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, 11^th 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

covid-19?: Nicholas Jones et al

BIBLIOGRAPHY:

 

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#Spread

https://coronavirus.medium.com/why-it-matters-how-much-virus-is-in-the-body-5a3998f8a323

https://www.health.harvard.edu/diseases-and-conditions/coronavirus-resource-center

https://www.bmj.com/content/370/bmj.m3223

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-how-is-covid-19-transmitted?gclid=EAIaIQobChMI--bQvILX6wIVRA4rCh3QrACgEAAYASAAEgIWvPD_BwE