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.

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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.

Clean hands save lives, so wash up, Berkeley expert says

Why aren’t we in the habit of washing our hands? Germs are invisible, and each of us has a hard time thinking of ourselves as a person with contaminated hands, says Berkeley Haas professor David Levine, an expert on overcoming barriers to improving health.

You don’t have to remind David Levine, UC Berkeley professor of business administration, to carry hand sanitizer and wash his hands thoroughly with soap.

But why do many of us — from children to adults — lack these habits, even in a pandemic? Much of Levine’s research focuses on ways to overcome barriers to improving health, especially in underprivileged nations. And as head of Hygiene Heroes, a program he’s led with UC Berkeley students on four continents since 2014, schoolchildren learn through the team’s special curriculum — it includes interactive stories, games and songs, and characters like Gerry the Germ — how to change health-related behaviors.

Berkeley News recently talked with Levine, a Berkeley alumnus who’s been on the faculty since 1987, about the importance of hand-washing, why people don’t always do it and what it will take for people and organizations to adopt healthier habits.

How did hand-washing become a focus in your work?

When I got tenure at Berkeley, I decided I should work on the most important problem I could help with. So, I chose the health of poor children in poor nations. Doctors taught me that hand-washing is the most important single behavior in preventing childhood illness, but the challenge of behavior change remained. And behavior change is something I study.

I’m currently working mostly in India. I have other behavior change projects on dental hygiene, safe water, safe cooking (to avoid smoky stoves that kill millions each year) and sexual and reproductive health. Any school can access my curriculum on hand hygiene and preventing respiratory infections; I’m glad to help run pilots or experiments.

Coronavirus has brought about death and also is a risk to businesses. I may start a small research project focused on when consumers prefer businesses with mandatory hand-washing and other signals of good hygiene. We will run some online surveys exploring what indicators of good hygiene are worth the hassle of longer lines or having to wash hands oneself. If good hygiene is profitable, it should spread more quickly.

What are the data on how hand-washing can prevent disease, and which diseases does it stop?
Hand-washing with soap prevents perhaps roughly a third of diarrheal diseases and a similar share of respiratory infections, such as colds and the flu. The proportion may be a bit lower for COVID-19, but we are not sure.

Both soap and hand sanitizer are highly effective. They key, in both cases, is to rub awhile. The standard advice is to rub for 20 seconds — about as long as it takes to hum “Happy Birthday” twice.

Elders often remind youngsters to wash their hands. Why doesn’t the habit stick? Is it a matter of not learning the right way, or not realizing why it’s important?

Leading doctors figured out it was important to wash hands with soap in the middle of the 1800s. But at the start of this century, most doctors did not wash their hands between patients. The result was that hospital-caused infections killed more people than auto accidents. Doctors’ hygiene has improved recently, but for 150 years, progress was quite slow. Germs are invisible, and each of us has a hard time thinking of ourselves as a person with contaminated hands spreading disgusting poop or snot around.

Has anything worked, to get people to change behavior and wash their hands — whether they’re surgeons or fast food workers or schoolkids in the bathroom? You’ve talked about the need to “harness shame.”

Interestingly, doctors did usually wash their hands — if they knew somebody was watching. We see the same pattern in public restrooms. Most people do not wash their hands with soap. But they do if they know someone is watching.

It’s important to establish a norm that it is disgusting not to wash hands with soap after leaving the toilet or before eating — and, more recently, not to wash hands with soap after a sneeze. (For guidance specifically on preventing the spread of COVID-19, see the CDC webpage)

To harness shame, managers must go beyond repeating messages to their employees about hand-washing to changing social norms. If they can convey the right messages, employees will feel disgust when they sneeze into the air or fail to wash hands with soap before eating. Effective change must build on messages about pathogens to include messages about poop and snot.

Washing your hands protects you — and the community. That is why social norms are important; we need society to use social pressure to protect itself.

What has your work promoting healthy routines in other countries shown?

Like many others, I find that providing easy access to soap or hand sanitizer is crucial. Also, like many others, I find that health messages — plus the availability of soap — is usually not enough.

