Controlling COVID-19: hand hygiene must be accessible to all

UNICEF and the World Health Organization have launched the ‘Hand Hygiene for All’ joint initiative to help control the spread of COVID-19.

In a bid to control the spread of the novel COVID-19 infection the United Nations Children’s Fund (UNICEF) and the World Health Organization have launched a new join initiative ‘Hand Hygiene for All’ to help make hand hygiene accessible to all, including the least developed countries that have a lack of hygiene facilities.

Hand Hygiene for All

Henrietta Fore, Executive Director of UNICEF, and Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, made a statement on the launch of the initiative. “As the world struggles to cope with a new disease, one of the most effective tools to prevent its spread is also one of the most basic. Hand hygiene has never been more critical, not only to combat COVID-19, but to prevent a range of other infections. Yet, nearly six months since the onset of the pandemic, the most vulnerable communities around the world continue to lack access to basic hand hygiene.

“According to our latest data, the majority of people in the least developed countries are at immediate risk of COVID-19 infection due to a lack of hand hygiene facilities. In the 60 highest-risk countries, two out of three people – 1 billion people in total – lack basic handwashing facilities with soap and water at home. Around half are children.

“All too often, schools, clinics, hospitals and other public spaces also lack hand hygiene facilities, putting children, teachers, patients and health workers at risk. Globally, two in five healthcare facilities do not have hand hygiene at points of care. We cannot overstate the threat.

“Many of the those who lack access to basic handwashing live in overcrowded, desperately poor conditions. Even before the pandemic, children and families faced barriers to accessing health and hygiene services. Now the grave risk of COVID-19 threatens further suffering and spread of this deadly disease.

“If we are going to control COVID-19, we have to make hand hygiene accessible to all. That is why we are launching a new global initiative to move the world towards the same goal: supporting the most vulnerable communities with the means to protect their health and environment.

“We are joining our efforts with those of other international partners, national governments, public and private sectors, and civil society organisations to ensure affordable products and services are available, especially in disadvantaged areas, and to enable a culture of hygiene.

“Public health response plans and reopening plans should couple physical distancing and other control measures with hand hygiene and access to safe water and sanitation, and must reach the most vulnerable communities.

“Our teams are developing comprehensive country roadmaps and committing human and financial resources to support global and local implementation efforts. Task teams will facilitate learning and knowledge exchange, while multisector stakeholders will strengthen hygiene programming and monitor global progress. Leaders and community mobilisers will advise on strategies and advocate for their implementation. Only together can we achieve universal hand hygiene.

“We must also ramp up investment in hygiene, water and sanitation, and in infection prevention and control. We urge countries to scale up, systemise and institutionalise hand hygiene and commit to strengthening the enabling environment, supply vital products and services, and to actively promote hygiene practices as part of a package of actions that save lives.

“The COVID-19 pandemic has exposed an uncomfortable truth: too many people around the world simply cannot clean their hands. But we can help to reduce the spread, and we can prevent future infectious diseases from following a similar path. It starts by making sure everyone, everywhere has access to basic hand hygiene facilities with soap and clean water or alcohol-based products in homes, schools and healthcare facilities.”

 

Published


Could COVID-19 Permanently Change Hand Hygiene?

An anthropologist tackles the slippery subject of hand sanitization in a world torn between concerns over contagion and antibiotic resistance.

Here in the Philippines, as in many parts of the world, there’s been an outbreak of hand sanitizers. Since late January, pump dispensers and bottles have appeared everywhere: airports, schools, dining tables, handbags. In SM, the country’s largest chain of shopping malls, large containers of hand sanitizers greet visitors as they pass through security. “This is a sanitized zone,” SM’s posters read. “Thank you for using the alcohol/disinfectant provided.”

