COVID-19 Update. How this extrovert deals with Social Distancing

We are social beings.  We all need connection. Some of us more than others. This Social Distancing thing is urgently important so we can minimize the anticipated surge in cases of COVID-19 in our communities in the next few weeks.  Unfortunately, the need to socially distance ourselves is not going to go away soon. 

Social distancing is not the same as quarantine or self isolation.  Those measures apply to people who are returning to Canada from international destinations, people who are  symptomatic and awaiting COVID-19 test results, those who have had a COVID-19 diagnosis confirmed and people who have had direct contact with COVID-19 positive cases.  These folks should not mingle at all with others for 14 days or until they are deemed cured.

Of course, if you are sick you should stay home, even if it is not COVID but is another Acute Respiratory Infection. This will minimize spread but also not lead to so many others getting a cold and then worrying it is COVID-19

All the rest of us need to practice Social Distancing. This means we minimize as much as possible close contact with others as well as follow all the other the routine advice for hand washing, elbow-sneezing, avoiding hugging or handshaking and not collecting in clusters of people.

I will share with you some practical strategies that I am adopting so I can comply with the need for social distancing over the next several weeks.

First of all, I will, at this point, go for walks outside.   I need to get outdoors and have some exercise. We are lucky that spring is around the corner so we can actually get some fresh air.  BUT that comes with the caveat that we must keep our distance from others.  The advised two metres is best.  I have a couple of friends who are also following the rules with whom I will meet periodically so we can smile at each other, have a bit of a laugh together and share some conversation.   But we will work to maintain the required physical distance as best we can. 

When I am out I don’t touch anything that I don’t need to touch.  I don’t sit on a public bench, for example.  I carry a small microfibre cloth in my pocket so if I have to open doors or carry a basket in the grocery store, I can use the cloth to make the contact.  When I get home I throw it in the wash. (I have a pack of 5 that I got at Dollarama).   If I can open a door using my elbow or hip or a push button or Key fob I do that rather than touch the handle.  I am also putting my clothes in the laundry basket if I have been out somewhere during the day so I can start with fresh clean clothes every morning. Although the virus has been shown to live on plastic and metal for up to 72 hours, it can also remain viable on clothing or cardboard for a day or so. Better safe than sorry.

When I pass someone on the street I am attempting to say Hello or Good Morning even if they are strangers.  It is always pleasant to be greeted and a brief verbal hello might just make someone’s day.

I will try to go to stock up on groceries at off-peak hours.  I live only 10 minutes from my usual grocery outlet so I will walk there early in the morning or go in the last hour before closing to avoid the busiest times.  We are being assured that generally the food supply will not be affected.  The empty shelves that you may have experienced last week are the result of exceptional panicked buying and hoarding. It will take a while for those folks to use all that toilet paper they have in their garage so that will leave some for the rest of us when we need to buy it.  Same with meat and pasta and rice and flour and…    There will be food.  Don’t panic.  And while I am at it, I will extend our thanks to the people who are working to keep us supplied  – clerks, shelf stockers, truck drivers, all of you.  We need you and appreciate this service.

I will still see my family who don’t live with me from time to time.  We will avoid hugging or touching and we will be careful to wash our hands or anything that we might have touched.  We will keep our distance as much as practical.  If any of us are sick at all we will self-isolate and not expose the others. 

For example, I spent a couple of hours this morning with my 8-year-old granddaughter. Kids are scared. They know what is going on and they also know that their family and friends are scared too.  We were able to have a great visit, taking extra care to avoid close contact, washing our hands after handling anything and playing interactive games that we streamed to the TV.   We talked about COVID, how to look after ourselves and our worries. When she went home, we both felt infinitely better.  She was happy and so was I.

I have been making a point of connecting with others both locally and internationally by using FaceTime or Messenger or Skype for audio/video chats.  We need to stay connected.  Text messaging is fine when we are busy and have the opportunity to interact face to face easily but a smile or the sound of someone’s voice does a lot to sooth that need for connection.

