UPDATED 4/5/20. No matter who you are, what you do, or where you live, COVID-19 likely dominates your life right now. You are probably continuously inundated with new and often conflicting information. And you are having trouble making sense out of it. For example, social distancing recommendations went rapidly from advising against congregations of 1000 to only 5 people in just a week’s time. This article tries to cut through the confusion to offer up some new rules of life that can help you stay safe and sane in the COVID-19 age.
First of all, in my opinion, and until further notice, we need to go to “all-in” on defense against this virus. We must stop approaching this scourge incrementally if we wish to save lives and shorten the duration of this nightmare.
New Rules of Life for the COVID-19 Age
I’ve been an emergency physician for more than 40 years. I have worked my share of disasters around the globe so I know how to tough it out in an uncertain and challenging environment.
I want to use what I’ve learned to share with you some common-sense rules that you can use to stay safe and sane during this current crisis. These rules will also serve you well in the future when inevitably other contagions or natural disasters, such as those related to climate change, emerge to threaten our lives and the lives of our loved ones.
Rules to stay properly informed
Stand up for science
Science – like gravity – is a fact, not a belief system. Good medical care and public health practices will defeat COVID-19. In turn, they are based on evidence that has been derived from solid research. They are not based on whim or “gut feelings.” Healthcare professionals and practitioners of public health need your support. Put your voices and money where your hearts, lungs, family, and well-being are.
Trust the Centers for Disease Control (CDC)
The link to CDC COVID-19 information is https://www.cdc.gov/coronavirus/2019-nCoV/index.html. There are sections on this site that are aimed at consumers, and others that target health care providers. Take the time to read it all. Stay informed to stay safe.
Rules to avoid getting or spreading Covid-19
Keep on scrubbing
Wash your hands frequently using a soap and water scrub for at least 20 seconds, or better yet, a minute. A link to an excellent hand washing video is https://www.youtube.com/watch?v=IisgnbMfKvI How long is 20 seconds? For me, it’s a slow recitation of the Pledge of Allegiance. For others, it’s singing Happy Birthday twice. How long is it for you?
Washing hands is very important if you’re going to handle food or anything else that will come in contact with your mouth (like your hands). Using hand sanitizer with at least 60% alcohol is a reasonable substitute (if soap and water are not available) or add-on after hand washing, but a great soap and water scrub is what you’re after.
Handwashing behavior will hopefully survive the pandemic because it’s the cornerstone of hygiene and prevents many communicable diseases. Begin each day by putting soap and a clean towel (for each person) near every sink in your home and at work.
No more elbow bumps
Quit shaking hands, hugging, kissing, spitting and all the other things you do to transfer your germs to others or to harvest their germs. Practice respiratory etiquette – “cover” your coughs and sneezes by directing them into your hands or the crook of your elbow. If we’re teaching everyone to do that, it doesn’t follow that fist and elbow bumps are safe. No touching! Once the coast is clear, we can decide if we want to go back to our old ways.
Pay particular attention to the vulnerable
So far, older and infirm persons with chronic medical conditions are more likely than younger healthy people to suffer severe lung disease and other overwhelming illness that sometimes leads to death. Take extra precautions to not bring the virus into their lives. But also take care to stay connected with them frequently – FaceTime, Skype, Zoom or pick up the phone and call.
Keep your surroundings disinfected
Use recommended disinfection chemicals (preferably “eco-friendly”) and public health-approved methods to wash, wipe and clean surfaces. Clean up to protect yourself (computer keyboards, doorknobs, cooking surfaces) and to protect others (exercise equipment, shared appliances). If you have food delivered and need to handle the outside of the containers, you can wipe them down first. Take the food out of the containers and serve it using your own dishes and utensils.
What about masks?
The prevailing opinion is that COVID-19 is mainly spread via droplets exhaled, coughed or sneezed from the mouth and nose. These droplets directly transfer coronavirus. If they land on surfaces, they might remain infectious for up to a few days (depending on the surface),. Therefore, they can be touched and then transferred, mostly when someone touches their face with hands. So, in some circumstances, wearing a mask that is impermeable to the virus makes sense. The filter on the mask needs to effectively block viruses. An “N95” (or better, such as an “N100”) mask is recommended. The National Institute for Occupational Safety and Health (NIOSH) provides a list of approved N95 particulate filtering facepiece respirators at https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/default.html Wear a mask if you have been tested positive for COVID-19 or are within 6 feet of persons who have symptoms of COVID-19 (fever, cough, shortness of breath, muscle aches: influenza-like illness).
Don’t cheat at social isolation
Why not? Because if you cheat, you become the enemy. Your secret party or pickup basketball game could spread the virus just when the neighborhood’s about to conquer it.
Follow the rules
If we are serious about halting the spread of COVID-19, we must be very strict about following official public health recommendations about the duration of time we need to practice social distancing and/or shelter-in-place. We need to limit our human-to-human contact to “essentials only.” Social isolation means limiting human contact in such a way as to decrease the transmission of germs, in this case, coronavirus. There’s no scientifically validated number of people in a group that makes it a higher risk. Fewer is better. It only takes one infected person. To put out this fire, we need to extinguish all the embers.
If you become ill, wear a proper mask (see above) when you’re around people
This should be an N95 mask without an exhalation valve to contain the virus-laden droplets you might cough or sneeze onto surfaces.
