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Oxygen Mask Theory... and Coronavirus

Seems like such common sense, the Oxygen Mask Theory.  Take care of your own needs first, because if you don’t, you can’t help others.  This idea has been a buzzword for some time now, along with other maxims such as “you can’t pour from an empty cup” and “taking care of yourself first.”  And, now that we may be facing a pandemic, this concept has never been more timely or more relevant.  Why?  What’s the connection, how is Oxygen Mask Theory relevant to coronavirus COVID-19?

Here’s why: one of the biggest dangers and risks with the emergent COVID-19 is the existence of “asymptomatic carriers,” people who are infected - and unknowingly contagious - yet are unaware.  This, coupled with a deficiency in our collective ability to accurately detect Wunan Coronavirus in suspected cases (and the lack of availability of test kits for the first two months of this event) has created a distinct possibility that “it’s out there on the loose.”  How widespread?  The next few weeks will tell, and the deaths in Seattle may turn out to be canaries. For now, it’s a “wait and see,” and it’s a good time to take personal protective measures, to put on your proverbial Oxygen Mask, whether you THINK you have been exposed or not.   It’s time to take care of yourself, first.

(Note: for those of you who want to cut to the chase, just scroll down for the list of 15 things you can do! If you were interested in learning a bit more about the “why,” keep reading here:)

When facing most any challenge, one can approach with an attitude either of fear, or of empowerment.  I understand the fear inherent in our society right now, I do.  We have been TAUGHT to be fearful of disease, of cancer, of infection.  But the other half to that duality is empowerment:  what CAN you be doing to protect yourselves and your loved ones?  My intention with this blog is to help with the latter part of the fear/empowerment equation, and perhaps by doing so, to indirectly mitigate the former.  So, let’s dive in for some empowering knowledge and practical steps.

First and foremost, viruses and bacteria are both physical things, and they are exchanged and transmitted through physical means.  Two technical terms from public health that may be of use when thinking about how contagion happens, and how to PREVENT contagion, are “fomite,” which is an inanimate physical surface that can harbor virus or bacterial particles (in the case of coronavirus, these viral particles can persist for a week or two, unfortunately), and “vector,” which is a LIVING creature that can transmit disease.  Fomites include door handles, sink handles, towels, shared pens, public water fountains, grip handles on buses...  things that an infected person can TOUCH.  A vector is more often a tick, a mosquito, or a bat, but could also be a pet, a cat or a dog that is touched by an infected host and perhaps infected themselves, and can carry particles to another person/host.  We’ll get to that later.

Now that you know the definition of these two words, you are better empowered for execution of your own personal Coronavirus Oxygen Mask Protection Plan (Figuratively, folks, not literally!!!)  So far, it seems that most transmission of COVID-19 is directly from person to person - but “community spread,” the occurrence of disease in the absence of any identified personal contact with an infected individual, seems to be an increasing possibility and concern.  This is not surprising, given that various strains of coronavirus have been around for years, and this virus family is well-known for its ability to persist on surfaces.  Look on the back of a Lysol can or a container of Clorox wipes and you’ll see that one of the pathogens targeted is, indeed, coronavirus.  This tells you two things:  first, that transmission of this bug via fomites is absolutely possible, and two, that we have ways to CLEAN surfaces (well, many of them) to break the chain of transmission.  It’s clearly not realistic, though, to Lysol every surface you’re ever going to come into contact with and wait two minutes for it to reach full effectiveness...  so that’s a tool to use when possible, but not a panacea.  

Now let’s move to the practical:  here are some SIMPLE things you may choose to do, whether it’s a simple cold or regular flu season or a suspected viral pandemic, to protect yourself and loved ones from fomites, transmission, and resultant disease.  (As a point of humor, I bet your mom taught you many of these... mine did!)

1. Wash you hands.  You’ve already heard this, and there’s a REASON for that.  Handwashing is a cornerstone of public health; it’s one of the best known ways to stop the chain of transmission of ANY bug, viral or bacterial!  Handwashing, when done properly, can remove fomites that could infect you if they were to find an entry to your body (eyes, mouth, nose, etc).  One of the simplest thing you can do to protect yourself and your family is to institute a rule at home where there the FIRST thing ANYONE does upon entering the house is wash their hands, with soap, for at least 20 seconds.  (And towels should be washed frequently, of course!) The same could be said for businesses - ask employees to wash their hands, as protocol, when they arrive.  If you’re out in public, and you sneeze or cough into your hands, go wash them - and please, use a paper towel to turn the faucet on.  If you touch a handle with a contaminated hand, you’re just leaving a fomite that will re-contaminate you when you turn the faucet off, and may be spread to each subsequent person who touches the faucet.  