Fortunately, even in resource-poor areas such as India, my team has found that adopting routines for hand-washing with soap work. When the lunch bell rings, students line up at the classroom door, and a lead student squirts a little soapy water on each student’s hands. The students scrub as they walk to sinks, rinse and then eat. Parents in our country may recognize this routine from their own children’s preschool days. Every school in America should establish similar routines.

What needs to happen to change health hygiene in the United States?

Managers in the United States must build new organizational routines related to hygiene. These will vary by the risks each business faces and must outlast the acute phase of this pandemic.

For example, hygiene is the most important near people who are sick. So, every doctor’s office should require people to wash their hands with soap or hand sanitizer as they enter.

It is important to establish routines for hygiene wherever people spend a lot of time together. So, every senior living facility should ask you to clean your hands as you enter. And places where people live together, like dorms and prisons, should establish appropriate routines for hand-washing before meals. For example, as you enter a dining area, someone can remind you to use hand sanitizer.

Good management has always involved a cycle of identifying problems and creating procedures to address them. Fighting COVID-19 requires using familiar management tools to address this novel threat.

First, businesses have to analyze where they can spread germs: an ATM keypad, a grocery cart, etc. Then, they have to create and implement procedures to keep workers and customers safe. Those new procedures require training, monitoring, incentives and often supplies. As a familiar example, the check sheets in some restaurants — “This bathroom was last cleaned by _________ at ___________ o’clock” — are part of an effective routine. Workplaces must extend that level of attention to hygiene to many other surfaces.

What opportunities does the current coronavirus pandemic present, to get people to adopt healthy or healthier hygiene habits? Are you optimistic about the chance for change?

Millions of people are paying more attention to hygiene today than they were a month ago. Some of the safer habits, like hand-washing a bit more often, will stick, but many people will become less careful when the pandemic dies down. I hope that organizations, from doctors’ offices to dormitories, can retain routines that keep people healthier.

Gretchen Kell
Published March 16, 2020

Bedre håndvask på store flyplasser kan bremse spredning av smittsomme sykdommer

Bedre håndvask på store flyplasser kan bremse spredning av smittsomme sykdommer.

Hvis flypassasjerer vasker hendene sine oftere og bedre på de ti største flyplassene i verden, kan spredningen av smittsomme sykdommer begrenses kraftig, ifølge ny forskning.

Før i tiden spredte sykdommer seg sakte, og sjelden veldig langt. Svartedauden som starten i Kina i 1334 brukte nesten 15 år på å spre seg til Vest-Europa.

I motsetning spredte det nye coronaviruset seg fra Kina til Europa på under en måned og det global transportnettverket kan spre smittsomme sykdommer til alle deler av verden under 24 timer.

I 2018 var det 4,3 milliarder mennesker som fløy med fly, og det forventes at det antallet vil øke til 7,8 milliarder i 2036. Derfor er hygiene ved transportknutepunkter som flyplasser viktig i kampen mot nye epidemier, skriver forskerne i studien.

Studien ble publisert i Risk Analyse.

Må vaske hendene oftere og bedre

Skitne hender kan være et stort problem. Spesielt på flyplasser hvor mange mennesker fra ulike steder er samlet. Noen steder på flyplasser, som for eksempel check-in automater, kasser ved sikkerhetsinngangen og toaletthåndtak blir berørt av svært mange gjennom dagen.

Ifølge forskerne bak den nye studien har bare 20 prosent av mennesker på flyplasser rene hender, som betyr at hendene har blitt vasket med vann og såpe i over 15 sekunder den siste timen.

Bare 70 prosent vasker hendene sine etter toalettbesøk på flyplasser, av de 70 prosentene så vasker bare halvparten hendene riktig. Bedre håndvask på alle flyplasser kan være vanskelig, men ifølge forskerne bak studien kan vi redusere spredningen av sykdommer med 37 prosent bare ved å vektlegge håndvask ved de ti største flyplassene i verden.

I en annen studie så forskerne på effekten av håndvask og bakteriespredning. De prøvde å spre bakterier på dørhåndtak. Uten håndvask fant de bakterier 44 prosent av gangene. Etter håndvask med vann fant de bakterier 23 prosent av gangene og håndvask med vann og såpe bare 8 prosent.

