What we do and don’t know about the novel coronavirus

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Experts from the Vet School, Med School, and Center for Public Health Initiatives provide insight into the new disease outbreak.

People in a subway station in Shanghai wearing surgical masks. One is carrying two bags, another is carrying a phone, a third is holding an umbrella.
Penn Today | Michele W. Berger | January 28, 2020

Until a month ago, it’s possible to never have heard of coronavirus, despite the fact that science has known about this family of seven viruses since the 1960s. Four are common, causing mild or moderate respiratory symptoms like a runny nose and sore throat, all of which dissipate quickly.

In the past few decades, however, several new coronaviruses have emerged, originating in animals and jumping to humans. In the early 2000s, it was severe acute respiratory syndrome (SARS), which lead to almost 800 deaths. A decade later Middle East respiratory syndrome (MERS) came about, which, according to the Centers for Disease Control and Prevention, killed approximately three out of every 10 patients with the virus.

In late December, news started to spread of a new disease originating in Wuhan, China. Since then, at the time of publication, 132 people have died from novel coronavirus (2019-nCoV). China has confirmed 6,061 cases, with many more in other countries. The United States has so far identified five.

Though the nature of this outbreak is changing daily, some facets are known. Penn experts Julie Engiles of the School of Veterinary Medicine, David Pegues of the Perelman School of Medicine, and Carolyn Cannuscio of the Center for Public Health Initiatives provide some context:

1. Like its predecessors, the novel coronavirus is a zoonotic disease.

At its simplest, that means the infection can spread between animals and humans, Engiles says. “Something like 61% of known infectious diseases occurring in people are zoonotic,” she adds. “And recently, about 75% of newly emerging infectious diseases are zoonotic, so either we’re seeing an increase in their relative frequency or we’re getting better at identifying them.”

They can be passed to humans through direct contact with animal feces and other secretions, contaminated food, indirect transmission via a conduit like water, or vector-borne transmission through mosquitoes, other insects, or even mammals, as is the case with rabies. In some zoonotic diseases like SARS and MERS, human-to-human spread then happens through contact with someone who is sick, likely in the same manner that the flu and other respiratory pathogens move from person to person.

2. Unlike for its predecessors, 2019-nCoV’s host animal hasn’t been confirmed.

SARS and MERS began in animals. “It was eventually determined that civets, which are wild racoon-like animals, were responsible for the SARS epidemic in humans,” Engiles says. “Originally, civets may have gotten SARS from bats, then individual animals likely acquired the infection due to a combination of stress and close physical contact associated with confinement in live-animal markets.” The civets then passed the SARS to humans.

The MERS outbreak 10 years later may also have bats to blame. “For the 2012 coronavirus respiratory outbreak that occurred in Saudi Arabia and other places in the Middle East, dromedary camels were identified as the likely source for viral spread to humans,” she says. “Much like with SARS, this may have arisen from bats, though the exact mode of transmission is still unknown.”

So far, the source of the novel coronavirus remains elusive, she adds, though many animals found at one particular seafood and animal market in Wuhan are being tested.

3. Scientists understand the basics of the new virus.

Though scientists don’t yet have a full picture of 2019-nCoV, they do partially know how it will behave. “This is in the family of common upper respiratory viruses that frequently infect humans,” Pegues says. “In a minority of instances, the upper respiratory problems can lead to pneumonia. We’re really talking about viral pneumonia as the cause of deaths; that’s what differentiates it from a typical respiratory infection like a cold.”

According to the CDC, symptoms include fever, cough, and shortness of breath, though health officials are now saying it’s possible for a person to have the illness before any of these appear. Though hospitals across the country can test for coronaviruses generally—Pegues says the Hospital of the University of Pennsylvania sees 20 or 25 positive results weekly—that doesn’t include the newest strain.

“Right now, that kind of testing is only available at the CDC,” he says. “Ideally, you’d want to develop testing capacity, validate that on a federal level, and then spread it as quickly as possible to the states.”

4. Though the experience with SARS and MERS has quickened reaction time to such an outbreak, this is still a public health challenge.

It took several months to definitively identify and sequence SARS and to determine the animal source of infection in humans, Engiles says. This time, the first part of that process happened in just 10 days. “This is an example of how previous research in these areas can really help in controlling a novel emerging disease,” she says. That doesn’t mean, however, it’s easy to grasp the epidemic’s full extent.

