COVID-19: Prevention

by Sean Elliott, MD

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    00:01 COVID-19 Prevention.

    00:04 So, what does one do, in the middle of an outbreak, with an illness like COVID-19.

    00:09 Well, there are many interventions that are possible and especially are important, when, many individuals in a local region are infected.

    00:16 So, mitigation strategies for an outbreak setting, are most successful if one can control public gatherings.

    00:24 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.

    00:35 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.

    00:50 And for those situations where one can not socially distance and even for those cases in a crowd setting, requiring face masks is critical.

    01:00 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.

    01:19 What about, where there's a limited number of infected people.

    01:22 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.

    01:35 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.

    01:52 The ring system means taking the index patient, quarantining all their first or primary contacts Nw and then quarantining the contacts of the contacts.

    02:02 It’s a two-ring system, which has been used very successfully in other epidemics and the global history of the world.

    02:10 What about looking specifically at individuals who are unvaccinated.

    02:15 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.

    02:25 Such as, an immunodeficient person a young child for whom a vaccine is not indicated et cetera.

    02:31 So, non-vaccinated people should take the following health measures.

    02:34 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.

    02:44 Avoiding crowds, avoiding close contact, this is the social distancing component, which while very very very difficult to adhere to, is critically important.

    02:55 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.

    03:12 Boy, I guess I recommend further is better, if and when possible, so, distancing at least two meters is appropriate.

    03:21 Other steps to take, not touching face or eyes with hands.

    03:24 This has to do with proven [inaudible] proven transmission, by the hands, to mucosal surfaces of active virus, within respiratory droplets.

    03:33 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.

    03:57 And then along with that washing the hands frequently.

    04:01 Soap and water scrubbing for at least 20 seconds, followed by a strong rinse.

    04:05 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.

    04:21 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.

    04:35 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.

    04:46 If there is an exposure, what do we do? And again, this is for unvaccinated individuals.

    04:51 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.

    05:09 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.

    05:28 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.

    05:37 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.

    05:48 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.

    05:58 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.

    06:28 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.

    06:42 Well, they actually have worked incredibly well, in preventing other respiratory illnesses, such as influenza.

    06:49 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.

    07:00 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.

    07:11 For all intents and purposes, influenza disappeared from the States, during the pandemic.

    07:16 And that is largely a testament as the evidence has shown, to the social distancing and the mass strategies which have worked.

    07:23 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.

    About the Lecture

    The lecture COVID-19: Prevention by Sean Elliott, MD is from the course Coronavirus.

    Included Quiz Questions

    1. To protect others from the spread of respiratory droplets from an infected person that contain the virus
    2. To block the air that asymptomatic people exhale, which contains airborne virus particles
    3. To decrease the forced expiratory volume (FEV1) in patients with the virus
    4. To identify oneself as a person with COVID-19
    5. Mostly to protect yourself from inhaling the virus in the ambient air
    1. 60% alcohol
    2. 70% alcohol
    3. 50% alcohol
    4. 80% alcohol
    5. 90% alcohol
    1. Decreased 99%
    2. Increased 10%
    3. Decreased 50%
    4. Was unchanged
    1. On public transportation
    2. In all indoor events
    3. At all times outside the home
    4. In health care settings
    5. By all persons who have suspected or documented COVID-19 or exposure to SARS-CoV-2

    Author of lecture COVID-19: Prevention

     Sean Elliott, MD

    Sean Elliott, MD

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