July 13, 2020


Carolyn D. Concia, Nurse Practitioner, Portland, Oregon
Thomas F. Kline, M.D., Ph.D, Physician, Raleigh, NC

We are not winning the war against Covid-10. Wearing masks and staying home is not completely effective. It is only half a plan. We need the other half of the control plan — direct spread protocols. The government can only do so much. The rest is up to us as individuals to guard our own health. We will explain how to add direct control plans to stop spread of disease.

Direct spread works by getting invisible amounts of virus laden saliva on your hands then passing it to yourself or others, hand to mouth, nose or eyes. Yes icky saliva, but deadly saliva. We use universal hand washing learned in 1847: you assume everyone is infected. When and where you cleanse virus from your hands is the critical part of an individualized Infection Control Plan or ICP we will tell you about. A perfect ICP is like a perfect football play, it should work every time. We need to jump on direct control. The masks are fine, and needed but obviously are not working to slow the rates enough.

Any person can draft an ICP for any place for any environment. Think of zones, which are defined as places or within a place. Your kitchen is zone within your home zone. Different Infection control plans need to be made, a meat packing plant or a third grade classroom, or your kitchen. Before you draft a plan you have to understand the enemy, the respiratory corona virus.

Respiratory viruses are spread by coughing, sneezing, talking loudly and singing (droplet spread) and by failing to wash hands after being invisibly contaminated with a tiny amounts of saliva (direct spread). Someone drinks out of a glass, you carry the glass to the kitchen transferring the germ laden saliva to your hands then forget to wash your hands. You get a new glass to drink from transferring the invisible saliva to the new glass, then you drink. In 7 days you will be sick. This is direct spread. Track the saliva, pretend you have red finger paint on your hands, follow the red color.

Nova Scotia has a draconian stay at home policy, leave only with written permission. New cases, of Covid19 are still climbing. Masks, and isolation are not completely working. People are jammed in together forgetting their direct spread ICP’s. Direct contact spread is likely involved with “family clusters” we hear about. Lock downs are are not medical infection control plans. You can have ICP in prisons too, anywhere. You won’t get the ICP from government officials a they only know lock downs and masks. Direct spread is up to you.

Spreading through the air is a maybe, but I think only if fogged recently with saliva droplets needs coughing, sneezing, singing or loud talking. Yes, singers might fill the air with aerosols so probably best not to sing in groups. The mask wearing has been pretty good, so we suspect it is failing along the lines of something else. A big culprit i see every day is failure to wash gloves. Virus live longer on gloves than on hands.

Glove direct spreading maybe responsible for many new cases, especially glove wearing at the drive thru’s and the Quickie marts and nursing homes. One third of deaths are from nursing homes. This is just awful. Where are the monitors, where are the epidemiologists, where are the cadres of public health nurses descending on nursing home. We have worked in nursing homes. They are warehouses and revenue streams for distant corporations who call each day and ask the manager “what is the census?” Full census leads to bonuses and new beemers. The more jammed into the semi private rooms passing corona virus the more profits.

Every day we read of another nursing home disaster. I heard some nursing homes are dumping people with the disease to make way for high paying “acute stays” with Covid 19. Nursing homes are corporate death camps for disease spread. One third of all american deaths? What else are they?

Wash hands, forget gloves. We do not fully understand this virus so all hands on deck, do everything reasonable. Universal precautions, assume everyone is infected.

Infection Control Plans are mandatory in our view. No guessing or ‘should we do this”. ICP’s are written plans drafted by volunteer Covid19 monitors for each home, school, stores, and drive through food businesses or meat packing plants.

In writing a ICP, first we do on site evaluation , look for direct spread avenues, think coughing and sneezing and then map out a written plan for that zone. Is the break room for direct spread. Is it the elevator for droplet spread? Maybe some public health videos to instruct us in the tricks would help. Maybe the CDC could get its head out of the sand an make some pratical how to do videos.