Det hadde ingen betydning hvilke bakterier forskerne brukte.

Små forbedringer kan gjøre stor forskjell

Hvishåndvaskingen på flyplasser øker med bare 10 prosent, noe forskerne mener er mulig å gjøre hvis de informerer passasjerene bedre, kan spredningen av smittsomme sykdommer reduseres med 24 prosent, skriver forskeren i studien.

– Å få bedre håndhygiene er vanskelig, men nye metoder innen utdanning, mer bevissthet og bruken av sosiale medier har vist seg å være effektivt i håndvaskingskampanjer, sier Christos Nicolaides som er en av hovedforskerne bak studien til MIT News Office.

Hvis vi tredobler antall mennesker med rene hender til 60 prosent, bremser vi potensielt smittsomme sykdommer med 70 prosent, skriver forskeren i studien.

Noen flyplasser er viktige enn andre

Forskerne kartla 120 flyplasser som de mener har størst påvirkning på spredning av smittsomme sykdommer. Et interessant funn er at flyplassene som påvirker spredning mest, ikke nødvendigvis var de travleste.

Forskerne bak studien peker på at flyplassene Narita i Tokyo og Honolulu på Hawaii, som rangerer på 46. og 117. plass i trafikkvolum, har større potensial til å spre sykdommer rundt verden enn større flyplasser. Dette er fordi flyplassene har direkteflyvninger til de største flyplassene i verden og at de har mange langdistanseflygninger.

Hvis det forekommer et sykdomsutbrudd, må man finne de 10 nærmeste flyplassene på listen av de 120 og få dem til å øke håndvaskingen blant passasjerene. Dette var den mest effektive metoden for å hindre spredning av sykdom, skriver forskerne i studien.

Ifølge Nicolaides er det mulig å forbedre håndvasking og hygiene blant passasjerene med å installere vasker bare til håndvask på forskjellige plasser og spesielt utenfor toaletter. Flyplassene kan også kartlegge områder der mennesker ofte er kontakt med objekter og vaske oftere der.

De ti viktigste flyplassene for å stoppe spredning av sykdommer:

•  London Heathrow lufthavn, England (LHR)

•  Los Angeles internasjonale lufthavn, USA (LAX)

•  John F. Kennedy internasjonale lufthavn, New York (JFK)

•  Charles de Gaulle internasjonale lufthavn, Paris (CDG)

•  Dubai internasjonale lufthavn, De forente arabiske emirater (DXB)

•  Frankfurt lufthavn, Tyskland (FRA)

•  Hongkong internasjonale lufthavn, Kina (HKG)

•  Beijing internasjonale lufthavn, Kina (PEK)

•  San Francisco internasjonale lufthavn, USA (SFO)

•  Schiphol lufthavn, Nederland (AMS)


Nicolaides, C. Demetris, A. Cueto‐Felgueroso, L. González, C, M. Juanes, R. (2019). Hand‐Hygiene Mitigation Strategies Against Global Disease Spreading through the Air Transportation Network. Risk Analyse. doi:




Study: To slow an epidemic, focus on handwashing

Improving the rate of handwashing at just 10 major airports could significantly slow the spread of a viral disease, researchers estimate.

A new study estimates that improving the rates of handwashing by travelers passing through just 10 of the world’s leading airports could significantly reduce the spread of many infectious diseases. And the greater the improvement in people’s handwashing habits at airports, the more dramatic the effect on slowing the disease, the researchers found.

The findings, which deal with infectious diseases in general including the flu, were published in late December, just before the recent coronavirus outbreak in Wuhan, China, but the study’s authors say that its results would apply to any such disease and are relevant to the current outbreak.

The study, which is based on epidemiological modeling and data-based simulations, appears in the journal Risk Analysis. The authors are Professor Christos Nicolaides PhD ’14 of the University of Cyprus, who is also a fellow at the MIT Sloan School of Management; Professor Ruben Juanes of MIT’s Department of Civil and Environmental Engineering; and three others.