Your doctor would love to see you in person, but there might not be enough appointment time to squeeze you in and it might even become dangerous. Let technology help us through this crisis.
Get off the bus
Eliminate unnecessary travel. This will reduce your exposure to people who are already infected but do not know it. It also saves money and puts less pollution into the environment.
Rules to help you stay sane
Social isolation doesn’t mean “stop communicating”
Anticipate loneliness, fear, difficulty sleeping, boredom, frustration and sadness. So, reach out to your friends and family by telephone, email, Zoom and FaceTime. Write notes and letters to share thoughts and feelings, and ask, “How are you?” Celebrate life by staying in touch and telling stories. Become a good listener. Gather virtually and sing or play music. Take joy in something.
Stop the blame game
We’ve heard enough about who made what mistake. Please, no more domestic and international political showmanship. We have work to do and can’t afford to waste precious time and energy on that kind of foolishness.
You can’t say thank you too often
If you buy takeout food from restaurants, thank them for being kind and staying open. While you’re at it, thank the people who deliver the mail, work at the grocery store, fix your car and collect the garbage. They’re brave.
If you can, continue to pay people who used to provide services to you. That means people who clean your home or mow your lawn. It also means the aestheticians, barbers, baristas and other gig workers who are now without gigs. Reach out to them to make the offer and help them set up a Venmo or other virtual cash transfer account so that you can help them get through this crisis. We are all in this together.
While you’re staying safe from the virus, find a way to do all the other things that need to be done
Life goes on. Ground yourself in reality. While you’re dealing with COVID-19, don’t forget that we need to maintain education, and also face climate change and migration, food and water shortages, homelessness and conflict-driven indecencies. We must keep up the activities needed to improve our situation.
Keep a diary
We need to record the details about every aspect of this pandemic. There are lessons across the board to be learned – preparedness, response, resilience, supply chain, what we have versus what we really need. We’re scrambling now because our memories are short. Let’s create the history book, and use it.
To that end, exercise your mind, and body
Resist the temptation to feel sorry for yourself. Get up and get moving. Create an activity program and stick to it on a daily basis. Try reading, meditating, writing, drawing, watching movies, learning a foreign language, and using exercise videos. Eat properly and stay in shape. This will help your immune system and help you remain healthy.
Rules for planning ahead
Plan for 2 weeks at home without re-supply
That doesn’t mean you need to hoard toilet paper or anything else. Keep enough food, water and essential supplies on hand, but remember that everyone is in the same situation. Check your pantry. You might already have most of what you need. Don’t fight over the last bag of rice. Be generous. That will carry you through most types of disasters.
Keep your immunizations up to date
We’ve learned this with measles, mumps, German measles, chickenpox, influenza, herpes, smallpox, polio, tetanus, whooping cough and pneumonia. As new vaccines are proven safe and become available, listen to the experts and take them.
Give your lungs a break
If you ever needed healthy lungs, now is the time. So give them a break. We believe that “co-morbid conditions” like chronic obstructive pulmonary disease (COPD) make COVID-19 lung infections more serious, sometimes fatal. If you’re a smoker or vaper, you should quit or begin to seriously taper off. Smoking cessation can be very difficult, so if you’re addicted to nicotine, do the best you can and at least begin the process.
If we can’t buy it, then build it
We need masks, ventilators, drugs, rooms and beds to care for everyone who will need doctors, nurses, technicians and aides to alleviate their suffering. We’ll soon have empty factories, hotels and restaurants. Use them.
The world is connected
Understand that the world is connected. Germs, contaminated air, bad weather, sea-level rise and hostility know no boundaries. The same holds true for sanitation, compassion, kindness, altruism, and peace.
It might be hard to see right now, but we have an opportunity to take stock of who we are and what we want to be. As the saying goes, “What doesn’t kill you makes you stronger.”
More by this author: The Fuse is Lit, It’s Time to Act
First published March 29, 2020, this post has been reviewed and updated for republication.
- 4/5/update: revised section on wearing a proper mask
- 4/3/ update: added section titled “Give your lungs a break”
COVID-19 ANNOUNCEMENT FROM THE DOCTOR WEIGHS IN:
**We’ve changed the focus of our newsletter to focus on providing daily reliable, usable information to help you deal with the challenges of the #COVID19 Pandemic. Stay safe. Stay informed.**
Paul S. Auerbach, MD
Paul S. Auerbach, MD is the Redlich Family Professor Emeritus in the Department of Emergency Medicine at the Stanford University School of
Medicine, and Adjunct Professor of Military/Emergency Medicine at the F.
Edward Hébert School of Medicine of the Uniformed Services University of
the Health Sciences. He is also Medical Editor of The Doctor Weighs In
He is the co-author of Enviromedics: The Impact of
Climate Change on Human Health, editor of the textbook Wilderness
Medicine, and author of Medicine for the Outdoors.Dr. Auerbach is a
founder of the Wilderness Medical Society, member of the Council on
Foreign Relations, and serves on the National Medical Committee for the
National Ski Patrol System. He was a first responder to the earthquakes in
Haiti (2010) and Nepal (2015) and is visiting scholar at the National Center
for Disaster Medicine and Public Health.
Wilderness Medicine (https://amzn.to/2UxIsLQ)
Medicine for the Outdoors (https://amzn.to/2Uz2jKx)