Even in this political year, it may be time for Americans to stop shaking hands.
On Feb. 25, the federal Centers for Diseases Control and Prevention warned that it was increasingly likely that COVID-19, the severe respiratory disease that emerged from Wuhan, China, in late December, will not be contained and will eventually spread within the United States.
“I told my children that that while I didn’t think that they were at risk right now, we as a family need to be preparing for significant disruption of our lives,” said Dr. Nancy Messonnier, who directs the CDC’s respiratory diseases center, in a telephone briefing with reporters.
Habits, and handshakes, may have to change.
Forget about “fist bumps,” said Dr. Steven Pergam, an infectious disease researcher at Fred Hutchinson Cancer Research Center and director of infection control at its clinical care partner, Seattle Cancer Care Alliance. To add a little distance between friends and strangers alike, he favors the customary Indian greeting “namaste” — a word spoken with palms and fingers pressed together as in prayer, with a polite bow. Another alternative is the elbow bump, which became popular during the H1N1 influenza pandemic of 2009.
While these gestures might be a little awkward for most Americans, Pergam said it is not too early to get into habits that might help you avoid spreading a dangerous respiratory virus. That also means washing hands often with soap and water, covering coughs or sneezes with the crook of your arm, and stopping yourself from touching your face — which one study said we do 23 times an hour. The obvious things —If you are sick, stay home from work — will become more important in a pandemic.
Infection control is serious business for Pergam. His job is to reduce the risk of infection for cancer patients at the University of Washington and SCCA. In a medical setting, prevention requires training, protocols, protective garments, adequate supplies. People who are undergoing chemotherapy or bone marrow transplants have weakened immune systems that can make them more vulnerable to infections. Pergam has been on heightened alert for rapidly spreading respiratory diseases well before the COVID-19 outbreak.
“We have been prepared for this in our clinics, because we prepared for measles, which requires precautions against airborne infection,” he said.
And while COVID-19 has not exploded in the U.S., we are in the midst of flu season, and an estimated 29 million Americans have been made ill by it since Oct. 1. There is still time to get a flu shot, Pergam said.
Less important for infection control outside of a medical setting is the wearing of surgical masks, commonplace in China because of air pollution, rather than disease. Pergam said that even so-called N95 masks worn in the surgical suite offer limited protection unless they are “fit-tested” to seal out airflow from the sides — an issue for men with beards. More to the point, the best protection they afford is when patients who are already ill and coughing wear them, to stop the spray of infected droplets.
However, wearing even a cotton mask can have some value because it tends to keep your hands away from your face, Pergam noted; and when you are wearing a mask, it is easier in social situations to keep your distance from others, as they are more likely to stand back from you.
Pergam said that his greatest concern about masks is that if the healthy public empties the store shelves, there will not be adequate supplies of them to protect health care workers, who would come in close contact with COVID-19 patients and will need them at hospitals.
“Remember that most of the people who get infected are not going to get that sick. But there will be a substantial number of people who need hospitalization and care. With pandemic flu, one clear increase in risk is related to those people who take care of patients,” he said.
— Dr. Steven Pergam
Pergam noted that cancer patients and survivors are particularly aware of the need to protect themselves from infectious diseases. However, the strength of their immune system likely depends on the kind of cancer they have and their treatment status.
“People who are still undergoing chemotherapy are at higher risk because their immune system is suppressed,” he said. “A person who had a tumor removed surgically, with no chemotherapy, may not be a risk. Any cancer that involves the immune system, such as lymphomas, increases the risk; but someone who had lymphoma eight years ago may have a risk similar to someone with no history of cancer.”
The CDC has its own acronym for the array of virus prevention steps: NPIs, or nonpharmaceutical interventions. The agency developed its latest lists of NPIs in anticipation of pandemic influenza. Although COVID-19 is caused by an entirely different virus, the precautions for both diseases are the same.
With no vaccine or treatments for COVID-19 on the horizon, CDC respiratory disease expert Messonnier called NPIs “the most important tools in our response to the virus.”
NPIs are placed in three categories: personal, environmental or community. Handwashing and staying home from work or school when sick fall into personal NPIs; regular surface cleaning of door handles, elevator buttons, and public places such as schools and day care centers are called environmental NPIs. School closures, cancelling sports events and public gatherings, and avoiding public transit — actions that may be mandated in an outbreak — are examples of community NPIs.
The news about COVID-19 is alarming, but infectious disease experts say that is a reason to keep informed and not for panic.
“There are a lot of opportunities to go down rabbit holes,” Pergam said. “I think it is important to tell people not to worry so much. There is too much misinformation and fear. Go to good sources like the CDC coronavirus disease page, not social media or Facebook groups.”
Sabin Russell is a staff writer at Fred Hutchinson Cancer Center. For two decades he covered medical science, global health and health care economics for the San Francisco Chronicle, and wrote extensively about infectious diseases, including HIV/AIDS. He was a Knight Science Journalism Fellow at MIT, and a freelance writer for the New York Times and Health Affairs. Reach him at firstname.lastname@example.org.
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