Slowing down transmission of COVID-1

One of the most important contributions we can make to slowing down transmission of COVID-19 and keeping ourselves and our communities safe is to wash our hands. Global COVID-19 Prevention.

This short animated video from Stanford Medicine illustrates how the novel coronavirus — the virus that causes the respiratory disease COVID-19 — is transmitted among people and how transmission can be prevented.

For more information, please visit https://med.stanford.edu/covid19.html


As the coronavirus spreads, the need for public handwashing facilities becomes vital

In pre-coronavirus days, about a third of all public restroom users washed their hands. That wasn’t good enough then and it really isn’t good enough now. During this pandemic, we all need to be washing our hands, often!

The problem we have now is a lack of public facilities to wash them, even though workers at establishments deemed essential—like hospitals, grocery stores, food delivery places—still have to work. Not to mention people who are out, while still practicing social distancing practices.


Access to public restrooms has diminished

In December I wrote an article on about the need for more restrooms and more accessibility for the diverse people within the region. I never imagined how relevant this topic would become during this pandemic.

WMATA closed the facilities in many Metro stations years ago. Elsewhere, there is a constant lack of public restrooms. Many businesses, during normal times, shut their restrooms off to non-customers. The opportunities we do have are often poorly maintained, under-staffed, and under-cleaned bathrooms long ignored by public agencies. Even interested parties often struggle to gain budgetary and staffing allowances to maintain public restrooms. So our hands often go dangerously unwashed.

People experiencing homelessness, immunocompromised people, trans and non-binary folks, people with disabilities, and older adults are especially impacted. Bathrooms are often inaccessible physically or due to socially-instituted barriers.

Trans and non-binary people often cannot use gendered restrooms, or cannot use them safely. Public restrooms are often an infection risk for immunocompromised people, even during normal times. Most bathrooms are inaccessible for people with disabilities and many older adults.

Businesses and institutions often demand payment before restroom use as a mechanism to exclude people experiencing homelessness. Not only does this mean that many people lack adequate opportunities to use the toilet, which leads to health issues, but also that members of these communities have fewer opportunities for hand hygiene.

Furthermore, some of these communities may be at greater risk from the coronavirus, due to the virus’ biology, common comorbidities, and limitations in accessing healthcare.

We already know that the majority of deaths from the virus are among older people and immunosuppressed people. Barriers to accessing healthcare are especially large for people with disabilities, trans and non-binary people, and especially people who are homeless.

Members of the last group often suffer from other health conditions that are potentially deadly when combined with coronavirus. Besides, barriers to healthcare are likely to surface in barriers to testing, or the ability to get a test at all, much less treatment. If people in these groups are unable to wash their hands, they are at greater risk to contract a virus that poses more of a threat to their well-being than for other people. This situation could be different.


What other countries are doing

In other countries, transit stations and interchanges offer frequent opportunities for handwashing. In Seoul and Dubai, most transit stations have restrooms with stocked and supplied sinks—as does much of the system in Istanbul. Pretty much every transit interchange in Japan and Australia has restrooms of some sort—including large bus stations. Many places also encourage hand washing and sanitizing throughout one’s day.

On Twitter, Michael Twitty recently observed a wide availability of hand sanitizer and opportunities to wash one’s hands in Senegal, with the encouragement and assistance of local leadership. In its most recent edition, The Economist noted that bus stops across the Indian state of Kerala were also providing hand washing basins.

In my own experiences in Jewish communities in the United States and Israel, the stand-alone sinks that are used for ritual hand washing are frequently used for hygienic hand washing too, even by people who are not observant of halakha.

 

What could we do here?

Reopening restrooms in Metro stations is a start. At the very least, these facilities—when maintained—offer a place for passengers to wash their hands, a habit that I hope continues after this pandemic. Also, making hand sanitizer regularly available throughout the WMATA system would be beneficial.

Adding restroom capacity at major interchanges would be helpful too. The restrooms installed in the 1970s probably do not meet the needs of a system that is currently far more heavily trafficked.

A program to install public restrooms and hand-washing stations across the region would be of great long-term benefit, especially for people who cannot afford to pay for services to which business restrooms are often tied.

 

Funding, staffing, and protocols would all need to be considered.

