By Dr Tariq Jagnarine, MD, MMED Family Medicine, CCFP
Infection prevention advice to individuals has the potential to reduce transmission of SARS-CoV-2 causing COVID-19, especially if the advice is timely, clear and easy to understand it can improve confidence in the response and give individuals a sense of control. It is important therefore that advice to individuals be considered as evidence based, rational and coherent.
Some of the individual measures to protect against infection with SARS-CoV-2, that have been consistently recommended by the World Health Organisation (WHO) and Pan American Health Organisation (PAHO) includes:
A cough should be caught in a single use tissue, or the crook of the elbow. The tissue should be immediately disposed of and hand hygiene performed using hand washing with non-antimicrobial soap and water, alcohol-based hand rub (60+% alcohol) or antiseptic hand wash. Coughing into bare hands means that they can become heavily contaminated and a vehicle for transmission, unless immediate and thorough hand hygiene is performed. Cough hygiene can reduce, but not totally eliminate, droplets being released by a cough or sneeze.
Avoiding face touching:
There is a reason humans are susceptible during disease outbreak like COVID-19, we keep touching our faces ever so often. Avoiding face touching is a self-protective measure. The risk is that contaminated hands can contact mucosal surfaces and cause an infection. The extent of its role in transmission of infection has not been thoroughly investigated. People have been observed to touch their face 23 times per hour and more in times of stress and in some social groups. As suggested by some Health experts in recent studies, the propensity to self-touch can he avoided with the use of facemask. While medical facemasks do not necessarily stop the virus completely, it can make it harder for individuals to touch their nose and mouth and prevent infection from the virus.
Social distancing or physically distancing is a series of measures, which include minimising social contact of large groups of people in crowded spaces and keeping a distance of at least two meters (3-6 feet) from others. It may also involve minimising physical contact through actions like hand shaking and kissing as a greeting, depending on social norms, which are culturally specific. Other measures include closing of schools and workplaces, isolation, quarantine, restricting movement of people, and cancellation of mass gatherings. Social distancing can protect both the individual and others around them. While the principle behind the intervention is sound, it is difficult to calculate the impact of each element. Several studies have shown that through social distancing, the transmission of the virus has drastically reduced which led to a decrease in the number of cases and deaths.
There are several concerns of the mental impact of such measure of social distancing, leading to stress, anxiety, depression or panic, increase incidence of gender base violence, especially in individuals with pre-existing mental health conditions. Widespread media coverage about a pandemic and its impact on the economy along with the possible resulting difficulties can exacerbate bouts of anxiety along with the stress of been away from other people.
Self-isolation is a more extreme form of social distancing, it has been recommended for high-risk individuals and for those with mild symptoms who do not require medical care. The isolation of asymptomatic high-risk individuals is rational if there is strong evidence of pre or asymptomatic infection. However mass isolation may have major social and economic effects so the risks and benefits should be balanced, and may be tailored according to risk, or consequences of the infection.
Frequent hand hygiene with either soap and water, or alcohol-based hand rub at key moments such as: after using the toilet, coughing or sneezing, before preparing food or eating, after touching communal surfaces such as door handles and before touching your face, has proven to reduce transmission of the virus. Hand hygiene should be thorough, to decontaminate all areas of the hands using the stipulated WHO guidelines for at least 20 seconds and as often as possible.
The value of wearing these outside health care settings is controversial, but it is one of the most visible features of the response in many areas. The evidence for the protective effect of asymptomatic individuals wearing masks is weak at present but research is still ongoing. Facemasks may change face touching behaviour if they become uncomfortable and need adjusting even resulting in accidental infection due to improper practices. There is evidence that wearing a mask reduces the droplet spray if individuals cough or sneeze. Social distancing and cough hygiene are other measures that can be instituted to control the effect of droplet spread.
Avoiding wet/live meat markets:
This is only relevant in areas where these exist. Many early cases were associated with the Huanan seafood market for this outbreak but it is not clear that this is where zoonotic transmission (spread from animals to humans) occurred. Without evidence of multiple events where zoonotic transmission of SARS-CoV-2 has occurred in wet/live meat markets, this measure would not affect the course of this outbreak, but it could reduce the risk of a similar future emergence.
Other measures can include:
- Active monitoring of health after travel to areas with transmission which includes areas of ongoing transmission.
- Avoiding close contact with anyone who is sick, this is the other side of self-isolation but will be difficult to adhere to for persons with caring responsibilities for others.
- Validate and recheck news obtained from unknown sources, not spreading rumours, which can result in widespread panic.
- Regular household surface disinfection.
- Avoiding spitting in public.
- There are currently no Vaccine or Treatment for COVID-19, avoid buying unnecessary tablets and herbal treatment but rather eat healthy and exercise.
- Keep updated with the latest information of COVID-19 using reputable sources such as WHO, PAHO, and the Centers for Disease Control and Prevention (CDC).
Once these measures are followed, chances of infection by COVID-19 are drastically reduced, and persons who become ill with mild to moderate symptoms can easily recover and have a healthy life and future as we all deserve. Practising safe measures saves lives, including yours and that of your family and friends, let’s be COVID-19 free.