An Update on my Covid-19 Viral Load Article

I am providing in full an article just published that emphasizes why my previous article on viral load is so important. Bottom line the more virus you are exposed to and have in your bloodstream the greater the risk of death. As we speak the recommended behaviors of wearing a mask, social distancing, staying away from crowds, staying our of confined crowded spaces are all designed expressly for the purpose of reducing your exposure and hence your viral load. Why people will not follow these guidelines is beyond me.


Jul 8, 2020

SARS-CoV-2 Viral Load in Hospitalised Patients Correlates With Risk of Intubation, Mortality
By Denise Baez

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load among hospitalized patients is independently associated with the risk of intubation and in-hospital mortality, according to a study published in Clinical Infectious Diseases.

Reed Magleby, MD, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, and colleagues evaluated 678 hospitalized patients with coronavirus disease 2019 (COVID-19) and found that 35% of patients with a high SARS-CoV-2 viral load on admission died, compared with 17.6% of patients with medium viral loads and 6.2% of patients with low viral loads.

The findings suggest that using cycle threshold (Ct) values, which are available when results from reverse transcription-polymerase chain reaction (RT-PCR) assays are reported to clinicians, could identify patients at the highest risk of intubation and death and guide treatment accordingly.

“We found that admission SARS-CoV-2 viral loads, as determined by Ct values that are generated with standard-of-care diagnostic assays, are independently associated with intubation and death among hospitalized patients with COVID-19,” the authors wrote. “These findings highlight the critical role of viral load in SARS-CoV-2 pathogenesis and suggest that Ct values should be reported to assist clinicians in identifying patients at high risk for adverse COVID-19-related outcomes.”

Dr. Magleby and colleagues analyzed data from 678 patients who were hospitalized with COVID-19 between March 30, 2020, and April 30, 2020, at 2 hospitals in New York City. SARS-CoV-2 viral load was assessed using a cycle threshold (Ct) values from a reverse transcription-polymerase chain reaction assay applied to nasopharyngeal swab samples.

In-hospital mortality was 35% among the 220 patients with a high viral load (Ct <25), 17.6% among the 216 with a medium viral load (Ct 25-30), and 6.2% among the 242 patients with a low viral load (Ct>30). The risk of intubation was also higher in patients with a high viral load (29.1%), compared with those with a medium (20.8%) or low viral load (14.9%).

In a multivariate model that adjusted for age, race, coronary artery disease, congestive heart failure, cerebrovascular disease, hypertension, chronic obstructive pulmonary disease, days of symptoms prior to admission, symptoms upon presentation, initial chest x-ray findings, and level of oxygen support within three hours of arrival to the emergency department, having a high viral load was independently associated with increased risk of in-hospital mortality (adjusted odds ratio [aOR] = 6.05; 95% confidence interval [CI], 2.92-12.52; P< .001) compared with having a low viral load.

The risk of in-hospital mortality was also higher in patients with a medium viral load compared with a low viral load, but this association was not statistically significant (aOR = 2.06; 95% CI, 0.98-4.34; P = .058).

Compared with those with a low viral load, having a high viral load was also independently associated with increased risk of intubation (aOR = 2.73; 95% CI, 1.68-4.44; P < .001). The risk of intubation associated with a medium viral load did not reach statistical significance (aOR = 1.59; 95% CI, 0.96-2.63; P = .07).

Higher viral load was associated with increased age, comorbidities, smoking status, and recent chemotherapy. Patients with higher viral loads were also more likely to develop myocardial infarction, congestive heart failure, and acute kidney injury requiring hemodialysis.

“While prior studies indicated that viral load correlates with severity of COVID-19 presentation, our study of a larger cohort of hospitalized patients adds to this knowledge base by identifying that admission viral load has important prognostic implications,” the authors wrote. “Reporting
SARS-CoV-2 viral load based on Ct values from admission NP swab samples could, therefore, help identify patients who are at the highest risk of adverse outcomes and who therefore may benefit from more intensive monitoring. Identifying high viral load patients could also be helpful for allocating scarce therapeutic interventions such as antiviral agents.”