I am distinctly aware that installing these facilities costs a lot of money; the cost for adding a restroom facility is often about $250 to $300 per square foot. For a typical 56 square foot accessible bathroom, that comes out to between $14,000 and $16,800 – and that’s before labor costs, the cost of maintenance, and the cost of supplying toilet paper, water, and soap. The Portland Loo, a commonly-touted but ultimately problematic solution to restroom access, runs at about $90,000 per unit.

Installation costs are not the only expenditure: additional staff would be needed to make sure restrooms stay safe, in working order, and maintained. By and large, the reason public restrooms in many countries are usable is that resources are allocated to keep them that way. Workers would need to be properly paid, and provided the materials to keep bathrooms clean, and the time to do so regularly.

It is likely that additional protocols will need to come into place to keep restrooms clean and safe. One example might be automatic faucets or soap dispensers, which are already called for by the United States Access Board.

Yes, this will cost a lot of money and time, and maybe the political will won’t be there. But that is where our activism comes in. Funding choices are political and not choosing to allocate resources to essential things like hand hygiene is a conscious choice that can have drastic consequences. Besides, after the pandemic, we will all need to rejig our priorities to ensure health and safety in our public spaces.

As we move forward, let’s make sure that includes restrooms and the ability to wash our hands, as needed. Also, take other hand hygiene precautions: cough into your elbow, avoid shaking hands, and use your sleeves or elbow to touch surfaces when possible. After all, you don’t know when you’ll next be able to wash your hands.

Jonathan Paul Katz is a community planning student at the University of Maryland-College Park, and lives in Hyattsville. He is interested in the intersection of disability access and planning. In his spare time, he also writes a food blog, Flavors of Diaspora.

By Jonathan Paul Katz.
Published March 23, 2020
https://ggwash.org


The simple power of hand-washing

Myriam Sidibe is a warrior in the fight against childhood disease. Her weapon of choice? A bar of soap. For cost-effective prevention against sickness, it’s hard to beat soapy hand-washing, which cuts down risk of pneumonia, diarrhea, cholera and worse. Sidibe, a public-health expert, makes a smart case for public-private partnerships to promote clean hands — and local, sustainable entrepreneurship.

This talk was presented at a TED Institute event given in partnership with Unilever. TED editors featured it among our selections on the home page. Read more about the TED Institute.

READ MORE ABOUT MYRIOAM SIDIBE
Meet Myriam Sidibe, she has a PhD in hand-washing >>


World Water Day 2020 highlights the essential role of handwashing

Good hand hygiene protects you and those around you. One of the most important contributions we can make to slowing down transmission of COVID-19 and keeping ourselves and our communities safe is to wash our hands. This is the main message of World Water Day 2020 on 22 March, and everyone has a role to play.

The provision of safe water, sanitation and adequate hygiene (WASH) is essential to protecting human health during all infectious disease outbreaks. Ensuring good and consistently applied WASH, environmental cleaning and waste management practices in communities, homes, schools, marketplaces and health-care facilities will further help to prevent human-to-human transmission of the COVID-19 virus. Strictly following good handwashing and personal hygiene practices is important for all, but especially in health-care settings, where it protects both patients and health-care workers.

Safe hygiene standards require a continuous and adequate supply of safe water, and sanitation systems that will continue to function even under stress or challenging conditions, such as under a changing climate. Within the WHO European Region, we have a strong multilateral mechanism: the Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes. The Protocol’s primary objective is to promote the protection of human health and well-being within a framework of sustainable development, through improving water management, including the protection of water ecosystems, and through preventing, controlling and reducing water-related disease.

“Washing your hands is such a simple act, and yet such an essential step in halting infectious disease transmission and saving lives,” notes Oliver Schmoll, Programme Manager for Water and Climate at the WHO European Centre for Environment and Health in Bonn, Germany. “But in order to be able to maintain good hand hygiene, hospitals, schools and communities require a continuous supply of safe water and the availability of functional hand hygiene facilities and soap.”

To support water and sanitation practitioners and providers, as well as health-care professionals, WHO has recently published a technical brief, “Water, sanitation, hygiene and waste management for COVID-19”.

