According to report by our news channel, If there is one thing that we have learned about Bill Gates is that if he predicts a global pandemic, then there’s a 110% chance that it’s going to happen.
In 2015, during a TED talk, he mentioned that the world government was not ready for a virus pandemic. Jump 4 years later, which is 2019, towards the end of the year the first patient of the COVID-19 virus is identified.
These past two years have proved that surely our governments where not prepared on how to tackle a virus pandemic.
The rates of infection seem to be slowing down worldwide.
England are even planning on doing away with masks completely however here in South Africa the picture isn’t yet quite clear.
Instead of celebrating that the COVID-19 pandemic is coming to an end, we have to be on the lookout for the new deadlier viruses that might be a pandemic. One has to wonder if all of this is being planned. How will it play out?
Neutropenia is when a person has a low level of neutrophils. It is a type of white blood cell.
All white blood cells help the body fight infection. Neutrophils fight infection by destroying harmful bacteria and fungi (yeast) that invade the body.
Neutrophils are made in the bone marrow. Bone marrow is the spongy tissue found in larger bones such as the pelvis, vertebrae, and ribs.
Some level of neutropenia takes place in about half of people with cancer who are receiving chemotherapy. It is a common side effect in people with leukemia. If you have neutropenia, practice good personal hygiene to lower your risk of infection. This includes washing your hands regularly.
People who have neutropenia have a higher risk of getting serious infections. This is because they do not have enough neutrophils to kill organisms that cause infection. People with severe or long-lasting neutropenia are most likely to develop an infection.
Types of Neutropenia
Healthy adults have an absolute neutrophil count of between 1500 to 8000 cells per microliter of blood. Depending on the severity of the deficit of neutrophils in the blood, neutropenia may be mild, moderate or severe. A neutrophil count of between 1000 and 1500 cells per microliter of blood is treated as a mild case of neutropenia.
When the level drops to between 500 and 1000 cells, it is considered moderate neutropenia. A neutrophil count lower than 500 cells per microliter indicates severe neutropenia and carries a critically high risk of infectious complications.
Cyclic Neutropenia– A type of neutropenia occurring every 21 days
Congenital Neutropenia– The most common, and could be inherited to the offspring
Idiopathic Neutropenia– Cause yet unknown
Isoimmune Neonatal Neutropenia– A type of neutropenia common to new-born babies
Depending on the nature of the mechanisms by means of which neutropenia manifests, this condition may be treated as either congenital or acquired.
These individuals are born with abnormally low levels of neutrophils in their blood because of having inherited genetic mutations responsible for neutropenia.
The absence of neutrophils may be attributed to severe infectious disease or medications. The patient may have undergone chemotherapy as a result of which neutropenia might manifest. Generally, the cause is one that can occur over the course of a lifetime and which is not associated with heredity. It may also be characterized as either acute or chronic. These are further divided into a number of subtypes.
If the level of neutrophils in the blood remains abnormally low for as long as two months at a stretch, the patient is said to be suffering from chronic neutropenia. This condition may eventually resolve itself or persist in the long term. This might be as a result of congenital defects or autoimmune disorders. Sometimes a cyclical pattern is seen where neutrophil numbers dip and rise in an alternating manner. Onset usually occurs in childhood.
This occurs as a result of any conditions that temporarily boost consumption of neutrophils or temporarily reduce the ability of the bone marrow to produce neutrophils. Chemotherapy is a common cause of acute neutropenia.
What increases the risk of neutropenia?