2. If you’re at a public place where you can’t realistically wash your hands, carry disposable gloves with you.  One of the most fomite-ridden surfaces is actually the pump handle at a gas station.  Now, I don’t love the idea of using a ton of plastic and throwing it away, that’s a given, but if you know you will not be able to wash your hands after pumping gas, either use a glove or use an alcohol-based wipe afterwards.

3. Use your elbows to open doors, punch elevator buttons, and the like.  Use an alcohol-based wipe to clean off the handles of the grocery cart, and maybe push the cart with your forearms.  At the gym, be extra courteous about wiping down the machines after you use them.

4. Cash is literally dirty.  Don’t believe me?  Look it up.  For the time being, using a card may be more hygienic - and....

5. Carry your own pen.  Shared pens make GREAT disease transmitters!  So carrying your own pen to sign receipts at restaurants, banks, etc is a simple step you can easily use to avoid picking up (or donating) bugs.

6. Just like your mom said, DON’T PICK YOUR NOSE!!!  OK, I’m actually serious about this one.  We silly humans all have habits, like chewing on nails, touching eyes or mouths, or wiping noses with bare hands, and these are ALL ways that viruses or bacteria can gain entry to your body.  These are also they ways that an infected person, symptomatic or asymptomatic, can spread disease via fomites - touch your mouth, then touch the pen to sign the receipt, that can be all it takes.  Be aware of your habits, and keep an eye on your kids’ habits and behaviors.

7. Don’t eat with your hands.  I’m grateful to live in a society where we have access to these neat little tools called forks, spoons, and knives, which help us to avoid transferral of anything infectious on our hands into our mouths.  USE THEM, even on fries!  (Sorry...) And don’t share them.

8. If you sneeze or cough, keep it to yourself.  Maybe do so INTO YOUR OWN SHIRT.  Yeah, that’s a little gross, I get it, but it will contain any respiratory particles far better than a tissue (which will likely leave your hand contaiminated....) or an elbow (which catches the particles, to some extent, but is still outwards-facing...)

9. After you’ve been out in public, wash your clothes.  In hot water.  This is a very simple step to get rid of any fomites you may have picked up, and it helps to protect your house from getting contaminated.

10. Pets.....  this may unfortunately be a big one.  What happens if you sneeze into your hand, or touch your mouth or nose, then pet your dog or cat?  THEY get your viral particles.  Might be that THEY get sick.  We don’t know yet.  And, the next person to pet them could also pick up the viral particles that you left behind.  The dog or cat can effectively become a vector.  I’ve always had my pups in the office, and this is a big area of concern for me presently.  Could my pups be a public health hazard?  Unfortunately, currently, yes.  I haven’t 100% decided what to do yet, but they may be staying home for a while.

11. Hugging, smooching, handshakes...  these are all methods of “community spread” for diseases.  Which is more important, social nicety or the halt of disease transmission?  Limiting your physical contact with others (social distancing) is absolutely a proven method for stopping the chain of transmission of any epidemic or pandemic.  

12. At our office:  As a healthcare practitioner who has physical contact with a lot of people during my week, you can bet that I will be taking measures to protect you AND me, and that will include frequent hand washing, NOT touching my face, and keeping out of “breath” distance.  We will also be instituting a strict hand washing requirement for ALL patients who visit.  When you arrive, the first thing you do from here on in is “wash yer paws!!”  We will be disinfecting surfaces, including doorknobs and faucet handles as well as chair handles and tables, frequently.

13. Masks?  Only if you’re sick.  And really, if you’re sick, please STAY HOME.  (That applies to me too!). We don’t know exactly what the morbidity and mortality stats are for this bug, as it’s an emerging picture, but even with a mortality rate of 0.5%, if 100,000 people were infected (a very low estimate for some forecasts), that’s a lot of deaths.  None of us wants to contribute to that.  We know that certain folks are more at risk for death from this bug, particularly our older folks with pre-existing health conditions - like my father, who has heart and lung compromise.  I’ve done what I can to advise and protect my parents and other folks in this same boat - please do the same by being aware that current statistics are indicating that this is not just “a cold,” and that your decision to go out in public and share this disease could be deadly to others whose bodies are not able to fight it as well as you.  Current statistics are showing that nearly one in five people in the elder demographic will die if they catch COVID-19.  Without appropriate caution and preventative measures, that’s a potential loss of a HUGE number of our elders.  

