You guys liked my last story about by pain in the ass but pretty good guy dad, so here’s another one. You might want to skip this if discussion of medical procedures bothers you.
As I mentioned in the last post, the old man was a country doctor. He did some surgery, and delivered many (~3,000) babies. When he was in his prime, he was deft with his hands, and fast. Now that he’s in his late 80s, he has degenerative arthritis everywhere, and his hands aren’t what they used to be. For example, when I was home a year ago, I had some stitches that had to be removed, and I basically ended up doing it with his direction because he couldn’t do it. This is a minor procedure he would have done in a minute, tops, when he was in his prime. For a lot of us, the Grim Reaper doesn’t take us with one fell swoop of his scythe — he hacks us to bits piece by piece.
Anyway, as some of you know, my mom has lung cancer. At one point in the course of her illness, she had a chest tube placed which could be drained by a device called a PleurX. This is essentially an expensive vacuum bottle that you attach to her chest tube regularly to drain excess fluid in her chest. It’s an advance in care because it keeps the patient out of the hospital. The downside is that the patient’s family, or a home health care worker, needs to manage the drainage. Not a problem for my family! You mean there’s a procedure we can do on our kitchen table, record the results, and discuss whether her output is up or down, and whether she needs to have that tube removed, literally for hours? Where can we get some of that?
Anyway, a PleurX comes in a sterile package, which contains the vacuum bottle, a sterile drape, gloves, alcohol swabs, and dressings. The idea is that you create a sterile field with the drape, and then the person draining the PleurX has to stay sterile while they perform the drainage. It’s a 25-step process and you have to be very careful to avoid infection.
I’ll skip more details, but what I learned performing this procedure is that keeping a sterile field is very fucking hard, especially if a guy who has done over 100,000 sterile procedures (no exaggeration) is watching over your shoulder, frustrated because he clearly didn’t raise his kids right, since they don’t know the first fucking thing about sterile technique.
There are so many ways to contaminate a sterile field, and I might have done a few of them. Once you open up the pack and put on gloves, you can only touch things that are sterile. Very hard, my friends. I had my assistant (usually the old man) removing Mom’s dressing, but the sterile operator has to put it on. It was a ~8×8 inch clear dressing, and that fucking thing stuck to itself almost every time. Added to the difficulty of the procedure was that if I accidentally touched the dining room table, or touched something else that wasn’t sterile, I’d hear about it from Dr. Frustrated as Fuck (gently, he’s not a yeller, he’s mastered the art of quiet intimidation). According to him, even using an alcohol swab to clean my glove wasn’t good enough if I touched something, but I should still do it because it’s better than nothing.
Well, enough of that story. The key point is that Mom didn’t get an infection and the chest tube is out, so whatever our violations of sterile technique were, they weren’t deadly. I’ll never capture the true essence of my dad — part prick and part saint that he is — but I did learn a few lessons that I take with me to the grocery store every time I go. These aren’t official advice, just my thoughts:
- Gloves are not a cure-all. If you touch a contaminated surface, or someone sneezes and it gets on your glove, and you touch your face, what’s the point of a glove? Since they’re in short supply anyway, better to have good handwashing technique.
- Home is my virus-free field, and transitioning to it is hard. After I check out at the grocery store, for example, I hand san, dump the cart, gather my bags and load them in the car. Then I wipe down my phone with a Clorox wipe, and hand san again, since I contaminated my hands touching the phone. I use the same wipe to wipe down my keys (touched by my contaminated hands). I often hand san twice in the car because I screw up and re-contaminate with something from the store. I also wipe down my steering wheel and shift handle just because I probably touched them out of habit with contaminated hands.
- The experts I’ve seen don’t think that getting the virus from groceries is very likely. And it’s basically impossible to clean every item you buy at the grocery store (or at least a hell of a lot of effort). So what I do is unload everything, and wipe down the packaging of anything I’m going to use right away with a Clorox wipe (or wash with water if it is produce because Clorox residue is going to make you sick). After I’m done putting everything away, I wipe down where it was sitting and then wash my hands carefully. I also wipe the knobs I touched. My assumption is that time will kill whatever virus is on the goods I bought.
- This may seem like a minor thing but I try to use touch free payment (Google Pay in my case, Apple Pay for the iPhone users) so I don’t touch my wallet or shove a card into a slot.
- Masks add a whole new level of complexity to this. Frankly, I think the role of the mask is to let people feel like they’re doing something. Dr. Howard Zucker, head of the New York State Department of Health, would not recommend masks when asked by Cuomo on Friday or Saturday (I can’t recall which day). The hope with the mask is asymptomatic carriers won’t spread the virus if they wear one. The real danger of a mask is a feeling that this questionable piece of protection will make you less vigilant. I have a couple of dust masks that I will use when I go to the store next time. When I take it off, I’ll put it in a paper bag to sit for a few days for any virus to die, and then I’ll sanitize my hands, because the mask could be contaminated.