The authors noted that additional studies that evaluate viral loads and clinical outcomes among all patients who present to the emergency department are warranted prior to pursuing this strategy clinically.

Reference: https://academic.oup.com/cid/article-pdf/doi/10.1093/cid/ciaa851/33448916/ciaa851.pdf

SOURCE: Clinical Infectious Diseases

Cooking with an Air Fryer

Like everyone else, I am sitting around all day looking for things to do to break the boredom. On TV for a significant portion of my life, I have been bombarded with "infomercials" telling me about the latest and greatest home device that will save me millions of money and minutes of time. On occasion, I succumb to the pressure and buy something. Over the past few years with the advent of Amazon I have developed the habit of looking at online reviews before I buy anything. To my amazement over 90% of the things, I look up to turn out to have a high percentage of negative reviews in which case I don't buy the product, so the actual products I buy are minimal. 

Having all this time on my hands has led me to cook more and a larger variety of foods at home and usually I make a big mess as I am a messy cook. Being from the South I love beyond logic fried foods, especially fried chicken and French fries. So why not try those great foods. Alton Brown has a YouTube video on making fried chicken that seemed simple enough. Unfortunately, it takes quite a lot of time and when it was all said and done the kitchen was covered in grease and oil. Same thing with French Fries. Joel Robuchon has a great recipe but most people do not realize in order to make great fries you actually are supposed to fry them twice meaning twice as much oil and grease on the countertops. 

Over the past year, I have seen ad on ad for an air fryer. Emeril Lagasse has been heavily advertising his Emeril's 360 fryer for a couple of hundred dollars and of course, the ad says you can cook anything with no mess in 10 minutes or less, Right? So I spent close to the past 9 to 10 months researching air fryers. First, an air fryer is nothing more than a convection oven where hot air is circulated constantly around the food at a high temperature. If you read the reviews some are better than others and cheaper than others. They also vary in size as well as some having a Rotisserie. After months of thought, I settled on a Ninja air fryer pictured here. 

It was around $100 and had some of the best reviews and fewest negative reviews. We also have another Ninja product we purchased years ago that has been indestructible. This particular air fryer is one of the smaller ones so the first "con" is you won't be able to prepare a large amount of food for a large family or party. It prepares food for one or two but for us being only two in the household it works well for us. But I will say the main motivation for me was I didn't want to invest money in a larger one only to find out I did not like it so I got a smaller and cheaper one in case I decided to throw it out as a failed experiment. But that didn't happen and I am happy to report the air fryer we have at least is amazing! 

The big "pro" of this air fryer is cooking time is quick and the mess is small to nonexistent and clean up is simple. I'm fairly sure the first thing anyone makes is French fries and I was no exception. Freshly peeled and cut French fries were coated in oil and placed in the fryer and they came out crisp, golden brown, and no preservatives or additives. There is a small learning curve using an air fryer. Things you learn are cook with a higher temp and shorter times and midway through the cooking cycle, you need to pause the fryer and turn or shake the food up a little bit. You also need to preheat the air fryer for 3 or 4 minutes prior to putting your food inside.  So far we have made fried chicken, bread loaves, schnitzel, baked potatoes, fried fish and everything has turned out well and on many occasions as good as you would get if you went out. Our unit also has a roasting button and reheat button which increases the versatility of the unit. So overall we are very pleased with our purchase and for two people we can prepare a really nice meal is generally a half-hour serving fresh foods freshly cooked. What more could you ask for?

Medical Update on CoVid-19 offered as a public service

As a physician with 40 years experience here is where we now stand and what we now know in regards to CoVid-19 understanding that with day 1 and patient zero we had essentially no knowledge of what this virus was capable of.

