Progress in the Fight Against COVID-19 but Stay Strong

Posted by Nurse Linda in Life After Paralysis on September 09, 2020 # COVID-19

As I write this blog, the first official emergency treatment for COVID-19 was announced. Plasma from individuals who have survived COVID-19 contains naturally (in the body) made antibodies. When given to people who have developed COVID-19, within three days of diagnosis, recovery is improved. The FDA has given emergency approval, which means that the antibody-containing plasma can only be given in a situation, such as to a person with a severe case (usually hospitalized) and perhaps with risk factors.

This greatly impacts the SCI community as individuals with SCI would be eligible for the treatment if your case of COVID-19 is severe (requiring hospitalization) and if the plasma is available in your area. Now that the natural antibody is isolated, researchers have been working on the development of a laboratory-created antibody. That will take some time to develop, like any other medication.man in wheelchair wearing mask

Several vaccines have been developed to inoculate individuals against COVID-19. Many more are being designed and developed. Some of the vaccines that are already created are in phase III testing. This point confuses people. A developed vaccine is not an approved vaccine.

Vaccines are developed but not ready for use until they pass human trial testing. Testing occurs basically in three phases. Phase one is straight from the laboratory trials. This testing is performed in small numbers of people. The outcome is to assess safety only, not necessarily the efficacy of treatment. Phase II is more extensive trials in larger numbers of people for dosing amounts. Phase III studies are in huge numbers of people to assess the efficacy of the drug before going to market. Subphases can be created as needed.

Viruses, once out in the world, are always present. They do not just disappear. We don’t hear about outbreaks of viruses such as polio, smallpox, or even measles because of vaccinations. If enough people get vaccinated, the virus has a difficult time spreading, although it is still there. The recent rise in outbreaks of measles is a perfect example. People stopped getting vaccinated. Measles flourished.

Even though progress is happening at a quick pace for medical research, the need to be vigilant is even more important. Now is not the time to become lax. Important steps to keep you healthy include getting your annual flu vaccination and every ten-year pneumonia vaccination. Having either of these viruses at the same time as COVID-19 will compound your illness and outcome.

Following the CDC guidelines of social distancing, washing your hands, and wearing a mask is critical for everyone. It is important to keep up these activities to prevent the spread of COVID-19.

Social distancing should be kept at 6 feet, further up to 12 feet if a person is singing or exercising. The extra force behind a burst of deep breathing, sneezing, coughing, speaking loudly, singing or yelling propels COVID-19 viruses further from a person who is carrying it if they have symptoms or not. Viruses can travel easily by air currents. Staying out of crowds and avoiding people who take risks of exposure is another safety measure.

Washing your hands should be done for a minimum of twenty seconds with warm, soapy water. Be sure to wash all sides of your hands, the palm side, top side, each of the two sides of the fingers, and thumbs. Don’t forget to pay extra attention to the nails—Wash, including your wrists. Twenty seconds is the amount of time it takes to sing happy birthday twice or the alphabet song twice. Use a clean, dry towel. Bacteria can stay on a towel for hours, even if it is dry.

Hand sanitizer can be substituted if soap and water washing is not available. The alcohol content of the hand sanitizer should be at a minimum of 60%; 70% is even better. These products have been challenging to locate but are back on the market now. If the price of hand sanitizer is out of your budget, you can use a wet, soapy paper towel and a wet paper towel to rinse. These should be kept separately in self-sealing bags.

The use of a wheelchair puts you at a viral disadvantage in position to others. You are lower, where virus droplets eventually fall. The mouth, nose, and eyes are all equal opportunity entries for bacteria and viruses. Wash you face when possible to avoid contamination, especially around the eyes. Be careful not to get soap in your eyes. You may use a wet, warm cloth to the eye area.

You might use the rims or wheels to propel yourself in a chair. Be cautious to avoid contamination of touching the rims or wheels with your hands. Wash your hands or use hand sanitizer after touching areas of your chair that touch the ground or where other people have touched. Clean the wheels or rims before entering your home.

Masks may be a key part of the future for everyone. It may be necessary everywhere or perhaps in cities or areas of pollution and other toxins in the air. In some countries, wearing a mask outside of the home is already the norm. This is for protection against respiratory illnesses as well as due to pollution. Some scientists think this might be the case especially depending on the length of time not only to develop and test a COVID-19 vaccine but also the time to have enough individuals inoculated to create safety for everyone. Everyone hopes this is not the case, but just as this novel virus arose, others have the potential to do the same in the future.

Researchers at Duke University conducted a test to assess different types of masks for effectiveness. You can read the details of the study here: https://advances.sciencemag.org/

The purpose of the mask is to prevent a person who has the virus from spreading it. The Duke study, therefore, tested the ability of different, commonly used masks to contain or at least slow the distance of travel of exhaled respiratory droplets. It is not a study of how a mask protects you from inhaling respiratory droplets.