Family history or inherited genes
Medical treatments, such as chemotherapy or radiation therapy
Certain medicines, such as penicillin or aspirin
Infections, such as hepatitis A or B, RSV, influenza A or B, cytomegalovirus, Epstein-Barr virus, and HIV
Autoimmune disorders, including hyperthyroidism, rheumatoid arthritis, and lupus
Bone marrow diseases, including aplastic anemia and acute leukemia
Lack of certain vitamins and minerals, such as B12, folate, and copper
It may be caused by different factors as outlined below:
Infections – HIV, Malaria, Hepatitis A, B, C, sepsis, typhoid
Chemotherapy agents for cancer treatment eg alkylating agents and antimetabolites
Bone marrow diseases eg aplastic anemia, cancer infiltration
Deficiencies in diet – malnutrition, vitamin B12, copper
Preeclampsia in mother – (congenital neutropenia)
Maternal antibodies against neutrophils of the infant (congenital neutropenia)
Neutropenia caused by an enlarged spleen
Cancer (e.g. large granular lymphocyte (LGL) leukemia)
Signs and symptoms of infection to look for:
Check your temperature twice a day or if you feel feverish. If your temperature is 100.4°F (38.0°C)
or higher, call your provider right away
Do not take acetaminophen (Tylenol) or aspirin to reduce the fever without talking to your provider first
Cough, sore throat, nasal congestion, or shortness of breath
Burning with urination or new lower back pain
Blood in urine
Diarrhea (worsening) or change in the odor of your stool
Rash, redness or swelling of the skin
Redness, soreness around central line catheter, feeding tube or a wound
Soreness or swelling in your mouth or throat, ulcers or white patches in your mouth, or a change in the color of your gums
The primary complication arising from this condition is heightened susceptibility towards infectious diseases.
Bacterial, fungal and viral infections occur with increased frequency in those with neutrophil deficiency.
An interesting feature of neutropenia-related infection is the presence of fever but an absence of inflammatory response. Inflammation is absent because neutrophils are depleted. This is known as febrile neutropenia.
Pneumonia is a common complication but this too does not present with its usual severity of respiratory symptoms. Critical complications include respiratory failure, kidney failure, and death.
Diagnosis and test
Your healthcare provider will ask about your symptoms and examine you. Tell him or her about the medicines or supplements you take and any health conditions you may have. You may need any of the following tests:
Blood tests will show the level of white blood cells in your body. This will tell healthcare providers if you have an infection and if your neutropenia is moderate or severe.
Urine tests will show if you have an infection of your bladder or kidneys.
A CT may show an infection or other problems causing your symptoms. You may be given contrast liquid to help the infection or other problem show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid.
Treatment and medications
Treatment is based upon the underlying cause, severity, and the presence of associated infections or symptoms as well as the overall health status of the patient. Obviously, treatment must also be directed toward any underlying disease process. Treatments that directly address neutropenia may include (note that all of these treatments may not be appropriate in a given setting):
Antibiotic and/or antifungal medications to help fight infections;
Administration of white blood cells growth factors (such as recombinant granulocyte colony-stimulating factor (G-CSF, filgrastim (Neupogen); sargramostim (Leukine);
A granulocyte-macrophage colony-stimulating factor (GM-CSF), or pegfilgrastim (Neulasta), a long-acting form of filgrastim) in some cases of severe neutropenia;
Corcorticosteroid therapy or intravenous immune globulin for some cases of immune-mediated neutropenia.
Preventive measures may also be implemented in neutropenic patients to limit the risk of infections. These measures might include strict attention to hand washing, use of private rooms, or in some cases, use of gloves, gowns, and/or face masks by caregivers.
Your child’s doctor will suggest ways to help avoid infection, such as:
Frequent hand washing
Avoiding crowds and limiting contact with sick people
Getting all recommended vaccines
Good care of teeth and regular dental check-ups to avoid problems with gums
Fever (over 38.50 C or 101.30 F) is a sign of infection and needs attention right away. We will give you guidelines about what to do if your child gets a fever.
They may need antibiotics to help fight infections caused by bacteria. Usually, antibiotics are given into your child’s vein using a tube, called an IV (intravenous) line.
A child who gets an infection may need to stay in the hospital until we are sure their infection is controlled.
Staph infection is caused by staphylococcus bacteria, types of germs commonly found on the skin or in the nose of even healthy individuals.
Most of the time, these bacteria cause no problems or result in relatively minor skin infections. But staph infections can turn deadly if the bacteria invade deeper into your body, entering your bloodstream, joints, bones, lungs or heart.
A growing number of otherwise healthy people are developing life-threatening staph infections. Treatment usually involves antibiotics and drainage of the infected area. However, some staph infections no longer respond to common antibiotics.
What are some types of staph infections?
Types of staph infections include:
Blisters – These look similar to a whitehead or a pimple. Once it breaks open and the pus drains out, the infection’s threat goes away.
Boils – Deeper than blisters, with the skin surrounding a boil, appear red, swollen and sore. It’s often very painful.
Impetigo – This contagious skin infection looks like a rash with a yellow crust. Impetigo sometimes secretes fluid and also is painful. You often see impetigo among children. It’s typically not serious and can be treated with a topical antibiotic.