By WHO
Published March 20, 2020
http://www.euro.who.int/


“The very sight of her hands did almost turn my stomach”: a brief history of hand-washing

As the disease known as coronavirus spreads around the world, the public has received one key piece of advice: hand-washing is our best defence. But what would our ancestors have made of this tactic? Katherine Harvey explores for HistoryExtra…

Contrary to the popular belief that people in the Middle Ages were disgustingly smelly and dirty, medieval people frequently washed their hands, usually on rising and before and after meals. This was not just a case of good manners; they were well aware of the link between dirt and illness. Consequently, the 14th-century surgeon John of Arderne required prospective apprentices to have “clene handes and wele shapen nailes…clensed fro all blaknes and filthe”. Hand-washing mattered because it was seen to remove both external dirt and harmful bodily excretions.

This dual concern with dirt and bodily excrement continued into the Renaissance. Italian physician Tommaso Rangone (1493–1577) advised that hands must regularly “be cleaned of superfluities, sweat and grime that nature often deposits in those places”. Other medical writers also recognised that hands could transmit disease, although their concerns focused on skin diseases such as scabies, rather than the more well-known plague. Therefore, hand-washing was thought to be necessary for good health.

Hands must regularly ‘be cleaned of superfluities, sweat and grime that nature often deposits in those places’

Early modern concerns about hand hygiene often focused on meals, so most people washed before and after eating. Some advice books insisted that even clean hands must be rewashed at the table, using a basin and ewer, so that everyone else would feel reassured about sharing food. As such, poor hygiene could provoke real repugnance: after dining with his Uncle Wight in 1663, Samuel Pepys recorded that “the very sight of my aunt’s hands…did almost turn my stomach”.

17th-century diarist Samuel Pepys.

 

Georgian polite society fretted a great deal about servants’ hands, particularly in relation to food preparation and table service. The 18th-century author Eliza Haywood required her maids to wash their hands regularly, and other employers made serving staff keep their hands “in open view, neat and clean”, according to a conduct book of the day. Jonathan Swift’s Directions to Servants (1745) specifically criticised domestic helpers who prepared salads with unwashed hands after handling meat or visiting the lavatory.

In the 19th century, scientists such as Louis Pasteur and Joseph Lister made significant advances in germ theory and its practical applications, which explained why hand-washing works in curbing the spread of disease. Though perhaps lesser known, another important pioneer was the Vienna-based Hungarian obstetrician Ignaz Semmelweis (1818–65), who realised that labouring women caught puerperal fever from doctors who went straight from the morgue to the delivery room. He proved that maternal mortality could be drastically cut by routine hand-washing with a chlorine solution.

This revolutionary new knowledge had surprisingly little immediate impact, partly due to resistance from physicians who resented being blamed for their patients’ deaths. Nevertheless, the following decades saw frequent attempts to persuade the wider public of the value of hand hygiene, the motivations for which were sometimes concerned as much with reaping profits as promoting public health. In the 1920s, the soap manufacturing company Lever Brothers ran a Clean Hands Campaign that urged children to wash their hands “before breakfast, before dinner and after school”. Their Lifebuoy soap was marketed as the best way to tackle germs, as in a 1927 advert in which a father advises his son that “Dirty hands are dangerous”. This wise parent practises what he preaches, using the product several times each day.

Adverts such as this had considerable impact, but their message still bears repeating. Despite centuries of advice, many of us are no better than the “plaine people in the countrie” who riled the Tudor physician William Bullein – because they would not clean their filthy hands.

Katherine Harvey is a historian of medieval Europe based at Birkbeck, University of London.

By Katherine Harvey

Published at HistoryExtra; The official website for BBC History Magazine, BBC History Revealed and BBC World Histories Magazine
March 5, 2020 at 1:08 pm

https://www.historyextra.com


UNICEF: Novel coronavirus (COVID-19) outbreak: What you should know

UNICEF:
– It’s important to remember that key prevention measures are the same – frequent hand washing, and respiratory hygiene (cover your cough or sneeze with a flexed elbow or tissue, then throw away the tissue into a closed bin).

– Continue to follow good hand and respiratory hygiene practices like regular handwashing, and keep your child up to date with vaccinations – so that your child is protected against other viruses and bacteria causing diseases.

– Instead of keeping children out of school, teach them good hand and respiratory hygiene practices for school and elsewhere, like frequent handwashing, covering cough or sneeze with a flexed elbow or tissue, then throwing away the tissue into a closed bin, not touching their eyes, mouths or noses if they haven’t properly washed their hands.

