A Must Read by Atul Gawande

I’ve passed on bits of information about the COVID-19 pandemic before. I just read this article by Atul Gawande – a surgeon and medical writer – which I’ve summarized; however, I really recommend reading his whole article if, for nothing else, than to enjoy the clarity of his writing (click on the title to get to the article).

Amid the Corona Virus Crisis,
A Regimen For Re-Entry

Atul Gawande

The New Yorker, May 13 2020

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[I’m both quoting and summarizing Gawande’s discussion in what I’ve shared below]

“… Hospitals have learned how to avoid becoming sites of spread. When the time is right to lighten up on the lockdown and bring people back to work, there are wider lessons to be learned from places that never locked down in the first place.

These lessons point toward an approach that we might think of as a combination therapy—like a drug cocktail. Its elements are all familiar: hygiene measures, screening, distancing, and masks. Each has flaws. Skip one, and the treatment won’t work. But, when taken together, and taken seriously, they shut down the virus.”

  1. Cleaning your hands is essential to stopping the transfer of infectious droplets from surfaces to your nose, mouth, and eyes. Frequency matters – The key, seems to be washing or sanitizing your hands every time you go into or out of a group environment, and every couple of hours while you’re in it; plus disinfecting high-touch surfaces at least daily (like your phone). BTW environmental transmission (i.e via touching things) may account for as little as 6% of COVID-19 infections, he says.
  2. The virus spreads primarily through respiratory droplets emitted by infected people when they cough, sneeze, talk or simply exhale (singing in a group is very hazardous!). That’s why physical distancing is so important – the six foot rule. While not perfect (some people’s sneezes can travel up to 20 feet!), it helps a lot since most droplets seem to fall within a 6 foot radius.
  3. COVID-19 is not actually crazy infectious – an infected person might infect 2-3 people while going about ordinary life but that means the disease spreads. Exposure time matters: less than 15 minutes with an exposed person makes spread unlikely. Again, the 6 foot rule goes a long way to shutting down this risk.
  4. In the health setting daily screening of all employees, patients, and visitors for symptoms of COVID-19 is crucial for preventing the spread of the disease. People are asked to confirm that they have not developed:
    a new fever,
    cough,
    sore throat,
    shortness of breath,
    loss of taste of smell,
    or even just nasal congestion or a runny nose – [My take-away from this, is we need to monitor ourselves for these symptoms constantly and keep away from other people should we experience any of them and stay away for another 72 hours after we’re feeling better.]
  5. The critical thing about COVID-19 is that the virus can make people infectious before they develop any symptoms of illness.
    That’s the reason for MASKS! Combining social distancing with masks can block the spread of respiratory droplets from a person with active, but perhaps unrecognized, infection.
    The cloth masks, while not as effective as surgical masks, can block droplet emissions, as well. (And the virus does not last long on cloth; viral counts drop 99% in three hours.)
  6. “Culture, is the fifth, and arguably the most difficult, pillar of a new combination therapy to stop the coronavirus….It’s about wanting, among other things, never to be the one to make someone else sick.” [It’s all about social responsibility – accepting that my actions can have serious (even lethal) consequences for other people.]

The first of the official guidelines in the US for re-opening is at least 2 weeks of very low to zero new cases! This is most difficult – waiting for the number of new cases in the community to drop to zero (or almost zero) and stay there.

I was explaining to someone the other day it’s kind of like the difference between setting off on a car trip to Chester (NS) vs a car trip to Vancouver! You’ve got a very different mind set when you start out to go to Chester (from Halifax) – it takes an hour and the trip’s over before you know it. The mind set for a car trip to Vancouver is a committed undertaking – you know it’s going to be a long, uncomfortable, inconvenient, sometimes boring, haul. 

Well, we’re all taking that long slow car trip to Vancouver right now – we need to accept the expectation that our commitment to – frequent hand washing, self-monitoring, social distancing, wearing masks, and remembering each of us does this not just to keep ourselves safe, but to keep others safe – will have to go on for a LONG time. The better we are at following the full regimen the safer we all will be and the faster we can experience the world beyond our homes safely again.

[Click here for the original article by Atul Gawande]