When the enhanced community quarantine started here on March 17, sanitizer showed up at road checkpoints. And though the shops in the mall are closed, customers can still shop at mall supermarkets—after the staff sprays alcohol on their hands.
This is not surprising. The COVID-19 pandemic has spurred people around the world to panic-buy Purell and other hand sanitizers, soaps, and antibacterial wipes. What is surprising is that, until the pandemic hit Western countries, the trend was going in the opposite direction.

Over the past decade, there’s been a growing concern that the impulse to kill all germs could have serious consequences, such as the creation of resistant superbugs. This has certainly impacted people’s hand hygiene habits.

For the last few years, the U.S. Food and Drug Administration (FDA) has advised people to stop using antibacterial soap, which is no more effective at preventing illness than regular soap and may negatively impact health. After discovering that common ingredients in antibacterial soap—most notably triclosan and triclocarban—disrupt hormones in lab animals and induce antibiotic resistance, the FDA banned those chemicals in 2016 and replaced them with alternatives.

However, when soap and water are unavailable, hand sanitizers and wipes are considered an acceptable alternative because they rely on alcohol to vanquish certain viruses (including coronaviruses) and bacteria.

Still, before the current pandemic, some health experts urged people to cut back even on alcohol-based hand sanitizer. That’s partly because some bacteria are becoming more tolerant of alcohol. And it’s partly due to concerns that sanitizers might harm the microbiome—the trillions of microbes living on and in the human body that are essential for healthy immune function, digestion, and more.
In recent years, many researchers have expressed concerns that over-sanitized societies are contributing to autoimmune disorders, allergies, and inflammatory conditions. This “hygiene hypothesis” is controversial, but there’s no question that scientists and the public have been awakening to the fact that some microbes can be beneficial.

Yet in the midst of the COVID-19 pandemic, everyone is understandably consumed by the process of hand sanitizing, and many people are finding it nearly impossible to buy sanitizer online or in stores. People who just weeks ago purposely petted dogs to boost the diversity of their microbiomes now find themselves disinfecting their hand sanitizer bottles with antibacterial wipes.

To understand this sudden change, it is revealing to explore the complex history and anthropology of hand cleansing. What motivates people’s handwashing habits? How do beliefs about sanitizers and microbes figure in? How have previous epidemics led to shifts in these notions? And what might the post-COVID future hold for hand hygiene?
Even before 19th-century scientists discovered that germs cause disease, handwashing was important for hygienic and symbolic purposes in many societies and religious traditions. The Prophet Muhammad, for instance, called on Muslims to wash their hands in a variety of situations, including “before and after any meal,” “after going to the toilet,” “after touching a dog, shoes, or a cadaver,” and “after handling anything soiled.”

In other societies, hand hygiene practices primarily originated from secular discoveries. In 1846, Hungarian doctor Ignaz Semmelweis observed that mothers giving birth were more likely to die if they were treated by doctors who handled cadavers beforehand. So, Semmelweis mandated that hospital staff wash their hands with soap and chlorine. He later became known as the father of hand hygiene. A few years later, forward-thinking nurse Florence Nightingale implemented handwashing in British army hospitals.

Despite the efforts of these pioneers, the practice of widespread, regular handwashing was slow to take off in most of the world. In the U.S., the first national hand hygiene guidelines weren’t published until the 1980s, spurred by several foodborne outbreaks and hospital-associated infections. It was in that decade that a global hand cleansing movement was born.

The rise of hand sanitizers mirrors this move of hand hygiene from the hospital to the world at large. Some accounts claim that Lupe Hernandez, a nursing student in California, invented hand sanitizer in 1966 when she realized alcohol mixed with gel could help hospital staff clean their hands in a jiffy.

Others trace its beginnings to Gojo, a family-owned Ohio company that launched a hand cleanser for auto mechanics then tweaked the recipe and released it in 1988 as Purell. After a slow start, the product achieved the near ubiquity it enjoys today.
Incidentally, alcohol-based hand sanitizers once caused ambivalence among Muslims, owing to alcohol being haram (forbidden). But today, Muslim health care workers largely accept them, even though the question of whether hand sanitizers are halal (permissible) continues to spark debate.