– On 17 February, UNICEF appealed for US$42.3 million to scale up support for efforts to contain the novel coronavirus outbreak. The preliminary funds will support UNICEF’s work to reduce the transmission of the virus including by strengthening risk communication and tackling misinformation so that children, pregnant women and their families know how to prevent COVID-19 spread and where to seek assistance.

https://www.who.int/docs/default-source/coronaviruse


UNICEF urges political heads to commit to firm ODF targets

Mole (S/R), Feb. 19, GNA – The United Nations Children’s Fund (UNICEF) has called on political heads at the regional and local levels to commit to firm Open Defecation (OD) targets.

They are also to work with Assemblies through Assembly Members to mobilise the citizenry to take ownership of sanitation to achieve the targets.

Madam Margaret Gwada, Chief of UNICEF Field Office, Tamale, who made the call, expressed the need for Metropolitan, Municipal and District Assemblies to enact by-laws and sanctions to correct defaulting citizens.

She said this would help to achieve the President’s agenda of a “Clean Ghana,” “A Ghana without filth, a Ghana where children do not lose their lives to preventable diseases such as diarrhoea and polio”.

She was speaking at the Ministers’ Sanitation Summit held at Mole in the Savannah Region, which was a lesson-learning platform to deepen dialogue in the fight against OD as well as share experiences and ideas on dealing with the menace.

It was also to share and receive feedback from amongst the various regions and to come up with constructive ideas and suggestions on the way forward to improve on basic sanitation in the country.

It was organised by the Northern Regional Coordinating Council in collaboration with the Ministry of Local Government and Rural Development, and the Ministry of Sanitation and Water Resources together with its development partners including UNICEF and Canada.

It was attended by some Regional Ministers and Deputy Regional Ministers from five regions in the north, and the Central and Greater Accra Regions and officials from the Ministries of Sanitation and Water Resources, and Local Government and Rural Development, Metropolitan, Municipal and District Chief Executives, Regional Community Development Officers, Regional Environmental Health Officers from those regions and development partners including UNICEF, Canada and the coalition of NGOs in water and sanitation.

According to the 2017 Multiple Indicator Cluster Survey (MICS), one out of five Ghanaians defecated in the open.

Data from the Environmental Health and Sanitation Unit indicates that Northern Region moved from five per cent Open Defecation Free (ODF) coverage in June, 2016 to about 58% in July, 2019.

Madam Gwada attributed the strides in the area of ODF to commitment of leadership to timely release of funds towards sanitation initiatives and behavioural change, hence, her call on the political heads to commit to firm ODF targets.

Mr Michael Gyato, Deputy Minister for Sanitation and Water Resources urged Assemblies to sensitise their people to pick plastic rubbers scattered in their surroundings to help improve sanitation practices in their communities.

Mr John Benam, Deputy Northern Regional Minister said the government had demonstrated commitment towards improving on basic sanitation in the country and called on development partners “To lean on that and work assiduously to achieve more ODF with resources within our reach.”

Mr Eric Chimsi, Development Officer, at Canada expressed the need to institute measures for the effective and sustainable supply of durable sanitation and hand hygiene solutions to accelerate progress towards country-wide ODF by the year 2030.

Mr Attah Arhin, Water, Sanitation and Hygiene (WASH) Technical Coordinator of World Vision Ghana called on development partners to renew their commitment to the WASH sector and the suggested to government to fully release budgetary allocations towards the sector to achieve set targets.

GNA (Ghana News Agency)
By Albert Futukpor, GNA
https://ghananewsagency.org


What to do next to control the 2019-nCoV epidemic?

The 2019 novel coronavirus (2019-nCoV) infection can lead to acute resolved or fatal pneumonia. On the basis of knowledge of other coronaviruses, the main route of human-to-human transmission of 2019-nCoV is probably through respiratory droplets. As of Feb 4, 2020, statistical data show that the outbreak constitutes an epidemic threat in China, where the exponential increase in patients has reached 20438 confirmed cases, with 2788 (13·64%) patients in critical condition and 425 (2·08%) deaths; 23214 additional suspected cases have also been identified so far. The most affected city, Wuhan, and related regions in Hubei province of China have reported 13522 confirmed patients (66·16% of total cases) and 414 deaths from 2019 nCoV infection (97·41%of total deaths in China). 632 patients with confirmed infection have recovered and have been discharged from hospital. However, the downward turning point for new cases of infection has not been observed yet (figure). Notably, 159 confirmed cases have been reported in 23 other countries beyond China, including Japan, Thailand, Singapore, South Korea, Australia, the USA, Malaysia, and Germany. Because of the seriousness of this outbreak, WHO declared it a public health emergency of international concern on Jan 30, 2020, followed by the USA announcing a public health emergency on Jan 31, 2020.

