Covid'19 Preventive Measures

REDUCING INFECTIOUS RISKS SUCH AS COVID-19

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PRACTICAL POINTERS ON REDUCING INFECTIOUS RISKS SUCH AS COVID-19 BY Dr. Edward Lin, former Henry Woodburn Fellow at Roswell Park Cancer Institute and Yale-trained anesthesiologist. Dr. Lin is the founder and CEO of HealO Medical, LLC, a Sarasota, FL startup with disruptive technologies in advanced wound care. The info and practices below (current as of March 22, 2020) are guidance I share with my family and friends. They reflect my personal actions and beliefs and do not constitute medical advice. Consult your own physician.

1. The COVID-19 virus is an exceedingly infectious and difficult-to-control virus, unlike any we’ve dealt with before.

Not only does this virus typically delay its manifestation for up to two weeks so that the infected persons unknowingly spread it while appearing well, it is also a FAST-mutating virus. Which makes developing vaccines even more challenging. It holds the potential to be around perennially, just like the “flu”. Only 40X more deadly. COVID-19 requires drastic decisive action in order to stop it—like what was done in China. But many western countries are unwilling to take such draconian measures. As a result, the disease has been allowed to spread uncontrolled and the golden hour to deal a decisive blow to this pandemic may soon pass. Based on current lame and halting action, we will likely see COVID-19 for many months, likely for the rest of 2020 and into 2021. In some few months, look at the explosive rise in incidence in countries that fail to adopt “drastic” measures promptly: Even if you feel fine, and fancy you belong to a less vulnerable group (younger and female), no one is immune. Every one of us must do our part to help control the spread of this virus or we could easily endanger someone else’s grandparents, parents, spouse or children. We must assiduously practice good hygiene and social distancing. Since there is no known effective treatment (insufficient data on the antimalarial drug, chloroquine, or its combo with azithromycin, to draw a conclusion) and no vaccine is likely to be available until mid-2021, it is best to hunker down for a long siege.

2. It is futile and impractical to seek total protection from COVID-19.

If you could find a mask fine enough to filter out a virus, you wouldn’t be able to breathe through it. And such a mask does not exist, for good reason. Seat belts and airbags can only reduce your Confidential Date REDUCING INFECTIOUS RISKS SUCH AS COVID-19 2 risks, not eliminate them. Similarly, compulsively wiping your hands with sanitizer for months (beyond when they are clearly warranted after touching public surfaces) could lead to cracking of your skin, potentially providing a point of entry for microbes. The approach to COVID-19 is to substantially reduce your risk and then stay calm. Stress increases our endogenous production of stress hormones, which in turn weaken our immune system. It is counterproductive.

3. Don’t hoard masks.

Each person needs only a few to wear when leaving home to encounter the public. Let healthcare workers who need them more than you have an adequate supply so they can do their job of taking care of the sick—and in turn protect the community and all of us. Without doubt, a mask reduces risk of infection as well as spread. You can “recycle” your non-woven mask by washing with soap and water, hang dry and rotate its use once or twice a day. Sterilize by placing in boiling hot water, if desired. Shake off excess water and hang to air dry. Avoid wringing it dry as that compacts and deforms the nonwoven fiber layers and may render it less effective and makes it slightly harder to breathe through upon re-use.

4. The PM2.5 atmospheric particulate matter have a diameter of 2.5 micron (about 3% the diameter of a human hair).

The N95 masks are designed to filter out almost all PM2.5 particulate matter, but not virus. Whether you wear an N95 mask or a surgical mask, their greatest contribution to your safety is in stopping the droplets of virus-laden sneezes from being inhaled, and in keeping you from touching your fingers to your lips and nose (common points of entry, in addition to your eyes).

5. Wear your mask properly by ensuring a tight fit all around your face. Identify the malleable metal strip that is near the upper border of the mask.

A common and serious mistake is failure to pinch and form-fit the metal strip that helps to conform the mask over the bridge of the nose. If this is not done, two gaping ventilation passageways remain on each side of the bridge of the nose allowing air exchange to bypass the mask entirely. Its protective function is then largely negated. Make sure the mask completely covers the nose and mouth. If you wear a mask with a pop-off exhalation valve on the side, remember that it does not filter your exhaled breath—so, if you are infected, you must not wear this type of mask. You should wear Confidential Date REDUCING INFECTIOUS RISKS SUCH AS COVID-19 3 the regular surgical mask instead to protect those around you.