The N95 mask is the best protection against spreading respiratory droplets and, therefore, COVID-19. These are reserved for healthcare professionals who are working directly with individuals who are known to have the COVID-19 virus. If you do happen to have an N95 mask, they must fit tightly to the face. You may have seen photos of healthcare professionals who wear these masks. They have cuts and scars from the tight seal that makes them work.

The most effective mask, according to the Duke study, is the surgical mask that you commonly see. These masks must fit snuggly across the bridge of the nose. There is a bendable metal piece at the top of the mask to adjust it to your face. The sides need to fit snuggly as well. The bottom of the mask needs to fit below your chin, wrapped around it. Keeping all sides sealed around your face helps prevent droplets from entering the mask’s protected area. The vents should be going down. You don’t want the vents up as that will serve as a reservoir to collect the virus.

You will notice, the top-performing masks are made of pressed fibers. They still allow effective breathing, so they are not airtight, but the areas for permeation are small and few. They also can have a distinct odor. That is due to the manufacturing process.

Next are cotton masks with woven fibers. These still offer greater protection, but the weave creates a bit of a larger hole through which viruses could pass. I did not see any cotton masks tested with an added filter. I think mostly because many people don’t use added filters. It is cumbersome. But if you fold a coffee filter that is contained within the inner area of the mask, you may benefit from pressed paper as well as cotton fiber. This method was not tested.

The least effective masks are the ‘gaiter,’ the one piece ‘turtleneck’ style, or a bandana. The researchers noted that both the larger space between fibers and the weave of the masks broke up a respiratory droplet into many smaller ones creating more opportunities for the virus to spread. There has been some pushback about the gaiter with statements that, if doubled, would work better. This idea was not tested. I assume because it is like the filter, no one does it. The testing was done as the masks were presented, not with adaptations.

That concludes my summary of the Duke study, but now let’s talk about mask use in general. In healthcare, masks are fitted, so there is a bit of space between the nose, mouth, and mask. This is called ‘dead space.’ It is an area where the mask does not touch your face, so there is space to avoid rebreathing some of the carbon dioxides your body gives off. Space prevents the mask from becoming too moist from your exhalations. It also helps reduce some of the odor of the manufactured masks.

If you can see your nose and mouth impression on the outside of your mask, it is too small or too tight. That ‘dead space’ is not there. You are then inhaling air more forcefully through your mask. Ear loops are standard, but people’s faces or not. You may need to enlarge your ear loops to accommodate your face or tighten them, so the mask is not falling off when you speak.

A large amount of facial hair, especially as a beard, can affect the fit of your mask. Hair is cushiony. It can create a gap between the mask and your face, which lessens the snug fit. You may need to obtain a larger face mask to accommodate facial hair.

Wearing a mask that is too big for your face or one that is too tight affects the efficiency of the mask. If you wear your mask below your nose, it is the same as not wearing one at all. Proper fit of the mask is key to your safety.

Remove a mask at the ear loops or sides, fold it, so the outsides are together. Either dispose of the mask in a trash receptacle, a self-closing plastic bag or put reusable masks directly into the washing machine. Never hang it off one ear or under your chin. That puts them outside of the mask close to your mouth and nose, defeating the whole purpose of the mask.

The same is true for glove removal if you wear them. Most people will hold their hands about chest height to remove their gloves. This puts the action closer to the face. Gloves should be removed at or lower than the waist, gently pulling them from the inside wrist area, turning them inside out as you remove then, which contains any particles on the outside of the gloves.

Some individuals should not wear a mask. Remember, it is the people around you that should wear a mask so as not to pass the virus to you. Those that have respiratory difficulty have difficulty in using their hands effectively or are under the age of 2 years should not wear a mask. This is for the safety and protection of those people who, by wearing a mask, would have an increased risk of respiratory insufficiency or rebreathing too much carbon dioxide.

I hope these reminders come at a time when perhaps we are all might be becoming a little complacent with COVID-19. It is still there and still very much a threat. Hopefully, with social distancing, wearing masks, and handwashing, we are approaching the downhill side of the pandemic. Nurse Linda

Pediatric Consideration: Children are at a higher risk of contracting COVID-19 than was originally thought. It is critical to help children social distance, wash their hands, and wear a mask as appropriate. Those under the age of 2 years should not wear a mask to avoid respiratory complications.

To help children wear a mask, you should wear one yourself. You and your child can practice mask-wearing in the house to get used to it before going out. Some masks can be decorated by the child which might improve their use.

Be sure to get a mask that is the appropriate size and fit for your child. Masks should fit snuggly at the top, with nose clips formed to their face, at the sides, and under the chin. Teach them to remove the mask by releasing it at the sides and throwing it away or into the washing machine without much handling of it. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.