During the epidemic, rapid and robust research is important to help guide clinical practices and public health policies. Zhu and colleagues sampled bronchoalveolar-lavage fluid from three patients and used next-generation sequencing and PCR to characterise the virus, and they identified the pathogen of this outbreak as a novel coronavirus that falls within the subgenus Sarbecovirus of the genus Betacoronavirus and confirmed the cytopathic effects (structural changes in host cells) of this virus.1 Their achievement not only improves methods of diagnosis confirmation in clinics but also promotes the study of the underlying mechanisms of viral infection.2 Subsequently, collaborations between Chinese and international scientists have rapidly unmasked some additional virological features of 2019-nCoV. A specific viral nucleic acid assay using RT-PCR was quickly developed for the diagnosis of 2019-nCoV infection.3,4Additionally, human angiotensin-converting enzyme 2 has been shown to be the putative receptor for the entry into host cells by use of bioinformatic prediction methods and in-vitro testing.2,5,6 Furthermore, bats are speculated to be the original host of this zoonotic virus, but whether an intermediate host facilitated the viral infection in humans is still unknown.7 Lastly, evidence of person-to-person transmission is accumulating,8,9 with an estimated R0 of 2·2 (95% CI 1·4–3·9),10 and the assessment of the full extent of this mode of transmission is urgently needed.

In The Lancet, two retrospective studies from Wuhan Jin Yin-tan Hospital have recently provided the first-hand evidence of epidemiological, clinical, laboratory, radiological imaging, and outcomes among 41 patients11 and 99 patients.12 Of 99 patients with 2019-nCoV pneumonia,12 the average age was 55·5 years (SD 13·1) and 50 (51%) patients had chronic diseases. Clinical manifestations were fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). In view of the findings from both studies, as well as accumulated clinical experience, the next crucial step would be to identify the proper treatment for patients infected with 2019-nCoV.

No fully proven and specific antiviral treatment for the coronavirus exists. Guidance from China’s National Health Commission suggests taking an anti-HIV drug combination of lopinavir and ritonavir and inhaling a dose of nebulised interferon α for the antiviral therapy.13Many efforts, including several clinical trials, such as NCT04246242 and NCT04252664, are in progress to screen existing antiviral drugs to identify those that could be specific and efficient against 2019-nCoV. Notably, the first reported use of remdesivir, in the first diagnosed patient with 2019-nCoV infection in the USA,14 has encouraged additional clinical study of this medication.

More importantly, patients in critical conditions often develop serious complications, such as acute respiratory distress syndrome (17 [17%] of 99 patients),12and thus medical groups should include physicians with expertise in both infectious diseases and critical care. It is noteworthy that patients in critical condition often show a reduction in peripheral blood lymphocytes.11,12 Whether immune cells infiltrate into the lungs and then cause serious lung lesions (as occurred in patients with severe acute respiratory syndrome [SARS])15 is not clear. Therefore, it is important to understand the lung microenvironment and the map of immune responses against 2019-nCoV infection, which might help to define clinical stages and uncover the pathogenesis of the disease. Recent data showed that mostdeaths were due to respiratory failure;11,12 however, no reports of lung pathology in patients who died from 2019-nCoV infection have been reported so far. Notably, elderly men with 2019-nCoV infection and other underlying diseases often have a higher fatality rate than that of elderly women or younger and more healthy patients;11,12more studies are needed to determine the associated influencing factors underlying this finding.

