Germs Public Health

COVID-19 Update #5

This week Governor Kay Ivey announced a ‘Stay at Home’ order for the entire state of Alabama. She cited Alabama’s increasing numbers of confirmed COVID-19 cases.  She emphasized that previous restrictions had not been adequate, and more has to be done. Ivey and State Health Officer Dr. Scott Harris issued the order for Alabama residents to stay at home except for essential activities.

The ‘Stay at Home’ order became effective on April 4, 2020.  If unsure what a ’Stay at Home’ order covers, you can get the details from “The Order Of the State Health Officer.”  Your free online subscription to the Huntsville Times also carried details about the order.  How effective the order will be without vigorous enforcement remains to be seen.

If you have been following one of the COVID-19 tracking websites, you have noticed that few countries show success in slowing the spread of COVID-19.  While there are many problems that contribute to the inability to contain the virus, the most pressing problem is limited resources for testing and the sensitivity of the available test.  The COVID-19 test now being used in hospitals is pretty good for people that have COVID-19 but may only be only 70% sensitive for negative results. In other words, if you take the test and get a report that you don’t have COVID-19, then there still remains a 30% chance that you actually do have COVID-19.  One reason for this is the sampling problem.  If the test swab doesn’t go far enough into the nose, it may not encounter the virus. Compounding the problem, as patients get sicker, the virus migrates from the nasopharynx to the oropharynx and into the respiratory tract. When the virus migrates varies from patient to patient.  Until better tests are available, physical distancing remains the best strategy.

To slow transmission of the virus without bringing the entire country under a blanket ‘Stay at Home’ order, we need better testing tools.  When it becomes possible to know who has the virus, who has recovered, and who has not had the virus, the country can begin the process of returning to normal.  When tests will be available in sufficient qualities is unknown.  In a world with over seven billion people simultaneously having similar resource needs, it will take some time to catch up with demand.  Complicating the problem is a dependence on ‘Just in Time’ inventory management systems that have, for many years, been maintaining the minimum inventory possible.  Often the small available inventory is stored in other countries that also have urgent needs. 

From the news, it might seem the battle against the COVID-19 has become one of every nation for itself.  Fortunately, in the sphere of scientists and doctors, information flows freely with helpful information turning up every day.  A typical example is the projected shortfall of respirators.  As we are learning from other countries, our lack of experience in using ventilators with the unique problems COVID-19 presents may be the bigger problem.  As new techniques are mastered, death rates of patients on ventilators could fall dramatically.  Every day, doctors in America are learning important lessons like this from doctors around the world.

The face mask dilemma typically rates high in any discussion of medical equipment shortages.  As an understanding of COVID-19 has improved, the need for mask has been elevated.  An expert committee recently concluded that COVID-19 could be aerosolized through talking or exhalation. This suggests that the virus can travel further and linger in the air longer than previously known – perhaps up to 23 feet.  What’s not clear is whether the viruses at that distance would be sufficient to cause infection.  For now, The World Health Organization’s recommendation does not reflect this new concern.  Given that face mask can significantly reduce the distance exhaled viruses travel, there is certainly a compelling reason to wear a mask when away from our safe area.

The concern about how far viruses can spread is in part why the Center for Disease Control (CDC) recently recommended that everyone should be wearing cloth masks when they go out in public.  For now, this is a recommendation to use homemade masks and save the surgical and N95 masks for healthcare professionals.  Fortunately, there are ways to make an effective face mask that will be mentioned later. 

Keep in mind that the recommendation for wearing a face mask is strongly motivated by the need to keep infected people that have not developed symptoms, from inadvertently infecting others.  Of special concern, up to 25% of people infected may never have symptoms.  The 48 hours before a person shows symptoms are the most contagious time for COVID-19, and that’s when many unknowingly spread the virus to others.

            Although a face mask can be helpful in many situations, they are not a panacea. The COVID-19 virus is approximately 120 nanometers in diameter. While that’s fairly large for a virus, it’s small enough to go through most fabrics. The advantage of a homemade mask is that shortens the distance the exhaled air travels. Unfortunately, if you are at the stage of coughing, a mask has little effect on how far exhaled breath travels.  With the force of a cough, the nano-sized virus can sail right through a mask. The message is clear.  Don’t leave home when coughing.

It’s easier than you might expect to make a face mask that meets the CDC recommendation for a face mask to use in public areas.  For a quick lesson, view ‘How to make your own face covering in 45 seconds from common household items’ by Dr. Jerome Adams.

If wanting a face mask that’s on par with what medical professionals use (when they can find one), a doctor explains how to make them at home.  This explanation is for a face mask, that if built properly, could be donated to a local medical services for use as a stand-in for a surgical mask. It utilizes a HEPA filter like the ones some vacuum cleaner bags are made from. To learn how view “A Doctor Explains How to Make the Safest Face Mask” (15 min.)

For general information about face mask, the CDC offers more advice about “Use of Cloth Face Coverings.” in areas of significant community-based transmission. The World Health Organization (WHO) also has an informative page dedicated to details of masks

In all of this, you may wonder, how does it end, and how long will it take.  While I don’t have that answer, I do have great faith in America.  Perhaps it’s a matter of perspective from having lived the first 29 years of my life under a Government that rarely responded to needs.  By comparison, America is doing great.  For a positive view of the situation, I suggest reading “Pandemics Are the Mother of Invention.” That’s what gives me hope for tomorrow.