Well, that’s what I do, for what it’s worth. Mom and Dad locked down a couple of weeks ago, because either of them will die if they get this. Which brings me to my last observation: if you have a terminally ill elderly person that you’re caring for, make sure you have what you need to ease their pain at the end. We have a supply of liquid morphine in the house for Mom.
Geoduck
One possibility to consider is just buying your own fold-up shopping cart, taking that into the store and then loading it into your car (and just leaving it in the car..) Yes, it goes into the contaminated store with you and back home again, but at least it isn’t being fondled and licked by a thousand other plague rats during the day.
cmorenc
Somewhat OT, but late UCLA Coach John Wooden was supposedly a grandmaster of quiet intimidation, capable of getting steely-firm through to his players with such a seemingly innocuous remark as “My goodness!“
TheOtherHank
My grocery store technique is to have an ungloved hand for me and my stuff (phone, keys, etc) and a gloved hand for the store. I have a bag in the ungloved hand and I do my shopping. My local grocery store supports Apple Pay so I can pay with my ungloved hand holding the phone.
It has, though, made me violate my principles a bit. The store has a self checkout area that I don’t like; I’ve been laid off enough times that I do not approve of doing someone’s work for free so the company can let that person go. But in the current circumstances, I do use the self checkout just to reduce the number of people touching my stuff by one (or two if there’s a bagger).
beth
My husband died at home from lung cancer. That last week was full of friends and family saying goodbye either in person, phone or email – made bearable by lots of liquid morphine. The goodbyes brought comfort to them and to my husband. I’m terribly saddened thinking about what is happening to people having to live through that at this time. I will keep your family in my prayers for a soft landing for all.
Betty Cracker
Sorry your family is going through all this pandemic bullshit at an already difficult time.
Dorothy A. Winsor
Sorry for the repeat from below.
My kindergarten teacher DIL is driving from house to house today, leaving each of her students material for next week. No contact, of course, but I’ll bet they’re excited to see her even out the window.
OTOH, My son’s employer is still requiring him to come into work where confirmed cases have been found. They’re a defense contractor and are apparently classified as essential. He can’t work from home because his work is classified. I’m angry and worried.
geg6
All good thoughts to your parents, mm.
I’ve been wearing gloves into stores for a couple weeks. We had some left from my John’s shoulder and knee replacements, so we dug those out and have been using them. I toss them in the garbage can outside the sore when I leave. Our local Giant Eagle only lets you grab a cart after the employee at the cart station disinfects it right in front of you. I do use my card to pay since I don’t trust Apple Pay, etc. But I wipe it and my car handle, steering wheel and gear shift as soon as I get in. I pretty much do what you do with my stuff when I get home. Today, I am making some bandana masks per instructions in the internet but I will be sewing the ends together, not just tucking them, as I don’t trust it to hold together. Since I’ve had super short hair for at least 35 years, I had no hair elastics and couldn’t find any, so my sister set some out on her deck for me to pick up. A friend who was using a Survivor (my guilty tv pleasure) buff reminded me that I had one my office colleagues got me many years ago and I’m going to try to dig it out from wherever I put it away.
sempronia
Thanks for the post. It captures some of my frustrations with the current craze for sterilizing everything – essentially, you can’t. People are going nuts over wiping down everything from the grocery, getting things delivered, etc., they have no idea how to not touch their faces and everything else with gloves on. It takes a long time to develop the situational awareness that maintaining a sterile field requires (I’m a surgeon). Mostly I’m just glad people are being vigilant, and repressing my inner sterile-field and sterile-vs.-clean pedant.
oldgold
According to a report from the New York Times Captain Crozier has tested positive for Covid-19.
geg6
@oldgold:
That’s terrible news. I hope he comes out of this safely. He’s a national treasure and we need more leaders like him.
trollhattan
@oldgold:
Damn. He does not deserve yet another layer on his shit sandwich.
Trump, soon: “I prefer my captains who don’t get infected.”
NotMax
Good move.
debbie
So glad your mother survived your ministrations.
Your care when shopping is impressive. I try, but fall far short when compared to your regimen. I’m being as careful as I can, but my regimen is to go as early in the day as possible and shop like a bat out of hell at breakneck speed. Whatever I’ve used for payment (cash or credit card) is put on the table where it will stay for at least 72 hours. When this all first started, I hit the ATM, but then realized most people don’t want to get anywhere near it. Now, I use it bit by bit at self-checkout where no one has to touch it.
debbie
@oldgold:
I hope that FAT ORANGE FUCK chokes on that. That is an illness he caused DIRECTLY.
scav
@sempronia: I will likewise admit to being a satisficer rather than a strict optimizer when it comes to the surgical sterile battleground. What is the level of satisfactory changes by personal condition, of course, but the joy of being a satisificer is panicking less about not attaining absolute perfection at all times.
trollhattan
@NotMax:
Yeah, hope it helps keep things going.
Quite concerned about the virus impact on California’s farmworker and food processing personnel. They work in very difficult conditions and Trump has added a layer of relentless fear atop that. If our ag industry is heavily impacted the entire nation will feel it.