#1 This one of the most virulent infectious virus in the history of mankind and the worst infectious disease I have seen in 40 years. It is HIGHLY transmittable from person to person. It is bad as Ebola and Plague in the number of people it can infect. Many people feel that the Government and media are over blowing this infection in an effort to scare people for some prejudiced agenda. I can assure you this is NOT true and if anything the Government and Media is underplaying this pandemic in this regard. You hear a lot about the "R" value which is the number of people one person can infect if they have the virus. All public health officials report we want the "R" value to be 1 or less which means one person infects 1 other person or less. I can assure you the "R" value of THIS virus will eventually be proven to be much, much, higher. Dozens, hundreds of people have already been proven to have contracted the virus from 1 person resulting in a massive spread of the infection.

#2 The good news is that for the vast majority of people somewhere around 80% will not get sick from this virus and if they do it will be like the common cold. And as it continues to be reported the vast majority of infected people have no symptoms at all. Again the problem is that unknowingly they spread the infection far and wide and eventually susceptible people contract the virus and end up seriously ill.

#3 The bad news is somewhere around 5-20% of the population is at risk from dying from this virus and those people have either some genetic variant that makes them more susceptible or they are immune deficient for some reason. When they catch the virus they end up in the hospital stressing the health care system. There is no question as the number of infected people rises so will the number in the hospital.

#4 Other good news physicians and scientists are getting much better in reducing the death rate with proper and improved treatment. A major cause of death is cytokine storm which simply is even in patients with a deficient immune system the body's immune response goes overboard and causes generalized organ failure resulting in death. Recent research has shown proper use and timing of steroids and anti-immune drugs, more specifically dexamethasone and Acumed are showing great results. The problem is one of timing. If given too soon or too late neither drug helps as much. It is clear today that Hydrochloroquine does not really work and there are other and better treatments. In addition convalescent plasma transfusion from someone who has recovered from CoVid-19 is showing good results as well. So as treatments improve the death rate comes down but not the hospitalization rate which to me is the qualifying data experts should pay more attention to.

#5 Some scientists and physicians have predicted that every human being in the world is at risk and will eventually be infected with CoVid-19. Until the virus goes through the entire population of the world or we have an effective and safe vaccine there is little we can do to prevent ourselves, our friends, and our family from catching this virus but there are things we can do.

#6 Initially the CDC underplayed the use of masks. They did so out of fear hospitals would run out and be unable to protect doctors and nurses. Everyone is aware if all the doctors and nurses caught the disease and 20% died it would be a major issue. It was a mistake and they have admitted so. But that is water under the bridge. There is no question today that any mask made from any material will significantly reduce the spread and infection rate of CoVid-19. In general current research has clearly shown if a full 60% or higher of the population wears a mask it will reduce the infection by over 60%. If two people are across from each other and talking if both individuals wear a mask the risk of one spreading the infection to the other is less than 5%. No, masks do not 100% solve all the problems but along with washing our hands and not touching our faces it is the absolute best thing we can do to protect ourselves and others today. As an additional barrier that poses no risk, I recommend using a coffee filter within any mask you choose. It can't hurt.

#7 A word about testing. Testing is important but only so far as we can identify the people who have been in contact with the infected person and then isolating or quarantining those individuals for 14 days until the danger passes. Unfortunately there is no State in the Union that has the public health infrastructure and the bodies to do all this contact tracing and follow up. The only Country in the world that did was South Korea and only because they were scared to death by SARS 1(CoVid-19 is SARS 2)and subsequently put a robust public health system in place specifically to do contact tracing and quarantine. Testing won't help that much until we have enough people to contact trace exposed individuals and exposed individuals or infected individuals cooperating with public health mandates.

#7 Eventually the one thing that will stop this pandemic will be a vaccine. I support and wish well those labs and companies rushing to bring one to market and want them to succeed. If they can get it done by the end of the year it will be a miracle. I have to say however that I am concerned it can be done that quickly as issues of safety, effectiveness, and ability for mass production are questions that must be answered prior to using it on the public in mass quantities. In my medical career I have seen over a dozen miracle medicines pulled off the market after a few months or year because once used across the country those miracle medicines were killing and harming people and we did not discover that in the initial trials. Don't forget no treatment, no vaccine, no mask is 100% perfect. But what we have today is the best we can hope for.

