the Islamic Republic, it is also likely to be the last to access a vaccine for its vulnerable population.

While the US State Dept. has repeatedly claimed sanctions don't restrict humanitarian goods like medicines, the reality is that Western and international companies have remained too concerned about punitive consequences for doing any level of business with Iran. Restrictions on Iran's access to international banking has also severely limited its ability to procure a vaccine.

This means Tehran will naturally look to US rivals like Russian and China for help. At the same time, Iran is reportedly rushing to produce and test its own domestic-made vaccine. Cuba is reportedly assisting Iran in these efforts, according to state sources.

And according to Russian media, talks for the Islamic Republic to potentially procure one of two Russian vaccines are already in the works.

"Iran and Russia are preparing a personal meeting on cooperation in producing the vaccine against the novel coronavirus, Iranian Ambassador to Russia Kazem Jalali said in an interview with Izvestia newspaper published on Sunday," reports TASS.

"The phone conversations in April-October 2020 between the presidents of Iran and Russia underlined Iran’s interest in cooperation with Russia in the field of producing the coronavirus vaccine and exchanging the experience. Currently, Russian documents on the vaccines are being studied. It has been decided that soon a personal meeting will take place," the Iranian envoy said.

Meanwhile, here's what state media sources had to say on the joint Iranian-Cuban vaccine venture:

The first batch of coronavirus vaccine which will reach Iran will be probably purchased directly from a foreign country, Health Ministry spokesman Kianoush Jahanpour said on Friday. 

“Following that, Iran will receive its share of the COVAX vaccines and then the Pasteur Institute of Iran will co-produce a vaccine with a Cuban company, and finally, the domestically-made vaccine will be produced,” he explained, IRNA reported.

He went on to say that the human trial phase of the vaccine has been carried out successfully in Cuba. “The second phase of the human trial is being conducted under the supervision of the Pasteur Institute of Iran in Cuba. Provide that the second phase is successful, the third phase will be implemented in Iran.” On December 29, 2020, the first coronavirus vaccine made by Iranian researchers, was unveiled and injected into three volunteers. 

The production line of the Iranian coronavirus vaccine with a capacity of 1.5 million doses per month will be launched within the next 40 days. By the next six months, vaccine production will reach up to 12 million doses per month.

Iran has over 1.2 million confirmed cases thus far, among these 55,540 deaths, but Iranian health authorities have long said the true infected numbers are in the multiple millions, given the rapid community spread and lack of testing that was a problem early on in 2020.

https://www.zerohedge.com/covid-19/russia-cuba-working-closely-iran-procure-covid-19-vaccine

U.S. may cut some Moderna vaccine doses in half to speed rollout

 The U.S. government is considering giving some people half the dose of Moderna’s COVID-19 vaccine in order to speed vaccinations, a federal official said on Sunday.

Moncef Slaoui, head of Operation Warp Speed, the federal vaccine program, said on CBS’ “Face the Nation” that officials were in talks with Moderna and the Food and Drug Administration about the idea. Moderna’s vaccine requires two injections.

“We know that for the Moderna vaccine, giving half of the dose to people between the ages of 18 and 55, two doses, half the dose, which means exactly achieving the objective of immunizing double the number of people with the doses we have,” Slaoui said.

“We know it induces identical immune response” to the full dose, he added.

Moderna and the FDA could not immediately be reached for comment.

The U.S. Centers for Disease Control and Prevention said it had administered 4,225,756 first doses of COVID-19 vaccines in the country as of Saturday morning and distributed 13,071,925 doses.

The U.S. has also approved a vaccine from Pfizer, which like Moderna’s requires two shots. Vaccinations have fallen far short of early targets, as officials had hoped to have 20 million people vaccinated by the end of the 2020.

Slaoui said he was optimistic vaccinations would continue to accelerate. He rejected the suggestion that officials should prioritize giving more people a single shot, rather than holding back doses for the second shot, saying that cutting Moderna vaccine doses in half was “a more responsible approach that would be based on facts and data.”

