"How to Avoid COVID-19"
The best way to survive COVID-19 is not to get it in the first place.
Governments can only do so much.
Preliminary evidence from Japan suggests the cancellation of
events, gatherings, and meetings may slow the spread of COVID-19
by as much as 35%, but that has not been enough to contain the outbreak.
During the unbridled phase of a pandemic, the best thing we can do
is shelter-in-place, staying home to reduce contact with those
outside our households as much as possible.
It’s something nonessential workers can all do.
Put simply, in the American Journal of Emergency Medicine,
staying home saves lives.
This is how social distancing works.
Instead of a scenario like this…
you start breaking some of these exponential chains of transmission
so one person staying at home can have a huge effect.
And you can’t just wait until you hear it’s in your area.
I grew up in Wyoming, which months in only had a few hundred
confirmed cases in the whole state.
But by the time a single death occurs in your community,
hundreds or even thousands of cases are likely present.
We just haven’t done the testing, so unless you’re on some remote
desert island somewhere—a remote desert island with good internet
if you’re watching this— then you should just assume
the virus is in your neighborhood wherever you live.
Those of us who need to leave our homes to provide essential services,
direct care or food delivery, should strive to keep a safe distance
from others and sufficiently sanitize our hands every time
we touch a public surface before we touch our mucous membranes,
meaning our eyes, or the inside of our nose or mouth.
This is good social distancing.
This...not so much.
Once the pandemic is more under control, ample testing is in place,
and the healthcare system is no longer overrun,
these social distancing precautions may start
to be relaxed at least for less vulnerable individuals.
The good news is you can’t infect others if you’re not infected yourself
and you can’t get the virus unless the virus can get to you.
The COVID-19 coronavirus is thought to be transmitted
from one person to the next via respiratory droplets
coughed out by the infected, propelled through the air,
and then landing up the nose, in the mouth, or perhaps
even on the eyes of a person nearby.
As a sign in 1918 put it, Spit spreads Death.
Indirect avenues of spread involve infecting yourself by touching
your eyes, nose, and mouth with hands contaminated by a virus-laden object
or surface, such as rubbing your eyes or picking your nose
after shaking someone’s hand, or touching a public surface
like an elevator button, handrail, gas pump, or toilet handle.
The levels of virus swarming in the snot of COVID-19 sufferers
can reach close to a million per drop, which explains how easy it is
for them to so thoroughly contaminate their surrounding environment.
The presence of the COVID-19 coronavirus in stool samples for up to weeks
after infection— in fact sometimes you can have a negative throat swab,
but a positive anal swab–suggests…
another way toilets may potentially transmit infection.
As you may remember from my why- you-need-to-disinfect-your-toothbrush-
with-white-vinegar video, modern flush toilets aerosolize a plume
of up to 145,000 droplets of toilet water into the air,
which can remain floating around for at least thirty minutes.
This may be one of the ways poliovirus is transmitted.
So, put a lid on it.
Close the lid before you flush and then,
of course, thoroughly wash your hands.
The presence of the coronavirus in feces is also why
the Oregon State health authority recommended people press pause
on their peach emoji, and why the New York Post asked if coronavirus
could be spread through farts, suggesting flatulence may be an
aerosol-generating procedure, something I was surprised to see
was actually put to the test.
“It all started with an enquiry from a nurse,”
She wanted to know if she was contaminating
the sterile environment of the operating room.
Investigators were determined to find out.
A colleague was asked to toot onto two petri dishes,
either fully clothed or with trousers down.
And… only the bare bottom fart sprouted bacteria,
suggesting that clothing acts as a filter.
Pants are like a mask for your butt, both for the gut bacteria
and the splatter ring they found of skin bacteria
thought to be blown from the cheeks by the sheer velocity of it all.
Their final conclusion – Don’t fart naked near food,
or at least within two inches of food.
Similar advice was given in the New York Post piece,
advising people to throw caution to the…wind.
A whole 'nother meaning to silent but deadly...(cough)
Coughed virus may make it more than 2 inches though,
which is why it’s safer to get groceries delivered than to go shopping yourself….
During the SARS outbreak, traces of the virus were not only found
on items handled directly by patients (like TV remote controls)
and surfaces touched by those who interacted with the patients
(like a refrigerator door at a nurses’ station),
but also floating in air samples taken from an infected patient’s hospital room,
suggesting the possibility of more robust airborne transmission
than just coughed droplets.
A similar study performed in a COVID-19 patient’s hospital room
found the virus on the majority of sampled surfaces,
but all the air samples were negative.