A monitor doing the origianl on site survey Maybe the meat packing plant will see one glove is touching the next glove on the line, or the break room has no plan for touching the drink machine. Be a detective. Think red finger paint on your hands spreading disease.

We still cannot get alcohol to put in our pump bottles and spritzing machines. Pretend like it is a war, which it is. This is inexcusable. Alcohol is now a critical strategic material. If the military was short we would have hundreds of tank care os alcholol in two days. We will not stop the spread of this awful disease without alcohol cleansers when soap and water is not available for direct spread containment. How about some help from the government?

Purchase automatic alcohol or sanitizer dispensers. Affixed to the wall or on a stand at the entrance and exit of each zone or where ever the monitor thinks best. These are $50 to $250 dispensing alcohol sanitizers spraying without touching the machine. Once placed people tend to use them without reminders. But you have to have alcohol to put in them.

An example of the ICP site survey might be an elementary school (or any place) . First walk around and picture every child with virus (finger paint) on their hands when they arrive. Maybe need a spray dispenser at the front door and at the entrance to the classrooms. In Denmark the kids went back to school, sat 6 feet apart and washed their hands hourly. A monitor went around and cleaned handles on doors, and faucet handles in the bathroom, places identified by the monitor for the ICP. Learn from others, this is no time for xenophobia.

Drive thru fast food places are in dire need of precautions to prevent direct spread by gloves. There should be a writen plan tacked on the front door: What we have done, and what we expect you to do. I watched a person putting on lids on drinks at the window of McDonalds, one after the other, keeping gloves wet, ideal for viruses, handing drink and food to carloads of customers never washing her gloves (because she was not told to do by “corporate”, we asked). She could have accidentally contaminated car loads of men women and children, passing the drinks around in the car with virus laden lids. This is a very dangerous situation. No wonder numbers are rising.

Keep in mind drafting the ICP Covid19 virus is “highly infectious” meaning the number of germs you need to get sick is small. Unwashed gloves or unwashed hands -very dangerous, it does not take much. Ask any infectious disease person why so many get sick in nursing homes, — gloves not washed. An article in the New York Times discusses the high attack rates at nursing home but never mentioned unwashed gloves the major culprit. Let’s be scientists. PPE’s are not the answer, gloves only to protect skin, soap and alcohol cleansing is critically important sanitize gloves or hands between each interaction: each customer in store, bank, fast food, quiki mart, handing out food at the church social, soup kitchens — each interaction.

After monitors have analyzed and drafted the infection control plan, the plans can be posted on the front door. This lets people know there is a plan in place, making it safer to “restart” and they can see what it is and what they need to do. ICP monitors need to be assigned in all places with a posted ICP. They circulate, watch, warn and crack knuckles

ICP plans and ongoing monitoring are especially important for restaurants where lots of saliva direct spread occurs. Virus is in the air, only if someone just sprayed saliva with cough, or sneeze and is sick. Go with the most likely — invisible viral saliva everywhere, but in the the air generally. Thewait staff puts contaminated thumb on plate and gives it to you; you touch the plate then your mouth. There should be sanitizer dispensers all over the restaurant. This reminds people because they are in the same place, but the monitor is there hovering too.

Do not accept food from employees wearing gloves unless you are positive have been washed before serving you. This simple act of glove cleansing would save lives.

We do not know this virus. To figure out just exactly how it is spread we need attack rate statistics, or rates of new cases, not useless scary whole numbers. Let’s say: Wyoming has 500 new Covid-19 cases, the state of NY has 5000. Who has the problem? Wyoming actually has twice the number of cases per person or attack rate. The population is 1:20 so something is wrong in Wyoming. Learning why the rate is different will tell us what to do for others. Maybe credit cards are being passed due to lack of insert your own card models. This is made up example but is an example of how the germ specialists hunt. Any differences in rate require epidemiological investigation. Florida had the most cases in the country — compared with what?