Asian collector snaps up bottle of Gautier Cognac from 1762

One of the world’s oldest bottles of Cognac has been sold by Sotheby’s for £118,580. 

Louis XV was busy ordering the construction of the Petit Trianon at Versailles for his mistress Madame de Pompadour when the bottle of Gautier Cognac – one of only three surviving and still bearing its original label – was being bottled in 1762. 

Some 258 years later, it has been snapped up in an online auction by a private collector in Asia, setting a new record for the sale of Cognac at auction. Sotheby’s said the Cognac should still taste fine as the bottle, which has been kept in a family cellar for the past 140 years, was in good condition. 

Known as Grand Frère (Big Brother), the Cognac’s Petite Soeur (Little Sister) can be found at the Gautier Museum in France, while its Petit Frère (Little Brother) sold at auction in New York in 2014. The owner who put the bottle up for auction recalls that as a child, his grandfather forbade him to play in the cellar, where he kept his oldest bottles of Cognac. It was only many years later he learned the story behind the amber treasure. During the 19th century, his great grandparents fostered an orphan called Alphonse who, between 1870 and 1880, went to work in the Cognac region. It is thought his return home after 10 years was prompted by the phylloxera crisis which had decimated the vines and wiped out the production of wine and brandies. With him, Alphonse carried a cart loaded with bottles of Cognac, presumably given in lieu of wages. Among them were the three Maison Gautier Cognacs. In 1914, Alphonse was sent to war and sadly never returned. 

Jonny Fowle, Sotheby’s spirits specialist, said: “The Gautier 1762 is renowned and revered across the world as a Cognac that transcends the world of spirits collecting. This bottle represents not only an example of pre-phylloxera viticulture, but also of early cask maturation from the dawn of Gautier’s production and even precedes the French Revolution. This bottle contains a distillation not only of superb brandy, but also of Cognac’s history.” 

Reprinted from "Taste of France" magazine.

The Worlds 5 Oldest Wines

Many years ago Clark and I celebrated her 50th birthday with family and friends at the Graycliff resort in Nassau, Bahamas. It truly is a bucket list experience with the epitome of luxury and fine food and wine. They have an extensive cellar and within that cellar is what is called the million-dollar rack where their rarest wines are stored. They used to have a bottle of allegedly Thomas Jefferson's bottle of Lafite Rothschild from 1789 that allegedly was dropped and broken years after we visited. The wine that impressed me the most was the 1727 Riesling described in this article. I was taken aback by the pristine condition of the bottle in a wine that old. The Graycliff represented at the time that it was the oldest bottled wine in the world which today is no longer true as we will see. 

The Speyer Wine Bottle

The Speyer wine bottle is believed to be the oldest bottle of wine in the world and is dated to around 325-350 AD. The bottle was unearthed in 1867 and one of 16 found in a sarcophagus in the grave of a Roman nobleman and his wife – the bottle was the only one still intact. The liquid, which is no longer alcohol, has most likely survived this long because the bottle was sealed with wax and olive oil was poured into the bottle to preserve the wine. 

Since its discovery, experts have debated whether or not the wine should be opened and analyzed. For now, the bottle remains unopened as part of the Pfalz Historical Museum collection in the German City of Speyer. The concern is what will happen the minute the wine is exposed to air. 

Strasbourg Barrel France 1472

The wine cellar under the Strasbourg city hospital (Cave Historique des Hospices de Strasbourg) in France is home to the oldest barrel-stored wine in the world. The barrel is marked with a date of 1472 and the wine inside is still drinkable. The wine has been tasted only three times in its history which I find amazing. I wish I could have been there. Once in 1576 to celebrate the alliance between Strasbourg and Zurich; a second time in 1716 after the hospital burned down; and finally in 1944 when Strasbourg was liberated by General Leclerc during World War II. The wine was most recently transferred to a new barrel in 2014 after its original barrel started leaking.  A new handmade egg-shaped barrel was made for the wine by two of France’s most-respected coopers Xavier Gouraud and Jean-Marie Blanchard.  I find it interesting that they put it in one of the new egg-shaped barrels that were invented with the intention of better extracting and aging wines today.  I guess they figure even though it was made in 1472 it still has an opportunity for improvement!