6. COVID-19, like the many strains of flu coronaviruses, is spread through aerosol contact.

If you only receive a tiny dose of the virus and you’re not a health-compromised patient (such as a cancer patient, transplant recipient on immunosuppressant’s or person with chronic lung disease such as asthma), then that small inoculum could possibly be just right to lead to the immunity. Since it is seldom up to you to choose the dosage of virus you may encounter, adopt common sense measures including:

  • Social Distancing of at least 6 feet
  • Avoiding Public Gatherings
  • Touching Germ-Laden surfaces such as handrails and doorknobs
  • Carry Tissue paper with you and use it as an intermediate layer when opening lavatory doors, flushing a toilet, turning off the faucet after washing your hands
  • Use the towel you dried your hands with to open the door and then dispose of the used towel properly
  • Whenever feasible, Open doors with your elbow or foot and press elevator buttons with your knuckles, etc.

Do NOT flush disinfectant wipes down the toilet! They are made of non-woven fiber, and do not disintegrate like toilet paper. Sewer systems are already getting clogged up from such blockage. Throw them in the trash can. The coronavirus can remain alive for three days, especially on metal and plastic surfaces, but only about three hours on paper carton, according to an MIT study.

7. Never sneeze into your hand/fist as is the awful habit of many.

It’s a sure way to next spread it to common contact surfaces from doorknobs to elevator buttons. Instead, sneeze into the crook of your elbow or your upper sleeves. It is commonly touted in the media that instead of a handshake, we should use the “elbow bump.” This is also a bad idea because the elbow is where many people sneeze into; it is likely very contaminated and when we cross our arms, our hands come into contact with that very germ-laden area. Instead, practice social distancing and greet by placing your right palm over your heart and nod your head. Zero contamination. Universally understood.

8. If I come down with symptoms consistent with a viral infection (fever, dry cough, headache, muscle aches and shortness of breath (remember that not all symptoms need be present), I’d promptly contact my doctor for guidance.

In the meantime, I immediately increase my fluid intake 2-3 times by drinking juices, tea, chicken soup Confidential Date REDUCING INFECTIOUS RISKS SUCH AS COVID-19 4 (contains antiviral cytokines). I also take an NSAID such as Aleve® or Motrin®, not only to suppress fever, but for its inherent anti-inflammatory actions. If the NSAID is insufficient to keep the fever down, I’d then take Tylenol as an added supplement because they act by different mechanisms.

9. In any inflammatory process (whether by infectious agent such as a virus, or noninfectious agent such as in self-destructing rheumatoid arthritis), the inflammatory pathways do cellular damage.

Suppressing at least a portion of the inflammatory pathway reduces the amount of damage. It is the damage from severe inflammation in the lungs that results in respiratory failure and death in COVID-19. When inflammation is out of control in the lungs, fluid leak from our capillaries into the microscopic air sacs in the lungs where oxygen diffusion takes place. The impairment of this critical function can be better understood by imagining yourself driving in the rain. If it is a sprinkle, one can still see and continue driving (and living). When the rain is too heavy, forward vision becomes blocked and the journey ends (respiratory failure). Ventilators are like the wipers that keep you going, unless the rain gets too heavy. Ventilators are complex machines that require a lot of skills to use and can readily have complications. We do not have even a small fraction of the ventilators that may be needed imminently, and even fewer trained personnel to operate them.

10. If you have respiratory allergies, it is important to suppress them with antihistamines, so your respiratory tract is not further weakened by inflammation and predisposed to invasion by microbes. If you’re a smoker, now is a perfect time to quit and preserve your lung function.

11. If you walk by someone who sneezes or into a contaminated area, immediately suspend your inhalation and try to get away a good distance, then exhale (to expel whatever little contaminant may have entered your respiratory tract) before inhaling again.

If you must sneeze, cover your mouth with a piece of tissue (keep an ample supply in your pockets), or absent that, cough into your upper sleeve (avoid hugs for this additional reason). A cough naturally starts with deep inhalation before a forced exhalation against a closed voice box. You can therefore suppress your cough by forcibly exhaling all the air in your lungs (while keeping you head down so you don’t exhale onto people near you) and close your voice box. Practice now, so you know how to do it right.

12. We’re about to face the biggest Tsunami on the healthcare system ever seen in history. And we are woefully unprepared to face this enemy we do not understand and continually underestimate.

Confidential Date REDUCING INFECTIOUS RISKS SUCH AS COVID-19 5 Now, more than ever, it is critically important to be on our best global citizenship. Our fate is all intertwined and we must do whatever it takes to reduce our spread of the disease even if we are relatively immune to or are recovering from the infection. Our careless or continued viral shedding could end the lives of many innocent others. For two authoritative articles on this pandemic, visit: https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-dief4d3d9cd99ca https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56

If you follow the above tips, you will significantly reduce your risk of infection by COVID19, and by many other contagious pathogens as well. Take care and stay well.