What prevents coronavirus? A pathologist grades COVID-19 precautions.

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COVID-19 is here, and it isn’t going away. The SARS-CoV2 virus, and the disease it causes, has entered the ecosystem of human pathogens and is running up numbers that make it appear to be heading into the realm of the pandemic.

Let’s look at how health care workers and patients alike can mitigate the damage it will cause.

What follows is a subjective grading system of some of the infectious-agent advice your patients are probably hearing nowadays. The scale is based on my own medical opinion, balancing known approaches to disease prevention with the likelihood that the proffered advice will actually work so you can recommend the best advice to your coworkers and those in your care.

Don’t shake hands, or hug and kiss when greeting people. A hearty nod or bow is best, or a fist bump if you feel it would be rude not to make some sort of physical contact. Yes, this puts a damper on selfie lines at political rallies and high-fives at sporting events, but it’s a small price to pay for cutting down on the hand-to-hand spread of unseen viruses. A+

Get your flu shot. Vaccination will likely stop you from catching the flu, and, even if you do get it, the vaccine makes it much, much less likely that you will die. Coronavirus causes “flu-like symptoms,” so, if you are not inoculated against influenza, and you get sick, exhibiting those symptoms will mean you have to be ruled out as a new coronavirus patient. Vaccines are currently being developed against COVID-19, and you’d better believe I will be the first in line when a safe and effective one is approved and available. A+

Wash and scrub your hands and nails well with soap and water. In our house, every time the kids or their friends come in, we send them straight to the bathroom with the mantra, “Wash your hands — it’s a big dirty world.” Make frequent stops at public restrooms to wash with soap and water. Use the hand towel — or a handkerchief, or your shirt sleeve — on the door handle when leaving. As doctors, we know that this is the most basic line of disease defense and beats hand sanitizer and everything else in its ability to kill germs once they’ve reached your skin. A+

Remove your shoes when you come indoors. Swapping outdoor shoes for indoor slippers, the norm in much of the world, is an excellent public health practice. Adopt this habit, and you will cut down on the transmission from the big dirty world into your home of fecal-borne bacteria and viruses that can cause gastroenteritis. A

Don’t touch doorknobs in public spaces. The sinister doorknob had its moment in the movie “Contagion” when the camera zooms in on this inconspicuous — and ubiquitous — fomite. Use a handkerchief or shirt sleeve to pull open doors, and your shoulder to push them. A

Stay home if you are sick. From a public health perspective, staying home when you have upper respiratory symptoms (coughing, sneezing, sore throat) or diarrhea is an effective and critically important way to decrease infectious disease transmission to others. Since this is not practical for those who have mild symptoms (and most COVID-19 infections may be subclinical or mild, and easily mistaken for a cold), it would make very good sense for employers to examine their sick-leave policies right now, and adjust them in order to ensure that all employees can self-quarantine. Guarantee your workers paid sick time, and you will keep your customers and the rest of your workforce healthy and productive. A

Cover your nose and mouth with your elbow when you sneeze. This one is relatively easy to train yourself and your kids to do, but it isn’t always practical, and sometimes (visit any preschool) results in imperfect snot containment. Spraying the unimpeded sneeze into an aerosol is far worse, but keep in mind that your sneezed-upon sleeve is till covered with invisible but potentially infectious goo. B

Hand sanitizer and anti-bacterial wipes to clean hands and sanitize surfaces work in a pinch, and are a fine idea to tote around while out of the house or office, but they are not a miracle cure. They’re expensive, of varying efficacy depending on the alcohol content, and the alcohol dries and damages the skin on repeated application. They don’t remove dirt the way scrubbing with soap, and hot water does. Use them as a stopgap measure between hand-washings. B

Wear gloves. Remember the days when ladies and gentlemen wore gloves everywhere outside the home? The frilly cotton ones are useless for infection control, but leather or polypropylene gloves might be helpful if they make you less likely to touch your face, and if you figure out a way to wash or sanitize them. This is the key, though — because if you don’t clean them regularly, then you’ve just covered your paws in fomites. B

Wear a face mask if you are sick. Face masks are designed to protect the public from you, not the other way around. If you have facial hair, or if you haven’t been fit-tested to ensure a perfect seal, then a mask might be worse than useless. It could give you a false sense of invulnerability. Some practitioners warn that you are actually more likely to touch your face (e.g., to adjust your mask) if you wear one. Panic-buying creates a shortage for health care practitioners, who really do need those N95 respirators to keep people safe from pathogens during all kinds of medical intervention. Surgical masks are a problematic precautionary measure for the current crisis, at least right now. C

Don’t touch your face. While you’re at it, don’t think about pink elephants. This is stupid advice and all but impossible. Every time I see a public health notice warning me not to touch my face, my eyebrows start itching, and I feel phantom hairs tickling my nostrils. Unless I’m at work in the morgue and wearing all my personal protective equipment (bouffant cap, face mask, face shield, triple gloves, and plastic sleeves), I’m going to touch my face. Walking around town with my PPEs on would scare people unnecessarily and create a shortage for when we need them at work. D

Most importantly, the habits that keep you and others healthy are worthwhile all year round and especially every cold and flu season. We really shouldn’t need an outbreak to get us to wash your hands regularly. Now go wash them. It’s a big dirty world.

Judy Melinek is a forensic pathologist and CEO, PathologyExpert Inc. This article originally appeared in MedPage Today

Image credit: Shutterstock.com

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