Calm, Clean, & Collected: Thoughts on COVID-19 Infection Control
We can’t hide from the paranoia and hysteria. The air smells pre-apocalyptic. The ripple effects of fear may be worse than this virus itself in many ways, and time will tell. Rational or not, I feel a burden that healthcare professionals are supposed to be a source of calm, reason, protection, and also solutions. This is still just as scary and confusing on my end, as well as for my colleagues. Truth is, every day we all face these risks to infection exposure, and it is certainly heightened when working in healthcare. Keeping the strictest of personal hygiene measures is easier said than done, and I know this as it’s part of my job!
In short, what is happening NOW: COVID-19 is officially at the level of pandemic, according to the WHO. Our primary goal is to slow down the pace of infection so as not to overwhelm our healthcare systems. The majority of us are robust; therefore, recommended practices (such as social distancing in addition to hygiene measures) are sacrifices that we will make to protect the less fortunate. Who? The elderly, healthcare workers at the front-lines, and those with disease and/or compromised immune systems. So that it doesn’t become a choice of life or death, as it is currently in other countries, sadly.
I am feeling a mixed bag of emotions; I am playing it day-by-day in trying to figure out what is safest for me/my family, my patients, and the community at-large. I know that while we WILL rebound and recover from this, COVID-19 is NOT going to be the last virus or superbug to plague us. We need to train, prepare, and respond MUCH faster for the next one. It’s still totally shocking to me (and the WHO also seems to agree with) how sluggish our government has responded to quelling this situation to keep it at bay. I feel really unsettled about our low-tech shrugging off approaches, however I’m not going to ramble about what we “should have done”.
What am I worrying about right now? Many things! There are so many uncertainties. During the initial weeks of watching this virus from a distance, I’d been worried about running out of masks, gloves, wipes – basics we need to work and protect ourselves and patients as healthcare providers. I had had three orders canceled! It is known that there are international shortages, and hospitals may only have a two-week supply for a critical epidemic status. This is why we need to slow down the velocity of viral spread so we have to time catch up. I’m worried that irrational fear will drive my office closed; however, I also recognize that it is certainly justifiable to postpone non-vital healthcare visits (and at this point large social functions; we all seem to be shutting down). This time may come, and I will be ready to accept it as it is.
Being an orthodontist certainly has its less glamourous elements; first having a baby and now the prevalence of COVID-19 have really brought them to light for me. I try to think rationally and logically, and it’s a fact that I face head-on (literally and figuratively!) many exposure possibilities. I half-joke that my job is my most high-risk social behavior, when we’re told to avoid public gatherings, ride the subway, work from home, etc. Doctors cannot work from home! My face is positioned inches away from others’ faces/mouths. During procedures, intraoral particles are positively airborne. However, let’s not forget to be grateful for our hearty immune systems that are protecting us.
As of today, I am still working. Thinking back, I used to get sick a lot, probably every 4-6 weeks(!) especially in the first five of my clinical dental years. Those masks we wear likely do not do much besides protect against giant fluid splatters; in reality, they protect the patient much more than the doctor. I’ve had splatter find its way under a mask or goggles plenty of times, unfortunately. Close-call needle-stick incidents were terrifying. However, healthcare institutions have systems in place and we are prepared for the most part; “society” (at least in the US) is not ready to face this burden.
We NEED a paradigm shift in our everyday hygiene/social behaviors. In respect for the less healthy/fortunate.
I modified many of my hygiene behaviors after having a baby introduced into my home. Generally speaking, he is also more vulnerable than I am to illness. Upon coming home, I would immediately wash my hands and disrobe. I would try my best to put on a fresh set of clothes before handling him. While orthodontics is on the cleaner side within the healthcare spectrum, my occupational garments are most likely dirtier than those of others, on average. In the “COVID-19-era”, I have now added taking a quick shower to my protocol.
Infection control is a crucial training that all healthcare professionals are required to renew annually. When thinking about pandemic-level infection risks, it really makes sense to me that all people are given this education so we may have safer protocols and awareness for everyday behavior modification. While our training is currently much more geared towards blood-borne pathogens (such as Hepatitis B/C and HIV), droplet or airborne particles are much trickier to contain. COVID-19 is understood to be transmissible via respiratory droplets (i.e. when an infected person coughs or sneezes). There is fecal-oral transmission, as well.
At this point, I think we’re all for the most part up-to-date on these recommendations:
Wash hands frequently or use hand-sanitizer as an alternative
Avoid touching face/eyes/nose as much as possible. Sometimes using a perfume or wearing gloves may serve as a reminder to break this habit. For me, I actually started using a lip balm/lipstick to help end a lip-pulling habit when I was younger!
Disinfect fomite surfaces (AKA objects that may carry infectious agents): doorknobs, utensils, clothes, furniture, etc.
Cover your cough or sneeze: ideally with a disposable tissue, and secondarily with inner crease of elbow
Don’t use your phone when using the bathroom! Also, clean your phone!
Stay at home if you think you’re not well. If you have to go out in public, please wear a mask
Brush your teeth 2+ times a day alongside with flossing (and if unwell, it is recommended to use a new toothbrush head once well)... I'm biased to add in this one!
Rest, eat well, light exercise is protective as well. Proven or not, I like using elderberry supplementation, and lately have added zinc into my routine and cooking with oregano
Still, even today, many don’t seem to care or follow these recommendations. Between yesterday and today, a lady speaking on her phone freely coughed indoors in an elevator shaft while I was teaching at NYU Dental (reality this can be anywhere); the guy sitting next to me on the subway coughed, and not in the “right” way. A mom in my operatory coughed openly while I was treating her child... It’s time to become more aware of these unconscious behaviors. Furthermore, we would ideally all be given the opportunity to wear masks/protective wear. Our government would institute stricter quarantine guidelines (and this may ultimately happen). Again, this is not to protect ourselves, individually; I want to be clear. It is to protect less fortunate/healthy persons from ourselves (AKA possible asymptomatic carriers!); these forfeits are made for the greater good.
Let’s take a breath, count our blessings. Please let’s come together as a community and put out the fire, and be ever-more aware and prepared for the next one.
P.S. Just in case you are seeing the dentist soon, here is some info for the dental patient: https://www.mouthhealthy.org/en/az-topics/i/infection-control