COVID-19 is a very dangerous disease, especially for sick and old people. Many will die even if they get access to excellent medical care. We see this in Switzerland, where we see a surge in deaths despite highly competent medical doctors working in excellently equipped hospitals without shortage of medical supplies. Thus, „flattening the curve“ is not the ultimate answer if we want to stop the dying. We need to get rid of the virus.

You may say: How possibly can we get rid of the virus? We can’t lock up everybody until we found a vaccine or therapy! Yes, we can – or almost. We can self-isolate and still lead a mostly normal life if we wear a mask whenever in public, and by following very strict personal hygiene rules, including washing hands and keeping them clean.

Let’s first look at what we know about the disease, what is known about protective approaches and what we can learn from success stories, before we conclude and define measures to be taken.

The disease COVID-19

We know that an infection with COVID-19 occurs by inhalation or mucosal contact (mouth, nose, eyes) and that it is followed by a five-day incubation period after which cases become highly infectious for about ten days even if they develop few symptoms. More recent news reports suggest that around 60% of those tested positive show only mild or no symptoms at all.

Protective approaches

To be successful, a protective approach needs to prevent inhalation and mucosal contact. We can look at the fundamental concepts:

  • Separation from the hazard should be very effective. Just keep distance from everybody else.
  • Preventing inhalation can be done by wearing high-efficiency masks. However, such masks can be worn only for a short duration because the airflow resistance is tiring. Medical staff still should wear them when directly interacting with patients – in addition they need to protect their eyes from splashes.
  • Stoping the release of virus droplets from mouth and nose into the air and onto surfaces can be done by wearing surgical masks. Actually, they were found to be almost as effective as high efficiency masks in preventing influenza infection among outpatient health care personnel.
  • Removing the virus from your hand by disinfectants and washing followed by keeping them clean can be done as discussed earlier.
  • Preventing the transfer from the hand to the mucosal area is another strategy. People touch their face about 23 times per hour, almost half of these are mucosal contacts. We can train ourself and we can put obstacles in the way of our hands such as face masks and glasses so that we become conscious of our attempts to touch a mucosal area.

Success stories

Countries such as South Korea, Singapore and Taiwan are touted for their success in containing COVID-19 by testing, testing, testing, and isolating cases. But I think this is not their only secret of success. An overlooked commonality is that in these countries, almost everybody wears a mask during the crisis when in public.

What can we conclude?

  • Everybody should wear a face mask when in public and when working near other people. This will prevent non-symptomatic cases from spreading the virus. I proposed this earlier.
  • Medical staff should continue heightened precautions when working with patients.
  • Washing hands and keeping them clean have to continue. Note that all, individuals, companies and maintainers of public installation have their role to play in this.
  • Testing and tracing of spreaders has to continue. We should aim to learn from identified spreading routes also about effective protective strategies.

What we need to do to return to a mostly normal life

An effective strategy that allows most of us to return to a mostly normal life should include the following elements:

  1. Wearing masks must be made a requirement for ever public and professional activity where people get closer than two meters. This will allow to re-open schools and let people get back from home-office. At risk patients, however, should remain in self-isolation until we are sure that the virus is gone. Many Asian countries but also Slowakia have already implemented such rules.
  2. We need more masks and hand disinfectants, and they need to be made available to the public, schools and workers. A good example is given by Taiwan where mask are rationed and prices controlled. Plus you can get them for a low price already when entering the country.
  3. Countries need to activate local industries that are competent at producing masks and disinfectants and pay the price it cost. The also should activate their testing labs (such as seen in Switzerland for the biosafety lab Spiez) to establish a rapid-testing program so that there is no delay to the market once new producers churn out their products in big numbers.
  4. Companies need to be active as well. Most companies have work flows where their staff needs to be close together for the production to be efficient. These companies should start their own production lines for masks (such as done by Foxconn, the producer of the iPhone) and hand sanitizers, or secure their supplies from local producers by paying the price it costs to produce them locally. The gains from being able to reopen will rapidly pay for this investment.
  5. Textile companies need to develop masks that can be taken off and folded in a way that prevents contamination of clean hands, and that can be washed and re-used.
  6. Individuals need to learn the rules of correctly wearing masks, washing and keeping hands clean, and develop new social interaction modes to prevent the spread of the disease once „mostly normal life“ is allowed to resume. Those NOT wearing a mask in public should get told by everybody „please put on a mask!“.

Once this crisis is over

Countries need to start as soon as possible („now“) to prepare for the next pandemic wave. This should include:

  • A more integrated health care system that includes a programme of scouting for newly appearing disease, and that allows to keep track of the evolving disease almost in real time so that we can study and understand exposure routes and disease patterns to optimize protective strategies as the disease progresses.
  • Tendering a pandemic readiness production programme that foresee different levels of readiness, such as „active crisis“, „alert for a crisis“ and „normal time“. Participating industries would need to prepare for a crisis by having the parts and supplies locally stored or secured in normal times, to be able to switch to „alert for crisis mode“ within a few weeks using local sources only, and to ramp up production within a few days once an active crisis is declared. 
  • Regular pandemic exercises for crisis managers and companies participating in the readiness programme but also the general public to improve the planning and preparedness, and to remind people of the importance of the topic.

It will cost quite some money to stay prepared also in normal times but the current crisis shows that it will be worth it.

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