We think Virus testing is a bad trap. If you get a negative test, you can still be infected two hours later getting a drink from the drive thru. False tests are rampant. No one, including the CDC, is rating the brand of tests to see if accurate. Until then, don’t get them, use “universal precautions” remember ssumes everyone is automatically positive for the virus. Let’s think this through. This is an infectious disease not political drama. Antibodies sounds good then they report positive antibodies along with virus postivie tests. Tests are ok for public health but until they are figured out, universal precautions

What if a family has been together for longer than three weeks and no one is sick. Unless there is a carrier who has not transmitted to another family member, it is probably ok. You decide, I am beginning to believe people are as smart or smarter than the CDC. By the way where can you go to get answers to questions? I tried the CDC ask me a question web site, 4 days now — nothing. The website says “we’re are busy”. Then hire more people, trillions are being sent. Duh.

How about smooching? Hate to say, but we doctors like smooching too, but bad idea. You get sick a week later and assume it was at the store. But the three week rule applies if together and not sick. This is a war with a new enemy. You think it through, then just do it. Go with the odds. There is science to defeating this virus. Wringing hands and lock downs is not science.

Staying home is wrecking out culture, our lively hoods, and is not working. Make your own ICP with care, and with logic and then go for it. Huddling is not an acceptable battle plan.

Surfaces are not the problem. Clothing is not the problem. No need to wear paper armor. It just gets wet and spreads more virus. Gloves, never wear unless protecting hands, to easy to get lulled into thinking “I am clean”.

On airplanes hands monitoring and masks, not just masks. Attendants handing out drinks with uncleansed hands or wearing gloves and not sanitzing between each passenger is passing disease

Hotel rooms are safe. Hair dressers and barbers are safe with masks within the 6 foot zone. The virus is not in your hair, but nose yes. Each place should have their own ICP posted. The virus dies quickly out of human body. If the staff is careful can return to Hair dressers, doctors, dentists. Each should have a posted ICP after analyzing the situation, droplets and red finger pain for spread with hands. Dentists need full face masks but the patients are ok, Still part B, direct spread. Sanitize hands just outside the office before getting into your car, the next zone.

Sitting next to each other in a theater or sporting event. This is a problem. Too much 6 foot zone violation. Like the kids in Denmark, gotta be 6 feet a part.

Spreading in air. Scientists signing letters at Duke and UNC. So what is their plan? If the virus is really spread in the air, we are all screwed any way. Ok, do stuff out doors is you can. Really its sneeze or cough fog, a runner zooms by without a mask - “fog” After a sneeze or cough the particulate floats in the air for a while, so move out of the fog. Other than putting a mask over the earth, I don’t get what we supposed to do. This is a war, spreading fear is not helping.

Where to get advice? The CDC, after spending four years telling doctors not to treat pain has a life span is limited life span.Seven million lives ruined without pain medicines after being forced off by the CDC, now they are bungling a real communicable disease, in their title Communicable Disease Center. Covod 19 is a communicalbe disease. I would be cautious with any of their advice. I keep checking so far a C-.

You can ignore most advice until verified by using universal precautions. Have i mentioned that?

Zone Control is a concept where you accept contamination as a fact but thenkeep it in control. You will not get sick from virus on your hands, only when it gets into a mouth or a nose. You go to a store cleanse before entering and on exiting. In between monitor your hands. Don’t stick them in your mouth or nose, don’t touch your cell when it rings, or clean it with your goo bottle right there.

Let’s get going. Maybe our public health nurses can help with the development individual Infection Control Plans (ICP’s), but if no time to do this, do the plan yourselves. Protect your own health. Think red finger paint on your hands. Watch for droplet spread. Be cleverer than the virus. Put your plan up on the front door of your home, Governor’s office, meat packing plant, McDonald's, or your kid’s school. Appoint monitors. Write direct spread infection control plans (ICP’s) ,only then restart. It can happen fast, and it can happen with less fear, but it has to happen with science and attack rates not “the most ever” statistics.

42 years varied primary care • former Chief, Hospital in Home Service @harvardmed • formerly: @UofMaryland, @StanfordDeptMed, @uoregon •