Tuesday 8 September 2020

Surviving Corona In The Big City

 Let me begin with 3 disclaimers first:

  • This article is aimed at an urban office-going, white collar demographic
  • It represents my personal views on the subject, culled from the scientific and non-scientific reading I have done so far, and is meant to be a general guide on how to avoid catching the virus
  • The information here is current as of Monday, 11th September, 2020, 7:16 pm (yes, that’s how often our knowledge on the subject changes!)


How does the virus spread?

Clearly, to avoid catching it, you need to know how it spreads in the first place. The virus spreads mainly from person to person, through respiratory droplets. These are produced when an infected person coughs, sneezes, or talks. Through the droplets, the virus can fall on the mouths or noses of people who are nearby and may also be inhaled into the lungs. The closer you are to the person, higher the chances of the droplets falling on you. Recent research has also shown that it can be spread through aerosols, which are very tiny particles that can carry the virus. These have shown to be ‘alive’ for a period of up to 3 hours, leading to the fear of airborne transmission.

However, do keep in mind that your body’s innate immunity is always making an effort to fight the virus, and whether you get the infection will depend on the fight put up by the immune system, against the total amount of virus attacking you, also known as the viral load. Higher the viral load you are exposed to, higher is the chance of you catching the infection (distance and masks reduce the viral load).

 

What do we know for sure?

As was alluded to in the disclaimer, our knowledge of the virus is literally changing every day, but we know the most important ways of avoiding it, with a high degree of certainty.

 

1.       Physical distancing (I prefer this term to ‘social distancing’)

2.       Masks (any type, ranging from the N95 respirator to a simple home-made face covering)

3.       Hand hygiene



Conversely, we also know with a fair degree of certainty, the situations which put you at highest risk. This is summed up nicely by the Japanese health ministry as the 3 ‘Cs’.

1.       C- Closed spaces with poor ventilation

2.       C- Crowded places

3.       C- Close contact settings, such as conversations

 

Let’s look at some common daily scenarios we might face, and the best way to handle them:


What about going to office?

This is a tough one to answer. For a lot of people, there’s a limit to the work that can be done from home, and going to office, is a matter of economic necessity and survival. If you’re lucky enough to have your own cabin at work, then the risk is very low, even if it’s a small room and you have the air conditioning on. One important caveat is that it should be a stand-alone AC, since a common unit could potentially spread the virus from one area to another. Avoid having people come in frequently, and when they do, leave the door open for better circulation and keep the meeting time brief (with masks on, of course).

If you do not have your own cabin, then physical distancing is vital, and it would be best if you could maintain at least ten feet distance from someone next to you. Six feet is the ‘official’ recommended distance, but ten would be even better. Weather permitting, it would be good to have the windows open to allow ventilation. It goes without saying, that larger the room, the safer it is. In office settings, people often let their guard down while talking during lunch (one time, when you have to let your mask down), or around the water cooler.

 

But, how do I get to office, or elsewhere?

If you drive your own car, that’s the safest means of transport. And you don’t need to wear your mask, while you are by yourself in the car! On the other hand, travelling in a crowded train or bus is clearly the riskiest environment to be in.

Driver/Ola/Uber:

If you don’t drive yourself, make sure that both, the driver and you, have your mask on the whole time. I would also recommend leaving the windows down to allow free flow of air. I’ve noticed many private cab operators, having the driver’s seat cordoned off by a plastic curtain, which seems a fairly innovative way of reducing risk. Clearly, it would be best to be driven in your own car, but I don’t think you need to worry unduly about riding in a cab, if the proper precautions are taken. In addition to windows down and masking, I would advise sanitizing your hands once you are out of the vehicle.

 

Can I go to the Club?

Different clubs are slowly opening up their activities, and I’m happy to see that they’re doing it in a graded manner. Walking outdoors, and tennis have opened in most clubs and are relatively safe activities. Some have started other services, like take-out from restaurants as well as their hair salons. Most sports activities, where distance can be maintained are safe by themselves. Often, it’s the congregation after the activities, or in the dressing room, which are the problem. Closed room activities, such as billiards or card rooms, should definitely be avoided.

Exercising outdoors, whether at the club or elsewhere is generally safe and healthy, since exercise builds immunity. A big question that pops up, is whether to wear a mask or not- with a lot of misinformation being spread on whatsapp. It got to a point, where I wrote a blog (http://drcontractor.blogspot.com/2020/08/) on the subject, and will post just the take-home messages here.