Slaoui said it would likely not be known until late spring whether vaccinated people can still spread the disease to others.

https://www.reuters.com/article/us-health-coronavirus-usa-moderna/u-s-may-cut-some-moderna-vaccine-doses-in-half-to-speed-rollout-official-says-idUSKBN2980NW

Doctor Sounds Alarm on How to Properly Inject COVID-19 Vax

 We’ve all seen the video and pictures over the past three weeks of people receiving the pandemic-altering vaccines into their upper arms, and that’s where the COVID-19 vaccine goes, straight into the deltoid muscle.

But Dr. Tom Pitts, a neurologist who practices in New York City, says as he’s watched the images, he has noticed too many instances in which the skin is being pinched as the needle is inserted.

That could lead, he says, to the vaccine being injected into the subcutaneous fat, the fat layer under the skin, instead of into the muscle where it needs to go.

If that happens, Pitts says the vaccine will not be effective.

“The hard part was getting the vaccine, the hard part shouldn’t be injecting it into the muscle,” Dr. Pitts said.

So he’s been sounding the alarm on social media in physicians’ chat groups, circulating diagrams which show the correct methods of injecting an intramuscular vaccine, and reminding health care professionals with a simple hashtag, #DoNotSqueezeMyArm.

“I’m so excited we have it, and I would just really hate to see not only people not get vaccinated, but to also give them the false sense of security that they were vaccinated, that’s almost worse, right?” Pitts said.

With millions of doses being distributed around the planet, if even a small percentage are given incorrectly, Pitts says the numbers will add up quickly.

“And you put that same situation in multiple hospitals across the world you have a catastrophe, and I thought this entirely avoidable and reversible so let’s go ahead and jump on it early, and see what I can do to help,” Pitts said.

He says he’s received an overwhelmingly positive response from other physicians since he started his outreach effort, reminding all health care pros to give the shot where it counts. 

https://www.nbcmiami.com/news/donotsqueezemyarm-doctor-sounds-alarm-on-how-to-properly-inject-covid-19-vaccine/2353866/

Serum Institute: to meet local demand for AstraZeneca vax for next 2 months, before export

 

Serum Institute of India (SII), the local maker of the AstraZeneca/Oxford coronavirus vaccine, said on Sunday it intends to concentrate on meeting India's own immediate demand in the next two months before exporting to other interested countries.

Chief Executive Adar Poonawalla said in an interview after the shot was approved for emergency use in the world's second-most populous country, that exports might be possible after supplying the Indian government with an initial 100 million doses.

The Indian government just wants to ensure that "the most vulnerable people of the country get it first - I fully endorse and support that decision", he said.

SII is still waiting to strike a formal supply deal with the Indian government, but is expected to do so in the coming days.

https://www.marketscreener.com/quote/stock/ASTRAZENECA-PLC-4000930/news/AstraZeneca-India-s-Serum-Institute-says-to-meet-local-demand-for-AstraZeneca-vaccine-for-next-two-32112026/

'Growing Body Of Evidence' COVID-19 Leaked From Chinese Lab

 The most 'credible' theory about the origin of COVID-19 is that it escaped from a Chinese laboratory, according to US National Security Adviser Matthew Pottinger, who made the comment during a Zoom meeting with UK officials.

"There is a growing body of evidence that the lab is likely the most credible source of the virus," said Pottinger, referring to the Wuhan Institute of Virology, according to the Daily Mail, which notes that 'even China's leaders openly admit their previous claims that the virus originated in a Wuhan market are false.'

Pottinger was one of the first US officials to sound the alarm at the White House over the origins of the virus in January 2020, when he initially suspected that the outbreak originated in a Chinese lab - after which Pottinger ordered US intelligence agencies to search for evidence. Good thing he kept this theory to himself, or Twitter may have banned him.

