The Virtue of Clean Hands

Good Old Soapy Water To the Rescue

 “Wash your hands like you’ve been chopping jalapeños and you need to change your contacts.” Canadian health officer Bonnie Henry

Who would have thought? The best defense is a thoroughly familiar one –  a good scrubbing of your hands with soapy water. A New York Times article “Why Soap Works” explains why soap is so darn effective (thanks, Tracey Anne).

“From the perspective of microorganisms, it (soap) is often extremely destructive. A drop of ordinary soap diluted in water is sufficient to rupture and kill many types of bacteria and viruses, including the new coronavirus that is currently circling the globe.”

 

 

The chemical structure of soap, it turns out, acts like “a crowbar” to split open the outsides of of bacteria and viruses, causing them to spill their guts. While that’s happening, the soapy water is also lifting them off the surface of your skin. Sanitizers, even alcohol-based ones, are actually less effective than good, old, ordinary soap!

In fact, after washing, simply leave whatever towel you used in bowl of soapy water for a while and the soap will destroy any viral particles that are left.

• After washing – moisturize to avoid dry, cracked skin which provides more places for the virus to hang out in.

Coronavirus Staying Power on Surfaces

A University of Alabama study measured how long the coronavirus can survive on surfaces:

• Plastic and stainless steel surfaces – up to three days on plastic and stainless-steel surfaces.
• Copper – up to 4 hours.
• Cardboard – less than 24 hours.

Note that the amount of viable virus “decreased rapidly” over time. Note that the higher the temperature and humidity, the more quickly the virus died. Instead of disinfecting packages, the authors simply recommended washing hands with soapy water after touching them.

Mail is not an issue – it’s unlikely that any virus is present and it would probably have been absorbed into the envelope, anyway.

Disinfecting

The good news is that the coronavirus is pretty much of a patsy when it comes to neutralizing or killing it.  The rhinoviruses that cause many of our common colds are much more difficult to kill.

First, wash with soapy water and then frequently disinfect touched surfaces such as tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets and sinks.  Dawn, or a similar dishwashing detergent, is effective at cleaning countertops, etc.

Note that you should allow any disinfectant to stay in contact with the surface for a period of time.

The EPA has a list of 1500 (!) disinfectants that can work.  Any product that claims to kill germs must be registered with the EPA and should have a label on it stating so. Some of the more common ones include:

• Clorox Multi Surface Cleaner + Bleach
• Clorox Disinfecting Wipes
• Clorox Commercial Solutions® Clorox® Disinfecting Spray
• Ecolab Products  – Oxycide Daily Disinfectant Cleaner, Virasept
• Lysol brand Heavy-Duty Cleaner Disinfectant Concentrate
• Lysol Disinfectant Max Cover Mist
• Lysol brand Clean & Fresh Multi-Surface Cleaner
• Purell Professional Surface Disinfectant Wipes
• Sani-Prime Germicidal Spray.

Bleach – the nuclear option – a bleach solution ( 1/4 – 1/3 cup of bleach per 1 gallon of cold water; 4 teaspoons of regular chlorine bleach and 1 quart of water)  is probably the easiest and cheapest solution, but also produces noxious odors and can damage metals and countertops.

A bleach solution requires a minute of contact to kill the virus. Re-make any bleach solution after a day as it loses potency. Never mix bleach and ammonia (glass and window cleaners) products together, as they will produce a toxic gas. 

Hydrogen peroxide (3%) or diluted to 0.5% concentrations is odorless and is believed to be effective at killing coronaviruses on surfaces – if left on the surface for one minute. Hydrogen peroxide is particularly good at hard-to-reach spots and crevices because you can just pour it on the area without wiping if off — it will decompose into water and oxygen.

Undiluted isopropyl alcohol (70%) – should be left on the surface for 30 seconds.

Hand Sanitizers – Most hand sanitizers contain enough alcohol to kill the virus (at least 30%, according to a recent study). Rutgers, however, recommends at least 60%.  Rubbing alcohol (70%) works fine, but don’t use 100% alcohol as it evaporates too quickly.

Wash clothes that may have been in contact with the virus. (Do not shake them.)