No matter how quickly a government recognizes the seriousness of an outbreak, surveillance is tricky, according to Cannuscio. “People want and deserve accurate information and answers to their questions, but what can be hard for the public to understand is that inaccurate or incomplete data are the norm” in the early stages of an outbreak, she says. “Counts tend to represent the tip of the iceberg, with only the most severe cases coming to hospitals and the attention of authorities.”

As a situation unfolds, focus tends to expand beyond a human-health toll to social, political, and economic concerns. Case in point: About a month into this outbreak, a quarantine in China now affects more than 50 million people, and public transit in Wuhan has been shuttered, meaning people there cannot go to work or easily travel.

“Epidemiologically, we often count the number of people who have become sick or died from a new virus,” says Cannuscio. “But the health effects may come not just from the virus itself but also from shortages of foods, medicines, or employment, or from longer-term economic effects. These figures are not captured in our case counts.”

5. At the local level, there’s currently nothing to do but use common sense health hygiene.

The five cases in the U.S. have occurred in Washington state, California, Arizona, and Illinois. One high schooler, a Chinese exchange student at William Penn Charter School in Philadelphia who had a connecting flight in Wuhan earlier this month, had symptoms, was tested, and does not have coronavirus.

“So far, we have not had documented cases of person-to-person transmission of the novel coronavirus in the U.S.,” Cannuscio says. “This is vitally important because once person-to-person transmission begins, it will be very difficult to identify and isolate new cases in time to prevent rapid escalation.”

Pegues offers the same advice he typically gives during flu season. People should maintain distance from anyone who is ill, cover their mouths when they cough or sneeze, and wash their hands—a lot. He also strongly recommends a flu vaccine; health care providers have already seen significant flu activity early this flu season. “It’s dry and cold and people are inside more and low relative humidity helps viruses spread more efficiently and persist longer,” he adds.

Beyond that, all three experts suggest keeping up with the latest news regarding the novel coronavirus through resources like the CDC, World Health Organization, and World Animal Health Information System.

Carolyn Cannuscio is the director of research at the Center for Public Health Initiatives at the University of Pennsylvania and an associate professor of family medicine and community health at the Perelman School of Medicine.

Julie Engiles is an associate professor of pathology in the Department of Pathobiology at the School of Veterinary Medicine at the University of Pennsylvania

David Pegues is a professor in the Department of Medicine at the Perelman School of Medicine at the University of Pennsylvania

Editors Note: The number of deaths and confirmed cases of the novel coronavirus are up to date as of Wed., Jan. 29 at 10 a.m. Eastern. F 

How to avoid bringing bed bugs home from spring break

Bed bugs are the one thing you don’t want to bring home with you when you return from spring break.

Despite their name, the insects can get into all of your furniture, even air ducts, once they enter your house.

Whether you’re staying in a cheap motel or a luxurious suite, we’ve heard horror stories about these creepy crawlers stowing away and getting into your home.

Inside your hotel room or short-term rental home, bed bugs could be lurking.

“They will stay waiting for the next host to come there,” said a bed bug expert.

You don’t think you could ever bring them home, think again.

“Bed bugs do not discriminate between the rich, the poor, the clean or the dirty,”. “If you happen to be at the wrong place at the wrong time, you will get a bed bug and bring it home with you.”

“Bed bugs hide really well. All they do is they come out and feed for ten minutes when you’re sleeping and they come back and hide inside the bed.”

As their name suggests, they love beds and people to feed on and they’re really hard to see unless you’re looking.

Chatman went along on a house call to demonstrate how to spot them. Expert said his crew only wears suits for extreme cases.

“So we found a bed bug on the zipper part of the mattress, of the box spring encasement,” expert said. “We see this all the time.”

So what can you do to make sure you don’t bring bed bugs home with you?

First, put your luggage in the bathroom as soon as you walk in your room or rental home. You can also place suitcases and bags on a luggage rack off the floor and away from beds or couches.

Next, check the sheets, mattress, box springs and even around the headboard.

Look for dark, rust colored spots. You may even see casings the bugs leave behind and eggs along hard surfaces like a picture frame.