Cellulitis – This skin inflammation occurs when your infection gets under the layers of your skin and spreads. It causes redness and painful swelling. You may even develop sores. Cellulitis can become more serious if it’s not treated immediately.
Sepsis – If your skin infection is severe it can progress to a more advanced stage known as sepsis. This inflammation, which enters your bloodstream, is more dangerous to older adults.
Endocarditis – Endocarditis occurs when staph enters your bloodstream and attacks your heart. Doctors typically treat it with strong antibiotics. Surgery is sometimes necessary if the infection damages your heart valves.
Pathophysiology of staph infection
For the majority of diseases caused by S. aureus, pathogenesis is multifactorial, so it is difficult to determine precisely the role of any given factor. However, there are correlations between strains isolated from particular diseases and expression of particular virulence determinants, which suggests their role in a particular disease. The application of molecular biology has led to advances in unraveling the pathogenesis of staphylococcal diseases. Genes encoding potential virulence factors have been cloned and sequenced, and many protein toxins have been purified. With some staphylococcal toxins, symptoms of human disease can be reproduced in animals with the purified protein toxins, lending an understanding of their mechanism of action.
Human staphylococcal infections are frequent but usually remain localized at the portal of entry by the normal host defenses. The portal may be a hair follicle, but usually it is a break in the skin which may be a minute needle-stick or a surgical wound. Foreign bodies, including sutures, are readily colonized by staphylococci, which may make infections difficult to control. Another portal of entry is the respiratory tract. Staphylococcal pneumonia is a frequent complication of influenza.
The localized host response to staphylococcal infection is inflammation, characterized by an elevated temperature at the site, swelling, the accumulation of pus, and necrosis of tissue. Around the inflamed area, a fibrin clot may form, walling off the bacteria and leukocytes as a characteristic pus-filled boil or abscess.
More serious infections of the skin may occur, such as furuncles or impetigo. Localized infection of the bone is called osteomyelitis. Serious consequences of staphylococcal infections occur when the bacteria invade the bloodstream. Resulting septicemia may be rapidly fatal; bacteremia may result in seeding other internal abscesses, other skin lesions, or infections in the lung, kidney, heart, skeletal muscle or meninges.
What causes staphylococcal infection?
Despite being harmless in most individuals, S aureus is capable of causing various infections of the skin and other organs. S aureus infection is common in people with frequent skin injuries, particularly if the skin is dry. Staph skin infections are seen most commonly in prepubertal children and certain occupational groups such as healthcare workers. But they may occur for no obvious reason in otherwise healthy individuals.
Most staphylococcal infections occur in normal individuals, but underlying illness and certain skin diseases increase the risk of infection. These include:
Medication with systemic steroids, retinoids, cytotoxics or immunosuppressives
Immunoglobulin M deficiency
Chronic granulomatous disease
Job and Wiskott Aldrich syndromes (associations of severe staphylococcal infection with eczema, raised immunoglobulin E and abnormal white cell function)
Who Is at Risk for Staph Infections?
While anyone can get a Staph infection, some conditions put people at higher risk including:
Women who are breastfeeding
Vascular or lung disease
Weakened immune system
Those who inject drugs or medications
Skin injuries or disorders
Use of intravenous catheters
What Are the Signs & Symptoms of a Staph Skin Infection?
Staph skin infections show up in lots of different ways. Conditions often caused by S. aureus include:
Folliculitis: This is an infection of the hair follicles, the tiny pockets under the skin where hair shafts (strands) grow. In folliculitis, tiny white-headed pimples appear at the base of hair shafts, sometimes with a small red area around each pimple. This happens often where people shave or have irritated skin from rubbing against clothing.
A furuncle, commonly known as a boil: These swollen, red, painful lumps in the skin usually are due to an infected hair follicle. The lump fills with pus, growing larger and more painful until it ruptures and drains. Furuncles often begin as folliculitis and then worsen. They most often appear on the face, neck, buttocks, armpits, and inner thighs, where small hairs can get irritated. A cluster of several furuncles is called a carbuncle. Someone with a carbuncle may feel ill and have a fever.
Impetigo: This superficial skin infection is most common in young children, usually on the face, hands, or feet. It begins as a small blister or pimple and then develops a honey-colored crust.
