So, what does one do, in
the middle of an outbreak,
with an illness like COVID-19.
Well, there are many
interventions that are possible
and especially are important, when,
many individuals in a local region are infected.
So, mitigation strategies for an outbreak setting,
are most successful if one
can control public gatherings.
I mean, this is all about social distancing,
if most people are infected, don't go to an area,
where you might be exposed to
all those respiratory secretions.
Physical distancing, minimum of three feet,
more like six feet, perhaps even
longer, in the setting of COVID-19,
where some transmission has been through aerosols,
those small droplets which travel far further,
than one to two meters out from the human being.
And for those situations where
one can not socially distance
and even for those cases in a crowd setting,
requiring face masks is critical.
In fact, if one looks at the pandemic to date,
one of the most successful
intervention strategies has been,
mandatory face masks to prevent
transmission of droplets
with a secondary smaller benefit of
preventing being exposed to the droplets
from other individuals.
What about, where there's a
limited number of infected people.
So, that this would typically be,
an intervention in the early stages,
either pre-epidemic or the very first stages
of introduction to a small community,
where there's a limited number of infected people.
In that situation one can
isolate the suspect case,
test them and then do contact tracing,
to see whom they are exposed to
and whom they might have
exposed and then provide a
quarantine sort of using the ring
system to limit the spread.
The ring system means taking the index patient,
quarantining all their first or primary contacts
and then quarantining the
contacts of the contacts.
It’s a two-ring system, which
has been used very successfully
in other epidemics and the
global history of the world.
What about looking specifically at
individuals who are unvaccinated.
Now, this might be you know
not having access to vaccine,
choosing not to get vaccinated or
those who may for whatever reason
be unable to be vaccinated.
Such as, an immunodeficient person a young child
for whom a vaccine is not indicated et cetera.
So, non-vaccinated people should
take the following health measures.
Using a facial mask which has multiple layers
whenever they are in public
or even in a small gathering
around other people who might
be ill, such as, the household.
Avoiding crowds, avoiding close contact,
this is the social distancing component,
which while very very very difficult
to adhere to, is critically important.
Physical distancing, if one is unable
to avoid being around other individuals,
the centers for disease control in
the States recommends two meters,
which is around six and a half feet,
the world health organization recommends
one meter which is three and a quarter feet.
Boy, I guess I recommend further is better,
if and when possible, so, distancing
at least two meters is appropriate.
Other steps to take, not
touching face or eyes with hands.
This has to do with proven
[inaudible] proven transmission,
by the hands, to mucosal surfaces of
active virus, within respiratory droplets.
So, potentially an effective person coughs
or sneezes onto a horizontal surface,
let's say the desk and then
your hand rests on the desk,
acquires the respiratory droplets
with active virus in and then you,
touch your eye you rub your nose,
I don't know, pick your teeth,
so, there’s absolutely, is there's absolutely
the potential for transmission that way,
so, avoiding that contact.
And then along with that
washing the hands frequently.
Soap and water scrubbing for at least 20 seconds,
followed by a strong rinse.
You can sing the alphabet song twice if that helps
or using an alcohol-based hand sanitizer,
where there is at least 60 percent
ethanol or our isopropyl alcohol,
in the hand sanitizer itself, rub till dry.
Using good respiratory hygiene,
if the person is unmasked,
now, that this may be,
maybe we had a mask rupture,
because that happens that
the strings come unattached
or we forgot the mask and it's
in our in a car or something.
So, coughing into the crook of the elbow,
using a tissue to cover the mouth,
anything one can do to cover nose and mouth,
when coughing or sneezing
is going to be appropriate.
If there is an exposure, what do we do?
And again, this is for unvaccinated individuals.
Quarantine is necessary at the
start of a non-severe illness,
for 10 days and so, unvaccinated,
was at a crowd setting,
may have been exposed, now I start to feel ill,
I need to self-isolate for at least 10 days.
If I'm unvaccinated and I have a known
exposure to a COVID-19 positive person,
then I need to isolate, or
self-quarantine for seven days,
if I can be tested on day 5 and I test
negative and I have zero symptoms,
which develop in those seven days.
However, if I'm not able to be tested,
10 to 14 days is the recommended self-quarantine,
after exposure in the absence of symptoms.
What about fully vaccinated people,
well fortunately, at least by CDC
and although the world health
organization is slower to adopt these,
but this is rolling out worldwide.
Fully vaccinated people can start
to resume normal activities,
without the mask without the social distancing,
if their local laws and
regulations allow this to be true.
Now, some caveats, travel is still highly
associated with a need for masking,
in large part due to the possibility
of breathing recycled air
and as delta variant and other mutant variants,
continue to emerge, it may be
that we'll have to backtrack
on the coming up from behind the masks,
until we see, if the currently available vaccines,
do as good a job as we would like
them to at preventing disease,
from actual mutant variants.
Just how successful are these steps?
I mean, many would argue and many
have, that these are draconian,
that these are horrible and where
is your proof that social distancing
and masks actually worked.
Well, they actually have worked incredibly well,
in preventing other respiratory illnesses,
such as influenza.
If one looks at the year 2019,
so pre COVID-19 pandemic,
in the United States of America
there were 38 million influenza
cases reported to the CDC.
During the pandemic, so from
October of 2020 to April 2021,
so, seven-month period during
the pandemic, only 2,000 cases,
that a night and day difference.
For all intents and purposes,
influenza disappeared from the States,
during the pandemic.
And that is largely a testament
as the evidence has shown,
to the social distancing and the
mass strategies which have worked.
So, it would be fantastic if,
vaccines continue to evolve
and more people get vaccinated to prevent
further spread of SARS-Coronavirus II,
but until those times,
these are interventions and
mitigations that are necessary,
for all of us to follow and continue to follow,
with proven demonstration of their efficacy.