If you find any signs of bed bugs, you should ask for a new room immediately.

“When you come home, do not bring the luggage in your bedroom,” Stavropoulos said. “Instead, empty it out in the garage preferably. Put the clothes in a bag and launder it when you can.”

Jim says don’t let the thought of bed bugs ruin your trip. As with most things in life, there are risks.

But following these steps should put you at a good advantage of steering clear, so that the bed bugs don’t bite.

Bed bug experts say if you notice that bugs are in your home, it’s best to call an exterminator. Don’t try to get rid of them on your own. It can cost anywhere from $500 to $5,000 to treat, depending on the severity and the size of the home.

He says bed bugs can also hide in airplane seats, bus chairs, pretty much anywhere humans sit and lay their heads and they’re the most prevalent in major cities.

Warning signs of a bed bug infestation

bedset_bedbugs.jpgLongview News-Journal May 11, 2019  kgentsch

When traveling overnight, travelers may have their minds on any number of things. Vacationers may be focused on fun in the sun, while the minds of business travelers may be preoccupied with important meetings. Few travelers may be thinking about bed bugs, even though hotels can be vulnerable to infestations of these unwelcome creatures.

Bed bugs might be considered a pesky nuisance, but such a reputation overlooks their potential to cause serious harm. According to the United States Environmental Protection Agency, bed bugs can cause allergic reactions, including anaphylaxis. The Mayo Clinic notes that anaphylaxis is a potentially life-threatening allergic reaction that causes the immune system to release a flood of chemicals, potentially resulting in shock. During such reactions, blood pressure can drop suddenly and the airways can narrow, compromising a person’s ability to breathe.

Bed bug infestations also can contribute to skin infections resulting from bites. Such infections may include impetigo, ecthyma and an infection of the lymph vessels known as lymphangitis. The presence of lymphangitis may indicate that a skin condition is worsening, potentially causing bacteria to spread into the blood and putting people’s lives in jeopardy.

Bed bugs can infest hotels and other public places, including movie theaters. But they also can occur at home. Learning to recognize when bed bugs are present can help people avoid the uncomfortable and potentially unhealthy consequences of infestations.

Red, itchy bites:  Flat, red welts in zigzag lines or small clusters are indicative of bed bugs on humans. Bites, which may be left in straight rows as well, are often irritating, prompting many people to scratch them, which can lead to infection. Arms and shoulders, which many people tend to leave exposed while they sleep, are common areas for bed bugs to appear.

Discomfort sleeping: Bed bugs can be found in places other than beds, but they’re most often found in bed. Some people first suspect bed bug infestations after some restless nights of sleep.

Odor: Bed bugs might be tiny, but that does not mean they don’t smell. Bed bugs release chemical substances known as pheromones. When released in large amounts, these pheromones can produce an odor reminiscent of a dirty locker room.

Stains on bedding: You might need a magnifying glass and/or flashlight to see the stains left by bed bugs, which tend to be rust-colored, reddish-brown or small and brown. These stains will appear after bugs have fed on humans and are typically seen near the corner or edges of the bed.

Bed bug infestations can be uncomfortable and alarming. Learning to recognize signs of such infestations can help people evict these unwanted visitors from their homes.

Here’s how California could be missing pesticides’ cancer risk – #sayNOtoPESTICIDES!

Strawberry_Fields.jpg

The local community is concerned about high levels of pesticides used near Rio Mesa High School in Oxnard, Calif., which is surrounded by strawberry fields on all four sides.  Photo:Sam Hodgson

February 17, 2016 | by Andrew Donohue | Reveal

The local community is concerned about high levels of pesticides used near Rio Mesa High School in Oxnard, Calif., which is surrounded by strawberry fields on all four sides.

California’s pesticide police could be missing a serious health concern for residents and farmworkers by failing to monitor what happens when pesticides get mixed together.

As a new report from UCLA highlighted today, California studies only how each individual pesticide affects human health. Often, however, workers and residents are exposed to a number of pesticides at the same time.

That can happen when pesticides get mixed together before they’re applied to fields or when different pesticides are used in the same field on the same day. A growing body of science is showing that the chemical cocktails could create greater health risks than each pesticide does on its own.

