Do and don’t

How to protect yourself from Coronavirus ? Tips for health care workers as an Infectious Diseases physician.

“The most important defense that is going to protect you from the Coronavirus is still common sense with some soap, and not the N95 mask !”

If you have a habit of touching the face with your unsanitized hand, eating snacks with a lowered mask, repositioning the mask with pinching on the front side, then probably you are already infected. You are done!

1. First, know your enemy-simple two rules-the virus spreads through air at a very close distance or through contact. All your moves will be based on this information with eternal vigilance with improvement in each moment.

2. First you need to relax; understand the mortality figures you see in the newspapers.

The virus runs an asymptomatic course probably in the majority.(1)⁠ Imagine the virus is sprayed on 100 peoples’ nose. 60 of them will never develop any symptoms and out of the rest 40, 20 may develop severe symptoms requiring hospital admission and out of these last 20, one person dies. The hospital will report the ‘case fatality rate’ as 1/20= 5%. Note that only 20 reached the hospital to get the testing done. The actual risk of death is 1/100 which is called the ‘infection fatality rate’. Its very difficult to find the figure, as no body knows the asymptomatic infection rates. For the current Corona epidemic it is estimated(2)⁠ by mathematicians to be around 0.5%. So don’t worry, 99.5% of the time, odds are in favor.

3. Being a health care worker (HCW), are you at higher risk of complications compared to public ? Probably no. All the complications depends on your age, and not the number of the viruses that goes inside. No significantly different viral loads in nasal swabs were observed between symptomatic and asymptomatic patients with SARS Cov-2 infection.(3)

4. During a cough or sneeze, salivary spray contain different types of particles. The larger respiratory ‘droplets’, are >5-10 μm, and travel only 3-6 feet due to their weight. The transmission through this is called ‘droplet transmission’. Very small ‘droplet nuclei’, <5μm in diameter, can remain suspended in the air for long periods of time and travel greater than 1 m- Airborne transmission.

In an analysis by WHO and China of 75,465 COVID-19 cases in China, airborne transmission was not reported.(4)

Now let the fear factor disappear, and you can think clearly and calmly about the defense.

5. N95 vs Surgical mask vs cloth masks- choose the right shield at right time.

Hence use a surgical mask when you are sitting in OPD or taking rounds, and N95 (to filter small droplet nuclei) only when you are doing or near to an aerosol generating procedure. Wear a cloth mask when you are in community, as the purpose is to prevent transmission from you. Use resources intelligently and effectively. You may require it for the big and long battle, just in case.

6. Don’t underestimate the surgical mask. It was found good even when intubating.(5)⁠⁠

7. Refrain yourself from lowering mask for making phone calls, while talking to your colleague, or inside your OPD. Refrain yourself from touching the front side. Refrain yourself from saying that the mask is suffocating (it is and will be; you need to compromise).

8. When you remove the mask for taking a tea, remove the lower tie first. Don’t touch the front side. Keep the mask inside your table drawer on a tissue paper, frontside down carefully. Practice hand hygiene after handling it- after removing or putting it back.

9. Make sure that, all around you are using the mask properly. If a friend lowers his mask for chatting with you (with a sigh of relief on his face) he is ready to shoot 3000 droplets in 5 minutes into air. Shoot him before that.

10. Don’t go near your colleagues wearing mask with nose exposed, over the head, under the chin. Preach to them from a distance.

11. Don’t go to canteen or mess room; bring food and eat inside your room or order food. Ask your nurse or assistant to eat inside your room too. Don’t talk during chewing.

12. Practice hand hygiene after each patient. Ask your colleague to monitor you. Watch your colleagues and give feedback; they shouldn’t get infected so that you also won’t.

13. Inside the OPD, install a good exhaust fan. Maintain good air circulation inside the room. Keep the temperature of AC to the highest tolerable; droplet wont travel towards sky. They will settle on floor soon. Install an exhaust inside the toilet also.

14. Corona can enter through eyes. Always wear a mask and an eye visor/ face shield right from the parking lot of hospital (personal recommendation). Do not remove it even while talking to your friend or nurse.

15. Avoid lift and take the stairs. If you are using lift, stay facing the walls keeping social distancing.

16. Always insist all the patients to wear a mask.

17. Tell the front desk to advise to wear mask to who ever calls for an appointment.

18. Start a separate fever clinic at some corner of your hospital. A doctor with full PPE can see patients here. Arrange a separate pharmacy for them.

19. Don’t go near the patients every time, unless absolutely needed. Turn their head to opposite side while auscultating, taking blood pressure, giving injections or drawing blood.

20. Limit the number of nurse visit to patients room by clubbing all the activities together- like checking vitals and delivering food and medicine.

21. Minimize transport of the patient inside the hospital, check the PPE of the accompanied persons.

22. All other staff stay outside the operation room, while the patient is being intubated and extubated during anesthesia.

23. Try to settle thing over phone as far as possible. Use Telemedicine. Don’t offer excuse; learn it.

24. Maintain social distancing inside the hospital like the same poles of a magnet. The droplets travel at very close distance only.

25. At home, don’t go near your parents. Ask them to wear mask. If you happen to cross their path, keep your breath in slow inspiration.

Dr. Rakesh T Parakadavathu

Infectious Diseases consultant

Gimcare hospital, Kannur, Kerala, India

(As the information is evolving, please update it in comments, I can corrrect)

References

1. Day M. Covid-19: identifying and isolating asymptomatic people helped eliminate virus in Italian village. BMJ. 2020 Mar 23;368:m1165.

2. Russell TW, Hellewell J, Jarvis CI, van-Zandvoort K, Abbott S, Ratnayake R, et al. Estimating the infection and case fatality ratio for COVID-19 using age-adjusted data from the outbreak on the Diamond Princess cruise ship. medRxiv. 2020 Mar 9;2020.03.05.20031773.

3. D C, M T, F R, V D, M A, P P, et al. The early phase of the COVID-19 outbreak in Lombardy, Italy. 2020 Mar 20;

4. Aylward, Bruce (WHO); Liang W (PRC). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). WHO-China Jt Mission Coronavirus Dis 2019. 2020;2019(February):16–24.

5. Ng K, Poon BH, Kiat Puar TH, Shan Quah JL, Loh WJ, Wong YJ, et al. COVID-19 and the Risk to Health Care Workers: A Case Report. Ann Intern Med. 2020 Mar 16;

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