Tokaji Royal Saxon 1650-1690

This bottle of Tokaji, dated between 1650 – 1690, was sold for an undisclosed amount in a 1927 auction that took place in the Saxon capital Dresden. During the auction, 62 bottles of Tokaji from the Royal cellar of Augustus II were sold. This wine is believed to be the oldest intact Tokaji bottle and was certified as authentic by the Foundation of the House of Wettin, which administrated the heritage of the former Saxon monarchy.

Made primarily from the Furmint grape, Tokaji wines are some of the most famous in the World, yet many people have no knowledge of them.  They are a very sweet wine, drank today primarily with dessert as well as with Foie Gras.  Originally these wines were produced on the island of Malvasia under the rule of Greece and then later Venice.  In 1358 Hungary's King Louis the Great received 30 barrels of the wine as a war indemnity.  Fast forward 200 years and Hungary began producing the wine and ever since Tokaji is known as a Hungarian sweet wine.  Tokaji has a long storied history.  Paracelsus, the famous Swiss alchemist, performed prolonged experiments with Tokaji's grapes attempting to extract gold from them.  The soil in Hungary that these grapes have grown in is known to have gold ore.  Early in the 20th-century physicians would prescribe Tokaji Aszu(the rarest and sweetest made) to patients in the belief that the gold rumored to be in the subsoil was responsible for the alleged health-giving properties in the wine.   As late as 30 or 40 years modern-day Rheumatologists were giving gold injections to patients with Rheumatoid Arthritis that actually treated the disease.  Today we have better drugs but not any cheaper! Another well-known story involves Catherine the Great of Russia who allegedly was paid tribute with Tokaji wines.  From 1733 to 1800 a company of Russian soldiers was regularly stationed in Hungary with the sole job of buying, shipping, and guarding these wines for the czar's court.

Apostelwein Wine 1727

The Apostelwein 1727 comes from the famous 12 Apostles’ cellar in the Bremer Ratskeller located in Bremen, Germany. The wine comes from 12 barrels of wines in vintages of 1683, 1717, and 1727, which were reduced in number due to evaporation – when there was only one barrel left, the wine was bottled in the 1960s. 

The most expensive bottle of Apostelwein 1727, valued at $200,000 belongs to the Graycliff Hotel in Nassau and is one of the rarest wines in the world. The wine is supposedly still drinkable due to its high sugar content. The picture is one I took at the Graycliff cellar. At the time I could not believe how new the label looked. Turns out I was right. The wine may be old but the wine was first bottled from barrel in the 1960's so the label is only around 60 years old but still in great condition for 60 years. It clearly demonstrates what a bottle of wine should look like when stored properly. 

Massandra Sherry 1775

In 2001, a bottle of the Massandra Sherry de la Frontera 1775 was sold at a Sotheby's auction for $43,500 in London making it the most expensive bottle of Sherry in the world. The wine was produced by the Massandra Winery, located in the Republic of Crimea, which is home to an extensive collection of valuable Russian and European wines. 

In 1922, after the Russian Revolution, the winery was nationalized and its cellars became a protected institution. In 2015, Russian President, Vladimir Putin, and former Italian Prime Minister, Silvio Berlusconi, allegedly drank from a bottle of Jeres de las Frontera worth $90,000. This picture shown is also a good example of what you might find when visiting cellars, especially in France. I have been in hundreds of cellars in France where you see bin after bin of dust-covered very old bottles usually with only the vintage year and the name of the wine on a plaque attached to the bin which on average stores 100 bottles I always ask the owner what they intend to do with the wines and the usual answer we open one bottle every year or two to make sure it is OK and someday in the future we might clean the bottles, put a label on them and sell them. The number of cellars with hundreds if not thousands of old and rare wine is mind-boggling. Every cellar I visited all had these cellars which are sometimes called their "library" selections. One vineyard I have visited in Bourgogne France is the Carillon vineyards whose original owner was born in 1520. I never got to see their "library" but I am willing to bet deep in their cellar are some very old and great wines even older than the ones I tell you about today. Then you consider the thousands of other family cellars in France alone and the potential for very old great wines is infinite. 