NotMax
@trollhattan
Bad enough but not yet horrible here. 36 confirmed cases total reported in the county (resident + non-resident) – 34 on Maui, 2 on Molokai. 1 hospitalization, 0 deaths.
debbie
@debbie:
I say that even knowing he will look on it as Jesus acting on his behalf for his behalf.
Ohio Mom
I can feel Mistermix’s affection for his parents. I wish both of them well, and as many meaningful, joy-filled and pain-free days as possible to his mom.
I am probably not as strict as many others when grocery shopping but I do follow a lot of the established rigmarole: bringing a wipe for the cart, shopping as quickly as I can (how I used to meander the aisles!) washing my hands as soon as I get home, and so forth.
But I am pretty convinced that the biggest risk is inhaling a wafting virus, straight into my asthmatic lungs. It doesn’t sound like homemade masks do much to mitigate that.
My county board of health lists cases by zip code; mine is up to four. Which is no doubt an undercount. The question is, by how many multiples? Is anyone keeping track of when those four get better, will the count be adjusted downward? I’d like to see a sign of hope.
hitchhiker
I’m trying to find the sweet spot between driving myself bananas over possible contamination risk and acting like nothing matters. There oughta be a lot of room there, right?
It SOUNDS like while the virus RNA is detectable for as long as 72 hrs on some surfaces, the MOST likely way to get it into your body is to be in a closed space with someone who has it, whether or not they have symptoms. Maybe this happens because you breathe in what they’ve breathed out. Maybe it happens because they touch something, leave the virus on it, then you touch that thing and THEN you touch your own mouth, nose, or eyes.
Ergo:
Cover my nose and mouth while in any indoor spaces that aren’t home. This ought to deal with the breathing in what they breathe out issue. Make those events rare and brief.
After any touching of anything, wash my hands. Wash my hands before cooking. While cooking. Before eating. After eating. Basically just keep it top of mind that if a virus wants in, it’s route is through my own unwashed hands.
More than those two precautions and I start to edge into bananas-ville, for the reason described in this post. It’s much, much harder to stay sterile than you think it’s going to be. Your living room can turn into a virus-laden hall of mirrors in no time, or at least mine can if I start to think that way.
the antibob
Good post. But as to your comment on masks making people less vigilant— it’s generally terrible policy to tell people not to do something because they might do it wrong. You teach them how to do it right. Clearly with potentially more than 25% of transmissions coming from transmission by asymptomatic carriers– the masks can be beneficial for the population. Also, clearly the elements of the population who wouldn’t consider wearing a mask are going to be the baseline of poor vigilance. Wear the masks,
raven
So how long does it take after you come in contact with the virus for you to be infected? You go to the store, drive home in 5 minutes and wash up. Is that enough?
Luciamia
Man, Almost holding my breath, reading your account of trying to maintain a sterile field.
Suddenly thinking of stories of doctors in the 19th c. being insulted when told they should wash their hands.
japa21
@raven: The virus can’t penetrate skin, so as long as you don’t touch your mouth, nose or eyes, you are fine. Just do a thorough washing.
catclub
The impeachment excuse:-” we were too busy with impeachment to mind the store”
Nope: Other things took priority than minding the store.
NotMax
@raven
Not a doctor, strictly opinion. So long as you don’t have an existing condition which compromises the immune system or otherwise might make you more susceptible, and keep your paws away from your mug, the odds are tilted in your favor.
Eljai
@the antibob: I agree. I’m no scientist and I know masks are not foolproof, but it seems like if even half the people in the grocery store have their faces covered, that would mean less air droplets circulating around.
ETA: Of course, keeping social distance with the mask on is also essential.
catclub
I am not there yet in terms of complete paranoia, but I do not touch the credit card reader any more.
I use a stylus (not the one attached). I figure that is touched by the most different people.
Kelly
I wore a mask on my grocery run a few days ago. Left my shoes in the garage, undressed into the washing machine, set the groceries on the counter in the spot Mrs Kelly designated and took a shower. She cleans and repackages the groceries more thoroughly than I think necessary but I don’t debate it because it clearly comforts her. When the groceries and I are cleaned up I walk over to Mom’s to deliver her groceries. Next grocery drop will be curbside pickup. One store in town offers that and delivery slots are booked a week out. I don’t worry about the car. It’ll set long enough to decontaminate before I drive again. While I’m out I pickup the mail which is also left to sit a few days.
catclub
more from the hoocoodanode article:
Kirk Spencer
I’ve debated masking to help me quit touching my face.
Honestly, despite being “essential industry” my daily contact with others is very social distance level. Though we’ve been taking great strides in reducing and controlling shared surface contact (door handle sorts of things) it’s still the weak point. And I both wear glasses and am used to scratching when and where it itches. (With some control for impolite areas, mind. I’m not a complete social failure.)
Anyway, so if I can quit touching my face between hand washings it’ll probably be a major source of improvement. Assuming I’m not already infected, I mean. And even then I’d be helping others by not sharing.
Ruckus
@TheOtherHank:
Here in my area – might be all of LA or CA, if you bring your own bags, you have to pack them. Which works for me I always do them myself anyway – I hate having the bread on the bottom, etc.