In particular, the report shows how three fumigants – a type of gaseous pesticide central to the strawberry industry and used near schools and homes – might combine to increase the risk of cancer for bystanders. Essentially, once in the human body together, the chemicals can team up to attack and mutate DNA in a way they wouldn’t on their own.

“The regulatory system that is supposed to protect people from harmful levels of pesticide exposure has been slow to deal with interactive effects when setting exposure limits for pesticides,” the report says.

The California Department of Pesticide Regulation’s mission is to protect humans and the environment from the dangers of pesticides. The report’s authors, who come from UCLA’s law and public health schools, said the department must begin studying the combined effects. And they point out that low-income and minority residents are at the greatest risk.

“DPR is required to assess this risk and protect public health, but isn’t doing so,” the authors wrote.

The department already is under fire for how it has managed fumigants, which can spread easily through the air. A Reveal investigation found that department leaders allowed growers and Dow AgroSciences to use heavy amounts of one fumigant despite strenuous objections of scientists because of its potential to cause cancer.

When Ventura County residents subsequently raised concern about the pesticide’s use in strawberry fields near Rio Mesa High School, department Director Brian Leahy responded with a series of exaggerations and contradictions.

The department has curtailed the pesticide’s use and begun drafting rules that would limit pesticide use around schools and require residents to be notified of fumigant use near their homes. However, the state continues to keep open the loophole it created at Dow’s request.

Last week, the department’s second-in-charge, Chris Reardon, left without explanation after nearly 13 years with the agency. An appointee of the governor, Reardon maintained close ties with the agricultural industry, copies of his calendars show.

The UCLA report focused on the fields around Rio Mesa High School to make its case. The school is boxed in on all four sides by conventional strawberry fields. Although pesticides aren’t applied during school hours, the gases can linger in the air for weeks after they’re applied without teachers or students knowing.

Combined, the health risk could be much greater than those of the individual pesticides.

“In fact, modeling shows that over the course of about one week people who live and work in the area around Rio Mesa High School in Ventura County were exposed to large doses of multiple fumigants,” the report says. “This level of exposure raises concerns about possible interactive effects.”

The report points out that 35 percent of all fumigants were applied on the same field on the same day as another fumigant, and 26 percent were applied as part of a pesticide mix.

The authors recommend the following changes in California’s pesticide regulation:

  • Pesticides sold as part of a mixture should be tested before being approved for use.
  • When pesticides are mixed at the field or applied near each other, regulators should require testing or create strict restrictions if there’s a reasonable chance of human harm.
  • The combined effects of the pesticides should be considered in the initial health research done by the Department of Pesticide Regulation and the rules it creates around the pesticides’ use.

#SayNOtoPESTICIDES!

Misled About BedBugs? Ask Real Estate

Apartment_BBS.jpg

Michael Kolomatsky/The New York Times

The New York Times | by Ronda Kaysen | November 21, 2014

Q. My wife and I recently signed a one-year lease for an apartment. It included a rider stating that all apartments in our building had been bedbug-free for at least one year before our move-in date. After we moved in, we learned from the superintendent that an apartment in our building had been infested by bedbugs and treated a few weeks before our move-in date. Needless to say, we were disturbed by this news — and want to know our rights. As we understand it, the landlord is responsible for the costs of fumigating. Who is responsible for other expenses, like replacing mattresses and furniture? Since we were misled (and have the signed rider as proof), can we demand remuneration for any repairs or replacement costs we might be forced to incur?

Astoria, Queens

A. There are two plausible explanations for what happened here, neither of them good. Either your landlord was woefully ill-informed about the state of the building or he lied. In either case, I would be concerned about how effectively the infested apartment was treated for bedbugs, which are notoriously hardy creatures.

“If this is a landlord who is willing to lie on a disclosure form,” said David Hershey-Webb, a lawyer who represents tenants, “then the tenants may not have a lot of faith in the landlord to adequately address the bedbug problem.”

The New York City administrative code requires landlords to disclose whether or not an apartment has been treated for bedbugs in the last year. The measure does not include any penalties for violating the law. However, if you do get bedbugs and incur damage to your personal property, you could take the landlord to small claims court and use that erroneous disclosure form as evidence of negligence. Under normal circumstances, a landlord is required to treat the infestation and a tenant is responsible for cleaning personal belongings, Mr. Hershey-Webb said.

