By Debbie Gardner
It’s September, and we’re now in the sixth month of the societal and lifestyle changes wrought by the coronavirus pandemic. We’ve locked down, quarantined, bubbled, learned to love the outdoors, tested, traced, and since mid–summer, slowly began to venture out again.
Massachusetts and Connecticut have, so far, been successful at bringing their infection rates down – though not without significant human cost, especially in our long-term care facilities. Today there’s little doubt that this virus, known as COVID-19, has exacted a terrible toll across the U.S. – and the world – in terms of lives lost, workers displaced, businesses disrupted and essential services stretched to the breaking point.
To date there is no definitively effective treatment, nor preventative, that can mitigate this global scourge, but there is some hope on the horizon. According to an article in Aug. 11 edition of The Sacramento Bee, researchers at the University of California, San Francisco have developed a nasal spray based on llama nanobodies that seems to disable the coronavirus, offering the promise of some protection from infection (the spray is now going into clinical trials). Blood plasma treatment has shown some promise to help the gravely ill, but as of this writing, has been FDA approved only for emergency use. There are also more than 165 vaccines currently under development worldwide, with 32 in clinical trials - including the one produced by Boston-based Moderna already moving into the third stage of human trials. Russia claims it has produced an effective vaccine, but there’s doubt among members of the scientific community. That one, and a recently approved Chinese vaccine have been tentatively approved by their respective countries for very limited use (NY Times, Coronavirus Vaccine Tracker, Aug. 21, 2020)
But this is now. The weather is cooling, and we’re all moving back indoors for the foreseeable future.
What can we do to try and stay healthy in the face of the traditional cold and flu season – that now also includes the threat of COVID-19? Prime reached out to local experts for advice.
Do the right things
Prime first reached out to Maggie Eboso, RN, MSN, MBA, CIC, Infection Prevention and Control Coordinator for Mercy Medical Center, for her take on where we are with COVID-19, and the best practices for staying as healthy as possible this fall and winter. As someone on the front lines of the pandemic from the beginning here in Western Massachusetts, Eboso had “a lot of accolades” for Gov. Charlie Baker’s response to COVID-19, and especially his measured approach to reopening the state, which, so far, has kept the infection rate in Massachusetts reasonably low.
“Every day we are learning something about [this virus],” Eboso said. “We don't know enough to make a full understanding of its effects.” She noted that in the beginning, “We thought come summer, it would fade out,” something that the ever-increasing numbers of positive cases – and death toll – across the country has proven false. Even in Massachusetts, with the governor’s measured approach to loosening restrictions, the summer vacation season and the opportunities to socialize more resulted in “a slight bump” in cases across the state, she said.
As life moves back indoors and people are once again in closer contact with each other, Eboso said it will become even more important to strictly adhere to the basic infection protections outlined by the CDC.
“I want to truly reinforce, you must wear the mask and wear it in the approved way,” in public, Eboso said. “I walk around the grocery store and as an infectious disease specialist, it drives me crazy that people are wearing their masks wrong!
“Whatever mask someone decides to get, it should cover the nose and the mouth and the chin,” Eboso said “Being worn directly under the nose negates the effectiveness [of the mask]. People wearing it to cover their mouth – you don't breathe through your mouth...If I’m sick and I’m not wearing it appropriately, I’m spreading [the virus].”
When wearing a mask, Eboso said it is imperative that it be fitted properly, tight against the bridge of the nose, snug along the sides of the face, and pulled down over the chin. She compared wearing a mask to the way we have been taught to cough or sneeze into our elbows, rather than our hands, to help stop the spread of cold germs.
“People have to keep wearing the mask, they can’t be tired of doing it,” she said. She cited stark evidence from the Navajo nation, which initially had a 30 percent COVID-19 transmission rate. When they instituted strict mask wearing for everyone, along with social distancing, hand washing and curfews, they flattened the transmission curve on their reservation.
The second important CDC basic is to continue with consistent hand washing – for everyone in the family. Despite the downward trend in infections in Massachusetts, “It is so important that we have to continue washing hands thoroughly, especially now that the kids are going back school,” Eboso said, adding “They are going to be coming in contact with more people” which increases the possibility they will come into contact with someone who has the virus.
It’s also important for everyone – especially anyone heading back to any level of school – to be cognizant of the health of the people around them.
“We have to encourage [kids] that they should not come in contact with others who have the sniffles,” Eboso said.
In terms of indoor air quality as we all spend less time out of doors, Eboso said increasing the flow of fresh air in rooms is important. That means opening windows when possible, or even using a window fan to increase airflow in a room. Room air purifiers are another suggestion, and some may be effective, but Eboso stressed these purifiers “are only as good as the filters, and that you have to remember to change them often.” That, she said, can lead to an expense.
Social distancing whenever possible, and disinfecting of frequently touched surfaces are also standard practices that need to continue into the fall and winter, she said.
“And I would say avoid crowded places as much as possible,” Eboso said. “With churches, go and see if they are well-ventilated, and everyone is well spaced. When I see concerts, or the Sturgis Bike Rally, it breaks my heart.”