The economy is also taking a hit right now and where that leads is uncertain for all of us.  We have enough to worry about now without being fussed about things we can not control.  None of us know what the next month or six months or year will bring.  It is futile to try to plan that far ahead right now so I am refusing to spend my energy trying to plan that far in advance or think about what situation I or, for that matter, the world, might be in by then.  It is best to set priorities about what we need to do now.  Currently my priority is to be responsible to my community, my friends and family and to myself so as to dodge as much as possible the immediate effects of COVID-19. Catastrophizing (is that a word?) is counter-productive and I will try to avoid going that route in my head.

There have been an absolutely phenomenal number of individuals, entertainers and groups that have reached out online to help us stay upbeat and mentally busy in our distancing mode. I have looked for those and will definitely join in to pass the added alone time.  I will also break out a jig-saw puzzle soon.

This will pass.  Unfortunately, the need to socially distance ourselves and the drastic disruption to our normal routine is going to last for weeks or even months. It will definitely get tiresome and I am afraid that it will be too easy to put these thoughts aside and let our guard down when the sun is shining and the weather is encouraging.  In order for it to work, however, we will need to stay the course. Remember that it will take some time before we reap the benefits of this challenging change in our social interactions.  

Hang in. Help others. Support each other. 

John A Geddes MSc MD CCFP

Kingston, Canada

March 20, 2020

My favourite coffee haunt looks more like a bowling alley these days. Up to be a pin-boy instead of a barista, Nick?

Addendum: Six hours after I loaded this post, Balzac’s closed (along with other coffee shops like Starbucks.

My Covid-19 update. ‘Social Distancing’ is imperative at this point.

Consider this.   Three weeks ago, on February 22, 2020, there were 11 known cases of COVID-19 in Italy.  Since then, there have been over 15,000 diagnosed cases and 1000 deaths in Italy alone that have resulted from this viral infection. Italy now has a COVID-19 case rate of 250 per million population. The country has an excellent health care system but it has been overwhelmed. One might expect that the death rate is going to go up more because many seriously ill people will not now be able to get the intensive care they need. There are just not enough resources to cope with the rapid spread of the virus.  The country is shut down and suffering badly both medically and economically.  

Today, in Canada, with a population half that of Italy we have 122 known cases, a rate of 3.2 per million. This changes by the hour. Where will that be three weeks from today?  We need to do whatever we can, and do it now, in order to mitigate the effects of this infection in our communities. 

In Canada, we have a couple of advantages. Italy has a slightly older proportion of people over 65, those who are at highest risk for serious consequences of COVID-19 (22%) compared to Canada (17%).  Their population of 60 million, nearly twice that of Canada’s, lives in a much smaller geographic area and therefore are living closer together in general.  Most importantly, North Americans have had some advance warning of what COVID-19 can do, how it is spread, and what measures can best be taken to control it.  Hopefully we can take what we have been able to learn from this head start in China, other places in the Far East and Europe and quickly – very quickly – change our behaviour in order to lessen the eventual impact this virus will have on our communities in Canada.

We have heard the “wash your hands”, “cover your nose when you sneeze” and “stay home when you are ill” messages and I suspect most of us are complying with those suggestions.

Another significant factor that has reduced the rate of spread of this disease and has been proven to be effective, both in the past and in some countries that have instituted it seriously for COVID-19 is Social Distancing.  The reason this works is because COVID-19 is spread by droplets, not by fine little viruses floating around in the air.  When an infected person sneezes or coughs, the droplet spray from their mouth or nose can travel a few feet but not more. If we are in the way, we are vulnerable.  It may also land around them and live for some time (there are varying estimates how long and I am not going to spread inaccurate information to you).  If  you pick up the virus with your hands touching the sprayed-upon item you might then transfer the virus to your face and nose and become infected.  Hence the hand washing advice.

So, increasing our comfortable social distance and minimizing close contact of numbers of people in close approximation to us is imperative.  This is why in the last 24 hours we have learned that all schools in Ontario will be closed for two of weeks after next week’s March break,  that the NBA and NHL have suspended the rest of its season (Netflix night in Canada replacing Hockey Night?), and that the Kingston Canadian Film Festival made the difficult decision to cancel the remainder of the festival after only one day.  We all need to be supportive of this strategy, both for our own benefit and that of our community.