The development of more efficient and quicker methods for the detection of viral nucleic acids is needed to ensure the accuracy of diagnosis. Several challenges remain for basic research, including viral mutation rateand transmission, infectivity dynamics, and viral infection-associated pathogenicity in vivo. Some evidence has suggested that the virus can spread during the incubation period9,16 and is detectable during the convalescent period.16 Notably, the virus was found in the loose stool of a patient in the USA,14 suggesting potential transmission through the faecal–oral route. It is of high priority to ascertain whether persistent asymptomatic carriers of 2019-nCoV exist and to reach an accurate definition of when a patient can be considered cured. Moreover, no certainty exists about the source of the outbreak, and a prophylactic vaccine is still under development.

WHO has acknowledged the efforts made by the Chinese Government to investigate and contain the outbreak.17 For example, authorities rapidly initiated the first measures to isolate Wuhan, which were then extended to the whole Hubei province, stranding 35 million residents during the heavy-travel Chinese Spring Festival holidays. At the same time, the two new-built hospitals in Wuhan have been put into use, with 2600 beds for the confirmed and suspected patients with pneumonia. The decision makers also extended the holiday period and postponed school openings. Additionally, at least 68 medical teams, including more than 8000 physicians and nurses, from other provinces and cities went to the most affected Hubei province to fight against the disease side by side with the local medical staff.18 The Chinese Government has initiated at least 13 research programmes as an emergency measure to study the different aspects of the outbreak such as the diagnosis, treatment, and prevention of 2019-nCoV-associated disease.19 Novel therapeutic approaches, including treatment with allogeneic mesenchymal stem cells, are expected to progress to clinical trials involving patients with 2019-nCoV infection in a critical condition when the projects meet both ethical requirements and the principle of informed consent (eg, NCT04252118). Furthermore, therapeutic drugs, protective equipment, and charitable funds from inside and outside of China are transported to the epidemic area to support the response. All these measures are aimed to maximise prevention and minimise the occurrence of new infections, which will help the in-time diagnosis and treatment of patients and protect the healthy population against viral infection not only in China but also in the rest of the world. China also faces other challenges, including asymptomatic carriers with 2019-nCoV might be a new potential source of infection; there will be a huge increase in people returning from trips after the Chinese Spring Festival vacation; and it may be difficult to control the outbreak due to the lack of adequate medical resources in epidemic communities and rural areas of Hubei province.

First-line medical staff and scientists in China have had a leading role in fighting the outbreak of 2019-nCoV-associated pneumonia. The basic and essential strategies that we should stick to remain the early detection, early diagnosis, early isolation, and early treatment of the disease. With the huge efforts from medical professionals to treat patients, substantial public health prevention measures, and accelerated research, we hope the downward turning points for both new cases of 2019-nCoV and the resulting fatal events might come soon.

We declare no competing interests.

*Fu-Sheng Wang, Chao Zhang
fswang302@163.com

www.thelancet.comVol 395 February 8, 2020

Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing 100039, China

1
Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; published online Jan 24. DOI:10.1056/NEJMoa2001017.

2
Zhou P, Yang X, Wang X, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; published online Feb 3. DOI:10.1038/s41586-020-2012-7.

3
Corman VM, Landt O, Kaiser M, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020; 25: 2000045.

4
WHO. Laboratory testing of human suspected cases of novel coronavirus (nCoV) infection: interim guidance, 10 January 2020. Geneva: World Health Organization, 2020.

5
Xu X, Chen P, Wang J, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci 2020; published online Jan 21. DOI:10.1007/s11427-020-1637-5.

6
Letko MC, Munster V. Functional assessment of cell entry and receptor usage for lineage B β-coronaviruses, including 2019-nCoV. bioRxiv 2020; published online Jan 22. DOI:10.1101/2020.01.22.915660 (preprint).

7
Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019novel coronavirus: implications for virus origins and receptor binding. Lancet2020; published online Jan 30. https://doi.org/10.1016/S0140-6736(20)30251-8.

8
Phan LT, Nguyen TV, Luong QC, et al. Importation and human-to-human transmission of a novel coronavirus in Vietnam. N Engl J Med 2020; published online Jan 28. DOI:10.1056/NEJMc2001272.

9
Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020; published online Jan 24. https://doi.org/10.1016/S0140-6736(20)30154-9.

10
Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; published online Jan 29. DOI:10.1056/NEJMoa2001316.

11
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; published online Jan 24. https://doi.org/10.1016/S0140-6736(20)30183-5.

12
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; published online Jan 29. https://doi.org/10.1016/S0140-6736(20)30211-7.

