By Dato’ Dr Amar-Singh HSS
Senior Consultant Paediatrician
Meal Times at Home and Outside
Eating together can pose a risk of transmission, especially with our lovely Asian style of sharing food. At this time it is advisable not to share food with another person. It is best to have a spoon for every dish and use that to put items onto your plate and not take food directly from the dish with your spoon or chopsticks or hands. It would be good to do this both at home as well as when eating out. This practice should be something that we should adopt as a lifestyle, in view that there may be other virus outbreaks in the future. When you go out to eat, bring your own personal chopsticks or fork and spoon. Higher risk individuals may also want to consider bringing their own cups for drinks. Avoid using a straw for drinks unless necessary, perhaps for a person with a disability. Straws are picked up by the fingers of the person serving you and then put into your drink and then you put your mouth on the straw – a high-risk event. Some fast-food outlets may offer you a covered straw. Our children need to be taught these hygienic practices, including not drinking out of someone else’s cup or licking a shared ice-cream.
Improved Hygiene Practises by Food Outlets/Shops
How well utensils are cleaned in shops, from the corner coffee-shop to the restaurant to the fast-food outlet, are of concern. Cups, plates and all utensils should be washed thoroughly between meals/patrons. All food outlets should also aim to clean the tabletops in between every customer. They should use an alcohol-based spray (at least 60% alcohol) to wipe the table. They should dispense with the habit of using a dirty, wet tablecloth that is often reused for the entire day. This wet table cloth can be a good virus transmitter. Use instead, a paper kitchen towel that can be used once and then safely thrown in the bin. If shops do not do this, we as patrons can try to clean the tabletop before we sit down to eat. Food-handlers and servers should consider the routine use of a transparent kitchen mouth shield (mouth or spit guard). Some restaurants already have this in place but time to consider the routine use of this item in all outlets. They are not expensive and can be reused after cleaning.
What to do if You Become Unwell and Dealing with the Unwell Person at Home?
What to do if you develop a respiratory infection? It should be the responsible thing to tell your employer or your school or university and refrain from going back until you’re well. That means self-quarantine yourself when you are unwell. All employers should be sensitive to this and offer compassionate leave as well as the opportunity to work at home at this time. If one person at home becomes unwell others should not sleep with them (this increases the virus load spread); there may be an exception for young children. The ill person should also use a separate bathroom, if available. All ‘high-touch’ surfaces (example counters, table-tops, doorknobs, bathroom fixtures, etc) should be cleaned using a household cleaning spray or an alcohol-based wipe. Generally, we should avoid sharing towels and hanging them in the bathroom; damp towels are good items to spread viruses. All items for personal hygiene (towels, toothbrushes, etc) should be personalised i.e. individual use. Use closed bins at home for discarded tissues. There is some evidence for this coronavirus to spread by stool (faeces). Flushing of the toilet should be done with the lid down and toilet bowl covers should be cleaned periodically.
How to Deal with Crowds, Conferences and Meetings?
It is best that we try to minimise contact with crowds, which is easier said than done. Try to keep your distance from individuals. Avoid shaking hands, hugging or touching others unless that is absolutely necessary. It is best to postpone events that can be moved and avoid large gatherings as much as possible. This is not the time for celebrations but only for essential meetings. Many medical conferences in the country have already been postponed.
Cough Etiquette and Dealing with Someone who is Coughing or Sneezing
Everyone should cough or sneeze into a tissue or learn how to cough or sneeze into a flexed elbow or sleeve when it happens unexpectedly. After the cough or sneeze dispose of the tissue in a closed bin and wash your hands with soap and water or clean your hands with alcohol-based sanitizers (at least 60% alcohol). If someone in public is coughing or sneezing, keep your distance from them (at least 1m away), and ask them to do the above. If they are repeatedly coughing or sneezing ask them to put on a mask (3-ply surgical mask or N-95 mask). Consider carrying some spare masks and offer them to individuals who cough or sneeze. We need to help others learn to be responsible. We also need to stop completely the habit of spitting in public.
Personal Protective Devices for Emergencies
It is important to carry our own personal protective devices for emergencies. Always carry some 3-ply surgical masks or an N-95 mask in your bag. We do not need to wear masks unless we are unwell ourselves or we are travelling in an enclosed environment with others, like an aeroplane, taxi, bus or train. Remember that the 3 ply surgical masks or cloth masks are no longer effective once they are wet. They have to be changed frequently (at least hourly) and be worn correctly. Remember to dispose of them safely in a closed trash bin. It would be the responsible thing not to travel if you are unwell. In addition, alcohol-based hand sanitizers, with at least 60% alcohol, are necessary to keep with you at all times. You should clean your hands after touching surfaces. Clean your hands with an alcohol-based sanitizer after you’ve left a shop or come out of an office, after touching doorknobs, public tables, etc. Of course, the common advice, which is difficult to adhere to, is to stop touching your face with your hands when out of the home. Contaminated hands can transfer the virus to your eyes, nose or mouth. Studies have shown that we touch our faces many times each hour and this increases our chances of getting infected. We need to support each other to reduce this behaviour of touching our face.
Dealing with Planned Visits to the Hospital or Clinic
Hospitals and clinics are higher risk locations to visit and we should avoid going to the hospital or clinic unless necessary. Many of us have planned visits for our chronic illness or we may need to visit a close friend or family member in hospital. For planned appointments, it would be good at this time for hospitals and clinics to offer mobile appointment services, so that we can limit the number of people waiting to see a doctor in the clinic or hospital specialist waiting areas. This would mean that we can arrive 10-15 minutes before the visit, see the doctor and go off quickly. This can be arranged if we improve the efficiency of our services at this time and may become a routine system to put in place for the future to limit crowds in clinic waiting areas.
Social Distancing Measures: Preparation by Schools, Universities and Employers
Those in education, as well as employers with numerous employees, need to prepare for a local outbreak; this means they need to have a contingency plan in place. The responses from China, South Korea and Japan have been swift and decisive. For example, they have closed schools for some duration but still are able to offer online education for the students. Iran has closed schools/universities and cancelled group Friday prayers in more than 22 cities. Are we ready if we are faced with a similar situation? Are we prepared for temporary closures of schools and childcare facilities as well as workplace social distancing measures like teleworking and temporary closure of all religious meetings? Social distancing measures, if required, will be difficult for everyone but can be achieved if we all work together as a community and support each other.
Dealing with False Information
There are many false ideas and suggestions circulating and it is important we verify them before sharing with anyone. It is best to check with accredited sources or read reliable sites. WHO has a COVID-19 Myth busters page for advice for the public that is worth reviewing. For example, they state very clearly that, at present, there is no evidence that pets such as dogs or cats can spread this new coronavirus. Also that it is safe to receive a package from China as coronaviruses do not survive long on objects, such as letters or packages.
The situation is fluid and everyone needs to keep up-to-date with the latest information so that we can work, not just as a country, but as a global community to deal with this threat. This outbreak will teach us many things about ourselves and the need for humanity to change and respect nature.