Cellulitis: This begins as a small area of redness, pain, swelling, and warmth on the skin, usually on the legs. As this area spreads, a child may feel feverish and ill.
A stye: Kids with one of these have a red, warm, uncomfortable bump near the edge of the eyelid.
MRSA: This type of staph bacteria is resistant to the antibiotics used to treat staph infections. MRSA infections can be harder to treat, but most heal with proper care. Most MRSA infections involve the skin.
Scalded skin syndrome: This most often affects newborns and kids under age 5. It starts with a small staph skin infection, but the staph bacteria make a toxin that affects skin all over the body. The child has a fever, rash, and sometimes blisters. As blisters burst and the rash passes, the top layer of skin sheds and the skin surface becomes red and raw, like a burn. This serious illness affects the body in the same way as serious burns. It needs to be treated in a hospital. After treatment, most kids make a full recovery.
Wound infections: These cause symptoms (redness, pain, swelling, and warmth) similar to those from cellulitis. A person might have a fever and feel sick in general. Pus or a cloudy fluid can drain from the wound and a yellow crust can develop.
What are the complications of staph infections?
Scalded skin syndrome is a potentially serious side effect of infection with staph bacteria that produce a specific protein that loosens the “cement” holding the various layers of the skin together.
This allows blister formation and sloughing of the top layer of skin. If it occurs over large body regions, it can be deadly, similar to a large surface area of the body having been burned.
It is necessary to treat scalded skin syndrome with intravenous antibiotics and to protect the skin from allowing dehydration to occur if large areas peel off.
The disease occurs predominantly in children but can occur in anyone. It is known formally as staphylococcal scalded skin syndrome
Treatment for staph infection
Treatment of a staph infection may include:
Antibiotics. Your doctor may perform tests to identify the staph bacteria behind your infection and to help choose the antibiotic that will work best. Antibiotics commonly prescribed to treat staph infections include certain cephalosporins, nafcillin or related antibiotics, sulfa drugs, or vancomycin. Vancomycin increasingly is required to treat serious staph infections because so many strains of staph bacteria have become resistant to other traditional medicines. But vancomycin and some other antibiotics have to be given intravenously. If you’re given an oral antibiotic, be sure to take it as directed, and to finish all of the medication prescribed by your doctor. Ask your doctor what signs and symptoms you should watch for that might indicate your infection is worsening.
Wound drainage. If you have a skin infection, your doctor will likely make an incision into the sore to drain fluid that has collected there.
Device removal. If your infection involves a device or prosthetic, prompt removal of the device is needed. For some devices, removal might require surgery.
Diagnosis of staph infection
For skin infections, a doctor’s evaluation
For other infections, a culture of blood or infected body fluids
Staphylococcal skin infections are usually diagnosed based on their appearance.
Other infections require samples of blood or infected fluids, which are sent to a laboratory to grow (culture), identify, and test the bacteria. Laboratory results confirm the diagnosis and determine which antibiotics can kill the staphylococci (called susceptibility testing).
If a doctor suspects osteomyelitis, X-rays, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Radionuclide Bone Scanning, or a combination is also done. These tests can show where the damage is and help determine how severe it is. A bone biopsy is done to obtain a sample for testing. The sample may be removed with a needle or during surgery.
How can you prevent a staph infection?
Practice good hygiene.
Wash your hands often with soap and clean, running water. You can also use an alcohol-based hand sanitizer. Hand-washing is the best way to avoid spreading bacteria.
Keep cuts and scrapes clean. Cover them with a bandage. Avoid contact with other people’s wounds or bandages.
Don’t share personal items such as towels, face cloths, razors, or clothing.
Keep your environment clean by using a disinfectant to wipe surfaces you touch a lot. These include countertops, doorknobs, and light switches.
If you’re in the hospital, remind doctors and nurses to wash their hands before and after they touch you.
Sundowner’s syndrome is a behavioural condition represented by a collection of symptoms. The exact cause is unclear, but some specialists believe it happens when a person’s biological clock is off kilter. This is often due to disturbances in their circadian rhythms or sleep cycles.
Many doctors and neuropsychiatrists believe there’s a direct connection between brain deterioration and an increased prevalence of sundowner’s symptoms. This is one reason the behaviours are more common among people with dementia. Some statistics show one out of every five Alzheimer’s disease patients has multiple symptoms associated with the syndrome.
