What I Do to Protect from COVID-19

My name is Dr. Tony Tow. I am a board certified pulmonary and critical care physician. During my more than 25 years of private practice, I held the positions of Director of Internal Medicine, Chief of Pulmonary, Director of the Intensive Care Unit, and medical director of Respiratory Care. I am currently retired and I want to share with you my understanding of certain aspects of COVID-19, as well as what I do to protect myself and my family from the novel coronavirus. I hope that this information is helpful and that you can incorporate some into your routine.

Disclaimer: I am not providing medical advice or recommendations.  I must emphasize that these are not official guidelines or recommendations. For those, please refer to the World Health Organization and the US Center for Disease Control.

Part 1. The Novel Coronavirus

The novel coronavirus is not a hardy virus. We can destroy it with relative ease. The virus has a lipid envelope that ruptures upon contact with soap and water. Washing your hands for at least 20 seconds, or the time it takes to sing happy birthday twice, kills the virus. Viruses deposited on surfaces (metal, glass, ceramics, paper) likely do not survive more than 5 days. You must take the proper steps to disinfect your groceries and mail. They are all potentially contaminated.
The novel coronavirus cannot jump from one person to another by itself. It needs the help of a human being to transmit the infection. Transmission most often happens when an infected person coughs or sneezes. The virus in respiratory droplets gets deposited onto various surfaces (doorknobs, table surfaces, hands, etc.). When another person touches these contaminated surfaces then touches their eyes, nose or mouth, the virus enters a new person and the cycle of transmission continues.

Rarely, transmission occurs when respiratory droplets (10 to 100 microns are suspended in the air (for up to 3 hours). They can be inhaled into the lungs of a new person, continuing transmission. We are also concerned the virus may be transmitted via breath or vapor from an infected person. Thus, we must keep a physical distance of more than 6 feet from one another.

A more controversial mode of transmission is via the fecal route (not fecal to oral as in hepatitis A). The viruses can be isolated from patients’ feces. Theoretically, flushing the toilet can aerosolize the fecal matter of an infected person. The aerosolized virus can then be inhaled by others. We need to learn more about this possibility. Still, I recommend to always put the toilet cover down before flushing.

Part 2. Sanitizing vs Disinfecting

Sanitizing decreases the number of organisms.
Disinfecting kills all the organisms.

When you are outside and unable to wash your hands, use alcohol-based gel, such as Purell, to SANITIZE. Once you get indoors, wash your hands with soap and water to DISINFECT.

Part 3. Weapons Against COVID-19

These weapons are not high tech, are very easy to do and everyone can use them.

• Keep your hands clean at all times. Use a rubbing action to wash your hands with soap and water for at least 20 seconds. Wash your palms, the backs of your hands, and all your individual fingers. Wash your thumbs especially because you use them more for holding and touching. Wash between your fingers, under your fingernails and your wrists.

• Know where your hands are at all times so that you do not touch your eyes, nose or mouth by accident.

• Physical distancing of at least 6 feet.

• Wear a face mask. Wearing the mask decreases the transmission of infected respiratory droplets into the environment. It also reminds you not to touch your face.

There are 3 types of masks I wish to discuss, N95 masks, 3-ply disposable masks, and cloth masks.

1. N95 masks: do not wear an N95 mask. Only a properly fitted N95 mask can protect the wearer from inhaling the virus. Reserve these masks for healthcare workers.  Please do not contribute to further shortages of N95 masks, which health care workers need.
2. The 3-ply surgical mask has a filtering efficiency of 94%.
3. Cloth masks: Studies show that 2-layer cloth masks are 63% to 84% effective at filtering particulate matter of 10 microns or less, depending on the fabric. After washing the cloth mask 4 times, filtering efficiency decreased by 20%. You can increase the filtering efficiency of cloth masks by wearing a 3-layer mask or putting a disposable filter between layers.

Please note that the purpose of wearing a mask is not to prevent from inhaling the viruses.  Please also note that up to 25% of infected people are asymptomatic while transmitting the virus.

As discussed earlier, there are two components of the spread of the infection: a) the transmission of the infected respiratory droplets, and b) the entrance of the viruses into a new person. There has been an emphasis on the latter while neglecting the former. Yet we need to manage both components. We must decrease viral transmission into the environment AND prevent new people from acquiring the virus. The latter is achieved with social distancing. In other words, STAY HOME.

Part 4. What I Do When I Get Groceries

1. I make a list of what I am buying, ask myself if I need to go out, and mentally walk through the store to minimize the time I spend there. I use the self-checkout counter to avoid contact with cashiers.
2. Wash my hands.
3. Wear gloves.
4. Wear a non-N95 mask.
5. Bring hand sanitizer.
6. Bring disinfecting wipes.
7. Pay attention to keep a safe distance from everyone else.
8. After loading all items into my car, I disinfect the car door handle, remove and dispose of my gloves, and sanitize my hands.
9. At home, I have designated clean and contaminated areas. I unload all purchased items into the contaminated area. Some people prefer the contaminated area to be in the garage.
10. I take off all my clothes for washing and proceed to shower and wash my hair.
11. Wipe down metal cans, plastic bottles/packages, and paper boxes with disinfectant sprayed onto a paper towel. For cereals, I take the inner bag out and recycle the outer paper box. For oranges, apples, lemons, and other fruit, I wash each one with soap and water for 20 seconds. I pay particular attention to items I place in the freezer because I worry that the virus may survive the freeze.
12. Place the cleaned items in the designated clean area, then disinfect the contaminated area.
13. Disinfect the car door handles, steering wheel, shift, hand brake, car keys, house keys, house doorknobs, and credit card. If you used the cell phone when you were out, disinfect it. I know it is a lot of work, but you are under lockdown anyway.

Part 5. Frame of Mind

We are at war with the novel coronavirus. It has killed many people, damaged our economy and our way of life. To fight this war, everyone must have the right mindset to do the right thing and not aid the spread of the infection.

Stay home and do not go outside unless necessary.

During the HIV pandemic, we were taught that when you have sex with someone, you are also having sex with all the people they have ever had sex with. Similarly, if you have close physical contact with someone right now, you are also having close physical contact with all the people they had contact with. If you must have close contact with someone, make sure they are not infected or in contact with anyone infected. You must vet all the contacts this person has had.

This COVID-19 is a new disease and we are still learning much about it. As new information is available, we will have to change what we need to do.