Guiding principles on making, buying, and tasting wine.

1. Almost no one makes "bad" wine anymore. Even the old timers are sending their children and grandchildren to the University of Davis in California to get a four-year degree in winemaking. Hence all wine in the world is now being made the same way with a precise outlined series of steps.

2. Read any wine publication and you will notice most all of the wines are "rated" 88-92. These rating should be used as a guide and not a "bible". They help point you to wines you may want to try but by no means are they infallible. Also remember that recent research has shown that because of our genetic differences each of may taste a wine and our taste can be totally different from yours. The variation in the number of taste buds in human ranges from a low of 500 to a high of 10,000 and at the top end they are called "supertasters" Just means we all taste something different and it is understandable someone with 10,000 taste buds will taste something different than someone with 500.

3. It boils down to STYLE. Each wine maker now makes wine in a style that he likes. That style is based on his experience and the grapes that he has to work with. Each of us is going to like certain styles better than others and that is what we need to work with.

4. Wine should primarily be enjoyed with food. And certain styles of wines go best with certain foods. So we learn what wines improve our food experience and also what foods improve our enjoyment of wine.

5. When making wine the wine maker has things he can control and things he cannot control. By manipulating the things he can control he is able to make a wine with a certain style. Consider these examples:\

Things a wine maker cannot control:

1. The weather, hot and cold weather, rain and hail.

2. The soil the vines are planted in and the chemical composition of that soil.

Things a wine maker can control:

1. Timing of harvest of grapes

2. Total number of grapes harvested and used to make wine

2. Type of oak barrels he uses and purchases

3. Controlling fermentation of grapes when to stop fermentation, temperature that fermentation occurs.

4. Months of aging in barrels, stainless steel, or bottles

By controlling the above things the wine maker is actually controlling the following that determine the style of wine.

1. Alcohol content

2. Acid content

3. Residual sugars or "sweetness" of wine

4. Oak,tastes like vanilla, or "oakiness"

5. Tannin content or concentration of wine

So one style of wine maybe high alcohol, heavy oak flavor, high tannin as opposed to low alcohol, low oak flavor, low tannin concentration. Dependent on what food you are serving you would want to choose a particular style of wine.

Examples:

High alcohol, high tannin wine as a rule goes well with meat as the alcohol and tannin cut the fat in the meat and in a sense tenderize the meat. A California Cabernet with steak.

Low alcohol low tannin high sugar wine goes well with sweet desserts. You don't overwhelm the dessert with the wine and the sugars in the wine compliment the sugars in the dessert.  A Sauternes with Creme Brulee.

Viral Load and Covid-19

Covid-19 has thrown a monkey wrench in all of our lives. Clark and I have been quarantined at home now for two months and frankly have not done much. You would think we would have the best organized and cleanest house on the planet but sadly not. I also have terribly neglected this blog and do apologize to my loyal readers. We had two trips canceled due to the virus so really had nothing to report on. As I have sat at home for two months now and watched the Covid-19 pandemic evolve and the citizens of the world reaction to it I have decided to post a short blog on the virus to hopefully offer some factual information to you with sound scientific reasoning. Unable to travel and not having any extensive wine parties to offer I offer this article to help you navigate the reopening of the society. 

