Live in the time of Corona - this is HOW you do it
Personal suggestions from a frontline clinician
I am a consultant vascular surgeon employed by the NHS in a full time clinical role. We, as a specialty, have markedly altered our working practice to help care for covid-19 patients. The comments below reflect my personal views, based on my interpretation of available scientific facts and official guidance from international bodies. Please read, interpret and apply based upon your own judgement, taking local and governmental instructions and policy into account.
A related blog on this website details my reasons for putting these tips out for the public.
1. The Golden Rule - maintain a 2 metre distance.
This is the single most important precept. Do not be closer than a 2 metre distance with anyone that you don’t live with. If you can’t tell what 2 metres is, as I read on a Twitter feed, imagine a 6 foot tall person, wearing a hat and boots, lying stretched on the floor between you and the person you are about to interact with.
Most of the contagion of Covid-19 is through droplets from infected persons. This will come off the person from their mouth as they speak, from their nose as they exhale and will obviously be contained in any sneezes or coughs. The person does not need to have symptoms, to be infectious. More than 50% of spread of this viral infection originates from asymptomatic persons - those who are not ill at the time.
If you are exerting physically, such as running or exercising hard, you should probably double your safety distance to 4m. My rationale is that your breath stream will travel that much more / you will inhale that much more, during such activity. I will look for any evidence about this and update in due course.
2. Beware the fomites.
Fomites are inanimate objects that can transmit infections. These include numerous items of our modern existence - phone handsets in the hospital; your own mobile phones; your keys; door handles; elevator buttons; microwave doors; fridge surfaces; your dog’s collar; the list is obviously interminable.
It is impracticable to be cleaning all of these all the time. The principle I am adopting therefore, is to maintain your individual safe environment, and to be on constant alert when you are outside of it. This should be relatively easy for those of us staying at home, and slightly harder for those who must go out to work. It is very do-able, nonetheless. Here is how I go about it :
- When I enter a new environment, such as my vascular surgery office in the hospital, I wipe down and clean all the surfaces I need to be in contact with; the mouse, mousepad, computer keyboard, desk surface, top of folders. It is impracticable to wipe all the paper so I treat these as non-clean.
- I do the same on a daily / 48 / 72 hour basis for the relevant items at home, depending on how much each fomite has been touched.
- I minimise contact with all objects outside of my ‘safe zones’; my home and my immediate work environment.
It goes without saying that hand hygiene remains of paramount importance. Taking off outerwear, and then thoroughly washing your hands with soapy water is vital. This must be done before you set about cleaning all the above surfaces, for the process to be effective.
3. Don’t eat coronavirus.
This seems obvious, but is easily overlooked. The maxim of ‘avoid touching your face’ is a tough one at the best of times. It is obviously almost impossible to avoid your hands being close to your face when you eat. Thus, it is crucial to never eat without cleaning your hands fully. Are you going to eat outside your home, in your workplace, for instance? If so, make sure your hands are clean, and do not handle any objects during your meal that might be infected. This would include things like paperwork. The covid-19 virus can survive for varying lengths of time on almost all inanimate (non-living) surfaces.
4. Maintain your immunity and your mental health.
I am taking a multivitamin supplement on a daily basis, as are all members of my family. Many of us are deficient ‘normally’ in trace minerals that are important for immunity, such as Zinc, Magnesium, Selenium. A multivitamin that tops up all of these is likely to keep your immunity high. Other contributors to a good immune response are eating and sleeping well.
Recognise that the stress of the lockdown, of going to work in these circumstances and of the lack of social contact can all ‘get you down’. Find your own ways to address this before it becomes a bigger problem. There is plenty of help online. I will put links on as and when I verify them.
5. Follow Social Media.
I cannot overemphasise the value of this. Mainstream media (MSM) are letting themselves down deplorably during this pandemic. I stopped trusting The News on the day that an official 1 million strong (at least - the real figures are thought to be higher) public rally in support of the junior doctors’ strike in 2015 did not make the hourly news on many flagship radio stations and TV, and barely featured in newspapers. I do not understand why MSM in a country like the UK does not hold authority properly to account. After a day when more than 900 people in the UK died of coronavirus (Maundy Thursday 2020), some tabloids led their front pages with the statement that it was a Good Friday because the Prime Minister was sitting up in bed.
I use Twitter. I don’t use Facebook, but you should find whatever works for you. My general impression is that Twitter has better ways of filtering out fake news than FB, but I can’t state this with authority as I do not use FB. An adage I have heard is “Twitter is where you tell the truth to strangers, and FB is where you lie to your friends”.
Twitter is easy to create a new account on, free to use, and quick to browse. If you put in a hashtag, you can find all the information you want about any topic. You could search for #covid19, or #PPE or #LoveInTheTimeOfCholera. It all works.
Once you get on Twitter, find people who seem to tweet things you find useful or like reading, and ‘follow’ them so that your Twitter timeline is automatically populated with their wisdom or folly. My twitter handle is @bloodysurgeon and my therapy dog Saoirse’s is @bloodydoggy.
6. PPE for the public.
Finally. The burning question. Should we use masks in public, and all the related queries. I will come back to this with references as soon as I can. For now, my personal opinion - and I stress, this is my suggestion, my advice, my recommendation, not (yet; one lives in hope!) official guidance - is very simple:
Follow rule 1 [keep a 2m distance from everyone you don’t live with]. This includes key workers in their offices, factories and hospitals. There is no logic in following social distancing at home and then flaunting it at work.
If you cannot follow rule 1, then cover your face.
Covering one’s face has two objectives:
[1] cover your own nose and mouth, with a cloth, fabric or paper mask, in order to minimise the risk you will give the virus to another person*
[2] shield your eyes, along with your own nose and mouth, to minimise the risk of you getting the virus from another person.
Your unprotected eyes are much more exposed constantly (while you are awake) compared to your closed nose and mouth. It follows therefore - if you need PPE for your face, it makes sense to include eye protection.
The single most important aspect of using PPE on your face is this : do not do more harm than good.
Follow good technique for the use of PPE:
Make sure the PPE item is clean before it goes on your face.
Do not touch your PPE while you are wearing it.
Use it for a limited time during an encounter where you cannot maintain Rule No. 1.
As soon as you can, remove the PPE safely, touching the outer surfaces as little as possible, clean it, and put it away safely.
Now, clean your hands, all the way up to your forearms beyond your wrists, using soap and water, ensuring that you’ve created a healthy lather of soap bubbles before you wash away those killed covid-19 bugs.
Repeat as needed.
*There are online resources for making your own masks safely, and for cleaning them. I will put links on as and when I am able to verify them.