Living la vida pandemica

Published October 19, 2021, 12:12 AM

by Raymundo W. Lo, MD, FPSP


The key to surviving in a new environment is adaptation. In a pandemic, the main solution is vaccination, notwithstanding the anguished cries of anti-vaxxers. This bears repeating: COVID vaccines are SAFE. Hundreds of millions of doses have been given with very minimal side effects, most of which are transient. No vaccine is perfect, as are all human endeavors, and the benefits to the whole population far outweigh the risks of the few side effects.

But as we inch toward herd immunity, what with the vaccine shortages, slow vaccine rollouts, and the lingering vaccine hesitancy caused by the Dengvaxia baggage, we need to know how to survive in the meantime.

So, what’s the game plan? Vaccinate the medical frontliners and most vulnerable. Check. Next, the economic frontline workers most in contact with the public. Done. Vaccinate their families. Check.

What’s left? Achieve mini-herd immunity in a defined population by immunizing a large majority of economic hubs to get the economy going again. Since the NCR generates over a third of the GDP, it is the ideal place to start forming a bubble of vaccinated persons who can go about their business activities without causing surges, thus protecting our fragile health system. It will also protect the unvaccinated by keeping them from areas where they are at greater risks than the vaccinated.

We shouldn’t forget basic public health protocols even among the vaccinated – face masks, distancing, and hand hygiene. Faceshields are overrated. They’re best used in certain clinical situations in the hospital, where droplet infection often occurs. Some studies even show that faceshields can direct airflow toward the face; therein lies the rub.

Early on, it wasn’t known that the SARS-Cov-2 virus can be airborne, but that’s been proven already. The rush in restaurants and other public venues was to install plastic or plexiglass barriers between persons. That may work with droplets that fall quickly to the ground due to gravity. Besides, droplet transmission is very much reduced by face masks.

But airborne viruses hang around in the air, which then circulates throughout the entire area, providing fertile ground for infection. Vertical barriers are thus ineffective, much like a face shield is totally ineffective in preventing transmission.

Study after study has shown that the virus is most dangerous in enclosed spaces. Airconditioning aggravates the situation by recirculating air that may contain myriads of virus particles from a super spreader. The solution is simple: Ventilate, ventilate, ventilate. Let’s look at the various scenarios in our work and business environments.

Mass transportation is safer with open windows even while the airconditioner on. I remember the days when there were no air-conditioned buses or trains. Fresh air is safest during these COVID times.

Business establishments can assure their fully vaccinated customers more safety with fully vaccinated staff and continuing surveillance testing among its workers with the use of pooled RT-PCR testing, which reduces costs markedly. For restaurants, salons, and gyms, the key to a safer environment for fully vaccinated customers is to improve ventilation, like opening doors and windows. In enclosed areas, operate HEPA-filter and UV-equipped air purifiers, the higher their airflow capability the better.

Malls and commercial buildings, condominiums, theaters, cinemas, supermarkets, and communal living facilities need to re-engineer their air handling systems to ensure a safer environment even after this pandemic ends. Even hospitals, churches, and jails will have to contend with the ventilation issue, for the next pandemic may just be around the corner.

Public restrooms need to be looked at. SARS-CoV-2 like the original SARS virus affects the gastrointestinal tract with diarrhea as a prominent symptom. As demonstrated in the SARS pandemic 20 years or so earlier, it can easily spread from the flushing of the toilet bowl which produces a fecal aerosol. Inhaling that aerosol aside from the unpleasant odor may cause COVID-19 infection since the virus concentration in the “toilet plume” can easily be in thousands of copies (it only takes 1,000 virus particles to cause infection). Re-engineering toilet seat covers to have exhaust capabilities should capture most if not all of the fecal aerosol. After all, the Japanese have taken toilets to its zenith with provisions for automated washers fore and aft, and even driers that do the job without you touching anything other than a switch. At present, the most we can do is to keep the toilet seat down before flushing after “No. 2.” All toilet stalls should have prominent signs “Put down toilet seat cover before flushing.” If it can be avoided, refrain from using public toilets for now.

While we’re at it, let’s look at our homes’ setup as well. The houses of the Spanish and American eras have got it right with the expansive windows and balconies admitting in fresh breezes. Modern homes may also have open living-area design that adapts well to pandemic times. But we do have to consider how to deal with pesky mosquitoes and the illnesses they may bring, like dengue or malaria.

Living in a tropical environment like the Philippines presents cooling problems. Because enclosed air-conditioned spaces are conducive to COVID-19 and other respiratory viruses, We will have to  compromise. Living without air-conditioner may seem unacceptable to many, but our ancestors made do without it. Airconditioning contributes to global warming directly because of the amount of heat it generates and the energy it consumes. We may have to revert to the old ways to avoid a multiplicity of issues like pandemics and climate change.

We are indeed headed for challenging times. It’s a whole new ballgame. Let’s play it well.