@geg6:
Also at the store that I go to regular they now have a person wiping down the carts and handing it off to you. They removed all the lot locations for cart drop off, so that every cart gets cleaned before it goes to a customer. Seems a bit better, this way they know that every cart that goes in the store has been cleaned and the customers don’t have to grab one, clean it and then find a place to throw the use wipe. Which some people seemed to have a problem doing.
oatler.
From the Joe My God site:
TX Woman Dies Of COVID After Posting Facebook Rant: “You Don’t Need Sanitizer, You Need Faith And Guns”
Hoodie
Mom was an OR nurse for 40 years, the last 15 running a pretty large surgical suite. She was always bitching about docs’ lax compliance with sterile procedures.
Spanish Moss
I have been taking the approach that something likely got contaminated on my trip to the grocery in spite of my best efforts to be careful, and focused my attention on not bringing much of it into the house with me. I don’t take my purse to the grocery store. I take my driver’s license and credit card in a pocket. When I return home I wash them both with soap and water. I leave my shoes and keys at the door. I remove my clothes to be laundered, and take a shower.
I have been staging my groceries — nothing I buy during this period goes into my pantry. It was too full before anyway so at some point I will appreciate the space that is opening up. Anything that goes in the fridge/freezer either gets its packaging replaced or the package gets washed with soap and water before being put away. Everything else gets divided into two different boxes: items in cardboard in one, everything else (cans, plastic) in the other, where I can wait the recommended amount of time to access them, or be very careful about washing when using something earlier. Crazy.
Kelly
Ah yes, my Dad could blow his top over relatively minor transgressions that I clearly could have been avoided if I tried a little harder. In a real emergency he was calmest, kindest, most resourceful man in the world. My best story is when I was 17 I took three girl classmates for a wild ride in my Dad’s 4×4 Jeep Wagoner. In the dark. Ran over a tall rock. He was surveying the damage the next morning when I got up. When I told him who I had in the truck that night all he said was “I can’t expect a fella to think when all yer blood is between yer legs”.
germy
germy
debbie
@Ruckus:
Here, they’ve asked shoppers not to bring their own bags until this is over.
trollhattan
@japa21:
To addend, while we can halt hand-to-mouth/eye/nose transmission by handwashing and gloving, this does nothing for the inhalation pathway.
Jinchi
A friend of mine who is a nurse gave that exact reason for why everyone should wear a mask, even if they don’t have access to high quality masks, or come in contact with many people. Repeatedly touching your mask reminds you that you are touching your face and can help train you to stop doing it.
Ruckus
@scav:
Expectations of perfection are insane. Perfection is never achieved. Close is possible, closer is dramatically harder, perfect just isn’t obtainable. I’ve stated here before that I work sometimes in millionths of an inch (or mm) but it’s millionths not even +/- a millionth. And it’s the same with everything else in life, including cleanliness and sterility.
trollhattan
@Hoodie:
I’ve perhaps noted this already, from pre-corona days: Some hospitals with higher than average patient infection rates began monitoring sterile protocols including video monitoring of handwash stations. They discovered the staff were not following the rules and after intervention, handwashing went up and infections went down. Human nature and all that.
Hoodie
@trollhattan: Yep. Being an infection control nurse at a hospital is one of the loneliest jobs on earth.
Ruckus
@debbie:
Here in the workers paradise of CA most of us have been trained to bring our own bags. And while they get reused, if the baggers have to load the bags, then you have to touch them. One more avenue of transmission. In reality we can never have 100% no avenues of transmission in public, any more than they can in an operating room. And they work hard to limit those, but it’s just not 100% possible and even less so in a supermarket. I think that having your own bags and only you touching them actually helps keep an additional layer of separation.
trollhattan
@Ruckus:
Achieving 99% reduction might take a level of effort of 1, and 99.9% might take an effort level of 100, etc. If we’re talking air travel nobody has a problem with the added effort and expenditure required. Other areas, maybe not. If you have a 1 in 100 widget rejection rate that you can reduce to 1 in 1,000, but it triples your per-widget price, you’ll gladly take the current waste rate.
Since we’re literally flying blind with COVID-19, we imagine the virus being everywhere and nowhere simultaneously. And medical staff have unimaginable time and resource constraints while they try to make the best decisions they can in real time. My Costco runs are a wee bit less fraught, but I still have to think about how to do it smartly while assuming everybody else is a moron.
OldDave
@Dorothy A. Winsor:
Sounds familiar. I’m in the same boat.
Dorothy A. Winsor
@japa21:
Glad to see you survived your tests. I hope the results are good.
trollhattan
@Hoodie:
Heh, I can imagine, especially once surgeons get involved. :-)
I work in a largely engineering organization and everybody theoretically has “stop work authority” if they spot something that seems unsafe. The subtext is more, “You can, but you’d better think twice.” It’s also pretty prosaic working in an office–“Damnit, stapled my hand to the table, again!” Powerplant tech, different hazard level entirely. How can one safety system be meaningful to both cohorts?