  • 1.       Exercise improves your immunity, for which moderate-intensity exercise is best.
  • 2.       When exercising outdoors, if you are able to maintain a 20 foot distance from others, it would be fine to let your mask (guard) down. When unable to maintain the distance, put it back on.
  • 3.       Exercising with a mask, may lead to a greater subjective perception of effort, so you may need to reduce your exercise intensity.
  • 4.       There are no ill effects of wearing a mask. If you feel uncomfortable while exercising with it, or have any serious health conditions, please speak to your doctor.

 

What about food delivery or other parcels arriving at home?

Currently there is no evidence that people can get infected by eating or handling food. However, people are afraid that the containers with food or any other delivery to the home, may be a source of spread of virus. For that to happen, an infected person needs to have ‘shed’ virus on the package, through sneezing on it, and you need to then touch the package (while the virus is still alive), and touch your mouth, nose or eyes, before you wash your hands. And, a sufficient amount of virus must be transmitted through this route for you to get the infection. While this is possible, it’s an unlikely route of transmission. However, it’s good practice to wash your hands after handling outside packages, to keep risk to a minimum.

 

Can I meet with family and friends?

This is the big one. Man is a social animal, and 'social distancing' can be crippling. Which, is why I dislike the phrase, but it's become part of our daily vocabulary. I prefer to call it physical distancing, which frankly is also a more accurate description. We have been deprived of the company of our loved ones for so long, and now that we are ‘allowed’ to meet, we shouldn’t let our guard down. But that’s exactly what happens, and I have observed this closely, including with my family. I think this is because of a subliminal belief that our near and dear ones, cannot pass on the virus to us. Sadly, this is far from the truth, and whether we like it or not, most of those infected would have caught it from those ‘nearest’ to them, pun intended.

Getting back to the question- it’s safe to meet, but you should not let your guard down. Avoid physical contact, and keep your masks on at all times. Most socializing also involves eating and drinking, at which point the mask has to be lowered, but at those times make sure there is adequate physical distance. And do keep in mind, that alcohol tends to loosen social inhibitions, and masks!

 

What’s your risk appetite?

I don’t think that many of us dwell on this, but on a daily basis we are taking decisions, which carry risk, which we subconsciously assess and decide whether to proceed or not. The simple act of crossing the road, walking in the rain, or even boiling water for tea carries an element of risk, which may not be as obvious as the risk involved in skydiving, bungee jumping or criticizing your wife’s cooking. And so, it is with our novel enemy, the Coronavirus. Apart from living completely by yourself in the wilderness with no human contact, every other situation carries the possibility of catching the virus. It’s a continuum of risk, ranging from minimal to very high, and you need to understand the relative risk of each activity and proceed as per your risk appetite. Each of the activities described above can be undertaken, but within each of them it’s important to be aware of the micro-environment, and keep your risk to a minimum. The BMJ- British Medical Journal published an excellent review article recently, titled –“Two metres or one: what is the evidence for physical distancing in covid-19?.” The table below, is from the article and grades your risk from low to high, in different daily situations.

Stay healthy, and stay safe. I will end by once again emphasizing, the best prevention strategy, whether you’re in a big city, or anywhere else in the world.  J

1.       Physical distancing (but socially connected)

2.       Masks 

3.       Hand hygiene




 Table from BMJ: 2020;370:m3223

Two metres or one: what is the evidence for physical distancing in

Thursday 6 August 2020

TO MASK OR NOT TO MASK (DURING EXERCISE) IS THE QUESTION

In the year 2019, if someone had told you that a rectangular piece of cloth, which can barely cover your face, would become, not only the saviour of the world, the following year, but would also be a potent symbol of political division, within the United States, you would probably dismiss them, at best, and question their sanity, at worst.

But still, here we are in the middle of 2020, and that’s exactly what’s happened. This rectangular piece of cloth (which could be cotton, chiffon, silk, polyester, or the surgical variety of polypropylene), more correctly termed as a mask, is our defender-in-chief, against the dreaded coronavirus, technically known as SARS CoV-2, or better known as Covid-19. As we battle this pandemic, we have come to realise that it’s a virus like no other seen before, hence the term, ‘novel coronavirus’, and it’s proving that every day. With all the weight of scientists and doctors (and quacks and charlatans) of the world behind us, we still seem to be struggling to understand how it affects the body, and what’s the best way to contain and treat it.