            Nancy Neighbors, MD

Food Safety

One of the few reasons we should leave the house during this time of social distancing is to buy groceries. Fortunately, there are steps you can take to protect yourself.  Importantly, shop when it’s not crowded. If you arrive and the store is packed, go another time.  Of course, bring your own sanitizing wipes in case the store doesn’t provide them.  While common sense plays a big part in being safe, when dealing with invisible nano-sized particles like a novel coronavirus, it’s best to stay abreast of the current recommendations.  As you will learn from a video that summarizes Best Practices from CDC, the recommendations about the use of face mask have changed. As mentioned previously, face masks are now recommended for everyone.

Although food may not be a great concern when it comes to COVID-19, food packaging and other food containers can be a concern.  To appreciate the finer points of how to protect yourself, watch the video “Food Safety Tips” by Dr. Jeffrey VanWingen (13.5 min.)  Given that viruses can live on surfaces for varying lengths of time, depending on quite a few factors that are difficult to know, precautions are appropriate.  For example, only bring nonperishables into your house as needed.  Just let the nonperishables sit outside your living area as long as practical, if even only for a few hours.  Note that the video disagrees with the World Health Organization (WHO) on one point.  Washing fresh foods with soap is not believed to provide protection beyond simply removing dirt and rinsing with water.

A Story with a Moral

After a pandemic ends, immunologists try to determine why some became very sick while others stayed healthy.  Sometimes the reason for the differences relates to age, gender, or other factors.  More often, the most significant factor is a person’s state of health before becoming infected.

Denmark provides an interesting story about how lifestyle affected health in a way that made an entire country more resistant to a virus.  In Denmark, the Spanish Flu pandemic claimed only 0.2% of the population.  This made Denmark stand out as the country with the lowest levels of excess mortality.  Interestingly, this outcome may be attributable to Mikkel Hindhede, a Danish physician and nutritionist that demonstrated how a mostly plant-based diet could improve health.  On Dr. Hindhede’s recommendation, the country moved to a mostly plant-based diet to avert starvation due to a World War I blockade.  Later, when the Spanish flu swept through the world, it had minimal effect in Denmark.  If interested, read more about this interesting story.  Unfortunately, in America today, most eat a diet that is high in processed carbohydrates, high in animal protein, and deficient in plant-based whole foods.  The moral is clear, in the time of COVID-19, lifestyle strategies that help maintain a strong immune system are more important than ever.

How to Self Check for a

Possible COVID-19 Infection

Apple launched a new website with a COVID-19 symptom screening app in partnership with the CDC, the Federal Emergency Management Agency, and the White House’s Coronavirus Task Force. The screening tool asks questions about recent exposure, symptoms, and risk factors.  The app then recommends your next steps, including testing if warranted.  Learn more about the screening tool at the CNBC website.  Let’s all look out for each other by knowing our status, by trying not to infect others, and reserving care for those in need.

The Public Library is Online

            Need a book, video, game, or help with study at home. The local public library is ready and waiting to serve your online request.  Below is a short list of resources available without leaving home.

The library currently has a three-month subscription to Hoopla for e-books, television shows, and movies.

Nancy’s Black Bean Recipe

Each week I try a different bean recipe.  As you might guess, the kitchen is my happy place, and I do like to experiment with spices.  The recipe below is one I especially liked. If still searching for a tasty bean recipe, give it a try.  Although I used an Insta Pot, you could use a stovetop pot, a slow cooker, or a conventional pressure cooker.  Whichever pot you use, cook the beans until soft.


  • 2 lb black beans (picked through and rinsed)
  • 1 large red onion diced
  • 4-6 garlic cloves minced
  • 1 tsp ground cumin
  • 1 tbsp ground coriander
  • 1 tsp ground turmeric
  • 1-2 tsp salt (as desired)
  • 8-10 cups of filtered water

            Combine all ingredients in an Insta Pot and pressure cook for 45 min. After cooking, let the pressure release slowly and enjoy.

            With the importance of preparing meals at home lately, there’s never been a better time to hone your kitchen skills.  If just getting started, consider taking an online cooking course.  At the Forks over Knives website they are currently offering an online course at a discounted price. You’ll learn core culinary techniques including flavor-balancing, seasoning, oil-free cooking, meal-prepping and more, – all at your own pace. Courses begin April 21st.

The Toilet Paper Shortage

That Surprised Us

            While there may have been some hoarding of toilet paper when people began self-isolating at home, the bigger problem was that with millions of more people at home, the demand grew.  The dilemma is that much of the country’s spare toilet paper is still sitting at schools, offices, etc., while we sit at home.  If your home supplies run low, maybe ask your boss for a spare roll.  Click here for the full story.

            If a shortage of toilet paper at home has you looking for alternatives, then explore bidets. Read more at “No TP? No problem! A bidet is the way.” With a bidet, you could be on your way to saving a tidy sum, given that the average American is said to use 141 rolls per year.  As a bonus, the bidet method is more sanitary.  Just so you know, a fancy bidet isn’t necessary. A quart size container filled with water and a little practice is all it takes. Given that most of the world has already mastered the trick, I’m betting you can do it.

By Nancy Neighbors, MD

... Dr. Neighbors provides a blend of traditional family medicine and evidence-based lifestyle medicine in Huntsville, Alabama. When indicated, lifestyle change is recommended as the first line of therapy.

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