COVID-19 protocols

The pandemic of SARS CoV-2, a new virus which causes COVID-19, is a global public health crisis of far-ranging scope.

Based on prior experience with infectious disease outbreaks, governments, nonprofit organizations, and the private sector have responded to the pandemic by publishing handbooks and guides containing policies, procedures, and decision-making algorithms which can be used by individuals and organizations to reduce personal and community risk of the disease.

Before vaccines are proven effective and become widely available, government, organizations, and individuals can implement strategies to reduce SARS-CoV-2 infection and the resulting COVID-19 disease. Non-pharmaceutical interventions (NPIs) include social distancing/physical distancing/ border closures, school closures, isolation of symptomatic individuals and their contacts and large-scale lockdown of populations. Most of these strategies involve behavior change. Evidence from prior pandemics, such as the 1918 influenza pandemic, suggest that behavior change is a necessary component of responding to the COVID-19 pandemic.

Allegrante et al published a review of U.S. CDC recommendations for individual behavior change to help reduce the spread of SARS-CoV-2. They suggest that adherence to these guidelines is dependent on an individual's relationship with multiple layers of society.

John P. Allegrante, PhD et al (May 2020) https://doi.org/10.1016/j.amepre.2020.05.004

Allegrante et al find:

Such multilevel studies are necessary to further understand the influences on protective behavior and evaluate the effect of novel behavioral interventions, especially those that are digitally mediated, to facilitate adoption and maintenance of COVID-19‒preventive behaviors.

A 2005 meta-analysis of non-vaccine interventions to prevent infectious acute respiratory disease (ARD) in military training centers found many types of policies and protocols which result in lower rates of infection. The meta-analysis, published by Terrence Lee et al, evaluated a sample of 38 population-based studies.

• 9 of 12 studies into mask-wearing supported the intervention.
• 10 studies into various administrative controls such as cohorting military training units to reduce contact between units (4 studies), providing adequate personal space to reduce crowding (5), and cloth barriers between beds (1); and 14 studies supported the use of engineering controls such as increased indoor air dilution and ventilation (2), dust suppression (4), and air sterilization (8).

Public and private-sector organizations have published general handbooks and guides addressing a wide range of topics around how to mitigate the risk of catching and spreading the virus which causes COVID-19.

These high-level guides may cover systems and methods for disinfection, the use and possible re-use of personal protective equipment (PPE), overviews of relevant medical procedures and equipment, and best practices for responding to an array of incidents.

In the mid-1800s, Ignaz Semmelweis introduced hand-washing into the standard medical protocol for reducing infection risk. By 1848, one year after instituting a hand-washing policy in an obstetric clinic in Austria, maternal death rate had declined by 87 percent.

A 2001 study of U.S. Army recruits found that hand-washing results in reduced outpatient visits for respiratory illnesses. A review of clinical records from 1996 through 1998 (representing 1,089,800 person-weeks) found that frequent hand-washers had fewer outpatient appointments for respiratory illnesses. After implementing a hand-washing program, researchers saw a 45% reduction in total outpatient visits for respiratory illness.

Personal hygiene practices such as thorough and regular hand-washing is associated with less risk of contracting or communicating infectious diseases such as SARS-CoV-2.

Guides to hand-washing, the use and formulation of hand sanitizers, and other guides about hygiene as a mode of risk reduction have been published by organizations around the world.

WHO: How to handwash? With soap and water (World Health Organization, via Youtube)

WHO: How to handrub? With alcohol-based formulation (World Health Organization, via Youtube)

Disinfection of surfaces, fabrics, and other items which can be exposed to SARS-CoV-2 is another way to reduce the risk of community spread. Chemically neutralizing viral particles using context-appropriate disinfectants and sanitizers is a way to keep spaces safer for personnel.

Guides have been published about how to derive and formulate disinfectants, as well as the systems and methods by which they should be used.

Transportation presents a set of risks and challenges during a pandemic. Moving people and goods which may carry SARS-CoV-2 is a way to accelerate the geographic spread of the virus. Confined spaces with many people kept in close quarters, such as on an airplane, train, or bus, present an elevated risk for infection.

Local, national, and international organizations have published guides and proposed policies for how to reduce the risk of viral spread via transportation. These guides may include instructions for how to manage crowds of people and protocols for disinfecting vehicles and equipment.

Air travel requires spending time around large numbers of people, such as in security lines and communal gathering areas of airport terminals. Although many viruses do not spread easily on flights because of how air is circulated and filtered, social distancing is difficult on crowded flights. Sitting within 6 feet of others, sometimes for hours, could increase risk of contracting COVID-19.

Personal protective equipment such as respirators (N95 or equivalent), gloves, face shields, medical gowns, as well as commercially-produced or homemade cloth face coverings serve a role in preventing the spread of infectious disease while protecting the person wearing PPE.

The pandemic of SARS-CoV-2 created increased demand for PPE around the world. And it has prompted people who may never have used personal protective equipment to learn about and utilize PPE in the interest of protecting themselves and their community from the virus.

Guides have been published about the proper use of PPE. Strategies for reducing the use of scarce PPE, as well as protocols for safely reusing certain types of PPE have also been published in response to supply shortages. Some guides are targeted at medical audiences while others are aimed at people outside the medical profession.

Engineering-based interventions, such as additions or modifications to HV/AC systems, implementation of dust suppression measures, and other solutions can be effective at limiting the spread of infectious respiratory diseases. Because they do not require behavior change on the part of individuals or oversight and enforcement measures by organizations.

Dust suppression has been proven effective at reducing the number of airborne organisms. During World War I, sailors aboard U.S. Navy ships applied oil to floors and wool blankets to reduce the amount of dust in the air. Later studies indicate that the practice reduced airborne organisms by 75% to 90%. However, studies conducted on soldiers between 1944 and 1945 and on sailors between 1945 and 1946 failed to document a beneficial effect from oiling blankets and floors during outbreaks of acute respiratory disease.