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CoVid-19 Part VII - 169 cases ROI (2 deaths) 45 in NI (as of 15 March) *Read OP*
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After my last kind of essay post seemed to be useful to a lot of people I’ve decided to write some more essay type posts in an effort to provide some useful information to people on various topics that questions have been asked about. I’ve asked Boards if I could gather them in a thread so they wouldn’t be lost in the morass here and people could find them more easily. I hope to hear back by Monday.
I’m providing this information to try to:
a) Give people some advice on how to protect themselves and others.
b) Answer some questions that keep coming up.
I’m not suggesting I’m a super expert on any of these things but:
a) I’m a doctor and Consultant in the Irish health service and so I probably know a bit more than Mary and Joe down the street.
b) I’ll try to differentiate between Fact [F], Extrapolation [E] and Informed Guesswork [G] or [O] Opinion to help people figure out for themselves what weight to give various elements of each post. I’ll put these letters in parentheses in front of each paragraph to help you determine when I’m listing facts, when extrapolation from known facts and when just offering an opinion.
This doesn’t substitute for personalised advice from your GP or specialist --- but good luck getting a hold of them in weeks to come.
Anyways, I thought a good first topic to address would be the issues of social isolation/distancing, protective wear, namely, gloves and face masks, and, lastly, handwashing.
Social Isolation:
[F] Lets be very clear the best way to avoid catching SARS-CoV2 and avoid passing it on to other is Social Isolation. Social Isolation is far superior to any other strategy but it isn’t always feasible, especially if you’ve got a job which involves public interaction. With that said the safest thing you can do is socially isolate yourself as much as possible.
[O] What does this mean? If you’re retired or otherwise not working at this time then stay at home. Don’t go out unless it is a matter of life and death – you must get food or you will starve or you must get medicines. Even in these cases I would ask why you have to go out? Have it delivered by the shop or pharmacy or have a relative who has to be out and about for work pick it up for you and drop it at your door without coming inside.
[F] I delivered supplies to my parents over the weekend and left them outside their door in a box and was back in my care before they opened the door to take them inside.
[O] If you want exercise exercise indoors or in your back garden if at all possible. The risks of catching SARS-CoV2 are low if you exercise on your own but my view would be even that isn’t worth the risk. Your view may well vary of course.
[F] With that said going to the pub, gym or parties in peoples’ houses are NOT examples of matters of life and death. Don’t be a moron, spread this and increase the burden on the healthcare system at this time. Your actions right now can decrease or increase the final death toll. Don’t be the sorts of morons who increase it.
Social Distancing:
[F] If you absolutely must go out to the shop then don’t touch others, don’t stand within 1 metre ( preferably two metres ) of them and don’t dally. Don’t lean against counters, don’t use cash, go contactless or if you absolutely must pay in cash let them keep the change or put it in the charity box. Don’t touch staff’s hands to get a few pence back and then put potentially infected money in your pocket contaminating your hands, clothes etc. Get in, do what needs doing and get out. SARS-CoV2 is very infections even with limited contact.
[F] If you are working in a job where you cannot work from home then socially isolate as much as possible from other employees and members of the public. All of the above advice applies.
[F] If you decide to go out for something non-essential then simply don’t. By doing that you risk catching and spreading SARS-CoV2. If you catch it and pass it to two people and they pass it to two others and the doubling rate is 4 days then after 28 days you will be responsible for 128 people having it. Of those 128 people 2 to 3 will die. Was that worth the price? I would argue that almost nothing except a matter of your own life and death or essential work warrants putting others at that risk.
Face Masks:
[F] A lot of conflicting things have been said about face masks. The bottom line is that most of the face masks people are purchasing aren’t of any use and even if they were members of the public don’t know how to use them appropriately in order to gain effective protection.
[E] For this reason I would say that buying face masks is ineffective UNLESS you have been advised on which ones to purchase and how to put them on, fit them and take them off. There is going to be a huge shortage of face masks for medical staff in Ireland soon. In Italy many hospitals have run out of face masks and the doctors and nurses have been treating patients without wearing facemasks themselves. This pretty much guarantees they will get infected and is why we’ve seen a rise in the number of doctors and nurses dying in Italy in recent days.
[F] The only face masks which are worth getting are surgical masks or ones rated as either N95/FFP2 or N99/FFP3. Simply put these two ratings mean they stop 95 or 99% of particles above a certain size IF put on properly but almost certainly the vast majority of you with these masks aren’t getting any protection from them.
[F] See the picture below which shows two Americans with surgical masks ( which their hospital staff will soon need – America has admitted it only has about 15 of the face masks needed if/when their number of COVID-19 cases explodes ) neither of whom have fitted it properly and thus neither of whom are protected. All they’ve achieved is preventing two doctors and nurses being protected.
