Even with some states judiciously re-opening for limited
business, I don’t think we are ever getting back to the previous “normal”, not
at least until next year if at all. Of course, there are some states that seem
to be recklessly re-opening at all costs placing the economy squarely above
public health. So, for this month’s column, I’m removing my food and wine hat
and getting back to what pays the bills in the Tatsumoto abode and putting my
health care worker hat back on.
The Careful
Balancing Act
I fully understand the current impact that COVID-19 is
having on the economy. With unemployment rates as bad as during the Great
Depression with many states bogged down by masses of unemployed now for close
to 2 months compounded by many state offices with employees working from home.
I know there are many workers who haven’t even seen their first unemployment
check. And it won’t be improving any time soon as even with businesses slowly
opening, many businesses will be operating with just the minimum skeleton crew
so it’s not like everyone will be back to work immediately. And even if
businesses are given the green light, how many shoppers and diners are likely
to re-patronize these businesses as if COVID-19 never happened? I miss my local
watering hole, Vino Italian Tapas and Wine Bar as well as Tanuki Sushi but I’m
probably not jumping right back into the fray as the dining experience itself
would be surreal at best with other tables seated 6 feet away along with the
constant cleansing of tables between table turns. We’ll probably continue to do
regular take-out to support our favorite establishments, but actual sit-down
dining will be placed on hold for the short term. And it’s not just for
personal reasons even though I’m just below the high-risk age cut-off and have
several medical conditions that place me just below high risk. I still have an
85-year-old mother who definitely is high risk and the last thing I want to do
is unwittingly transmit COVID-19 to Mom.
Reducing Risk
The first, second and third measure to reduce the risk
for COVID-19 infection is washing your hands properly and as often as possible.
Get that lather nice and soapy and scrub the fingertips, between the fingers
and the palm for at least 20 seconds – sing happy birthday to yourself
(silently or out loud) twice and that should be 20 seconds. And even if you
wash your hands often, get in the habit of NOT touching your face! You can wash
your hands for 100 seconds but if you then touch a surface that still has
viable virus particles then rub your eyes or touch your mouth or nose, those
virus particles now have an entry point through your mucus membranes to
initiate the infection. I engaged in the “no touch” behavior when I first
worked in retail pharmacy 20 years ago as any virus infection including the
ubiquitous common cold primarily is passed hand-to-mouth. You simply touched that
patient’s insurance card or paper prescription (which many patients placed in
their mouth while searching for their insurance card) then either rubbed your
eyes or mouth and voila! Those same viruses that the patient saw the doctor for
now are in your system!
And if you can’t wash your hands with soap and water for
20 seconds, use an alcohol-based gel to temporarily disinfect your hands. Since
most alcohol-based gels like Purell are probably in short supply, I created my
own using a recipe from the USP or United States Pharmacopeia… I am a
pharmacist after all. Their recipe was to create 10 liters of alcohol gel which
was a lot more than is needed for personal use, so I scaled back my
measurements. For starters, while the minimum ethyl alcohol (the same alcohol
in adult beverages) required is 60% (Purell is 70%), most experts recommend an
80% ethyl alcohol gel. That’s why homemade gels using Tito’s vodka fall far
short of the recommended alcohol level as even pure vodka is usually just 43%
alcohol. My recipe also uses a “beverage” that you usually find at liquor
stores but it’s either Everclear or Clear Springs grain alcohol which is 190
proof or 95% ethyl alcohol. Though they’re sold at liquor stores, they’re not
really produced for plain consumption – and while I do have bottles in my home,
I use it to make either limoncello or to rinse out decanters.
80+% Ethyl Alcohol
Cleanser
7 ounces 190 proof grain alcohol
2 tsp 3% hydrogen peroxide
Enough glycerin to make 8 ounces of liquid total
Mix the liquids until the glycerin “dissolves” into the
alcohol and peroxide mixture. I use an empty 8 ounce Dawn dishwashing container
and leave it upright in the beverage holder of my vehicle and use it whenever
washing my hand with soap and water isn’t practical or available (leaving the
gas station or supermarket). This solution is a lot runnier than Purell gel so
don’t forcefully squeeze the bottle when using this sanitizer.