Dorothy A. Winsor
@OldDave:
I’m trying to be discreet here because I don’t want to get my son fired, but this is in a west Chicago suburb. Would that be the area you’re in?
Cheryl Rofer
Mistermix, I sympathize. You are doing a great thing for your parents.
I also agree with your conclusions. I’ve had to use PPE for plutonium handling, which requires similar techniques.
One thing to consider about surfaces, like things you bring home from the store, is that viruses don’t reproduce unless they’re inside an organism. They’re more like a chemical, like plutonium, than like dirty grubby bacterial contaminants. If a store employee touched them and had viruses on their hands, only some of those viruses rubbed off, and then only some will get into your cereal bowl at most. Maybe one or two by the time you get there. We don’t know how many virus particles are needed to make you sick, but I’ll bet it’s more than one or two.
And I totally agree about gloves. The virus is a surface contaminant. It doesn’t go through your skin. Just wash your hands.
Aleta
@ download my app in the app store mistermix
The stories about your dad are great. This one reminds me of my neighbor when I moved here. She was born in 1908. Her story about her dining room table: when she was young, her father had been operated on and died on it. She and her mother worked hard to survive after that; eventually they had to start farming while knowing nothing about it. The two of them traveled a couple of days to Boston to get sheep at an auction and then had to drive them home on foot.
eta Also appreciated the sterility story, because it’s been driving me nuts each time I’m handling things and realize I messed up. Somehow it gets complicated fast.
randy khan
@TheOtherHank:
I hate to point this out, but using the self-checkout doesn’t necessarily reduce your contacts with other people, since people who use self-checkout usually have relatively few items and the store expects to cycle more people through a self checkout terminal than past a human checker. (There’s at least the same level of theoretical contact with every person who came through the regular checkout line, of course.)
raven
@japa21: Aha, thanks!
Tdjr
@geg6: I tried using a mask on a grocery run and I kept fiddling with it. I remembered that I have a Survivor buff that I wear in the winter to walk the dog in that cold cold air. That’s what I’ll use from now on. Probably not the best solution but it will keep my hands off my face and limit my droplets from going too far. ?
chris
Queen Liz is on TV. Hope this link works.
https://www.ctvnews.ca/health/coronavirus/tracking-every-case-of-covid-19-in-canada-1.4852102
comrade scotts agenda of rage
@oatler.:
Possible proof that there is a just and loving God after all?
Jinchi
@randy khan: That was my thought too. Last trip to the store, I had a choice between a checker, who was gloved and masked and cleaned off all the surfaces between customers… and a self-checkout machine, which potentially dozens of other customers have interacted with between cleaning, touching all the same buttons and surfaces that I would touch as well.
I went with the checker and tried to be as efficient and respectful of her space as possible.
raven
@Dorothy A. Winsor: You are Northwest, Elmhurst, Villa Park, Lombard. . .are West.
MagdaInBlack
@Dorothy A. Winsor:
Not discreet. Kinda obvious to anyone local.
There are a lot of us in the north and west suburbs and all over the country, getting up and going to work every week day, meeting the public every weekday. None of us feel good about it.
Ruckus
@trollhattan:
So situation normal, all fucked up. SNAFU
When we are dealing with basically the unseen we are always flying blind. One of the greatest achievements of modern medicine is understanding more and more of what kills us and ways to slow/stop that. I grew up with the concept of polio. I personally know, have known 4 people with it. Watched them go through life with it. One of those people is a current neighbor. Others around my age or older have the same experience. Most people under say 60-65, in much of the world, may not know anyone with polio or even anyone who knows someone with it. Humans have been on this planet for a lot longer, but it’s really the last 65 yrs when most major healthcare break throughs have happened. The only major disease that most people my age didn’t go through was smallpox. And the last known outbreak of that was 71 yrs ago, the year I was born.
raven
@MagdaInBlack: My idiot neighbor thinks it’s all overblown so he feels fine going to his electricians job.
Barbara
Someone was recently looking for quarter inch elastic. I was ripping up an old fitted sheet to use for a dog bed and I realized the hem has narrow elastic sewn in. You can cut around the hem and pull the elastic away from the seam. I now have at least three feet of the stuff. It isn’t “fresh” elastic so you will need to adjust the length to account for that.
raven
@Ruckus: So hydroxychloroquine is what the malaria pills they made us take were.
Barbara
@raven: At least some electrical work counts as essential. I wonder whether some people are simply full of false bravado so they don’t have to think too hard about how much danger they are assuming.
John Revolta
@Ruckus: Wait, do I read that as millionths of a millimeter?
raven
@Barbara: I dunno, this dude and his lady have been fishing on a river at night the last three nights. It’s fairly calm but, damn.
Ohio Mom
Cheryl Rolfer: I have gotten to be fascinated by the question about how many individual viruses it takes to make you sick.
I don’t know if this is at all accurate, but I’ve begun to think of the viruses escaping from a breath or cough as akin to sperm. So many at the start, so many never make it anywhere near their goal. But that one sperm who makes it all the way changes everything.
Someone exhales in a grocery aisle, a virus lands on a random shelf and lays there undisturbed until it becomes inert (is that the correct term?).