But before we wander too far down the road of future infestations, determine your risk. If the affected apartment is adjacent to yours or in the same line, you have good reason for concern. But if several floors and walls separate you from that apartment, your risk is considerably lower.

“If it’s an immediately adjacent unit or if it’s in that line, it could have an effect,” said Gil Bloom, the president of Standard Pest Management and an entomologist. “Outside of that, it normally does not make a difference.”

Once you have assessed your risk, decide whether you want to stay in the apartment. Ultimately, you might want to consider packing up your belongings and moving out before the bugs move in. You “have the option to try to rescind the lease on the basis of fraud,” Mr. Hershey-Webb said. Consult with a lawyer to see if you can get out of the lease. Otherwise, you may find yourself battling a bedbug infestation with a dishonest landlord.

BedBugs reported in some of NYC’s swankiest hotels. They were always there; and it’s getting worse. More important to follow as BedBugs transmit deadly Chagas disease.

February 8, 2016 | by Leonard Greene | New York Daily News
It’s not just the fleabags and flophouses.

Bedbugs have been reported in some of the city’s swankiest hotels with a list that includes the Waldorf Astoria the Millennium Hilton and the New York Marriott Marquis.

According to the Bedbug Registry, a nationwide database of bedbug reports and complaints, bedbug sightings in New York hotels have jumped more than 44 percent between 2014 and 2015.

The Millenium Hilton at 55 Church Street in New York New York.
Google Maps Street View

The Millenium Hilton at 55 Church Street in New York New York.

The data focused on establishments that are members of the Hotel Association of New York City.

Of the 272 association members, 65 percent, or 176 members, have had a guest file at least one complaint about bedbugs at the property.

NR

Michelle Bennett/Getty Images/Lonely Planet Image

Taxi cabs outside Waldorf Astoria Hotel.

Eighteen hotels had a combined 363 complaints, representing 42 percent of all bedbug complaints.

“I stayed in room 2306 for one night,” a Millennium Hilton guest wrote in a complaint to the hotel in 2014. “I found blood on my sheets and a live bug on my bed. I ended up with 60 plus bites.”

At the Times Square Doubletree guest said a stay there last year left hundreds of bite marks on the face, neck arms and hands.

“Extreme case of bed bug attacked on my entire upper body,” the guest wrote.” Went home to Florida a day early and ended up in my local emergency room.”

Research Entomologist Jeffrey White shows off some bedbugs at a informational bedbug conference at 201 Mulberry Street in Manhattan Wednesday.

Warga, Craig/New York Daily News

Last month, a California couple posted a YouTube video about their $400-a-night Central Park hotel room nightmare. The couple found dozens of bedbugs beneath their mattress at the Astor on the Park Hotel.

Lisa Linden, a spokeswoman for the hotel association, said hotels in New York are addressing the issue.

“Bedbugs are a global issue that extend beyond hotels,” Linden said.

”Every member of the Hotel Association of NYC that we are aware of has an active anti-bedbug program in place. If a problem arises, it is dealt with immediately and effectively.”

Scientists who recently studied the bloodsucking creatures in the city’s subway system discovered a genetic diversity among bedbugs depending upon the neighborhood where they were found.

They said the discovery could lead to better insecticides.

#SayNOtoPESTICIDES!

Watch this BedBug go from flat to FAT

FYI – A 2014 Penn State Study confirms that Chagas CAN be transmitted by bed bugs and that bed bugs carry 40 other pathogens and MRSA.  ~A. Steiner~

February 8, 2016 | Christopher Terrell Nield | The Conversation
The bedbug problem is getting worse. Infestation horror stories have popped up in most major cities and a pest control team was even asked recently to exterminate bedbugs on an offshore oil rig.

We tend to associate bedbugs with dirty living conditions, but this is a myth – they don’t actually choose dirty homes over clean ones.  Unusually for many blood-sucking insects, bed bugs haven’t (yet) been implicated in spreading disease to the humans they bite, so that’s one small thing in their favour, though they are suspected of carrying organisms that cause leprosy, oriental sore and the bacterial brucellosis, and may be able to transmit Chagas disease.

After feasting on human blood the same bedbug goes from flat (00:25) to fat (3:25).