13
Chu CM. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax 2004; 59: 252–56.

14
Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med 2020; published online Jan 31. DOI:10.1056/NEJMoa2001191.

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de Wit E, van Doremalen N, Falzarano D, Munster VJ. SARS and MERS: recentinsights into emerging coronaviruses. Nat Rev Microbiol 2016; 14: 523–34.

16
Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med 2020; published online Jan 30. DOI:10.1056/NEJMc2001468.

17
Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol 202; published online Jan 29. DOI:10.1002/jmv.25689.

18
Huaxia. 68 medical teams sent to Hubei to aid coronavirus control. 2020.Xinhuanet, Feb 3, 2020. http://www.xinhuanet.com/english/2020-02/03/c_138752003.htm (accessed Feb 4, 2020).

19
Ministry of Science and Technology of the People’s Republic of China. Emergency scientific programs on prevention and control of the novel coronavirus-induced pneumonia. Jan 25, 2020. http://www.most.gov.cn/kjbgz/202001/t20200125_151233.htm (accessed Feb 4, 2020).


Antibacterial Soap? You Can Skip It, Use Plain Soap and Water

When you buy soaps and body washes, do you reach for products labeled “antibacterial” hoping they’ll keep your family safer? Do you think those products will lower your risk of getting sick, spreading germs or being infected?

According to the U.S. Food and Drug Administration (FDA), there isn’t enough science to show that over-the-counter (OTC) antibacterial soaps are better at preventing illness than washing with plain soap and water. To date, the benefits of using antibacterial hand soap haven’t been proven. In addition, the wide use of these products over a long time has raised the question of potential negative effects on your health.

After studying the issue, including reviewing available literature and hosting public meetings, in 2013 the FDA issued a proposed rule requiring safety and efficacy data from manufacturers, consumers, and others if they wanted to continue marketing antibacterial products containing those ingredients, but very little information has been provided. That’s why the FDA is issuing a final rule under which OTC consumer antiseptic wash products (including liquid, foam, gel hand soaps, bar soaps, and body washes) containing the majority of the antibacterial active ingredients—including triclosan and triclocarban—will no longer be able to be marketed.

Why? Because the manufacturers haven’t proven that those ingredients are safe for daily use over a long period of time. Also, manufacturers haven’t shown that these ingredients are any more effective than plain soap and water in preventing illnesses and the spread of certain infections. Some manufacturers have already started removing these ingredients from their products, ahead of the FDA’s final rule.

“Following simple handwashing practices is one of the most effective ways to prevent the spread of many types of infection and illness at home, at school and elsewhere,” says Theresa M. Michele, MD, of the FDA’s Division of Nonprescription Drug Products. “We can’t advise this enough. It’s simple, and it works.”

The FDA’s final rule covers only consumer antibacterial soaps and body washes that are used with water. It does not apply to hand sanitizers or hand wipes. It also does not apply to antibacterial soaps that are used in health care settings, such as hospitals and nursing homes.

What Makes Soap ‘Antibacterial’

Antibacterial soaps (sometimes called antimicrobial or antiseptic soaps) contain certain chemicals not found in plain soaps. Those ingredients are added to many consumer products with the intent of reducing or preventing bacterial infection.

Many liquid soaps labeled antibacterial contain triclosan, an ingredient of concern to many environmental, academic and regulatory groups. Animal studies have shown that triclosan alters the way some hormones work in the body and raises potential concerns for the effects of use in humans. We don’t yet know how triclosan affects humans and more research is needed.

“There’s no data demonstrating that these drugs provide additional protection from diseases and infections. Using these products might give people a false sense of security,” Michele says. “If you use these products because you think they protect you more than soap and water, that’s not correct. If you use them because of how they feel, there are many other products that have similar formulations but won’t expose your family to unnecessary chemicals. And some manufacturers have begun to revise these products to remove these ingredients.”

How do you tell if a product is antibacterial? For OTC drugs, antibacterial products generally have the word “antibacterial” on the label. Also, a Drug Facts label on a soap or body wash is a sign a product contains antibacterial ingredients.

Triclosan and Health Concerns

Triclosan can be found in many places today. It has been added to many consumer products—including clothing, kitchenware, furniture, and toys—to prevent bacterial contamination. Because of that, people’s long-term exposure to triclosan is higher than previously thought, raising concerns about the potential risks associated with the use of this ingredient over a lifetime.