In the next while we will all be significantly inconvenienced by school closures, lack of availability of some items at the stores from people hoarding, cancellation of entertainment events and sports competitions and we will all have our anxiety piqued by the general sense of panic around us.  Younger people may realize that their risk of death from this is much less than older people but it is not zero. They must also adhere to our community restrictions for the benefit of their neighbours and friends and parents and to avoid over-taxing our health care system which is already running at near capacity.  If we can “flatten the curve” of this illness we can deal with it  If it comes in a surge we are going to be overwhelmed.

 I am 72 and hate to be called “elderly” but, in this case definition, I qualify.   People over 70 have a 10% or more chance of becoming seriously ill with this virus or dying from it.  Seniors with health problems like heart or lung diseases are at even greater risk. They should pay even more heed to the social distancing message.

So, what is my advice?

If you are sick, stay home.   Don’t go to the Emergency Department.  You might call your Family Doctor’s office for advice and to know if you need to be seen.  There is no treatment for this illness at present so resting, taking medication to lower fever and drinking fluids is all that you can do.  If you are becoming increasingly ill, you need to talk to your family doctor’s office about where to present for assessment and treatment.  There will be designated regional assessment centres and you should not show up at the wrong place where you might contaminate other vulnerable people.

Wash your hands whenever you come in from being out somewhere or use hand sanitizer if you can find it available.

Cover your nose and mouth when you cough or sneeze

Be ready to be in isolation for 14 days if you become infected.  Develop a circle of friends or relatives who can support each other by bringing groceries and leave them on your doorstep if you are in isolation.  It is probably reasonable to have some extra pasta or soup or cereal in your larder but hoarding should not be necessary and even makes things worse for others.  In Italy, where most of the country is currently shut down (including tourist sites, restaurants, cafes, churches) the grocery stores and pharmacies have remained open.

When you do go out, think about keeping a reasonable distance (at least a metre) from others.  Don’t shake hands or hug when you meet a friend or colleague.  The old elbow bump would be more appropriate (if you have not just sneezed on our sleeve, of course.)

If you are over 70, you might want to limit your exposure by staying away from group events, exercise classes, theatres, festivals and even church if you can not keep a metre between you and your neighbour.  The more you are exposed in a group, the more chance you have of being infected.  Even people who are in the incubation phase with no symptoms can shed virus and be infectious for a couple of days before they realize they are sick.

Help each other.  We are all in this together. We need to be cooperative, to listen to our Public Health Leaders and to follow instruction.  This is a time to think about our community, manage our health care resources and support our family and neighbours.  The measures i have talked about have been proven effective.  But only if we follow them.  

Although i am a pretty fearless traveller, I have decided that, until this has all stabilized in some way, I will stay in Canada where I can access my health care, not have to worry about international travel restrictions or being quarantined in some other country.  There will, no doubt, be good travel deals to be had while the tourist industry is struggling but I prefer the safety and security of home for the time being.

Our municipal,  provincial and federal governments, led by public health experts, are evaluating the best course to be taken to reduce the stress of this outbreak on our communities in terms of health and economics.  There is no right answer.  This is unproven ground and you can see that the situation changes daily.  I think we need to be patient and trust that our community leaders are assessing and making decisions that are in our best interest and I am glad that they will guide us through this turbulent time.

I was astounded when my previous blog article was shared and read by over 40,000 people in three days. I thought I was writing it for 50 of my Facebook friends who were asking me questions. https://johnageddes.com/2020/03/08/coronavirus-in-kingston-canada-my-take-on-what-we-might-expect/

I soon realized that there is a thirst out there for some common sense advice from a regular Family Doctor and so I hope that this is helpful as an update for a crisis that seems to change by the hour.  I have had lots of questions in the comment section of my previous article and am willing to answer any that I feel qualified to answer if you post it in the comments.  I am not claiming to be an “expert” but I try to be a rational, down-to-earth family physician who has tried to keep up on the medical writings about this serious and unique health crisis. I hope these suggestions are helpful to you in wading through this quagmire of information about COVID-19.

John A Geddes  MSc MD CCFP

Kingston, Canada

March 13, 2020

Check out this article about how social distancing (or lack of it) was shown to have an effect on spread of influenza in the 1918 epidemic in the US.