Staying Safe in the Time of COVID-19
In the span of two months, everything has changed. We’re all wearing masks in public. New terms like “staying safe,” “social distancing,” “contactless delivery” and “antibody testing” have become commonplace. Unfortunately, this Sars-CoV-2 virus isn’t going away anytime soon. We are still 12-24 months away from a vaccine that might or might not be 100% efficacious. While we’re “flattening the curve,” there is great concern that we may experience another spike as the world reopens. With that being said, a continued lockdown will devastate the economy and lead to poverty and hunger.
As we put on our masks and step out into this brave new world, it’s important to equip ourselves with the practical knowledge of how to actually stay safe and prevent the spread of this disease. My clients have been asking what specific things they can do to bolster their immune systems. My advice is to keep the immune system strong by avoiding inflammatory foods, exercise regularly, sleep 7-9 hours consistently, and to employ personalized strategies to lower stress. I prescribe targeted supplements that optimize the immune system. After all, our goal at The Anti-Aging & Longevity Center of Philadelphia is to optimize health with a personalized plan. But what else can we do and what do we need to know as we carefully try to resume normal life?
First, it’s important to know if you are infected. There are two kinds of tests available, viral tests and antibody tests.
The viral test is a nasopharyngeal swab, performed at specialized drive-through testing centers or hospitals, that tells you if you are currently infected with COVID-19. Results come back generally in one to three days. If you are sick right now with a fever, dry cough, and muscle aches, the viral test can confirm that you are infected with this specific coronavirus, so you can isolate yourself from other people.
The antibody test is a finger-prick blood test that tells you if you had a previous infection. The test can be done in a doctor’s office and results are available within 10 minutes. If you were sick a month ago and are now wondering whether it was the coronavirus or just the common flu, an antibody test will tell you whether you have already been exposed and are now immune to reinfection. Antibody testing has just recently become available and we’ve been doing them in our office. My patients always ask, “Do I want this test to be positive or negative?” In general, a positive result is reassuring because it indicates that someone has already been infected and recovered. However, it’s not entirely clear whether people can get sick from the same Sars-CoV-2 virus more than once. While a positive antibody test provides some reassurance that we’re safe to enter the community, it’s not a license to take off our masks and start shaking hands again.
The next question my patients all seem to have is, “How do people really contract this disease and what specific things can we all do to avoid getting sick?” Is it safe to go to the grocery store? How about a department store? How about dining in a restaurant or shopping in a store? Do we need to wear a mask if we go outside for a run, and can we get infected by running too close to someone else?
Basically, we get sick when viral particles enter our body through moist mucous membranes like the mouth, eyes, and nose. The vast majority of infections occur from direct person-to-person contact. If we look at data from other respiratory viruses like MERS and SARS, it’s hypothesized that you only need to acquire 1,000 SARS-CoV-2 particles in order to get infected.
For example, someone could sneeze next to you and you could inhale 1,000 viral particles in a single breath. It’s also possible that you could take 10 breaths with 100 particles each while talking to someone at close range. If an infected person rubs their nose and touches a door handle, you can pick up particles by touching the same handle and immediately rubbing your eye.
Essentially, we reach that 1,000-particle threshold based on a high-viral-load exposure in a short period of time, or a low-viral-load exposure over a longer period of time. What happens when people sneeze, cough, or just breathe? Why is coughing and sneezing more dangerous, and how? If you want to understand why it helps to wear masks, here’s some good data.
Studies show that just one cough releases 3,000 droplets in the air, some of which can travel up to 50 mph. Most of these droplets are larger and fall quickly, but it’s possible for small particles to stay in the air and even travel across a room.
A sneeze can release about 30,000 droplets that travel up to 200 mph. Since most of the droplets are small, they can easily travel a large distance. When considering a person infected with COVID-19, a single cough or sneeze can cause almost 200 million viral particles to be spread in the environment around them. When that infected person is wearing a mask, a large majority of those particles are prevented from being dispersed in the air.
What happens when you breathe out? A single breath from the mouth can release 50-5,000 droplets. Most of these are not moving quickly and do fall to the ground quickly with gravity. When breathing out of the nose, that number is even lower. Because there isn’t a strong force when exhaling with a breath, you aren’t spreading viral particles from the lower respiratory areas. This is why exposure from someone via breathing contains lower levels of virus.
How about talking? Speaking increases the release of respiratory droplets to 10 times more than simply breathing. In theory, it would take about 5 minutes of speaking face-to-face with an infected person to acquire the critical dose to infect yourself.
Is it safe to go running outside? Certainly, as long as we take precautions. Don’t consistently stay behind the same person. When passing others, even though they might be breathing hard, you are passing by quickly, so your exposure time is low. Generally, this is considered safer.
Large gatherings in close quarters can be particularly dangerous. For example, at a church in Washington state, 60 parishioners spent a few hours in an enclosed space and 45 became infected, with two deaths. In this specific example, people were singing, which to a much greater extent than speaking causes aerosolization of respiratory droplets. Deep breathing while singing causes those respiratory droplets to go deep into the lungs. The 2-hour time period was long enough to ensure that so many were exposed to a sufficient viral load. Similarly, birthday parties and social gatherings/celebrations will likely not be a good idea in the near future, given how highly contagious this particular virus has shown to be.
How about public bathrooms? The consensus is to avoid them if possible. There are many potential surface areas that can contain viral particles – door handles, faucets, toilets. The flushing of a toilet aerosolizes virus and can be a source of infection. If you have to use a public bathroom, try not to touch surfaces directly, do not flush in the vicinity of a toilet, and use paper towels instead of the dryer after washing.
In general, we want to be careful about spending a great deal of time in an indoor space with limited air exchange or recycled air and lots of people around. Even if the viral exposure is low, if we spend enough time in an enclosed space it’s possible to acquire enough particles to cause an infection.
At some point, restaurants will open up and people may be wary of dining in. Keep in mind that if outdoor seating is available, that will lower your risk of exposure as the air is not recirculating. Reducing crowds and background noise will allow people to carry on conversations at a safe distance without leaning in and breathing on one another.
If you’re going to the grocery store, you need to consider how large the space is, how many people are in it, and how long people spend in the store. It’s much safer for you as a customer who gets in and out as compared to a worker who is there all day.
As work closures start to ease up, take a look at your workplace environment. Is the office full of people? What is the airflow like? Consider how much time you are spending in that environment. As those variables increase, so does your risk of infection. Your risk is lower when you’re sitting in a well-ventilated space with fewer people around.
It is time we all got back to work, to start supporting our local businesses, and to life. We are all in this together, and we will get through it by staying safe.
Stay well & optimistic,
Dr. Bonney