Another one wends its way into a shopper’s upper respiratory track but is caught in the mucus of a post nasal drip headed for the stomach.
But third one makes in to just the right area of a lung. Maybe it was inhaled directly or maybe it went from a soup can top to a finger to an eye…
Why would just one virus not be enough to make someone sick?
The fourth virus gets into someone who has already had Covid-19, and that shopper’s immune system springs into action.
Of course, as I said, I made this up. No idea if this is how it works IRL.
Another Scott
My FIL had a trach tube in his neck for his last couple of years when he lived with us. We learned all about the sterile procedures too, and learned how to make a suction wand that didn’t make him bleed whenever it was used, also too.
It was always painful to see him admitted to the hospital when something came up, because the pulmonary team would invariably come in and be nonchalant about the proper techniques (e.g. adjusting the O2 flow with their sterile hand). Even the experts get sloppy. :-(
Best of luck to your folks, MM. And to all of us!
Wash your hands!!
Cheers,
Scott.
Redshift
@randy khan:
It’s not just the number of people. If you go through a human checker, there’s no way to remain six feet from that person and possibly a bagger too. I’m inclined to think that passing through an area that a few more people have passed through is not more of a hazard than that, though I could be wrong.
Jinchi
I’m starting to think that the winning case against Trump in November will be:
Would You Trust this Man with Your Life….Again?
raven
@Ohio Mom: Is virus a unit of measurement?
Sister Rail Gun of Warm Humanitarianism
@Ruckus:
I keep the used wipe handy and use it to open frozen/refrigerated food doors. My last trip, I plucked it from the cart I came to the check-out with, intending to use it to wipe off the card kiosk, and was fervently thanked by the cashier. I think the used wipes are starting to become a bit of an issue, though most places I shop have a trash can for them at the wipes station.
Ohio Mom
John Revolta@67: there is a very exaggerated story in my family about the machinist uncle trying to build a deck for his shopkeeper son and never getting anywhere because he could not get the wood measured just right. Nothing was ever cclise enough to suit him.
Sloane Ranger
I take my own bags when I go shopping and use hand sanitizer before taking a shopping trolley, the dash round as fast as I can while trying to maintain at least 6 feet between me and others in the shop, which is almost impossible. I tried using a pen on the self service tills but it didn’t work so I use my index finger. Then I pack my bags, return the trolley and use more hand sanitizer. When I get home I unpack everything, wipe as much as I can with a wet wipe and put it away. Then go and wash my hands thoroughly. I try not to touch my face until after I’ve washed my hands but honesty compels me to say I haven’t always been successful.
Watched the Queen just now. I thought she was spot on. She talked about WWII. As the only Head of State or Government to have actually served, she could do so with authority. She didn’t mention Prince Charles, perhaps because she knows other families have had members who have actually died from the virus. She ended on a note of hope, deliberately using a line from a famous WWII song “We’ll meet again.”
J R in WV
People have mentioned a “Survivor” buff several times — what the hell are you guys talking about>?
I have no clue whatsoever what a buff is or who Survivor is…
Mikeindublin
I walk directly into the shower with all my groceries and commence to wash myself and everything off with soap and hot water, veg fruit and all.
Jk I do as you all. Wipe, disinfect all wipe and disinfect again in case I missed anything
Ohio Mom
Raven, I mean a single “virus” as a single sphere of protein and lipid encasing a single strand of RNA — like the picture of the gray ball with the red spikes.
Maybe a bunch stick together? Even as a small group, they would still be moving around the world randomly. A lot would land where they could do no harm but obviously, enough get into enough people.
OldDave
@Dorothy A. Winsor: No, I’m somewhere in Florida. I suspect this is a common thing.
Kelly
@J R in WV: A buff is a ski mask that is a kind of big stand alone turtle neck. Also called a neck gaiter.
Cheryl Rofer
@Ohio Mom: As I understand it (and I am not an expert), you have it pretty much right, except for one thing.
Even in a non-immune person, there is a kind of generic immune system, the innate immune system, that just says “Huh, you don’t look good to me, buddy,” and eats or deactivates the virus. So that’s another place that a virus will fail to cause disease. Different viruses activate this system to different degrees, and I’m pretty sure that more than one virus is usually required to cause disease.
There was an op-ed in the New York Times a week or so ago, speculating that the more severe cases of covid-19 were due to getting a heavy virus load, like that poor bus driver who had someone cough on him. That kinda makes sense.
I’m looking for information on this and haven’t seen any, so this is all speculation.
Ruckus
@trollhattan:
Two of the major areas of my work are tooling for aerospace control surface hydraulics and medical device (like catheter) production. Both of these require that tolerances be reduced as much as possible, simply because it saves lives. It’s not that money is no object it’s that saving pennies is far out weighed by loss of life. So the industries shoot for zero in 1,000,000 cases or something along those lines. So even if money is the major object, close isn’t good enough. Now if you are making a million 1/4 inch plugs for guitar amp cables a year, production cost is paramount.
raven
@Ohio Mom: Beats me, that’s why I asked.
raven
@Ruckus: My mom worked for Ramsom labs back in the day. Optical stuff I think.