14. One thing you may not have thought of.....  if you get sick with a coronavirus, your home - and your car - have become biohazard zones.  Fomites EVERYWHERE.  You’ll need to be aware of that, and clean appropriately to prevent further “sharing” or dispersion.  Another conservative measure, if your house or car has been contaminated, may be to decline guests for a month or so.  

15. Are YOU healthy?  A healthy host has less of a chance of getting infected, or becoming an agent in the chain of transmission.  What are you doing to KEEP yourself healthy?  Here’s what I’m doing: I have juice every day with carrots, spinach, and lemon to boost my intake of vitamin A, vitamin C, and several micronutrients.  I take vitamin D, selenium and N-acetyl cysteine, as well as a quality probiotic and omega 3s, to biochemically boost immune system function.  Your car will perform according to the fuel you put in it, and the same can be said for nutrition and the human body.  I aim to drink half my body weight in ounces of water each day (75 oz) and I aim to maintain great sleep hygiene, with an average of 7.5 hours of sleep per night.  I exercise regularly (absolutely proven by research to improve immune function) and, though I was already pretty good about hand washing and making sure my office is a clean environment that prevents the transmission of any contagious agents, we’re about to take that to another level.  MY responsibility, indeed, is a level above most people’s, and I will be taking that very seriously.

In sum, both personal protection from a contagious agent AND breaking the chain of transmission STARTS WITH YOU.  Indeed, both of these things are absolutely your responsibility as a human in our society.  If you may be an asymptomatic carrier, please keep it to yourself!   If you get sick, please keep it to yourself!  If your kids get sick, please limit their ability to share their bugs!  Take basic measures, like being aware of fomites, vectors, and the NECESSITY for frequent hand washing, to protect yourself and others.  

What qualifies me to write these suggestions?  Glad you asked!  Prior to becoming a healthcare provider (an education which naturally included learning basic public health principles), I worked in various research labs for twelve years, at four different institutions: Bates College, the Medical College of Wisconsin, Harvard Medical, and then the biotech I used to work at as a research scientist.  In those labs we worked with any number of things that we did not want to get contaminated with, including caustic chemicals, biohazards and pathogenic agents, and a wee bit of radioactivity.  I’m not by nature a germaphobe, and also on the flip side I am certainly not BSL-4 trained, but I am inherently aware of what needs to be done to prevent contact exposure.  (And for those of you who know me, yes, of COURSE there was a practical learning experience that goes along with this knowledge... ask me about the pre-lunch radioactively labeled phosphate accident sometime.  Nope, not glowing anymore, short half-life.)  Further, the other half of our Path of Life team, Maryse, was a nurse for years.  So yes, I’m quite qualified to make these suggestions, and we as a team are quite prepared to curate the physical environment at Path of Life to keep you, and us, safe.

Some have compared COVID-19 to the 1918-1920 Spanish Flu epidemic, which was absolutely devastating in its breadth and consequence.  In my opinion, it’s a little too early to draw that parallel.  Only time will tell.  Clearly, many things are different today than a century ago!  Those of you reading this probably enjoy the privilege of clean drinking water, public sanitation, better nutrition, indoor heating and plumbing, and other modern amenities will work in our favor as we face this public health challenge.  On the flip side, others have suggested that COVID-19 is “just another flu,” which it may well be, and that the media has created an environment of fear that is disproportionate to reality.  Again, time will tell.  Common to both possibilities is the fact that we live in a society where bacteria and viruses DO circulate, by way of fomites and vectors, and the fact that we can all improve our personal well-being and that of our families, friends, and those around us by taking very simple (and respectful) public health measures.  And so, the bottom line is very simple - it’s your responsibility, and mine, to apply “Oxygen Mask Theory” to the best of our abilities because an ounce of prevention may be worth a lot more than a pound of cure in this case.  Again, time will tell, and I prefer to err on the side of conservative.  Or, as one of my friends put it, “you only notice public health measures when they FAIL.” Take care to make sure you’re contributing to the solution and not furthering the problem - and I hope that this writing has empowered you to do that.

Now, go wash you hands!