Epidemics have repeatedly stimulated the popularity of hand sanitizers. In the Philippines, a clothing store called Bench introduced Alcogel shortly after the 1997 H1N1 outbreak. It attained “phenomenal success,” according to Bench’s CEO Ben Chan. A similar sanitization surge occurred in the U.S. during the H1N1 epidemic of 2009.
As The Guardian’s Laura Barton wrote in 2012, “Thanks to the heightened fear of contamination experienced during recent flu epidemics, there is now a value judgment attached to carrying and using an antibacterial gel.”

Infectious disease outbreaks have also influenced societies’ soap-and-water habits. A 2003 study of six international airports found that in Toronto—which was hit by a major outbreak of severe acute respiratory syndrome (SARS) that year—95 percent of male travelers and 97 percent of female travelers washed their hands in the public restrooms. By contrast, in New York’s John F. Kennedy Airport, only 63 percent of men and 78 percent of women washed their hands.

So, is fear of disease a great motivator for soaping up or squirting hand gel? Perhaps during a pandemic, the answer is yes. However, fear generally has only a temporary effect on ablutions, according to a review led by anthropologist Valerie Curtis. Furthermore, Curtis has warned, creating cleanliness campaigns that play on people’s anxiety is not good for mental health.

Instead, she recommends harnessing a different emotion.

In the early 2000s, Curtis was aiming to change the handwashing habits of people in Ghana, where only 4 percent of adults regularly used soap after going to the bathroom. Previous campaigns had failed, and the situation was urgent, since an estimated 84,000 children were dying of diarrhea each year.

So, Curtis created a campaign designed to generate disgust. At the time, bathrooms were considered cleaner alternatives to pit latrines, so they didn’t inspire an ick factor that might prompt Ghanaians to lather up. Curtis and her group developed ads that showed mothers and children exiting bathrooms with their hands covered in purple pigment, which they then transferred to everything they touched. Soap use subsequently rose by 13 percent following trips to the toilet and by 41 percent before eating.

Such a campaign could inspire future efforts in the wake of COVID-19. In a study released in December 2019, researchers at the Massachusetts Institute of Technology (MIT) and the University of Cyprus calculated that if travelers at airports raised the bar on their soap-use habits, the impact of a future pandemic could be reduced by 24 to 69 percent. Yet the same researchers estimated that, although 70 percent of air travelers wash their hands, most do not wash them adequately (frequently, with soap, for at least 20 seconds), so only 20 percent actually have clean hands.
Pandemics arguably tip the scale back to a Pasteurian paradigm.

Shifting views about microbes may complicate the issue of disgust. MIT anthropologist Heather Paxson has written that many people hold a Pasteurian worldview, in which they “blame colds on germs, demand antibiotics from doctors, and drink ultra-pasteurized milk and juice, while politicians on the campaign trail slather on hand sanitizer.”

But Paxson also points out that there is an emergent, alternative paradigm: a “post-Pasteurian” view. Post-Pasteurians “might be concerned about antibiotic resistance” and embrace microbiome diversifiers like probiotics, unpasteurized milk, kombucha, and unsanitized handshakes.

Since Paxson’s work was published in 2008, this post-Pasteurian paradigm has grown. Scientists have even considered ways they might promote more positive feelings for microorganisms and foster collaboration in human-microbe relationships.

Pandemics arguably tip the scale back to a Pasteurian paradigm. Currently, people are bombarded with images (and imaginings) of a potentially deadly virus for which there is, at least at the moment, neither vaccine nor cure. Thus, hand sanitizers and wipes emblazoned with the statement “kills 99.9 percent of germs” give people a sense of control over an unseen, and suddenly hostile, microbial world.
But people’s hand hygiene practices are also motivated by a visible and often friendlier force.