The main concept I want you to gain from this is the concept of "Viral or Bacterial Load". Simply put Viral load is how many viral particles(or Bacteria organisms) you are exposed to. Our bodies are bombarded daily with viruses and bacteria. At any given point in time it could be one or two organisms or it could be millions. There are a variety of factors that determine what the viral load might be and a variety of factors that either increase or decrease the viral load. Many we cannot control. A few we can. So when facing a pandemic we need in-depth knowledge of what the risks are and how to reduce those risks and to fully understand and institute those measures that reduce the viral load to a level that presents a low risk to us and our families. The #1 issue regarding viral load that we can control is the concentration of viruses or bacterial particles in a measured space. One million particles in a one-gallon space area is a high concentration. One or two particles in that same one-gallon space or volume is a very low concentration. Obviously breathing air with the concentration of the higher one is going to lead to a high concentration of viral load. So to reduce risk we need to do things that reduce the concentration in a given area. The best way to lower concentration is dispersion. If I take a gallon of one million particles and put it my bathtub and get into the bathtub I get exposed a lot. But if I dump the gallon into my hot tub and get in it may be the same number of organisms but the concentration is significantly reduced. If I am standing next to you talking and you sneeze I get the full concentration of whatever is there.  If I am 6 feet from you or better yet 12 feet the amount, number, and concentration of whatever has 6 to 12 feet to disperse and lower the concentration.  The main way to reduce concentration is through hand washing. You are diluting the number of organisms as well as killing them and the concentration theoretically should go to zero. Inside a building the virus is confined and just hangs in the air. Outside the wind and weather and temperature disperse the virus in a matter of minutes if not seconds. Study after study has shown a rapid reduction in a concentration outside. The #2 thing to consider is the time of exposure. If you breathe air with a concentration of one million virus particles for one minute as opposed to one hour you obviously get more exposure with more time. But if the concentration is one or two virus particles being exposed a very long time could potentially expose you to the same number of particles. So the less time you are exposed, the fewer particles you are exposed to reducing viral load. The #3 way to reduce viral load is filtering. Most of us have filters somewhere whose sole purpose is to prevent whatever we are filtering from getting into something we don't want it to get into. We just made Lobster Bisque. We filtered the soup to remove the crab shells and other unwanted solids from the soup. With Viruses the best way to filter them out is with a mask. Over the past two months these are the three things other than quarantine that have clearly demonstrated close to a 95% reduction in the spread of infection and that is hand washing(lowers concentration) and face masks(filters out virus). At the same time the less time spent out when you must go out also helps. I am going to restaurants but I am no longer sticking around and gossiping for 2 or 3 hours. I go out to enjoy my meal and leave and go home reducing the time knowing I am reducing exposure. I also wear my mask when not eating and wash my hands coming and going to the restaurant and going and coming home. To me it is a small inconvenience but together makes a significant reduction in the viral load I am exposed to. 

Viral load is important as whether or not any given individual will actually become ill from the infection. Average humans with average immune systems most will not become sick if exposed to a very low viral load. Our immune systems are designed to daily protect us and make sure we don't get infected with small exposures. Otherwise there would be no human race. There have actually been experiments where volunteers were injected with one or two HIV viral particles and none of them got infected with HIV. HIV concentration varies in infected individuals from very high number of particles to very low number of particles in their blood and other humans exposed through for example a needle prick may or may not get infected dependent of whether or not the concentration of the HIV virus was high or low when they were exposed. Covid-19 is no different so average humans with good immune systems most likely will not get infected if exposed to low viral loads. The people who get infected get infected because they are exposed to a high viral load or they are more susceptible due to a weakened immune system. I suspect the majority of people who have died from Covid-19 were people with low immune systems and exposed to a high viral load. Other than knowing diabetics and heart disease and high blood pressure and older people have weakened immune systems we don't have a test that tells us for sure who is more susceptible. 

So you ask why is Covid-19 different from the regular yearly flu. We have not needed to wear masks in the past years when the flu came around. The answer has to do with the infectivity of the virus or how efficient it is in infecting you. Bottom line a lower viral load is needed to infect any given person with Covid-19 so it is even more important to lower the viral load with COVID 19. What you are trying to do is lower the viral load of Covid-19 that is too low to infect you. 

So the foreseeable future me and my family wash out hands many times a day and when out and about wear masks. We also add a layer of protection by putting a coffee filter inside our masks. There is no risk and it is one more mechanical barrier that might catch a few additional virus particles. It can't hurt and is not noticeable. We also try hard to not linger as long when out. Along with you we are looking forward to the day when this terrible pestilence is over. But until then please follow the above recommendations to help protect yourself and others.