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An additional way to protect ourselves from COVID-19 is to avoid places where a virus may linger as part of an aerosol, argues Mario D’Cruz.
With the reimposition of lockdown in Melbourne, in response to a surge in the number of reported new cases of COVID-19, it is hard to remain objective about how to manage ourselves and our environments.
The onset of new restrictions may also leave us feeling confused about what lies ahead.
I have been keeping a close tab on the Covid 19 pandemic and its rapidly updating information landscape, from the perspective of a medical practitioner living with a C5 spinal cord injury.
Here are some thoughts that might help other people living with a spinal cord injury get a better handle on their situations, and empower them to make safer decisions.
Before I begin, however, let’s remember that everything about the Covid-19 situation is unprecedented. Most of the knowledge and recommendations are nowhere near being definitive, and (as we are painfully aware) are being constantly revised.
I would like to emphasise that this is a personal perspective, with a specific reference to people requiring disability support care.
If we wish to minimise the possibility of aerosol transmission, we must modify our behaviour.
My most important suggestion is to keep in mind our primary objectives, which are:
preventing yourself from becoming exposed to the Covid-19 virus;
preventing the spread of Covid-19 in your environment and community.
Stay focused on these two objectives, rather than worrying about the letter of the law or arguing about what is legally acceptable.
Mario D'Cruz is a medical educator.
Remember, restrictions and requirements put in place by health authorities are aimed at helping us achieve these two objectives. If it seems extremely unreasonable or unsafe to comply in a particular situation, then almost certainly you have misunderstood how the requirement applies in that situation.
If we can show that we have been trying to do the right thing, authorities will be very unlikely to penalise us for it, especially those of us in the spinal-cord impaired community.
Do not waste any time or effort on the behaviour of others. Simply take responsibility for yourself and your dependents and have clear, logical and informed reasoning to support your decisions and behaviour.
What is a safe distance?
Always maintaining a safe distance remains the most important measure for keeping yourself and others safe from viral transmission.
What’s the safe distance? When all of this started, 1.5 metres was recommended. Transmission was thought to be mainly from large droplets that didn’t travel much further than 1.5 metres before falling, and didn’t remain airborne for long.
At a time when community transmission has been increasing, the use of masks is crucial.
Now, many researchers believe that in addition to this form of transmission, infected persons can transmit the virus in the form of a fine aerosol mist that can stay in the air for an unspecified period - depending on airflow, temperature, people movement and other factors.
I believe it is prudent to take this belief into account.
If we wish to minimise the possibility of aerosol transmission, we must modify our behaviour to keep as far apart as is practically possible from people who are not part of our households.
And we must absolutely minimise the time we spend in shared environments that are poorly ventilated (such as vehicles or rooms).
Bear in mind that these environments include the kind of spaces where people come and go intermittently, such as clinics or shops, even though they may be unoccupied when you’re there.
Even in well ventilated environments and outdoors (shopping centres, fitness areas, sports courts, walking paths and the like), people breathing heavily or speaking loudly can generate a significant aerosol mist that could transmit the virus to people passing through the mist a short while later. This gives you another reason for keeping as far from other people as possible, and for the diligent use of masks.
The dual role of masks
If viral transmission indeed occurs by aerosol as well as by droplet, masks are our best defence from airborne viral particles. Equally, masks are the best way to minimise the viral particle load shed into the atmosphere by infected people.
At a time when community transmission has been increasing, the use of masks is crucial. Please do not consider this as fulfilling a legal requirement or avoiding a penalty, but as a way of protecting yourself and your community.
All in the same boat
Clearly, and especially for people like us who may require assistance with personal care and daily activities, distancing and wearing masks can be impractical and unsafe in some conditions.
Chief among these is when you are in an environment in which you spend eight hours a day or more, and where you are exposed to other people on a daily basis and for extended, continuous, periods.
Consider seeking assistance from your care coordinator to streamline the number of carers you have.
Your usual place of habitation, and possibly your workplace, may fit this description. In such an environment, if a person were shedding the virus then the atmosphere could be virus laden. A mask would not be an effective barrier to transmission to the usual, regular inhabitants of this environment.
In such a situation, the most effective action would be preventive: that is, to reduce, to a bare minimum, the number of people spending significant time in this environment.
This can be achieved in your usual environment by having people who need to join you in that environment stay for the shortest time they are required to be there, and for both them and you to wear masks while they are there.
Consider seeking assistance from your care coordinator to streamline the number of carers you have, so as to reduce your exposure to people from outside your household. Note however that both you and your care provider may need to balance competing requirements and risks. For example, the fewer carers you have, the more you may be affected if one cannot work.
You’ll find some thoughts on this and other matters in Living in the Age of COVID-19, a guide compiled by the Spire peer health team.
Note also that if you are seeking to minimise the risk of aerosol transmission, having people pop out of the environment for short periods and back in again is not going to diminish that risk if the overall time spent together is long.
How long is too long?
How long is too long? This clearly depends on the environment, ventilation, and other factors particular to that situation.
As a general guide, if someone shares an indoor environment with you every day, for more than four hours at a time, then that person can be considered part of your usual environment. In such a scenario, It is highly likely that viral transmission would occur if either of you became infected.
Obviously (but not so obviously for some it would seem), at the first signs of a possible Covid-19 symptom one must get tested and then, importantly, as much as possible, remain in isolation till the results of the test become available.
If the results are negative, your earlier precautions can continue. If positive, subsequent decisions will be the prerogative of health authorities.
Mario D’Cruze is a medical practitioner and educator, and a Peer Health Coach with AQA Spire. Mario has been living with a C5-6 complete spinal cord injury since 2001. The views expressed in this article are his own and do not necessarily reflect any policy or position of AQA Victoria Ltd.