However, what we do know for sure, is that the best ways to keep it at bay, are:

1.       Physical distancing (I prefer this term to ‘social distancing’)

2.       Masks (any type, ranging from the N95 respirator to a simple home-made face covering)

3.       Hand hygiene

 

Exercise and Immunity:

Regular exercise has been shown to boost immunity. Having a stronger immunity is clearly an asset at a time like this. However, this is not a case of ‘more is always better.’ Research has shown that exercise and immunity have a ‘J-shaped relationship’, which means that the best immunity is attained with moderate levels of exercise. Not exercising at all, and excessive exercise lead to lowered immunity as compared to moderate exercise. Do keep in mind, that the terms moderate and excessive are relative. If you have been exercising, prior to the start of the lockdown, please continue to do so at your usual levels, but do not increase it dramatically. If you haven’t been exercising it might be a good time to start a moderate program, such as brisk walking or cycling.

 

 Exercise and Masks:

When exercising indoors, in your own home, you certainly do not need to wear a mask. The recommendations will be focussed on outdoor exercise. In general, the risk of viral transmission is significantly lower outdoors, than indoors, which is a great advantage to start with. But do keep in mind when exercising outdoors, especially at higher intensities, the risk of aerosols and droplets (which contain the virus) travelling further due to heavy breathing, or the wind is theoretically much higher, than when a person is standing still.

 

Intensity matters:

For most people, wearing a mask is uncomfortable at first, especially during exercise. But like with most things, with a bit of practice one gets used to it. While doing low or moderate intensity exercise, such as brisk walking, wearing a mask should not be uncomfortable, but when you start increasing the intensity, the degree of discomfort might increase. When exercising with a mask, your perception of effort tends to increase, which means you might need to reduce your intensity to feel the same level of effort you feel, without a mask.

 

Distance matters, even more:

If you are lucky enough to stay in an area where you can exercise outdoors, with no one around you, then it would be fine to exercise without a mask. Most guidelines recommend you stay 6 feet away from those around you (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html). However, during exercise, I would suggest increasing that distance, since, as explained above, the droplets may travel further. There is no specific cut-off that has been scientifically proven, but out of abundant caution, I would recommend trying to maintain a distance of 20 feet. Now, I know that’s not possible for most people living in crowded cities, so here is my practical suggestion. Try and exercise using routes, and timings, such that you come across the least number of people. Have your mask around your neck, or ears, and lower it when no one is around you. When passing through an area, where you cannot maintain the required distance, raise the mask and cover your nose and mouth. You can lower it again, when clear of people.

 

What about carbon dioxide poisoning?

There have been reports in the social media, from various parts of the world regarding people collapsing due to exercising with face masks, and blaming it on carbon dioxide poisoning due to ‘rebreathing’ the air. There is no scientific evidence to support this. Masks are designed to allow the flow of air in both directions. Surgeons and other healthcare workers, have been wearing masks since decades, without any ill effects. Yes, sometimes one does feel a sense of suffocation if not used to it- in that case, it’s fine to simply uncover your face and mouth for a few breaths, till you feel better. Here are links to two good articles on the subject.(https://www.forbes.com/sites/marshallshepherd/2020/07/01/debunking-2-myths-toxic-coronavirus-masks-and-breathing-warms-the-climate/#3b2d907a30f4

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/debunked-myths-about-face-masks)

One word of caution here – those with pre-existing respiratory and cardiac conditions may feel a greater subjective sense of discomfort, with a mask and need to adjust their activity accordingly. Actually, this can apply to others, too. If you are feeling uncomfortable exercising with a mask, reduce your exercise intensity and see how it feels. If you feel better, that’s great, if not, stop exercising and have a word with your doctor.

 

Take-home messages:

1.       Masks, physical distancing and hand hygiene are proven strategies to prevent the spread of coronavirus.

2.       Exercise improves your immunity, for which moderate-intensity exercise is best.

3.       When exercising outdoors, if you are able to maintain a 20 foot distance from others, it would be fine to let your mask (guard) down. When unable to maintain the distance, put it back on.

4.       Exercising with a mask, may lead to a greater subjective perception of effort, so you may need to reduce your exercise intensity.

5.       There are no ill effects of wearing a mask. If you feel uncomfortable while exercising with it, or have any serious health conditions, please speak to your doctor.