To date, no unifying explanation of the pathophysiology of sundowning has emerged in the literature. However, one of the most accepted biological mechanisms involves the dysfunction of the body’s circadian rhythm in sundowning.
The part of the nervous system that controls circadian rhythms, and thus sleep-wake cycles, is the suprachiasmatic nucleus(SCN), which receives sensory input from photosensitive cells in the retina via the retino-hypothalamic tract.
It has been shown that patients with severe dementia have neuropathological changes in the SCN. It has been hypothesized that these changes may be linked to the disordered circadian rhythm that many clinicians observe in patients with severe dementia.
Initially, Alzheimer’s disease, about 20 to 30 percent of the patients of Alzheimer’s experience this syndrome at some point in their lives.
Person’shistory of substance or alcohol abuse increases the risk of experiencing sundowning syndrome, with chronic symptoms. Some of the behavioral motions are linked with this syndrome.
Day and night experiences changes
Stress level increases after visiting a doctor or an unknown face
Shadowsincrease fear paranoia
A care giver who is exhausted and frustrated
Some of the causes of Sundown Syndrome:
Too Much End-of-day Activity: Some researchers believe the flurry of activity toward the end of the day as the facility’s staff changes shifts may lead to anxiety and confusion.
Fatigue: End-of-day exhaustion or suddenly the lack of activity after the dinner hour may also be a contributor.
Low Light: As the sun goes down, the quality of available light may diminish and shadows may increase, making already challenged vision even more challenging.
Internal Imbalances: Some researchers even think that hormone imbalances or possible disruptions in the internal biological clock that regulates cognition between waking and sleeping hours may also be a principle cause.
Winter: In some cases, the onset of winter’s shorter days exacerbates sundowning, which indicates the syndrome may have something to do with Seasonal Affective Disorder, a common depression caused by less exposure to natural sunlight.
The overall symptoms associated with sundowner’s syndrome involve dramatic changes in behavior as early evening or night-time approaches. Specific signs of possible sundowner’s syndrome include:
Increased agitation as evening draws near (typically occurs between 5 p.m. to 11 p.m.)
Drastic mood swings or changes in personality with no external trigger, other than sunset
Shows signs of mental confusion often accompanied by difficulty thinking or speaking clearly
Experiences sleep disturbances like restlessness, waking in the middle of the night or insomnia
Develops aggressive or violent behavior including yelling
Becomes overly paranoid and may begin to hallucinate
This syndrome can increase injury or likelihood of a person with Alzheimer’s or dementia. They might require an essential medical advice.
Some patients become more violent and agitated, that can potentially result in getting injured.
Some researchers of Psychiatry Investigation suggested that this disorder might deteriorate mental function speedily with Alzheimer’s patients.
A diagnosis of Sundowners or sundowning disease is similar to the diagnosis for Alzheimer’s disease and dementia.
To diagnose sundown syndrome, doctors will use similar tactics that are used to diagnose Alzheimer’s disease or dementia. Because sundown syndrome stems from dementia and cognitive decline, the doctor will first conduct tests to determine the severity of dementia.
This may include imaging scans, blood work, and memory and cognitive tests. It’s important to get a proper diagnosis of dementia when treating sundown syndrome because without it treating the symptoms of sundown syndrome alone, as opposed to treating dementia as a whole, can lead to improper treatment and complications.
Managing sundown syndrome
Try these tips to help you manage these behaviours:
Maintain a predictable daily schedule for waking up, meals, activities and bedtime. Routine helps reduce uncertainty.
Plan daytime activities and adequate exposure to light to create strict day and nighttime separation and to encourage sleepiness at night.
Limit daytime napping to increase sleepiness at night.
Limit caffeine and sugar in the diet too early in the day or not at all.
Use a night light to illuminate dark spaces to reduce anxiety at night when surroundings seem unfamiliar.
In the evening, turn off the TV to reduce background noise, upsetting sounds and extra stimulation.
If you need to go to an unfamiliar setting, bring familiar things along to make it more soothing. These things can be pictures or favourite items such as a throw blanket or pillow.
Play calming music or sounds of nature in the evenings to create a soothing atmosphere.
Visit your geriatrician regularly to diagnose any underlying infections such as a UTI. These types of infections are fairly common in seniors.