Since then, though, we’ve learned differently.
Studies performed at the Nebraska Biocontainment Unit
and the National Quarantine Unit found the majority of air samples
tested positive for traces of the virus—
even in the hallways outside of patients’ rooms.
However, the researchers were unable to verify if the airborne virus
was infectious, given the extremely low concentration,
less than a hundred copies per cubic foot of air.
Nevertheless, because we know the virus can remain viable for hours
when experimentally misted into the air, special care should be certainly
taken for healthcare workers during aerosol-generating medical procedures.
How long does the virus last on contaminated surfaces?
You may have heard that coronaviruses, like flu viruses,
are “enveloped” viruses. Enveloped in what?
As coronaviruses, shown here in yellow,
bud out of infected cells, shown here in blue,
they cloak themselves in the outer layer of our cells.
They are wrapped in a stolen swath of our own cell membranes.
That oily coating helps them hide from immune surveillance
because it looks like us, but it also makes them susceptible
to disinfection and environmental inactivation.
Non-enveloped viruses, like polio, can last for weeks outside the body,
whereas enveloped viruses tend to only be able to survive for days.
As enveloped viruses go, though,
coronaviruses tend to be relatively resistant.
There's a coronavirus that infects pigs, for example,
that can last for a month on nonporous surfaces like metal, plastic, or glass,
but, at most, human coronaviruses only make it to about a week.
On copper and brass, coronaviruses may not be able to survive more than
a few minutes at low levels of contamination
and a few hours at higher doses.
But different coronaviruses have different environmental stability.
The SARS coronavirus lasted more than six days dried on plastic, whereas
one of the common cold coronaviruses didn’t even make it three days.
The SARS virus lasts up to four days in water or soil,
but survived for just minutes after drying on paper when lightly soiled
or up to a day when heavily contaminated,
and less than an hour on cotton cloth.
But what about SARS 2, the coronavirus that causes COVID-19?
The COVID-19 virus appears to be more stable on paper than the SARS virus,
with infectivity extinguished only after twenty-four hours
at the same viral load that led the SARS
to become inactive after eight hours.
The half-life of the COVID-19 virus on steel or plastic is about six hours,
so about 99% is gone by 48 hours, but it may take as long
as 96 hours for all infectivity to disappear.
On cloth, the COVID-19 virus may only last for one day,
but, on the outer layer of surgical masks,
it can survive for at least a full week.
On printing paper, though, the COVID-19 virus
appears to survive for less than three hours.
The virus can only infect you, however, if it can get inside you.
Having the virus on your fingers is only a problem
if you then inoculate yourself by transferring that virus
to your eyes, nose, or mouth.
It’s funny when they do experiments for like the common cold
to see if transmission is more through the air for through touch,
they put people in these crazy arm braces
where they can’t bend their elbow ensuring that they never touch their face.
Having the virus on your fingers is only a problem
if you then inoculate yourself by transferring that virus
to your eyes, nose, or mouth.
It’s not your face in general— touching your forehead, cheek, or chin
is presumably no more dangerous than touching your elbow.
The virus can’t pass through your skin.
The virus can only replicate in live cells, and the outer layer of your skin
is covered by protective strata of dead skin cells.
To get into your lungs, the virus has to find its way to your mucous membranes,
the moist lining of your eyes, nostrils, or mouth.
The reason your nose starts to run when you cry is that tears
drain through tiny channels that tunnel through the nasal bone
and spill into your nostrils, and viruses in your eye can travel
the same route to get to your lungs.
As long as you don’t touch your face,
why does it matter if surfaces are contaminated?
Because you do touch your face.
The oft repeated 23 times-an-hour statistic
is an overestimate, since of the touches recorded
in the cited study on university students,
most were just to the skin on the face, but ten touches an hour
were to the eyes, nose, or mouth.
Adults videotaped in an office-type setting did worse,
each touching their nostrils, eyes, or lips
an average of nearly 16 times an hour.
What about doctors?
Medical professionals were covertly observed
during a ground rounds lecture at a hospital.
And… about one out of every three subjects picked their nose at least once.
In family medicine offices, clinicians and staff touched
their eyes, nose, or mouth an average of 19 times in two hours
(with a range from zero to over 100 touches).
More concerning in terms of patient safety, however, was the finding that
doctors only wash their hands about 30% of the times they should—
even in intensive care units.
And, even when they did manage to wash their hands,
it was for an average of less than nine seconds.