#SayNOtoPESTICIDES

Messing with BedBugs’ Genes Could Carry Other Risks?

Bed Bugs Will Outlive All Of Us Unless We Screw With Their Genes

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photo:  Bluejake/Sara Bibi/Gothamist

Bed bugs, like cockroaches and new seasons of The Bachelor, seem impossible to eradicate from the face of the Earth, no matter how many exterminators our landlords call to spray that one time and then never, ever again. But Science says there’s some small hope for the extinction of a moviegoer’s biggest fear—screwing with their genome.

Scientists have managed to map the genome of the common bed bug, revealing some fun things about the little suckers. For instance, bed bugs are actually able to break down toxins, like the ones an exterminator might use, to render them harmless, allowing them to survive even when you try to whack them with bug killer. They’ve also been MUTATING, producing genes that make them resistant to certain insecticides and making it all the more difficult to eradicate an infestation. Another fun fact is that bugs’ genes vary from location to location—a Brooklyn bed bug will have a different genetic sequence from a Queens bed bug, though both are equally disgusting.

Bed bugs also inbreed, and their sex is quite violent. This violent sex has been well-documented, and for those of you who have not yet seen Isabella Rossellini’s bed bug porno, you’re welcome, and sorry:

The takeaway here is that bed bugs have been able to hold us hostage for a long time, but scientists might be able to murder them, provided they make a few genetic tweaks. First, though, let’s kill all the mosquitoes.

[A. Steiner:  So…..Messing with Genes Could Carry Other Risks – YES!]

#SayNOtoPESTICIDES!

Genome of BedBug shows close relationships to Kissing Bug, one of several vectors for deadly Chagas disease, and the body louse. Both have tight associations with humans.

February 2, 2016 | News from Weill Cornell Medical College

Researchers Sequence First Bedbug Genome.  Scientists have assembled the first complete genome of one of humanity’s oldest and least-loved companions: the bedbug. The new work, led by researchers at the American Museum of Natural History and Weill Cornell Medicine, and published Feb. 2 in Nature Communications, could help combat pesticide resistance in the unwelcome parasite. The data also provides a rich genetic resource for mapping bedbug activity in human hosts and in cities, including subways.

male and female bedbugs – both fed and unfed – comparison with apple seeds

“Bedbugs are one of New York City’s most iconic living fossils, along with cockroaches, meaning that their outward appearance has hardly changed throughout their long lineage,” said one of the paper’s corresponding authors Dr. George Amato, director of the museum’s Sackler Institute for Comparative Genomics. “But despite their static look, we know that they continue to evolve, mostly in ways that make it harder for humans to dissociate with them. This work gives us the genetic basis to explore the bedbug’s basic biology and its adaptation to dense human environments.”

The common bedbug (Cimex lectularius) has been coupled with humans for thousands of years. This species is found in temperate regions and prefers to feed on human blood. In recent decades, the prevalence of heated homes and global air travel has accelerated infestations in urban areas, where bedbugs have constant access to blood meals and opportunities to migrate to new hosts. A resurgence in bedbug infestations since the late 1990s is largely associated with the evolution of the insects’ resistance to known pesticides, many of which are not suitable for indoor application.

“Bedbugs all but vanished from human lives in the 1940s because of the widespread use of DDT, but unfortunately, overuse contributed to resistance issues quite soon after that in bedbugs and other insect pests,” said Louis Sorkin, an author on the paper and a senior scientific assistant in the Museum’s Division of Invertebrate Zoology. “Today, a very high percentage of bedbugs have genetic mutations that make them resistant to the insecticides that were commonly used to battle these urban pests. This makes the control of bedbugs extremely labor intensive.”

The researchers extracted DNA and RNA from preserved and living collections, including samples from a population that was first collected in 1973 and has been maintained by museum staff members since then. RNA was sampled from males and females representing each of the bug’s six life stages, before and after blood meals, in order to paint a full picture of the bedbug genome.

When compared with 20 other arthropod genomes, the genome of the common bedbug shows close relationships to the kissing bug (Rhodnius prolixus), one of several vectors for Chagas disease, and the body louse (Pediculus humanus), which both have tight associations with humans.

Click here to read complete article.

 

SayNOtoPESTICIDES!

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