Warning! Don’t touch your eyes with antiseptic sprays. Some are very powerful. DeJurgen presented a horrific story of a woman who suffered severe eye damage after contaminating her eyes with antiseptic sprays.

Products That Don’t Work

Vinegar, tea tree oil and other natural products for disinfecting surfaces are not recommended. Either studies show they don’t work or the products have not been studied.

How Not to Touch Your Face

Touching your face is dangerous because the virus enters the body through the nose, mouth and eyes.

• How you can truly stop touching your face
• How to stop touching your face

How To Make A Mask

It is now universally agreed that we should all be wearing some type of mask in public or when near someone who is infected.  Masks inhibit infected people, particularly asymptomatic people who are not aware they are sick, from unknowingly passing the virus on, and they also help to block the virus from coming in.

• Check out an  excellent review from the New York Times (including the  t-shirt, 1 paper towel & some safety pins mask!)

Materials – the materials you make the mask from matter and many are being assessed. HEPA furnace filters, vacuum cleaner bags, layers of 600-count pillowcases and fabric similar to that found flannel pajamas have scored well.  One test has been proposed – holding the fabric up to a bright light.

“If light passes really easily through the fibers and you can almost see the fibers, it’s not a good fabric. If it’s a denser weave of thicker material and light doesn’t pass through it as much, that’s the material you want to use.” Dr. Scott Segal, chairman of anesthesiology at Wake Forest Baptist Health

If you want to try putting an air filter (minimum efficiency reporting value (MERV) rating of 12 or higher, or a microparticle performance rating of 1900 or higher) between two layers of a bandana or other cloth that would help.

Otherwise, folding the material several times greatly increases the amount of virus it stops – except in cotton bandanas! Cotton bandanas are the worst at stopping the virus. Masks made out of “quilter’s cotton”, masks made with a double layer of thick batik fabric or with a double layer of flannel and an outer layer of cotton were the best.

Vacuum bags can be used to make a non-sewable mask – but only if they don’t contain fiberglass. Check out this warning from a doctor.

As someone who has spent my formative medical career within Respiratory Medicine – there is a whole spectrum of what we call Occupational-Exposure Lung Diseases. Micro-materials that bypass the normal protective and clearance mechanisms of the lungs and stay in the alveoli, causing inflammation. These can cause a whole range of potentially lifelong and sometimes very significant problems. The reality of this very unfortunate situation with COVID-19, is that it’s going to be sufficiently prolonged that I believe you are potentially putting yourself (or others) at risk if you’re not careful.

Making a Mask

Check out the CDC’s website for several ideas on how to make and wear a face-mask.

Super easy, multi-folded mask from the CDC using a t-shirt and rubber bands:

How to make a mask from a t-shirt with a filter (no sewing required)

From the New York Times – a no-sew, hepa filter mask.

Nose Stuff

As the virus often makes its way into the lungs and body through the nose, several ideas have been proposed to either stop its entry or to get it out of the nose before it goes deeper.

Dr. Klimas recommends using saline nose drops or soap to rinse off the areas where the virus would attach in your nose. This is because the virus goes up through the nose into your airways. Wash your hands and face well with soap and warm water, then stick your soapy finger a quarter-inch into each nostril.  Soap, rinse and then gently blow your nose. (She does not recommend Neti Pots or similar devices).

Dr. Klimas also suggests trying nose sprays with xylitol in the U.S. (and cellulose in Canada and Europe) that coat your nose, reducing the ability of viruses to bind to the mucosa in your nose. Look for the sprays in either the cold/flu or the allergy section of stores.

Practice pre-bed hygiene. Stop any virus particles in your nose and mouth from getting to your lungs while you sleep. Do this by washing your hands and face well with soap and warm water, including — on a finger — a quarter-inch into each nostril. Then, gently blow your nose. Brush your teeth and tongue, swish and spit, and gargle once or twice with an antiseptic mouthwash. Find out more here.

Sustained Contact is Believed to Be a Key Driver

While it’s certainly possible to get the coronavirus from casual contact, practicing social distancing (staying 6 feet from other people) washing one’s hands after touching surfaces, wearing a mask, and not touching one’s face0 – is believed to be quite effective.

