Public Health Advice for Coronavirus COVID19

FOREIGN POLICY

REPORT
The Wuhan Virus: How to Stay Safe
As China’s epidemic continues to spread, things may seem scary. Here are 10 simple precautions that can protect you from contracting the coronavirus.
BY LAURIE GARRETT | JANUARY 25, 2020, 2:47 PM
Laurie Garrett is a former senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science writer.

As the new Wuhan coronavirus has spread not only all over mainland China, but also worldwide, panic is rising. Inside China there is a growing sense of helplessness, as the government is compelled to take drastic measures to stop the virus, including introducing some travel restrictions in Beijing. I have received panicked queries from journalists and public health workers in China, asking, “How can we protect ourselves and our families?”

The epidemic could have been controlled fairly easily three weeks ago had there been more openness, swift action, and no attempted cover-up. But now it’s too late, and this virus is spreading globally. Because there is no vaccine or treatment for nCoV2019—the Wuhan pneumonia—and infection has spread throughout China, the government is forced to turn to its 2003 SARS playbook. And that means entire cities must be cut off, and the population of the nation must be restricted in its movements and potential disease-spreading behavior. It is not surprising then that travel out of Beijing may be forbidden; the entire mainland could go on lockdown soon.

I know people are very frightened. And I expect panic will rise in the coming days. But very simple measures can protect you.

During the SARS epidemic, I traveled all over China and Hong Kong, interviewed people infected with the virus, doctors and nurses treating the disease, government officials, police—everybody. I was never concerned that I would become infected, despite being in the room with sick individuals. And that’s because I knew what precautions to take. Here are the most important ones to know:

1. When you leave your home, wear gloves—winter mittens or outdoor gloves—and keep them on in subways, buses, and public spaces.

2. If you are in a social situation where you should remove your gloves, perhaps to shake hands or dine, do not touch your face or eyes, no matter how much something itches. Keep your hands away from contact with your face. And before you put your gloves back on, wash your hands thoroughly with soap and warm water, scrubbing the fingers. Put your gloves on.

3. Change gloves daily, washing them thoroughly, and avoid wearing damp gloves.

4. Masks are useless when worn outdoors and may not be very helpful even indoors. Most masks deteriorate after one or two wearings. Using the same mask day after day is worse than useless—it’s disgusting, as the contents of your mouth and nose eventually coat the inside of the mask with a smelly veneer that is attractive to bacteria. I rarely wear a face mask in an epidemic, and I have been in more than 30 outbreaks. Instead, I stay away from crowds, and I keep my distance from individual people—a half meter, about 1.5 feet, is a good standard. If someone is coughing or sneezing, I ask them to put on a mask—to protect me from their potentially contaminated fluids. If they decline, I step a meter (about 3 feet) away from them, or I leave. Don’t shake hands or hug people—politely beg off, saying it’s better for both of you not to come in close contact during an epidemic.

5. Inside your household, remove all of the towels from your bathrooms and kitchen immediately, and replace them with clean towels that have the names of each family member on them. Instruct everybody in your home to only use their own towels and never touch another family member’s. Wash all towels twice a week. Damp towels provide terrific homes for viruses, like common colds, flus, and, yes, coronaviruses.

6. Be careful with doorknobs. If it’s possible to open and close doors using your elbows or shoulders, do so. Wear gloves to turn a doorknob—or wash your hands after touching it. If anybody in your home takes sick, wash your doorknobs regularly. Similarly, be cautious with stairway banisters, desktops, cell phones, toys, laptops—any objects that are hand-held. As long as you handle only your own personal objects, you will be ok—but if you need to pick up someone else’s cell phone or cooking tools or use someone else’s computer keyboard, be mindful of not touching your face and wash your hands immediately after touching the object.

7. If you share meals, do not use your personal chopsticks and utensils to remove food from a serving bowl or plate and, of course, tell your children to never drink out of anybody else’s cups or from a container of shared fluid. It is customary in China to prepare several dishes for a meal and then allow everybody at the table to use their personal chopsticks to pull food from the common dishes: Don’t do this until the epidemic is over. Place serving spoons in each dish and instruct everybody at the table to scoop what they want from the serving dishes onto their personal plates or bowls, return the serving spoon to the main dish, and then use their personal chopsticks only to pick food from their personal plate or bowl into their mouth. Wash all food and kitchenware thoroughly between meals and avoid restaurants that have poor hygiene practices.

8. Absolutely do not buy, slaughter, or consume any live animal or fish until it is known what species was the source of the virus.

9. When the weather allows, open your windows at home or work, letting your space air out. The virus cannot linger in a well-ventilated space. But of course, if it is cold or the weather is inclement, keep warm and close those windows.