?BillinGlendaleCA
The Canadian mask will keep you from touching your face for a long while.
Ruckus
@comrade scotts agenda of rage:
They think all the germs are full sized humans. Their faith keeps effectively telling them that and their guns make them able to shoot the germs that they fear. I remember that when I was very young hearing there was a concept that people were darker skined because they were dirty and that was handed down. The whiter you were the cleaner. (I’m lucky, my parents didn’t believe this crap, but I heard this at school.) Of course most know this is 100000% bullshit but one tends to believe if not educated different and if you trust the people telling you that and they are successful……. and you can tell success by the successful’s use of excess, which is the evangelical church model.
randy khan
@Redshift:
There are multiple factors, which is why I said not necessarily. For instance, a checker practicing good hygiene – wiping down, wearing gloves, etc. – is less risk than one who is not. And at Costco near me (and apparently lots of other places) they have installed plexiglass shields between you and the checker so you can’t breathe on each other, which obviously is a big plus.
joel hanes
@Jinchi:
Take a pencil with an eraser to use on the touchpad
joel hanes
@Ohio Mom:
People are not really very much alike in some respects.
The immune system is one of those respects.
Some people, by birth or by happenstance, will already have substantial effective immunity, so even if a considerable number of virus particles hit receptive mucosa, their bodies will kill off the attack in short order. I think this is what happens in many of the “asymptomatic” cases.
Others can probably be infected by a small number of particles.
randy khan
@Cheryl Rofer:
I have just enough training in microbiology to be dangerous, but generally the way people think about these things is that any one virus could infect you, but the more there are the more likely you are to be infected. As a general proposition, I’m not sure there’s any relationship between severity and the number of virus particles that reach you, but that’s not to say that it isn’t true for some diseases.
Richard Epstein, in his really embarrassing interview with The New Yorker, did get one thing right, which is that different strains of a virus may have different levels of virulence, but so far nobody believes there’s any difference in virulence among the 8 strains of COVID-19 identified so far. (Epstein also made the horrifically wrong assertion that HIV has somehow gotten weaker over the years, so it’s kind of amazing he got anything right.)
Uncle Cosmo
I spent about a dozen years involved in math modeling for chemical & biological defense programs under contract to the Army. You are probably correct – there are not many organisms that are likely to turn into full-blown illness from “one or two.” But at least one agent I modeled had an ED50[1] not all that much larger than that.[2]
I note that severe cases of COVID-19 are often associated with dry cough indicating infections in the deep lung. No surprise; the deep lung is an ideal environment for most pathogens, and is hard for white blood cells and antibodies to cover. A number of biological agents[3] are engineered to reach and lodge in this area for maximum effect.[4]
As it happens, a single SARS-CoV-2 virus is right around the “ideal” size – too small to be stopped by the body’s filtration systems when inhaled and too large to go right back out during the exhale.[5] I wonder whether one factor (among many) in serious/fatal cases of COVID-19 might not be the virus speedily reaching the deep lung & setting up shop there very early in the course of the disease. It seems plausible, though it would be hard to know. But snagging as many of the beasties before they reach the air passageways would seem to be a good thing in any case, no? So long as you don’t touch the mask where they were snagged…
[1] For the uninitiated reader: ED stands for “effective dose,” and ED50 for an agent is the “median effective dose,” at which 50% of those exposed will develop the illness. (The equivalent for fatality is the LD50, for “lethal”.) ED50 is a statistical value over a large number of those exposed – it does not mean one cannot contract the illness from a much lower dose, nor that one might not contract the illness from a much higher dose.
[2] The ED50 value was (& AFAIK still is) classified – one of the few instances in the 20 years I held a Secret clearance when I actually needed it to do my job. No reason to name either the agent or the value.
[3] E.g., Bacillus anthracis, which is not a virus. Anthrax was once known as “wool-sorter’s disease” as it was contracted cutaneously from spores in sheep’s wool, but it was rarely fatal. But pulmonary anthrax often is, if it gets into the deep lung.
[4] It is often fairly straightforward to produce an agent in the proper size range, but (luckily for civilization in general) much harder to stabilize it for delivery in that range. It is not widely known that the Aum Shinrikyo cult’s 1995 Tokyo subway sarin attacks were actually their Plan B. First they tried to kill tens of thousands by scattering aerosolized anthrax spores across Tokyo from tall buildings. Growing the spores was easy; milling them to the right size not terribly hard; but when dispersed, electrostatic forces clumped them up and the clumps fell out of the air to be washed down the sewers by the next rainfall, with not a single victim getting ill. What terrified the knowledgeable about the “anthrax letters” just after 9/11 was that the enclosed spores were stabilized in the right size range – meaning whoever did it knew how to do that and could damn well do it again.
[5] Don’t believe the number is classified, but again, no reason to mention it.