In 2016, researchers found that doctors and nurses at a California hospital washed or sanitized their hands 57 percent of the time when they knew that designated “hygiene patrol” nurses were watching them but only 22 percent of the time when volunteers who they didn’t recognize observed them.

Just like the wearing of face masks, social pressure can certainly motivate people to clean their hands. A recent review from Curtis and other researchers showed that people were more likely to lather up when there was more than one person present in a public restroom.

Prompted by the COVID-19 pandemic, some health experts are attempting to “responsibilize individuals” by framing handwashing as a selfless act that saves lives. Social media campaigns like #SafeHands and #HandwashingHeroes are also making appeals to social responsibility by showing celebrities and adorable children getting sudsy to prevent disease.

Similarly, face masks became an emblem of “public spiritedness” during the 1918 influenza pandemic. In some places, for instance, Japan, the practice of wearing masks continued and became part of the country’s hygiene culture.

In the aftermath of past pandemics, people have generally returned to their previous handwashing habits. But the COVID-19 crisis is different from other outbreaks. Never before have hand sanitizing and social distancing practices been enacted on such a global scale.

So, could COVID-19 cause permanent changes to handwashing habits around the planet? Could hand sanitizer become an enduring symbol of responsible world citizenship? Could the pro-microbe perspective swing back to a Pasteurian panic over germs?
Only time will tell. But it’s something to ponder while you scrub or sanitize your hands for at least 20 seconds.

By Gideon Lasco
He is a senior lecturer of anthropology at the University of the Philippines.
Published  8 April 2020
https://www.sapiens.org


How Do You Wash Your Hands To Fend Off Coronavirus If Water Is Scarce?

It’s something we’ve heard again and again from health authorities in the coronavirus pandemic. Wash your hands. Frequently. With soap and water. For at least 20 seconds. That’s an effective way to eliminate viral particles on your hands.

But for the 2.2 billion people in the world who lack safe drinking water — mostly in low- and middle-income countries — that advice will be difficult to heed. In these places, water is scarce for a number of reasons. It could be due to drought or climate change. Or local water supplies could be contaminated. Or the nearest source of water may be far away from home.

Aid groups and public health officials are doing all they can to help people in these communities overcome the obstacles and wash up. Washing your hands, they say, is a small action that can make a huge difference in the coronavirus pandemic.

“Hand-washing is one important tool to check and control spread,” says Amanda Glassman, executive vice president at the think tank Center for Global Development — along with other known interventions such as testing, isolating the sick and social distancing.

Water that is safe enough to drink is the best option for hand-washing. The ideal is to use clean, running water to wash away germs because it is less likely to contain harmful pathogens like e-coli, which can make you sick.

So how do you get water to those in need? Aid groups can truck in vast amounts of water, for example, but many say that’s expensive and unsustainable.

In less than ideal circumstances, other types of water can be used to wash hands. Non-potable water (for example, water that’s been used to clean dishes or do laundry) — along with soap — can be effective, according to a 2019 study published in the journal Environmental Science and Technology.

Small-scale solutions work, too – like setting up a network of public hand-washing stations – something done in West Africa during the Ebola outbreak of 2014. “When Ebola hit, one of the big concerns was the lack of running water and sanitation for hand-washing and proper waste disposal,” says Joia Mukherjee, chief medical officer of Partners In Health and associate professor of global health at Harvard Medical School. “It almost seemed like an unsolvable problem. And yet relatively rapidly, solutions were put together.”

The simplest kind of hand-washing station needs just two buckets. One bucket contained a mix of chlorine and water for the washing, with a spigot so people could tap into the supply, she explains. A second bucket, underneath the spigot, caught the wastewater.

These hand-washing stations were put in public buildings, schools and markets in Ebola-affected areas — and public health officials stressed why it was important to wash hands. Soon “people adopted this hand-washing technique everywhere,” says Mukherjee.

