Life in the Time of Coronavirus - Brought to you by Dr. MZ

What I Would and Wouldn’t Do

As this pandemic grinds on, I am getting calls from friends and acquaintances the gist of which really boil down to what would I do and not do. It’s usually phrased somewhat differently, more like, “don’t you think it’s ok to do X, or don’t you think the Swedes have it right, or if we are all negative, can’t we hang out together, or it’s really alright to play bridge with my friends, isn’t it?

I suspect many who call don’t get the answer from me they are hoping for. I hear loud and clear what they want me to say but I can’t, in good conscience, recommend they do something that I wouldn’t do myself so here is my list of what I, as an infectious disease physician, in the middle (I hope it’s the middle and not the beginning) of this pandemic, would or wouldn’t do. All of this could change over time, based on new data and knowledge. Science isn’t static, nor is it cut and dried, so changes are inevitable. Unfortunately, some changes may not be in the direction we might like; therefore some degree of caution going forward is always a good strategy.

 On my “Yes I Would” list:

1.  I would visit the LA Arboretum assuming that social distancing was maintained and everyone was wearing a mask. There are miles and miles of open space and wide paths; the outdoors is a much more forgiving environment than a confined space like a living room, game room, restaurant, or bar.
2. I would and do regularly go outside to take a walk. I wear a mask, stay away from others other than my better half and enjoy the fauna, flora, sunshine, and the conversation. Do it—it’s good for your mental health.
3. I would go to a doctor’s appointment to seek necessary medical care. Most medical spaces are exceptionally cognizant of the infectious risks and take great pains to protect patients and staff. I would avoid the Emergency Room if possible but if the problem is truly emergent, by all means, seek care at the ER.
4. I would go to a pharmacy to obtain necessary medications but I would first try to get the medications delivered if that is an option. I would go at a time when there were fewer people, would wear a mask, and stay away from others as much as possible.
5. I would seek emergency dental care if I had an indication for it. Those indications would include an abscessed tooth, a cracked tooth, or any indication of an odontogenic infection. The usual signs for these problems would include toothache, pain in the neck, throat or jaw, any obvious redness or swelling, and fever. This would be a situation where the immediate threat overrides the risk of COVID-19 acquisition.

 On my “No I Wouldn’t” List:

1. I would not fly in an airplane at this time if I could avoid it. Social distancing is not reliably possible, transmission of infectious disease may occur, and being up close and personal with other people is regrettably part of the experience. Dr. Joseph Fair, the well-known viral immunologist and frequent contributor to NBC News, found this out the hard way.
2. I would not, no way, no how, go on a cruise. As I have said before, cruise ships are floating infectious disease incubators where, on the largest of them, you are cheek by jowl with nearly 5,000 of your closest friends and you have no idea what infectious agents they are harboring. We are all familiar by now with the unfortunate outcomes of a number of cruises. You won’t find me on one of them any time in the foreseeable future.
3. I would not go and get my hair or nails done. Easy for me to say, since I don’t color my hair, can perfectly well grow it out for a while (the ponytail project), and have never been a manicure or pedicure person. Long and artificial nails are forbidden in most hospitals for infection control reasons and the medical literature is replete with case reports of people who have acquired difficult-to-treat finger and toe infections from nail salons. As a result, that is just not something I do. A nail clipper and a wastebasket are all I need. It is not possible to cut, color, or style someone’s hair or to minister to their finger or toenails without coming into droplet range. I have not seen any nail or beauty salon that was willing to go to full personal protective equipment for both stylists and clients to get these services accomplished. So better to forego these services for the nonce.
4. If possible, I would avoid grocery stores. We all need to eat but there are delivery services that will deposit your groceries at your doorstep for a modest fee. I tip these people generously and am incredibly grateful that they are willing to do this work. It is difficult to stay 6 feet away from people in grocery aisles and equally difficult to check out the groceries with the checkout cashier without getting into droplet range. If you do go to the grocery store, please be kind and respectful (mask, 6 feet, keep your mouth closed, don’t cough or sneeze) to the people that work there. They are at considerable risk spending eight hours a day in that environment.
5. I would not party or play bridge with friends, period. I know that is harsh but people tend to forget the necessary requirements when they get into the having-fun mode, especially when alcohol is served. The large COVID-19 outbreak in Pasadena was traced to a birthday party where masks and social distancing were not used and a person with mild symptoms (coughing) was present. At least five cases resulted from this party, luckily with no deaths so far.
6. I will not be going back to our gym any time soon, much as I liked the gym. It’s exceedingly difficult to maintain social distancing in a gym, and basic hygiene is challenging. Equipment is close together, people are touching many surfaces, sweat is flying everywhere, and people are breathing hard, expelling viral particles at high velocity if they are infected. Staying fit is exceptionally important so I suggest working out a home routine that doesn’t expose you to others. I have a small collection of weights (3, 5, and 10 pounds), a 20-pound kettlebell, a yoga mat, and a vintage collection of Jane Fonda workout tapes (very 1980s when Jane was in her prime). This mini-gym keeps me fit without exposure to others and will suffice for the present.
7. I would not dine at a restaurant or hang out at a bar at this time. These are enclosed spaces where small virus particles, emitted from the mouths of people who are talking loudly, can hang in the air for minutes to hours. The now famous report of an index patient who, while asymptomatic, ate lunch at a restaurant in China, and infected 9 other people who were also eating gives me significant pause. Eating is an activity usually accompanied by a substantial amount of talking and also takes place over an extended time frame. Both of those characteristics increase the risk of infection.

 There is a gray area I call my “Maybe” list:

1. I am living for the day that the Huntington Botanical Gardens opens. I love this place and long for the day when we can go back there. They say they are working on a plan to reopen. When that happens, I will be assessing carefully whether or not they have been successful in opening with minimal risk. There are lots of wide-open spaces and many lovely walks but often there are substantial crowds. If their plan seems reasonable, you will find me there but please don’t get too close (and please don’t take it personally).
2. Another enticing outdoor venue is Descanso Gardens which is open with advance tickets for non-members and open to all members. Masks and social distancing are required. All indoor spaces are closed but the gardens themselves are a wonderful place to enjoy the beauties of nature as long as you can keep your distance from others. My better half and I will be checking this out soon. As I said to him, “If it looks like social distancing is not being observed, we can always leave.”

When all is said and done, everyone will make his or her own decisions about what risks are acceptable. I have simply let you know what I think. I only hope that you will make choices based on critical thinking and scientific evidence as we know it today. Stay well and safe, and take care. Our lives will never be the same but we will overcome this problem.

 ___________________________________________________________________________________

Dr. Margan Zajdowicz is the Co-Chair of the League of Women Voters-Pasadena Area Healthcare Committee and a retired infectious disease physician who spent many years in clinical practice and emergency preparedness and pandemic planning for the US Navy. She holds a Doctor of Medicine degree from the University of Maryland School Of Medicine and a Master of Public Health degree from Old Dominion University/Eastern Virginia School of Medicine.