What tools do you use--for preventing infections?

New tools and old tools.

Now that the COVID-19 emergency is ending—although COVID-19 transmission is not—practice seems to be returning to normal. Our healthcare systems are moving to “mask optional” policies for many settings. As I reflect on what that means, I hope that “mask optional” becomes normal.

I was watching a Jimmy Kimmel monologue recently and he commented about the official ending of the COVID-19 National Emergency. Something he said really struck me: “The state of emergency might be over, but Covid is still out there. At this point, it’s kinda like a crazy ex. Like you deleted her number, but you still have to worry you might run into her at a bar one night.”

Which is true for many infectious diseases. Sometimes, they just happen. While we may spend time looking at risk factors, one cannot reduce risk to zero. It could be catching a viral or bacterial infection from kissing your children or grandchildren (Group A strep or cytomegalovirus); it could be picking up a life threatening fungal infection while hiking or fishing (blastomycosis); or it could be picking up a mosquito borne illness while vacationing (Zika). Risk is always there. The question we always ask ourselves is: what risk is worth taking and what measures are worth using to reduce risk?

About 20 years ago, I was returning from a volunteer experience in South America on an eight hour flight from Bolivia to Miami. The flight was completely full—not an empty seat to be found. Almost as soon as wheels were up, the person behind me started coughing, and coughing, and coughing—pretty much the whole way to Miami. As this was July, which is winter in the Southern Hemisphere, I was very concerned it may be influenza. With no empty seats on the flight, I could not ask to change seats. I was trapped.

Sure enough, three days later, I had fevers, cough, chills and body aches.

I can’t ask other people to wear masks, although source control—masking a sick or infectious person—would have been very appreciated and courteous. From now on, I will be traveling with a KN95 available for use, if needed. The highest risk of transmission is from those immediately around you on a plane—two to three rows.

For better and for worse, the pandemic, like any crisis, has added new tools to reduce risk. These tools are not for everyone, and some may choose to ignore them, but they are present.

• Hand sanitizer—small bottles are easier to find and to carry, and good to use prior to eating.

• Rapid diagnostic tests at home. Why restrict to just pregnancy and COVID-19? How about rapid tests for influenza?

• Masks—yes, I know, an unfortunately politicized measure when mandated during a true crisis. Many studies indicate they provide some level of protection, but they need to be used judiciously, like any other tool. I’m pretty much going with just using them on planes or other settings where I am close to a stranger for a prolonged period of time. I put mine on walking down the jetway, take it off for eating and drinking. If my spouse and I are sitting on a plane row with just two of us together, I might leave it off—or not. I prefer the tightest mask I can tolerate—a KN95. In the airport, I try to avoid lines and crowded areas as much as possible.

• Masks—again. But this time as a courtesy to others if I know I am sick, but must still venture out. In this case, a simple procedure mask would be helpful.

My new travel companion . . .Purell

Other old school ways to prevent infection:

• Wash hands before eating and while cooking, especially if raw meat is involved.

• Long pants and long sleeve shirts in the evening when mosquitos are biting. Insect repellent such as DEET or permethrin at any time is also helpful.

• Foot covering outside—yes even at the beach, in case you step on something sharp. But I’m all for sand between my toes when sitting still.

• Wear sunscreen to prevent burns (Also reduces skin cancer!)

• Don’t smoke.

• If you have diabetes, keep your blood sugar under control.

Like investing, everyone will have their own risk tolerance. Some may choose to go through life doing none of those things, and they may be just fine. However, their risk will be increased, and so they should be prepared. Eat healthy, exercise and keep your health screening and health insurance up to date.

One common fallacy I see in risk assessment and implementation is “All or None” thinking. That if I don’t do all of these things, then don’t bother doing any of these things. But that is just not true. Risk is a continuum, not a binary state. You have the power to decide how much and when to mitigate risk.

A phrase I have adopted during the pandemic, as different practices have been used: “You do you.”

For myself, I will make these risk assessments as needed. I will remain grateful for whatever good health I have. It is not guaranteed.