He also slammed the World Health Organization's probe as a ruse - saying "MPs around the world have a moral role to play in exposing the WHO investigation as a Potemkin exercise," referring to the facade villages created in 18th Century Crimea to convince the visiting Russian Empress Catherine the Great that the region was doing well.

Iain Duncan Smith, the former Tory Party leader who attended the meeting, said Mr Pottinger's comments represented a 'stiffening' of the US position on the theory that the virus came from a leak at the laboratory, amid reports that the Americans are talking to a whistleblower from the Wuhan institute.

'I was told the US have an ex-scientist from the laboratory in America at the moment,' he said. 'That was what I heard a few weeks ago.

'I was led to believe this is how they have been able to stiffen up their position on how this outbreak originated.'

He added that Beijing's refusal to allow journalists to visit the laboratory only served to increase suspicion that it was 'ground zero' for the pandemic. 'The truth is there are people who have been in those labs who maintain that this is the case,' he said. 

'We don't know what they have been doing in that laboratory. They may well have been fiddling with bat coronaviruses and looking at them and they made a mistake. I've spoken to various people who believe that to be the case.' -Daily Mail

"Even establishment figures in Beijing have openly dismissed the wet market story," Pottinger told the call participants.

Meanwhile, emails obtained via a public records request revealed that influential scientists have been hard at work crafting the 'natural origin' thesis, while suggesting a lab leak as a 'fringe conspiracy theory.' Via USRTK.org:

*  *  *

Influential scientists and many news outlets have described the evidence as “overwhelming” that the virus originated in wildlife, not from a lab. However, a year after the first reported cases of SARS-CoV-2 in the Chinese city of Wuhan, little is known how or where the virus originated. Understanding the origins of SARS-CoV-2, which causes the disease COVID-19, may be crucial to preventing the next pandemic.

The emails of coronavirus expert Professor Ralph Baric - obtained through a public records request by U.S. Right to Know - show conversations between National Academy of Sciences (NAS) representatives, and experts in biosecurity and infectious diseases from U.S. universities and the EcoHealth Alliance.

On Feb. 3, the White House Office of Science and Technology Policy (OSTP) asked the National Academies of Sciences, Engineering and Medicine (NASEM) to “convene meeting of experts… to assess what data, information and samples are needed to address the unknowns, in order to understand the evolutionary origins of 2019-nCoV, and more effectively respond to both the outbreak and any resulting misinformation.”

Baric and other infectious disease experts were involved in drafting the response. The emails show the experts’ internal discussions and an early draft dated Feb. 4.

The early draft described “initial views of the experts” that “the available genomic data are consistent with natural evolution and that there is currently no evidence that the virus was engineered to spread more quickly among humans.” This draft sentence posed a question, in parentheses:

“[ask experts to add specifics re binding sites?]” It also included a footnote in parentheses: “[possibly add brief explanation that this does not preclude an unintentional release from a laboratory studying the evolution of related coronaviruses].”

In one email, dated Feb. 4, infectious disease expert Trevor Bedford commented:

“I wouldn’t mention binding sites here. If you start weighing evidence there’s a lot to consider for both scenarios.”

By “both scenarios,” Bedford appears to refer to lab-origin and natural-origin scenarios.

The question of binding sites is important to the debate about the origins of SARS-CoV-2. Distinctive binding sites on SARS-CoV-2’s spike protein confer “near-optimal” binding and entry of the virus into human cells, and make SARS-CoV-2 more contagious than SARS-CoV. Scientists have argued that SARS-CoV-2’s unique binding sites could have originated either as a result of natural spillover in the wild or deliberate laboratory recombination of an as-yet-undisclosed natural ancestor of SARS-CoV-2.

The final letter published Feb. 6 did not mention binding sites or the possibility of a laboratory origin. It does make clear that more information is necessary to determine the origins of SARS-CoV-2. The letter states,

“The experts informed us that additional genomic sequence data from geographically – and temporally – diverse viral samples are needed to determine the origin and evolution of the virus. Samples collected as early as possible in the outbreak in Wuhan and samples from wildlife would be particularly valuable.”