Mukherjee was heartened to see these stations again in February on trips to Liberia and Sierra Leone — set up by the countries’ health authorities to combat the spread of coronavirus. “I was very pleasantly surprised that they had already re-initiated this type of hand-washing at airports and outside of public buildings like the Ministry of Health. The lessons learned from Ebola were immediately being used.”

This kind of innovation is exactly what the developing world needs right now to ward off coronavirus, says Glassman, who is the author of Millions Saved: New Cases of Proven Success in Global Health. “We should deploy and test everything we’ve got,” she says, citing the hand-washing stations. “Affordability and fast availability is what matters now.”

The lower the technology, the better, says Glassman. If people can use objects and materials available in their own communities, like buckets, it makes the solution more likely to work.

One such device — which has been praised by global water researchers — is the SE200 Community Chlorine Maker. Developed by the global organization PATH, it can make chlorine from just water, salt and a car battery. Chlorine is commonly used to disinfect water because it kills many bacteria and viruses but isn’t always easy to obtain. The clean water can then be used to safely wash hands.

In preparation for the surge in coronavirus cases, 13 countries from sub-Saharan Africa as well as from Myanmar and Vietnam have put in requests to PATH for the devices. The group is finalizing logistics to get them up and running.

Then there’s the question of how to keep hand-washing stations safe from being a hot spot for disease transmission. Myriam Sidibe, a senior fellow at the Harvard Kennedy School, is working with the aid group WaterAid in Kenya to figure that out. They are trying to find ways to make 10,000 water stations across the country safe for people to congregate around.

The plan is introduce “social distancing nudges on the ground, similar to what we are seeing in supermarkets in some countries,” says Sidibe, who is based in Nairobi. “These can be red dots painted on concrete or if the surface is more uneven you can get stones or pieces of wood and sort of partially bury it in the dirt and then paint the visible bit red.”

As for soap, it’s not as much of a problem as water.

Soap is available to purchase almost everywhere in the world, says Sidibe. Most people, including those living in poverty in rural and urban areas, have some kind of basic soap, even if just for laundry, she says.

But in this time of crisis, soap supplies may run short — or people who lose their income because of the pandemic may find soap is not affordable.

In New Delhi, Sudhanshu S. Singh, CEO of the nonprofit Humanitarian Aid International, has been collecting donations of soap and hand sanitizer — increasingly in short supply as the city is in lockdown — for the 1,000 refugee families he serves in Delhi.

The families fled Pakistan from persecution and are living in camp settlements in a slum. Because they are stateless, they don’t have the same rights to water as Indians living in the slum, says Singh, and have even less access to water. “They’re living in absolute abysmal conditions. They’re vulnerable to different kinds of diseases and health issues. Eventually the virus is going to affect them.”

So far, he’s distributed a 15-day ration of hygiene materials and taught them proper hand-washing. To ensure the families have enough water to wash their hands, he and other groups petitioned the government to bring more water to the part of the slum where the refugees live. Last week, the authorities brought in a tanker of water to provide additional supply for drinking and hand-washing and will do so regularly.

But offering soap and water is no guarantee that people are going to wash their hands. In every country, from high income to low income, there are a lot of folks for whom a thorough scrub is not a regular habit.

“Just instructing people to wash their hands is not going to get them to do it,” says Sidibe, who previously worked at a project at Unilever focused on changing hand-washing behaviors in 55 countries. “People don’t practice hand-washing. It’s inconvenient and they have other priorities. To change behavior, you need to create an enabling environment. You need to establish a positive social norm. And you need to make it a desirable thing to do.”

In Nigeria, where there are only 111 reported coronavirus cases so far, aid groups like UNICEF have been emphasizing the importance of hand-washing in the low-income areas they serve. “We are trying to spread the message through celebrities, community and religious leaders, and reaching out to media and radio stations,” says Zaid Jurji, head of UNICEF’s water, sanitation and hygiene program, based in Abuja.

They’re collaborating with artists to sing about hand-washing, too.