So, now that I’ve told you that in all the panic you’ve probably bought masks which won’t screen out viruses AND even if they did you don’t know how to wear them properly so as to protect yourself AND even if you get that bit right the way you put them on and off will spread infection do I offer any solutions? Sure, if you’ve already bought them you’re hardly going to return them to hospitals so the people who really need them ( front line healthcare workers ) can benefit from them so you might as well learn how to get some benefit from them.
Here are three good videos I have found and can recommend to show how to put on, fit and remove both surgical masks and more general oval N95 face masks.
How to properly put on, fit and remove Surgical Masks:
Using Surgical Masks 1
Using Surgical Masks 2
N95 Oval Type Mask:
Using N95 Oval Type Masks
[O] Once removed the face masks should be placed in a bin which is in a relatively well-ventilated area and which you don’t use often. I use a bin on a balcony which has no risk of being spread to others and also doesn’t act as a source of infection in the living area.
Gloves:
[F] Buying pairs of disposable gloves is a reasonable precaution. I, personally, have purchased several hundred pairs of vinyl, transparent powder-free gloves as they don’t irritate my skin as much as powdered or latex gloves. Why transparent? Well, they don’t attract as much attention when out in public. I’d also consider whitish ones. If you can’t source them then any colour will do. This isn’t after all, about fashion.
[F] Again, gloves are almost useless if you don’t know how to use them properly. There is a set procedure for how to put them on and remove them and, yes, you guessed it there’s a video for that.
How to put on and take off surgical gloves without contaminating oneself:
Surgical Glove Use
[O] Once removed the disposable gloves should be placed in a bin which is in a relatively well-ventilated area and which you don’t use often. I use a bin on a balcony which has no risk of being spread to others and also doesn’t act as a source of infection in the living area.
[F] Do NOT re-use them. If you do that you might as well just go around shaking hands with everyone you meet and then smearing your hands all over your face repeatedly every few minutes.
[F] The gloves won’t help much if you keep touching your face. The outside of the glove will transmit COVID-19 droplets to your face readily. So is there anything you can do to prevent yourself subconsciously touching your face out of habit? Yes, read the next paragraph.
[O] Doctors and nurses need to get used to not contaminating sterile gloves by touching our faces or other non-sterile things. I’ve always found it useful to purposely interlace my fingers so that to touch my face I’d have to consciously uninterlace them. Since this isn’t always practical and with COVID-19 we are less worried about maintaining a perfectly sterile environment I’ve taken to carrying a tissue in one hand and a biro in the other. I find that carrying something in each hand prevents the vast majority of habitual face touching because I don’t want to poke my eye out with the biro and/or I have to move the tissue in order to free that hand up. By the time I’ve thought of doing that I realise what I’m about to do and can prevent myself from touching my own face. You might find different things that work for you, this is just something that works for me.
Handwashing:
[F] Handwashing is a good idea but, obviously, social isolation is the best followed by social distancing and protective gear ( masks and gloves ). After all of those though it is still well worth washing one’s hands…. Yeah you’ve guess it…. So long as you do it properly. The sort of handwashing most people do verges on useless. On the positive side there are, as ever, videos to show you how. Here is one I found useful and have recommended to non-clinical staff/friends and family.
How to wash your hands the medical way.
Elevators:
One last important point I’d like to make is about the use of lifts in apartment buildings and anywhere else… I’m going to set out some assumptions first to help people understand the reasoning behind the point I’m going to make…
a) Most lifts are used at least once an hour
b) Most lifts are poorly or not at all ventilated.
c) Most lifts are small
d) The HSE recommendation is that you allow at least one hour for droplets to settle before you enter a room in which someone with COVID-19 was.
So, yeah, if someone with COVID-19 has been in that lift in the last 1 hour+ then you can expect there to be droplets in the air there. Elevators are actually quite a high risk location and should be avoided unless you are wearing a suitably fitted mask.
Lastly:
Should you go out on Paddy’s Day?
The thought that people would be selfish enough to do that actually makes me angry and I’m normally very placid. The more go out and mix in public places the more they’ll spread SARS-CoV2 and the higher our peak will be, the more our health service will be overwhelmed and the more people will needlessly die due to this overwhelming. You having a good time isn’t worth people dying. Stay at home and relax.
In the picture these ladies haven't fitted the masks properly around their nasal bridges, cheeks and chins. Therefore those masks are not protecting them at all... but now healthcare professionals who really need them won't have them./cdn.vox-cdn.com/uploads/chorus_image/image/66379373/GettyImages_1202999295.0.jpg)
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