10. Finally, if you are caring for a friend or family member who is running a fever, always wear a tight-fitting mask when you are near them, and place one on the ailing person (unless they are nauseated). When you replace an old, dirty mask from the face of your friend or loved one be very, very careful—assume, for the sake of your protection, that it is covered in viruses, and handle it while wearing latex gloves, place it inside of a disposable container, seal it, and then put it in the trash. While wearing those latex gloves, gently wash the patient’s face with warm soap and water, using a disposable paper towel or cotton swab, and seal it after use in a container or plastic bag before placing it in your household trash. Wear long-sleeved shirts and clothing that covers your body when you are caring for your ailing friend or relative. Clean everything your patient wears or touches very thoroughly in hot soapy water, including sheets, towels, and utensils. If you have space, isolate the sick person in your household in a room, or a corner of a room, where they are comfortable, but separated from the rest of the household. If the weather is tolerable, open a window that is on the opposite side of the room, so that air gently blows past the patient’s face and then outdoors. Of course, don’t do this if it is very cold, as your friend or loved one will be made sicker if uncomfortably cold.
The Chinese government will take very drastic actions over the next few weeks, and this will be a time of hardship for the Chinese people. As the virus spreads in other countries, similarly draconian measures may be invoked to slow the epidemic. But with these simple precautions, if taken by everybody in your household, building, office, and school, you will dramatically reduce the spread of the virus and bring the outbreak to its knees.

Be safe. Do not panic. Take commonsense precautions. As frightening as this time is, you will get through it.

Laurie Garrett is a former senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science writer.

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James Robb, MD FCAP

Date: February 26, 2020 at 2:35:50 PM EST
Subject: What I am doing for the upcoming COVID-19 (coronavirus) pandemic.
Dear Colleagues, as some of you may recall, when I was a professor of pathology at the University of California San Diego, I was one of the first molecular virologists in the world to work on coronaviruses (the 1970s). I was the first to demonstrate the number of genes the virus contained. Since then, I have kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources.
The current projections for its expansion in the US are only probable, due to continued insufficient worldwide data, but it is most likely to be widespread in the US by mid to late March and April.
Here is what I have done and the precautions that I take and will take. These are the same precautions I currently use during our influenza seasons, except for the mask and gloves.:
1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.
2) Use ONLY your knuckle to touch light switches. elevator buttons, etc.. Lift the gasoline dispenser with a paper towel or use a disposable glove.
3) Open doors with your closed fist or hip – do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.
4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.
5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.
6) Keep a bottle of sanitizer available at each of your home’s entrances. AND in your car for use after getting gas or touching other contaminated objects when you can’t immediately wash your hands.
7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!

What I have stocked in preparation for the pandemic spread to the US:
1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.
Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average – everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.
2) Stock up now with disposable surgical masks and use them to prevent you from touching your nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you – it is lung-specific. The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth – it is only to keep you from touching your nose or mouth.
3) Stock up now with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.
4) Stock up now with zinc lozenges. These lozenges have been proven to be effective in blocking coronavirus (and most other viruses) from multiplying in your throat and nasopharynx. Use as directed several times each day when you begin to feel ANY “cold-like” symptoms beginning. It is best to lie down and let the lozenge dissolve in the back of your throat and nasopharynx. Cold-Eeze lozenges is one brand available, but there are other brands available.
I, as many others do, hope that this pandemic will be reasonably contained, BUT I personally do not think it will be. Humans have never seen this snake-associated virus before and have no internal defense against it. Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus. Unbelievable molecular knowledge about the genomics, structure, and virulence of this virus has already been achieved. BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.
I hope these personal thoughts will be helpful during this potentially catastrophic pandemic. You are welcome to share this email. Good luck to all of us! Jim
James Robb, MD FCAP

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Dr. Robb is a recognized expert in biospecimen science with over 50 years of experience in molecular pathology, virology, and genetics. He is board certified in anatomic pathology, clinical pathology, cytopathology, and dermatopathology. Dr. Robb is a consulting pathologist to the National Cancer Institute (NCI) and the Office of Biorepositories and Biospecimen Research (OBBR). He served as a member of the council on scientific affairs, the CSA Education Working Group, the Council on Education, the Personalized Health Care Committee, the Ad Hoc Committee on Pathology Report Standardization, and the CSA Working Group on Informed Consent for Biospecimens. He was the leader of the NCI’s Cancer Human Biobank (caHUB) Biospecimens Subgroup, NCI’s US-Latin America Cancer Research Network (US-LA CRN) Pathology Committee, and National Community Cancer Center Program (NCCCP). Dr. Robb was the governor of the College of American Pathologists (CAP) Informatics committee, an organization comprising of over 18,000 board-certified pathologists.

Dr. Robb, graduated with a BA in theoretical physics from the University of Colorado. He then enrolled at School of Medicine at the University of Colorado Medical School in 1965, and earned his MD degree with honors. He completed his pathology residency and molecular biology training at the Yale University and went on to become a senior surgeon at NIH. After NIH, he moved to the Department of Pathology, University of California San Diego (UCSD); worked as a staff pathologist at Scripps Clinic, La Jolla, California; and lately served as the Director of Anatomic and Molecular Pathology, Cedars MC, Miami, Florida. Dr. Robb’s research interests include molecular oncologic and neurotropic virology.

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