On Sunday, UNICEF posted “We go win (Corona)” to their YouTube channel. It’s an original song from the popular Nigerian musician Cobhams Asuquo.

The lyrics go, “Corona no big pass us … as long as we remember to always do the right thing: wash your hands, love each other, we go win.”

The idea that a song could change behavior may seem naive, but it did work during the Ebola outbreak.

By Malaka Gharib
Published March 30, 2020
https://www.npr.org


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


It’s still true: Good hand-washing is the best way to stay healthy

Everyone is concerned about staying healthy in the midst of the coronavirus pandemic.

But experts agree, one of the best things we all can do to prevent the transmission of any illness is to practice good hand hygiene.

“Wash your hands, with any soap, 20 seconds at least, or use an alcohol-based sanitizer — it will do the job,” said Dr. Frank Esper, of Cleveland Clinic Children’s.

Esper said germs can be transferred from person-to-person when we touch things like doorknobs, money or even other people.

“The grocery store, movie theater, for example, are all places where we all come together, and when you bring a bunch of people together, you’re bringing a bunch of germs together,” he said. “You can help prevent those infections by washing your hands.”

The good news, according to Esper, is we don’t need anything fancy to keep hands clean.

“A regular, good, generic soap will do just as fine as the expensive ones with labels that say ‘antibacterial’ and things like that,” he said.

Esper said parents can teach their kids good hand hygiene practices at any age — but usually once kids are of school age, they can get a better handle on how to wash up properly.

And for small children, hand sanitizer is a good choice.

“The youngest children — the 1- and 2-year-olds — are not very good hand-washers,” Esper said. “They generally have a hard time working with soap and water and doing the whole sequence. That’s where alcohol-based sanitizers help — you can just squirt it into their hands and rub, rub, rub — and it works so much better for the smaller children.”

 

By Elizabeth Misson, Cleveland Clinic News Service
Published March 6, 2020
Copyright 2020 by Cleveland Clinic News Service.
https://www.news4jax.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


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.

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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.

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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.

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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.

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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.

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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.

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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.

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

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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.

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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.

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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.

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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


CDC (Centers for Disease Control and Prevention) on: 2019 Novel Coronavirus (2019-nCoV), Wuhan, China

This is an emerging, rapidly evolving situation and CDC will provide updated information as it becomes available, in addition to updated guidance.

Background

CDC is closely monitoring an outbreak of respiratory illness caused by a novel (new) coronavirus (named “2019-nCoV”) that was first detected in Wuhan City, Hubei Province, China and which continues to expand. Chinese health officials have reported thousands of infections with 2019-nCoV in China, with the virus reportedly spreading from person-to-person in many parts of that country. Infections with 2019-nCoV, most of them associated with travel from Wuhan, also are being reported in a growing number of international locations, including the United States.

Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people such as with MERS and SARS.

Source and Spread of the Virus

Chinese health authorities were the first to post the full genome of the 2019-nCoV in GenBankexternal icon, the NIH genetic sequence database, and in the Global Initiative on Sharing All Influenza Data (GISAIDexternal icon) portal, an action which has facilitated detection of this virus. CDC posted the full genome of the 2019-nCoV virus detected in the first and second U.S. patients to GenBank.

2019-nCoV is a betacoronavirus, like MERS and SARs, all of which have their origins in bats. The sequences from U.S. patients are similar to the one that China initially posted, suggesting a likely single, recent emergence of this virus from an animal reservoir.

Early on, many of the patients in the outbreak of respiratory illness caused by 2019-nCov in Wuhan, China had some link to a large seafood and live animal market, suggesting animal-to-person spread. Later, a growing number of patients reportedly did not have exposure to animal markets, indicating person-to-person spread. Chinese officials report that sustained person-to-person spread in the community is occurring in China. Learn what is known about the spread of newly emerged coronaviruses.

READ MORE: www.cdc.gov