Masking
For starters, let me clear the air for personal mask use.
It primarily is to prevent the wearer from spreading viral particles to other
people in close proximity. Because most masks used in public are either basic
surgical masks, cloth masks or masks enhanced with PM2.5 filters, they prevent
the spread of viral particles if the mask wearer coughs, sneezes or even simply
speaks – yes, speaking causes the propulsion of air from your lungs and those
minute vapor particles do carry viruses. But don’t surgical masks prevent you
from inhaling viruses since surgeons use them in the operating room? While they
can reduce the wearer from inhaling infectious agents, they don’t make a
complete seal around the nose and mouth and their primary utility is to prevent
the surgeon from passing infectious agents to the patient who had their sterile
body parts cut open. Even masks with the PM2.5 filters are primarily meant to
prevent the wearer from inhaling particles 2.5 microns or larger which usually
are pollutants like smog, car exhaust and chemicals. COVID-19 is one of the
larger viral particles and it’s still only 0.12 microns in size which easily
can pass through a 2.5-micron filter. Because a fair number of COVID-19
patients exhibit no symptoms at all, requiring mask use for everyone reduces
the chances that one of those asymptomatic patients will spread the infection
into the general public.
But what about reducing your chances of infection? The
only mask that reduces the wearers chances of inhaling viral particles are the
N95 or KN95 masks. Both block 95% of particles 0.3 microns or larger with the
N95 meeting American CDC and NIOSH standards and the KN95 meeting China’s
standards. But didn’t I just say COVID-19 particles are just 0.12 microns? Yes,
but the viral particles invariably float through the air on water vapor or dust
particles which are usually larger than 0.3 microns and electrostatic fibers in
these masks tend to bind even particles smaller than 0.3 microns. However,
these are the masks that frontline healthcare providers need and are in very
short supply in most hospitals. Ideally, each mask should be used for an
individual patient encounter, but many nurses are using a single mask for their
whole 8 to 12 hour shift due to the supply shortage.
What About the
COVID-19 Vaccine?
This is my personal professional opinion so take it
either way you want but I’m not really hopefully that a COVID-19 vaccine will
be the cure-all, end-all of COVID-19. For starters, it does take quite a while
for any new vaccine to hit the market as you first have to make sure it’s safe
in a small population then see if it’s possibly effective in that population
then you have to do randomized trials in a larger population for both safety
and efficacy and if you attain statistical significance that it’s efficacious
and the potential side effects don’t outweigh the benefits, then it can be
produced an marketed. Just the testing alone even if a beneficial vaccine is
created places mass immunization into next year at the earliest – not when the
usual flu season begins in a couple of months.
Secondly, COVID-19 comes from the corona family of
viruses, many of which are the causes for the common cold. And like most
people, I’ve had a case of the common cold many times in my life because
virtually all of us never develop immunity to this family of viruses. And even
if a vaccine is produced, different vaccinations have different abilities to
produce immunogenic responses with varying durations of that response. For instance,
the Pneumovax provides 60% protection on the lower end up to 100% protection
with the Tetanus vaccination. And it’s widely accepted that contracting the
disease provides a greater response and immunity than the vaccination alone. As
a personal example, I contracted chickenpox some 46 years ago and still have
high titers of antibodies to the varicella-zoster virus whereas the Zostavax
only provides guaranteed disease protection for about 10 years. And because
we’re finding patients who were COVID-19 positive and had symptom resolution 2
to 3 weeks later with an accompanying negative test only to test positive again
a month or so later, I’m not sure how effective a vaccine will be for long
lasting COVID-19 protection.
The New Normal
So, the new normal will probably include
frequently handwashing and/or alcohol gelling, more frequent mask use and I see
the educational system eventually moving to more online teaching and training
especially at the college and high school level. And I hope people realize that
it’s not just simply about trying not to get infected with the virus, but it is
also about trying not to infect others…
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