If you must schedule something unusual during the day, be sure to tell your loved one well in advance about what will be happening, and do not schedule such events two days in a row.
Excessive noise also seems to contribute to fatigue because it creates additional stress. Since the loss of light is considered to be one of the reasons for Sundowner’s, you might avoid disorientation when darkness falls by turning on plenty of lights well before the sun goes down.
Because of the dangers involved with wandering, it’s one of the behaviors you will most want to prevent.
Think about what might cause your loved one to wander. Perhaps they enjoy walking or are looking for someone. Sometimes, this confusion may involve feeling the need to complete a task. They may believe they’re going to work, as it’s often hard for people with dementia to come to terms with retirement. Perhaps your loved one needs to exercise.
You can try to introduce some form of gentle exercise, although check with your doctor first to make sure you prevent injury.
According to report,Chinese property developer Evergrande Group’s struggle with $300 billion in liabilities has been fairly protracted but did not threaten financial stability in Britain, Bank of England Governor Andrew Bailey said on Wednesday.
China was clearly trying to reduce its reliance on the property sector for growth and the BoE was closely watching events at Evergrande, Bailey told parliament’s Treasury Committee.
We are seeing contagion within China but it seems to be being kept under control. They are managing it by effectively preferring onshore to offshore creditors, we do have to note. But obviously it is a concern to us, Bailey said.
Two banks in Britain, Standard Chartered and HSBC, have large exposures to east Asia.
BoE Deputy Governor Jon Cunliffe said Britain’s banks were resilient, holding enough capital to withstand another COVID-19 like shock to the economy without requiring government help.
Lawmakers also asked about the end of the use in Britain of London Interbank Offered Rate (Libor) for loans and other financial contracts that took place in December. This was one of the biggest changes in markets in decades and had raised concerns about financial stability risks.
I am very pleased with the way it has gone, Bailey said.
While the demise of Libor in Britain has been smooth after six-and-a-half years of preparations, there was still work to do in whittling down the number outstanding contracts still referencing Libor, which is being replaced by the BoE’s overnight Sonia rate.
The former lawmaker who represented Kaduna Central Senatorial District, Shehu Sani has taken to his official Facebook handle to call on his brother Nnamdi, saying that now he has won one billion naira, he should not forget people like him (Shehu Sani) who did not insult him.
While sharing on his official Facebook handle, the President of the Civil Rights Congress of Nigeria, Shehu Sani also made it known that when he (Nnamdi) is out, he (Shehu Sani) will tell him the names of all his open and hidden e enemies.
Alexander Zverev believes there are probably more players at the Australian Open who have tested positive for COVID-19 but they are not being tested, the third seed said on Wednesday.
Frenchman Ugo Humbert said earlier on Wednesday that he had tested positive for the coronavirus, a day after his first round defeat by compatriot Richard Gasquet, forcing him to isolate for a week in Australia.
Players must be fully vaccinated to compete at the Australian Open, a rule that forced the government to deport world number one Novak Djokovic due to his unvaccinated status.
We are allowed to go outside to eat, allowed to do whatever we want, so I think it’s natural that more people get COVID,” Zverev told reporters after dispatching Australia’s John Millman in straight sets in the second round.
I think quite a few players had it when they arrived. Quite a few players I think have it now. We’re not getting tested, so I think if we would get tested there would be probably more positives than there are now, in a way.
Reuters has contacted Tennis Australia for comment.
Australia’s ABC News reported players must conduct daily rapid antigen tests by themselves while supervised tests are conducted on the day they arrive and between days five and seven of their stay.
Bernard Tomic had criticised the COVID-19 testing protocols during the qualifiers last week, saying: “I can’t believe nobody is getting tested. They’re allowing players to come onto the court with rapid tests in their room … No official PCR testing.”
The mercurial Australian tested positive two days later.
Zverev said he is taking all precautions and staying in his own bubble to avoid infection as the 24-year-old Olympic champion seeks his maiden Grand Slam title.
I’m here to play the tournament and I understand that there is a lot of cases in Melbourne, there is a lot of cases in Australia all around. So I don’t do much outside, I haven’t been to any restaurants yet, I haven’t been out, he said.
I haven’t been anywhere but the hotel room and the courts, so I’m kind of doing a bubble for myself, simply because I don’t want to take any risks and I want to give myself the best chance possible to do well here.