People can be surprisingly casual about washing their hands, even in crowded locations like airports where people from many different locations are touching surfaces such as chair armrests, check-in kiosks, security checkpoint trays, and restroom doorknobs and faucets. Based on data from previous research by groups including the American Society for Microbiology, the team estimates that on average, only about 20 percent of people in airports have clean hands — meaning that they have been washed with soap and water, for at least 15 seconds, within the last hour or so. The other 80 percent are potentially contaminating everything they touch with whatever germs they may be carrying, Nicolaides says.

“Seventy percent of the people who go to the toilet wash their hands afterwards,” Nicolaides says, about findings from a previous ASM study. “The other 30 percent don’t. And of those that do, only 50 percent do it right.” Others just rinse briefly in some water, rather than using soap and water and spending the recommended 15 to 20 seconds washing, he says. That figure, combined with estimates of exposure to the many potentially contaminated surfaces that people come into contact with in an airport, leads to the team’s estimate that about 20 percent of travelers in an airport have clean hands.

Improving handwashing at all of the world’s airports to triple that rate, so that 60 percent of travelers to have clean hands at any given time, would have the greatest impact, potentially slowing global disease spread by almost 70 percent, the researchers found. Deploying such measures at so many airports and reaching such a high level of compliance may be impractical, but the new study suggests that a significant reduction in disease spread could still be achieved by just picking the 10 most significant airports based on the initial location of a viral outbreak. Focusing handwashing messaging in those 10 airports could potentially slow the disease spread by as much as 37 percent, the researchers estimate.

They arrived at these estimates using detailed epidemiological simulations that involved data on worldwide flights including duration, distance, and interconnections; estimates of wait times at airports; and studies on typical rates of interactions of people with various elements of their surroundings and with other people.

Even small improvements in hygiene could make a noticeable dent. Increasing the prevalence of clean hands in all airports worldwide by just 10 percent, which the researchers think could potentially be accomplished through education, posters, public announcements, and perhaps improved access to handwashing facilities, could slow the global rate of the spread of a disease by about 24 percent, they found. Numerous studies (such as this one) have shown that such measures can increase rates of proper handwashing, Nicolaides says.

“Eliciting an increase in hand-hygiene is a challenge,” he says, “but new approaches in education, awareness, and social-media nudges have proven to be effective in hand-washing engagement.”

The researchers used data from previous studies on the effectiveness of handwashing in controlling transmission of disease, so Juanes says these data would have to be calibrated in the field to obtain refined estimates of the slow-down in spreading of a specific outbreak.

The findings are consistent with recommendations made by both the U.S. Centers for Disease Control and the World Health Organization. Both have indicated that hand hygiene is the most efficient and cost-effective way to control disease propagation. While both organizations say that other measures can also play a useful role in limiting disease spread, such as use of surgical face masks, airport closures, and travel restrictions, hand hygiene is still the first line of defense — and an easy one for individuals to implement.

While the potential of better hand hygiene in controlling transmission of diseases between individuals has been extensively studied and proven, this study is one of the first to quantitatively assess the effectiveness of such measures as a way to mitigate the risk of a global epidemic or pandemic, the authors say.

The researchers identified 120 airports that are the most influential in spreading disease, and found that these are not necessarily the ones with the most overall traffic. For example, they cite the airports in Tokyo and Honolulu as having an outsized influence because of their locations. While they respectively rank 46th and 117th in terms of overall traffic, they can contribute significantly to the spread of disease because they have direct connections to some of the world’s biggest airport hubs, they have long-range direct international flights, and they sit squarely between the global East and West.

For any given disease outbreak, identifying the 10 airports from this list that are the closest to the location of the outbreak, and focusing handwashing education at those 10 turned out to be the most effective way of limiting the disease spread, they found.

Nicolaides says that one important step that could be taken to improve handwashing rates and overall hygiene at airports would be to have handwashing sinks available at many more locations, especially outside of the restrooms where surfaces tend to be highly contaminated. In addition, more frequent cleaning of surfaces that are contacted by many people could be helpful.

The research team also included Demetris Avraam at the University of Cyprus and at Newcastle University in the U.K., Luis Cueto-Felgueroso the Polytechnic University of Madrid, and Marta Gonzalez at the University of California at Berkeley and MIT. The work was supported by startup company Smixin Inc and MIT International Science and Technology Initiatives.

By David L. Chandler | MIT News Office
February 6, 2020