It occurred to me today that I should reduce exposure at the grocery store by going to only one, rather than bouncing between the many I might go to, depending on where other errands take me. Each has some things the others do not, or has better produce or lower prices for one item or another - but now there are no other errands. I should also go less often.
Yes, I might by sad misfortune pick the one which is most infected of all my choices and re-expose myself there, but that future is impossible to see. I probably should glove as well as bringing wipes or sanitiser in the truck. Should we begin to mask? The South Koreans are doing that and their containment is the best in the world at present. Putting on a mask has a humiliation factor, because then everyone expects that you must be sick and looks at you darkly for coming out. Still, humiliation in a good cause is a reasonable sacrifice. It's also better than making your neighbors sick, if you are an asymptomatic carrier.
I have not left home since Monday, and probably won't until Monday. When I do, we'll visit the county dump (outside, no human contact), check mail at the Post Office and hit the two small stores in the valley. It's not a big community; I'll probably be physically close to only a few people during the whole trip.
I've been carrying dish soap and a jug of water to wash my hands immediately after every trip inside anywhere. So far, so good.
My thought also on my last shopping foray. I placed the items on the conveyor, the gloved cashier lifted them to scan them, and I carried them out.
So were I a carrier with virus on my hands, it would now be on the cashiers gloves to transfer to the next-person's purchases. And there really wasn't a means to handwash between placing the stuff in my car and touching the steering wheel, which could now presumably be "hot" for a few days.
After my first (and only) experience of kidney-stones, I started to consciously drink a lot of liquid all day, which means frequent restroom trips. And for years I've been doing the full-lather-up handwash each and every time, and using the towel that I dry with to open the door-handle. Even with such frequent and thorough handwashing, I manage to occasionally succumb to cold and flu, so I'm now suddenly pretty conscious of all surfaces that I tough in public, and what personal stuff I need to tough afterwards.
Oh, I don't know that people will automatically assume you're sick because you're wearing a mask. I saw someone in a mask at my grocery store this afternoon and figured they're just being careful. I don't think so highly of myself to believe I'm the one special person who came to that conclusion.
“... touching the steering wheel, which could now presumably be "hot" for a few days.”
You can use dish soap and a little water on the steering wheel too. Since the virus has a layer of fat that protects it, soap will be effective. It dissolves the fat and exposes the virus to destruction.
Masking the well and relatively hardy has never made much sense to me. If you're sick you should be staying at home and not out infecting the public. I would assume a mask indicated a person who might have great risk from contracting virus.
Tomorrow, I'm breaking 13 days of *almost* quarantine. I went to the bank once where I was approximately 2 feet away from the teller. At the mailbox location, I was maybe one foot away from the person who held the door for me so I wouldn't have to touch it. I've had some service people at my house and they were careful not to come closer than six feet, most stayed even further away. I've talked to my neighbors from a distance too. It's not like I'm hunkered down in a bunker.
But tomorrow, I'm going to hug my granddaughters who have been similarly quarantined, except with each other and their parents. And I'll probably burst into tears when I do. I saw them once when they dropped off some groceries in my garage... and at that time I was fine with blowing kisses and pantomiming hugs. Now, I want to feel the squeeze. Oh hell, I need to feel the squeeze.
It's not that we're giving up on trying to flatten the curve, or that my family isn't still trying to protect me, it's that we think we've gone a bit overboard. I've never gone this long without touching someone.
The thought behind masking and gloving is that we are contagious before we have symptoms, and thus can spread the virus, or any such illness, unwittingly.
There's apparently not strong evidence for asymptomatic contagion--not that we can rule it out, but if you're playing the odds, it's not the high risk. Washing your hands often and disinfecting surfaces is the effort that promises to pay off the best.
Similarly, while we can't rule out airborne contagion, the pattern of exposure doesn't suggest it's a high risk. Just keep washing those hands, don't touch your face, and above all, stay home if you have any symptoms. Test results suggest that nearly everyone with symptoms actually has something else, but they're all contagious, and we don't need the noise in the signal right now.
I gather the Japanese and Koreans consider wearing masks an absolute minimum social courtesy: "I am doing my part to protect you."
WRT the contamination: Yes, you have to define those zones you want to protect--and probably the inside of your car is one. So wipe the handles, discard the gloves, and don't touch the stuff you bought until you've sanitized the items (wearing new gloves). That glove usage adds up fast. I suppose you could try to make your tailgate a sanitation station: wipe down gloves, transfer things to clean bags as you wipe them down, and discarding the contaminated grocery bags and old gloves before you get in to drive.
From what I had heard, asymptomatic transmission is likely. I’m focusing my own efforts on hand washing, social distancing, and limiting outside trips. But this NEJM letter indicates that asymptomatic is a problem. Of course, we will all know a lot more in 6-12 months, and many things will seem obvious that aren’t at the moment.
The usual pattern is that, while asymptomatic transmission of a virus is possible, it's nowhere near as great a risk as in the symptomatic phase. At some point the risks become so small we have to ignore them, if we're to have any energy or resources left to address the much bigger risks. By far the biggest risk is intimate, repeated contact with a symptomatic person, which is why the usual pattern is housemates or health workers. Not the 100% pattern, just the dominant one.
Yet aren't all "community spread" cases, where no risk factor of travel or contact is identifiable, by definition acquired from a person who didn't know she was sick but infected you?
I'm willing to look at numbers, because Lord knows we don't know anything. But I can't see how those cases, and they are increasing, stem from anything but asymptomatic carriers. At my hospital, that is what all our efforts are designed to contain. We have long had methods for dealing with obviously contagious people, and they have names like Standard Precautions or Universal Precautions, which can be enhanced to other specific protections. We are now ramping up to protect against infections that do not come from those obvious sources.
Other possibilities are that someone was sick and you didn't know it, even if the sufferer already had some symptoms, as long as they weren't very obvious. Not everyone is conscientious. But also, I'm not saying no cryptic spread happens, only that it's the minor risk. The major risk is contact spread, usually caused by a symptomatic person coughing or sneezing on a surface. There are cases we can't definitely pin on intimate contact, just not that many of them.
I'd like to keep my exposure as close as possible to zero. But for public policy purposes, we have to weigh measures with partial effectiveness against side effects of measures with more complete effectiveness. There's more bang for the buck in surface-disinfection and handwashing and isolation of high-risk groups than there is in putting the whole country under house arrest and hoping like heck the food holds out and there are any jobs left when we emerge.
Hospitals are a special case. They ring a lot of bells: high concentrations of people, high concentrations of people coming in specifically because they have symptoms, high concentrations of other people at high risk. Hospitals are a place where almost no level of care is too high, but we can't treat the entire culture with that level of care, any more than we can adopt sterile operating-room protocols for factories.
We talked again this morning and decided that, no we weren't going overboard. So we used ZOOM and laughed at each other for 40 minutes. No extra exposure.
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