The emails show some experts discussing the need for clear language to counter what one described as “crackpot theories” of lab origin. Kristian Andersen, lead author of an influential Nature Medicine paper asserting a natural origin of SARS-CoV-2, said:

the early draft was “great, but I do wonder if we need to be more firm on the question of engineering.”

He continued,

“If one of the main purposes of this document is to counter those fringe theories, I think it’s very important that we do so strongly and in plain language…”

In his response, Baric aimed at conveying a scientific basis for SARS-CoV-2’s natural origin.

“I do think we need to say that the closest relative to this virus (96%) was identified from bats circulating in a cave in Yunnan, China. This makes a strong statement for animal origin.”

Meanwhile, 27 scientists issued a statement drafted by Daszak (who didn't want to be identified as its author), in which they "strongly condemn[ed] conspiracy theories suggesting that COVID-19 does not have a natural origin,” and reported that scientists from multiple countries “overwhelmingly conclude that this coronavirus originated in wildlife.” The letter included no scientific references to refute a lab-origin theory of the virus.

One scientist, Linda Saif, asked via email whether it would be useful “to add just one or 2 statements in support of why nCOV is not a lab generated virus and is naturally occuring? Seems critical to scientifically refute such claims!”

Daszak responded, “I think we should probably stick to a broad statement.”

Growing calls to investigate the Wuhan Institute of Virology as a potential source of SARS-CoV-2 have led to increased scrutiny of EcoHealth Alliance.

The emails show how members of EcoHealth Alliance played an early role in framing questions about possible lab origin of SARS-CoV-2 as “crackpot theories that need to be addressed,” as Daszak told The Guardian.

https://www.zerohedge.com/covid-19/top-us-official-says-growing-body-evidence-shows-covid-19-leaked-chinese-lab

How Airflow Inside a Car May Affect COVID-19 Transmission Risk

 A new study uses computer simulations to track airflows inside a car’s passenger cabin, providing potential strategies — some of them counterintuitive — for reducing the risk of transmitting airborne diseases.

A new study of airflow patterns inside a car’s passenger cabin offers some suggestions for potentially reducing the risk of COVID-19 transmission while sharing rides with others.

The study, by a team of Brown University researchers, used computer models to simulate the airflow inside a compact car with various combinations of windows open or closed. The simulations showed that opening windows — the more windows the better — created airflow patterns that dramatically reduced the concentration of airborne particles exchanged between a driver and a single passenger. Blasting the car’s ventilation system didn’t circulate air nearly as well as a few open windows, the researchers found.

“Driving around with the windows up and the air conditioning or heat on is definitely the worst scenario, according to our computer simulations,” said Asimanshu Das, a graduate student in Brown’s School of Engineering and co-lead author of the research. “The best scenario we found was having all four windows open, but even having one or two open was far better than having them all closed.”

Das co-led the research with Varghese Mathai, a former postdoctoral researcher at Brown who is now an assistant professor of physics at the University of Massachusetts, Amherst. The study is published in the journal Science Advances.

A study published recently in Science Advances looks at how airflow patterns inside the passenger cabin of a car might affect the transmission of SARS-CoV-2 and other airborne pathogens. The simulations produced some potentially counterintuitive findings. For example, one might expect that opening windows directly beside each occupant might be the simplest way to reduce exposure. The simulations found that while this configuration is better than no windows down at all, it carries a higher exposure risk compared to putting down the window opposite each occupant. “When the windows opposite the occupants are open, you get a flow that enters the car behind the driver, sweeps across the cabin behind the passenger and then goes out the passenger-side front window,” said Kenny Breuer, a professor of engineering at Brown and a senior author of the research. “That pattern helps to reduce cross-contamination between the driver and passenger.” Credit: Breuer lab / Brown University

The researchers stress that there’s no way to eliminate risk completely — and, of course, current guidance from the U.S. Centers for Disease Control (CDC) notes that postponing travel and staying home is the best way to protect personal and community health. The goal of the study was simply to study how changes in airflow inside a car may worsen or reduce risk of pathogen transmission.

