Letter to the editor: Physician offers more context on COVID-19 science
Peter Ryersbach’s letter of June 4 suggests we use science to guide decisions on what COVID precautions are reasonable. The guide will reveal that the science of viral epidemics is not only incomplete, but changing day to day, even among the most respected doctors. Dr. Fauci said yesterday the virus confounds him more every day. If you and I and Peter are not confused, we should be.
Despite unwise cutbacks in budgets, the CDC has tackled sophisticated topics in epidemiology skillfully. It has done poorly at teaching us enough science to motivate us to follow their advice on how to live safely day-to-day.
They have instructed us to clean our hands with soap and water or 70% alcohol-based hand sanitizer. They have not told us precisely how. Does anyone reading this letter really believe that 20 seconds of soap-and-water washing will provide safe hands when we are trying to prevent a fatal outcome? Has anyone questioned the adequacy of 30 seconds with alcohol products when past research on the SARS coronavirus has shown that, to be effective, 70% alcohol must have complete contact with the virus for 60 seconds? Are you aware that when your hands no longer smell like cheap gin they are no longer sanitized? When following CDC guidelines, alcohol and soap and water get the same grade: better than nothing, but miles away from adequate.
It seems as if the brightest researchers at the CDC took off after Nobel Prizes that will reward those who find drugs that will inhibit COVID-19 or a vaccine that will protect us entirely. Nobody went back to reexamine the simple principles of microbiology, particularly hand hygiene. The CDC and WHO last updated hand care in 2002, when alcohol was established as the clear first choice among what else was available at the time. Since that time remarkably effective and long-acting antimicrobials, quaternary ammonium organosiicates, have been developed. They have struggled in the world of venture capitalism and medical politics to reach the market.
Nobody at the CDC returned to the principles of hand antisepsis that I learned as a medical student. The first principle is dilution is a solution to pollution. When microbes are immersed in water they loose their grip on surfaces and each other and will be less infective at lower concentrations. The second principle is abrasion will dislodge microbes. Use fingers, sponges, brushes, picks or water in sufficient volume and pressure to detach them from skin and places where they hide out, usually some place wet, dark and out of traffic. Since the nail beds harbor 95% of bacteria and viruses, we might start there. Apply chemicals in sufficient concentration for a sufficient time to physically disrupt the microbes. We have learned through experiences with bacterial drug resistance that, if we limit our attack on bugs to slowing down or partially disrupting important functions like cell wall building, resistant forms will emerge. Any remedies must avoid injury to the host or environment.
The CDC gets “social distancing” right. It’s a tough one to enforce without inspections from space. Not all people are as smart as Vermonters in following this principle. Anyone like to write a law?
While we’re writing laws, let’s write one that requires all citizens to wear scientifically designed masks. The cloth mask made by my angelic sister is nice as a sign of affection. It has no useful function as a barrier to infection. If I am constantly adjusting my mask by grabbing it near my nose and mouth, am I not increasing the chance of spreading virus from my mouth and nose to my mask and then to who-knows-where? And back?
I strongly agree with Peter that many citizens who are trying to follow the guidelines of the CDC or CIDRAP mistakenly feel confident they’re meeting all reasonable standards of care for family, country and world by washing for 20 seconds or sanitizing for 30 seconds, staying home and/or socially distancing, wearing an unadjusted mask and not picking their noses, rubbing their eyes or coughing uncovered.
To those who await the certainty of science, or scientific method, you are on the wrong planet. Our institutions and their purest minds are as confused as we are. The moronosity of our political system has proved as contagious as any virus. Be patient. Maintain discipline. We haven’t been here before.
Patrick Stine, MD
There have been five wars in the last 15 years between Israel and Hamas. How do we end the … (read more)
It was the summer of ‘68. Cities across America were erupting in riots, political differen … (read more)