Jim, Foolish Literalist
Uncle Cosmo
@Barbara: Boys’/men’s briefs that are nearing the end of their useful life. After washing them in hot water with bleach one last time, separate the waistband (the least nasty of the nasty bits) and cut it in half lengthwise, then into the lengths required. I’d guess you’d get enough for 2-3 masks per pair. (I was tempted to suggest repurposing the rest of the material for filters, but that’s a britch[es] too far even for me…)
Ksmiami
@japa21: Since we all trend a little older here at BJ, one thing I do when I grocery shop is wear my glasses inside as they are a pretty effective barrier and have the added benefit of helping us see
Jinchi
The most shocking thing about that news was learning that Boris Johnson has a 32-year-old pregnant fiancee.
She also has coronavirus.
Uncle Cosmo
No doubt that pathetic twerp Niggling Falange is rubbing his hands in gleeful anticipation of a vacancy…
ziggy
@randy khan: Yes, viral load counts. I found a good article on this a couple of days ago, I’ll try and find it again. So that keeps me from going crazy with the sanitary procedures. I don’t have to be perfect, I just have to do the best I can.
After watching a few videos of the “spray” from an unmasked person–even just talking–no way I’m going into an enclosed area without a mask. It’s a phenomenal amount and travels quite well.
From Bill Arnold’s post yesterday:https://vimeo.com/402577241
Viral load article:
https://www.nytimes.com/2020/04/01/opinion/coronavirus-viral-dose.html
Seanly
That wasn’t gross at all. Let me quickly regale you with the time I had a Grosse Kempf nail removed from my femur.
I broke my right femur while traveling in Scotland. My choices in the ER were 6 months in traction or have a Grosse Kempf nail installed in my femur & get out of the hospital in a couple of weeks. The GK nail was supposed to be permanent according to the British doctors, but they left a little bit protruding at the top of the femur which began developing scar tissue. My time in the open ward in the Edinburgh Hospital was its own adventure. Spent my 20th birthday there in January 1988.
Back in the states, Lehigh University’s health center suggested I remove the GK nail. The orthopedic doctor I was sent to was used by the Lehigh University sports department so the HC referred me to him. He removed the nail and I got to take it home. They did sterilize it, but when I got back to my dorm I saw it had a tiny bit of marrow in it. And that’s not the gross part, but should’ve been a clue to what was going to happen…
Turns out the doctor I was sent to was called the Butcher of Bethlehem by the Lehigh students who saw him via the sports department. My wound get infected and I had to visit him several times for him to clean the wound. His rooting around in the wound was one of the worse pains I’ve ever felt. He left the wound open to “air it out”. I did question him, but I was a young 20-year-old so I didn’t push hard.
WARNING – highlight to show grossness
Then one day in the shower I had a huge amount of blood and puss come out of the wound. After that, I seemed to turn the corner. And it wasn’t until about a year later when a friend told me the doctor’s nickname among the students.
I had the GK nail as a souvenir of my trip to Scotland for many years until my wife made me get rid of it. She got to be there the time I got a staph infection in the bursa of my left knee which is another good story.
ziggy
Also another thing I do not understand at all–why does a mask become this dangerous germy thing that must be sterilized (I’m talking about for us on the street, not medical professionals!), but other surfaces, such as your hair, your purse, your eyeglasses, that a virus particle could alight on, are just fine? It’s not like a pair of gloves that you are touching things with. It’s just a barrier, and we’re not doing intubations.
MoxieM
I worry worry worry about my nephew who recently had brain surgery for an Oligodendroglioma that suddenly made itself known. The surgeons at Columbia/Presbyterian (NYC) think they got the whole tumor, he’s got all his motor & cognitive function, it seems. Giant Phew. (sometimes living near huge cities with vast medical infrastructure is a good thing) He’s now having radiation Tx, Ok, Ok. But get this: he’s a mechanic at Mercedes, at it’s considered a “necessary occupation” or some such. So he’s working part time. In and out of other people’s cars all damn day. And his wife is 33 weeks pregnant, (first baby) and works in a Doc’s office. In a hospital. So she too is working (not on the front lines, she’s not a nurse and it’s a GI practice.) Still. Exposure, what?
They need the money since of course they just bought their first house. Parents are hovering. But it’s just a paralyzingly scary situation. Send good thoughts please. Thx.
JR
Gloves are for the wearers protection. If you’re worried about contaminating stuff you are sometimes better not wearing them.
Jon Marcus
Where/how does one get a supply of liquid morphine?? My father died on the ides of March, just as isolation was revving up. Mourning distantly is horrid.
My mother is not in great health, and if/when we get to that stage I do not want her to suffer.
MoxieM
@Jon Marcus: Good question. I think you need to be an MD, and even so, Nowadays they track stuff like that like crazy.
Ohio Mom
Jon Marcus@102: Hospice is known for providing pain relief but merely being old and frail is not enough to qualify. Maybe talk to Mom’s PCP about your concerns? You will need her permission to do so.
Condolences on the loss of your father, and I’m sorry you have to mourn alone.
jame
My deepest gratitude for this post. I was accused just today of being too fanatic about possible contamination. Now I know I’m on the right track, but still not careful enough.