The computer models used in the study simulated a car, loosely based on a Toyota Prius, with two people inside — a driver and a passenger sitting in the back seat on the opposite side from the driver. The researchers chose that seating arrangement because it maximizes the physical distance between the two people (though still less than the 6 feet recommended by the CDC). The models simulated airflow around and inside a car moving at 50 miles per hour, as well as the movement and concentration of aerosols coming from both driver and passenger. Aerosols are tiny particles that can linger in the air for extended periods of time. They are thought to be one way in which the SARS-CoV-2 virus is transmitted, particularly in enclosed spaces.

Part of the reason that opening windows is better in terms of aerosol transmission is because it increases the number of air changes per hour (ACH) inside the car, which helps to reduce the overall concentration of aerosols. But ACH was only part of the story, the researchers say. The study showed that different combinations of open windows created different air currents inside the car that could either increase or decrease exposure to remaining aerosols.

Because of the way air flows across the outside of the car, air pressure near the rear windows tends to be higher than pressure at the front windows. As a result, air tends to enter the car through the back windows and exit through the front windows. With all the windows open, this tendency creates two more-or-less independent flows on either side of the cabin. Since the occupants in the simulations were sitting on opposite sides of the cabin, very few particles end up being transferred between the two. The driver in this scenario is at slightly higher risk than the passenger because the average airflow in the car goes from back to front, but both occupants experience a dramatically lower transfer of particles compared to any other scenario.

The simulations for scenarios in which some but not all windows are down yielded some possibly counterintuitive results. For example, one might expect that opening windows directly beside each occupant might be the simplest way to reduce exposure. The simulations found that while this configuration is better than no windows down at all, it carries a higher exposure risk compared to putting down the window opposite each occupant.

“When the windows opposite the occupants are open, you get a flow that enters the car behind the driver, sweeps across the cabin behind the passenger and then goes out the passenger-side front window,” said Kenny Breuer, a professor of engineering at Brown and a senior author of the research. “That pattern helps to reduce cross-contamination between the driver and passenger.”

It’s important to note, the researchers say, that airflow adjustments are no substitute for mask-wearing by both occupants when inside a car. And the findings are limited to potential exposure to lingering aerosols that may contain pathogens. The study did not model larger respiratory droplets or the risk of actually becoming infected by the virus.

Still, the researchers say the study provides valuable new insights into air circulation patterns inside a car’s passenger compartment — something that had received little attention before now.

“This is the first study we’re aware of that really looked at the microclimate inside a car,” Breuer said. “There had been some studies that looked at how much external pollution gets into a car, or how long cigarette smoke lingers in a car. But this is the first time anyone has looked at airflow patterns in detail.”

The research grew out of a COVID-19 research task force established at Brown to gather expertise from across the University to address widely varying aspects of the pandemic. Jeffrey Bailey, an associate professor of pathology and laboratory medicine and a coauthor of the airflow study, leads the group. Bailey was impressed with how quickly the research came together, with Mathai suggesting the use of computer simulations that could be done while laboratory research at Brown was paused for the pandemic.

“This is really a great example of how different disciplines can come together quickly and produce valuable findings,” Bailey said. “I talked to Kenny briefly about this idea, and within three or four days his team was already doing some preliminary testing. That’s one of the great things about being at a place like Brown, where people are eager to collaborate and work across disciplines.”

Reference: “Airflows inside passenger cars and implications for airborne disease transmission” by Varghese Mathai, Asimanshu Das, Jeffrey A. Bailey and Kenneth Breuer, 4 December 2020, Science Advances.
DOI: 10.1126/sciadv.abe0166

https://scitechdaily.com/how-airflow-inside-a-car-may-affect-covid-19-transmission-risk-what-works-best-for-windows-and-ventilation/amp/