Protect your own health
Keeping up with seasonal vaccinations will also be critical this fall, Eboso said. This means everyone should get the flu vaccine this year, and elders who haven’t had a recent pneumonia vaccine should get that as well, Eboso advised. “While the flu vaccine doesn’t mean you won’t get it, it means you won’t get it as bad,” Eboso said, adding that having protection from the flu means doctors can rule that illness out if you begin presenting with symptoms that could be COVID-19. Faster diagnosis of the proper illness can mean a better outcome.
Eboso said following good health hygiene will also be critical this fall and winter “Getting adequate rest, eating well, staying hydrated, it will help boost your immunity,” Eboso said. “Doing those things well, you have some reserve” if you do become ill. An adequate intake of vitamin C is another thing that can help boost immunity in the winter months, she said.
She also suggested continuing to take advantage of any special shopping hours designated for elders or people with compromised immune systems. “When you go in first thing, things are a bit cleaner,” Eboso said. “And at this point, it is a matter of every little bit helps.”
Visits, and holidays
Eboso said when it comes to family visits – especially grandchildren visiting grandparents, “If they go visit, they should wash their hands and they should absolutely be wearing masks,” and social distancing, Eboso said, especially if the family hasn’t seen each other in awhile. If the children are attending in-person learning, parents should try to double-check with the school to insure there have not been any instances of illness in the child’s building – or class – before the visit. “You can visit but don't be hugging – and keep your distance,” Eboso said. “Kids can get sick but may not be symptomatic.”
Bottom line, it should be a decision made by both parents and grandparents, weighing the risks of the visit. “Recent studies show that people who are asymptomatic, when we swab them, they have the same level of virus as someone with symptoms,” Eboso said. They may have a strong immune system, but are still shedding the virus, and this is a concern.
“Kids can get sick and not be symptomatic,” she added. “Because this is a new virus and no one has immunity, everyone is vulnerable.”
When it comes to the upcoming holiday season, Eboso said families may want to start thinking now about what Thanksgiving and Christmas
celebrations will look like this year.
“Families will want to come together because it’s Thanksgiving, it’s Christmas - but we’ve had to do things differently for funerals, and weddings [already],” she said. “In order to have grandparents longer we will have to do things differently – have fewer people and zoom in everyone else.” She said we may also need to decide “who will be the designated checker to make sure everyone is healthy before we gather” in any manner.
It could be that families celebrate with the one person or people who have been seeing the elders regularly, and the family brings everyone in virtually through an app, or they have a drive-by visit and everyone drops off cards and gifts, she said.
“We will have to really think outside the box this year until we really know what this [virus] is about,” Eboso said. “We’re still at the beginning. We need to give ourselves at least a year until we really know what this is all about.”
The loneliness factor
Prime also reached out to Dr. Edna Rodriguez, LP-PsyD., a licensed clinical psychologist and director of Clinical Assessment and Ambulatory Clinical programs for Providence Behavioral Health Hospital to talk about another health issue of this pandemic – loneliness. She said that in the past year, a recent study indicated 45 percent of people surveyed reported they felt lonely and isolated.
“I think that we understand what loneliness does to people,” Rodriguez said. “We know it does impact physical health, not just mental health.” She said we are just beginning to understand how isolation and loneliness – two issues that have cropped up during the lockdowns and quarantines of COVID-19 – have impacted people over 60.
“Loneliness is identified as a public health problem among elderly because when it impacts the immune system, they are physically more vulnerable,” Rodriguez said. “Now thinking about it in the face of a pandemic, where they were protected by isolation, we know that it has a negative connotation physically.”
Noting that this is “an unprecedented year,” Rodriguez said the challenge for elders – and their families – is going to be “how to remain emotionally connected” and “How to maintain the essence of relationships and quality of relationships” while keeping elders safe from COVID-19.
One of the things people – and families – can do is ask what older family members need, and want, and then try to fulfill that need, she said. That act alone, she noted, is “very humanizing” for everyone involved.“How we remain connected even when we are distant – that means different things for different families,” she said.
“If something you are doing is working, ask yourself, ‘how can I do more of it?’” she said. “How can you help enhance it – like a visit from outside – or a drive through visit with big posters. If it is working do it more, or with different people.”
When it comes to the holidays, it “may be a party with just three people” this year to keep everyone safe, she suggested.
“We are going to isolate and be healthier,” Rodriguez said of the best way to protect those over 60 from COVID-19, “but we are also going to be lonely, so we need to address both.”
Editor’s Note: If you are experiencing loneliness, try reaching out to your local Council on Aging or Senior Center. Most have a weekly check-in service that will provide a periodic wellness call, and they may be able to help you connect to other members by phone or social media.
Mask Musts
Here is information on the proper removal, and care of, your reusable masks, courtesy of Johns Hopkins Medicine (www.hopkinsmedicine.org/ health/conditions-and-diseases/coronavirus/coronavirus-how-to-care-for-your-face-mask): When is it safe to take my mask off? Keep your mask on until you have finished your trip, errand or work shift. You can remove it outside, once you are away from others, or in your car on your way home. Don't forget to bring your mask inside to be cleaned. If you wait to take your mask off until you have returned home, it may be easier to put it directly into the laundry. What's the best way to take off a face mask?
How do I clean my face mask? You should clean your mask after every wearing. This reduces the risk of spreading the coronavirus or other germs.
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