In addition, laboratory studies have raised the possibility that triclosan contributes to making bacteria resistant to antibiotics. Some data shows this resistance may have a significant impact on the effectiveness of medical treatments, such as antibiotics.

The FDA and the Environmental Protection Agency (EPA) have been closely collaborating on scientific and regulatory issues related to triclosan. This joint effort will help to ensure government-wide consistency in the regulation of this chemical. The two agencies are reviewing the effects of triclosan from two different perspectives.

The EPA regulates the use of triclosan as a pesticide, and is in the process of updating its assessment of the effects of triclosan when it is used in pesticides. The FDA’s focus is on the effects of triclosan when it is used by consumers on a regular basis in hand soaps and body washes. By sharing information, the two agencies will be better able to measure the exposure and effects of triclosan and how these differing uses of triclosan may affect human health.

The EPA reevaluates each pesticide active ingredient every 15 years. The EPA’s Final Work Plan for the triclosan risk assessment can be found in docket EPA-HQ-OPP-2012-0811.

More on the FDA’s Rule

The FDA’s rule doesn’t yet apply to three chemicals (benzalkonium chloride, benzethonium chloride and chloroxylenol). Manufacturers are developing and planning to submit new safety and effectiveness data for these ingredients.

With the exception of those three ingredients that are still under study, all products that use the other 19 active ingredients will need to change their formulas or they will no longer be available to consumers. Manufacturers will have one year to comply with the rule.

This rule doesn’t apply to hand sanitizers. The FDA recently issued a final rule on OTC hand sanitizers and will continue to review the three active ingredients commonly used in hand sanitizers. To learn about the difference between consumer hand sanitizers and consumer antibacterial soaps, visit our consumer information page.

Consumers, Keep Washing with Plain Soap and Water

So what should consumers do? Wash your hands with plain soap and water. That’s still one of the most important steps you can take to avoid getting sick and to prevent spreading germs.

www.fda.gov/consumers


Hand hygiene is key to preventing the flu, but researchers say it’s going to take more than just hand sanitizer

Colder months on the way, there will be more chances for infections to spread. Before flu season is fully underway, it’s a great time to think about what we all can do to prevent the highly contagious virus.

A new study has revealed that hand sanitizer alone isn’t completely effective in killing the bacteria that spreads the flu from person-to-person. Researchers say more drastic measures need to be taken to help stop the infection.

“The physical properties of mucus protect the virus from inactivation,” said researcher Dr. Ryohei Hirose. “Until the mucus has completely dried, infectious [influenza A virus] can remain on the hands and fingers, even after appropriate antiseptic hand rubbing.”

Keeping hands clean

Based on previous studies, the researchers learned that ethanol-based disinfectants (EBDs) like hand sanitizer aren’t the most effective in stopping the spread of the flu virus. With that in mind, they set out to discover how consumers can do their best to keep the infection to a minimum.

Dr. Hirose and his team ran various tests with infected mucus and EBDs. One of their primary goals was to be able to minimize the spread of the flu at doctors’ offices, as germs are easily transmitted among sick patients.

The researchers learned that EBDs tend to struggle to deactivate the flu virus when infected mucus is wet, mainly due to its thickness. In one trial, they discovered that it took at least four minutes of exposure to the EBD for it to do the trick, as anything under the four-minute mark didn’t kill the germs of the flu virus.

Ultimately, what this means for consumers is that when they use hand sanitizer to stay virus-free, the product doesn’t work instantly, and so the risk of developing the flu remains.

Preventing flu outbreaks

However, the researchers did explain that EBDs tend to work differently if a consumer came into contact with infected mucus that was wet versus dry. Hand sanitizer can more easily attack the virus when the mucus is dry, killing the germs in up to 30 seconds.

The researchers encourage consumers not to underestimate the power of simply washing their hands with antibacterial soap, as doing so can also kill the flu germs in under one minute.

“These findings will greatly contribute not only to the development of a more effective method of preventing [influenza A virus] outbreaks, but also to the advancement of current hand hygiene and contact infection prevention strategies,” the researchers wrote.

By Kristen Dalli
Published 09/19/2019 | ConsumerAffairs
www.consumeraffairs.com