Studies suggest that the virus is mostly spread from person to person during times of “sustained contact”; i.e. having a face-to-face discussion with someone or sharing the air they’ve been in for a period of time.

“If you have a passing contact with an infectious person, you would have a very, very low chance of transmission occurring.” Dr. Benjamin Cowling,  University of Hong Kong epidemiologist

Determining who is infected is, unfortunately, impossible as 25% to 40% of those infected may not be showing symptoms. In fact, some studies suggest that people are most contagious prior to their showing symptoms; hence, the need to keep your contact with others to a minimum.

Is the Virus in the Air?

Is the virus spreading through the air? There’s no doubt that if someone sneezes or coughs on you or next to you, you can get it that way, but could somebody sneeze, cough or simply breathe, and thirty minutes later infect you if you walk through the air they were in? Staying aloft that long would require that the virus be present in aerosolized particiles (as opposed to droplets) smaller than 5 micrometres (.0002 inches) in diameter. These tiny aerosolized particles can be passed simply by talking and breathing.

You’d think this would be worked out by now but it hasn’t been. On March 27th, the World Health Organization stated – read this carefully – that “there is not sufficient evidence to suggest that SARS-CoV-2 is airborne.”

Nature reported, though, that experts on airborne infections assume the virus is airborne, but that it will take time – too much time – to gather the evidence that it is. Aerosol scientist Lidia Morawska, of the Queensland University of Technology in Brisbane, Australia, said:

“In the mind of scientists working on this, there’s absolutely no doubt that the virus spreads in the air. This is a no-brainer.”

A Chinese researcher found evidence that viral transmission through the air can occur and “impact people both near and far from the source”. He recommended that the public wear masks. Two other studies, however, did not find airborne coronavirus, and one that did so didn’t find any infective particles. One study attempted but failed to find RNA from the virus in air collected  just 10 centimeters in front of an infected person who was breathing, speaking and coughing,

The sole study, amazingly enough to test the aerosol idea out, demonstrated that the virus can be found for up to three hours in the air under laboratory conditions which involved using a nebulizer to feed viral particles into a special drum. The study found that the viral infectivity half-life; that is, the amount of time that half the virus was still able to infect a culture was just over an hour.  One of the co-authors noted that the conditions were “highly artificial”, but that there is probably “a non-zero risk of longer-range spread through the air”.

Another question involves whether enough virus is present in the air to infect someone. Quickly passing through an airspace where someone was breathing or emitting virus is one thing – standing next to someone who’s been hacking away for 30 minutes is quite another.

The consensus right now appears to be that when the virus is being transmitted, it’s usually being transmitted by picking it up on our hands and transferring it to our mouth, nose and eyes. When respiratory transmission occurs, it probably most commonly occurs via large droplets passed by coughing or sneezing which quickly fall to the ground after travelling at most a couple of feet.

STAT News reported that microbiologist and physician Stanley Perlman of the University of Iowa stated:

“I think the answer will be, aerosolization occurs rarely but not never. You have to distinguish between what’s possible and what’s actually happening.”

Some epidemiologists believe that we would see far higher rates of transmission, particularly among people who don’t know each other, than we are seeing thus far if the virus was strongly aerosolized. Earlier this month, the CDC reported that 10.5% of household members are getting the virus but only 0.45% of close contacts. That figure suggests that aerosolization of the virus is not a major source of infection as well.

Aerosolized transmission may be occurring but it’s not now believed to be a major source of infection. It should be noted that the danger of picking up an aerosolized form of the infection is worse in poorly ventilated areas.

 

Coronavirus Central – Resources From Health Rising

• Tracking – check out the multiplicity of ways the virus is being tracked: its spread, its infectious rate, the deaths it’s causing, efforts to model its effects.
• Advice From ME/CFS/FM Doctors and Researchers – ME/CFS/FM doctors and researchers give advice.
• Staying Safe – how to stay safe including: hand washing, nasal irrigation, disinfecting, making a mask, plus – is the virus being aerosolized? How long the virus is alive on different surfaces, and does the amount of virus present matter?
• Treatments – Check out the astonishing number of COVID-19 treatment trials underway.
• Apps – be part of the solution; use apps that help us understand the spread of the virus; plus, use apps that can warn you if you’ve been in contact with someone who is infected.